1
|
Takenaka T, Nakamura H, Yamada S, Kidani T, Tateishi A, Toyota S, Fujinaka T, Taki T, Wakayama A, Kishima H. A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle. World Neurosurg X 2024; 23:100370. [PMID: 38584877 PMCID: PMC10998237 DOI: 10.1016/j.wnsx.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Objective The risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms. Methods We retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021. We defined the NBA as the angle formed by the MCA aneurysm neck and M2 superior or inferior branch vessel line. The superior and inferior NBA were measured on admission via three-dimensional computed tomography angiography on admission. We divided the patients into clipping (106 patients) and coiling (22 patients) groups according to the treatment. Risk factors associated with procedural CI were analyzed in each group. Results Both groups showed that an enlarged superior NBA was a significant risk factor for procedural CI (clipping, P < 0.0005; coiling group, P = 0.007). The receiver operating characteristic curve showed the closed thresholds of the superior NBA with procedural CI in both groups (clipping group, 128.5°, sensitivity and specificity of 0.667 and 0.848, respectively; coiling group, 130.9°, sensitivity and specificity of 1 and 0.889, respectively). Conclusion The NBA can estimate the procedural risk of ruptured MCA aneurysms. In addition, an enlarged superior NBA is a risk factor for procedural CI in both clipping and coiling techniques.
Collapse
Affiliation(s)
- Tomofumi Takenaka
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shuhei Yamada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoki Kidani
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan
| | - Akihiro Tateishi
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan
| | - Takuyu Taki
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Akatsuki Wakayama
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
2
|
Bak SH, Park J, Lee S, Kim JH, Lee HY, Park JY. Clinical usability of 3D gradient-echo-based ultrashort echo time imaging: Is it enough to facilitate diagnostic decision in real-world practice? PLoS One 2024; 19:e0296696. [PMID: 38722966 PMCID: PMC11081383 DOI: 10.1371/journal.pone.0296696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/17/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND With recent advances in magnetic resonance imaging (MRI) technology, the practical role of lung MRI is expanding despite the inherent challenges of the thorax. The purpose of our study was to evaluate the current status of the concurrent dephasing and excitation (CODE) ultrashort echo-time sequence and the T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence in the evaluation of thoracic disease by comparing it with the gold standard computed tomography (CT). METHODS Twenty-four patients with lung cancer and mediastinal masses underwent both CT and MRI including T1-weighted VIBE and CODE. For CODE images, data were acquired in free breathing and end-expiratory images were reconstructed using retrospective respiratory gating. All images were evaluated through qualitative and quantitative approaches regarding various anatomical structures and lesions (nodule, mediastinal mass, emphysema, reticulation, honeycombing, bronchiectasis, pleural plaque and lymphadenopathy) inside the thorax in terms of diagnostic performance in making specific decisions. RESULTS Depiction of the lung parenchyma, mediastinal and pleural lesion was not significant different among the three modalities (p > 0.05). Intra-tumoral and peritumoral features of lung nodules were not significant different in the CT, VIBE or CODE images (p > 0.05). However, VIBE and CODE had significantly lower image quality and poorer depiction of airway, great vessels, and emphysema compared to CT (p < 0.05). Image quality of central airways and depiction of bronchi were significantly better in CODE than in VIBE (p < 0.001 and p = 0.005). In contrast, the depiction of the vasculature was better for VIBE than CODE images (p = 0.003). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significant greater in VIBE than CODE except for SNRlung and SNRnodule (p < 0.05). CONCLUSIONS Our study showed the potential of CODE and VIBE sequences in the evaluation of localized thoracic abnormalities including solid pulmonary nodules.
Collapse
Affiliation(s)
- So Hyeon Bak
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jinil Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Seokwon Lee
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jong Hee Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Jang-Yeon Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| |
Collapse
|
3
|
Wu S, Zhong D, Zhao G, Liu Y, Wang Y. Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study. J Orthop Surg Res 2024; 19:21. [PMID: 38167000 PMCID: PMC10763452 DOI: 10.1186/s13018-023-04484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Both Unilateral Biportal Endoscopic Discectomy (UBED) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) have resulted in favorable clinical outcomes in the management of LDH. The aim of this study is to comprehensively compare the efficacy of UBED and PEID in treating migrated LDH in the lower lumbar spine, with a specific focus on high-grade migrated LDH. METHODS 96 patients who underwent UBED (31 cases) and PEID (65 cases) procedures were enrolled in the study. All patients received a minimum follow-up period of 6 months. Clinical outcomes of the patients were assessed with incision length, operation time, total hemoglobin loss, hospital stay, intraoperative fluoroscopy times, visual analogue scale (VAS) for lower back and leg pain, Oswestry disability index (ODI), modified MacNab criteria, complications, area of lamina loss and increased intervertebral height. RESULTS The VAS scores for lower back and leg pain and ODI significantly decreased in both groups after the operation. Preoperatively, at 1 day, 1 month, and 6 months after the procedure, the VAS and ODI scores exhibited no significant differences between the two groups. There was no significant difference in terms of modified MacNab criteria, area of lamina loss, and increased intervertebral height. The UBED group had a longer incision length, operation time and postoperative hospital stay, and fewer intraoperative fluoroscopy times than to the PEID group. Complications were noted in both groups throughout the follow-up period, but there was no significant difference in the rate of complications. Moreover, there were no notable differences in clinical outcomes between the two groups in the high-grade migrated LDH. CONCLUSIONS Both UBED and PEID could achieve favorable clinical outcomes for treating migrated LDH at the lower lumbar spine. Despite the longer operative time and postoperative hospital stay associated with the UBED group, UBED remains safe and innovative for treating migrated LDH at the lower lumbar spine.
Collapse
Affiliation(s)
- Shan Wu
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Dian Zhong
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Guosheng Zhao
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yang Liu
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
| |
Collapse
|
4
|
de Vries ISA, van Ewijk R, Adriaansen LME, Bohte AE, Braat AJAT, Fajardo RD, Hiemcke-Jiwa LS, Hol MLF, Ter Horst SAJ, de Keizer B, Knops RRG, Meister MT, Schoot RA, Smeele LE, van Scheltinga ST, Vaarwerk B, Merks JHM, van Rijn RR. Imaging in rhabdomyosarcoma: a patient journey. Pediatr Radiol 2023; 53:788-812. [PMID: 36843091 PMCID: PMC10027795 DOI: 10.1007/s00247-023-05596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/28/2023]
Abstract
Rhabdomyosarcoma, although rare, is the most frequent soft tissue sarcoma in children and adolescents. It can present as a mass at nearly any site in the body, with most common presentations in the head and neck, genitourinary tract and extremities. The optimal diagnostic approach and management of rhabdomyosarcoma require a multidisciplinary team with multimodal treatment, including chemotherapy and local therapy. Survival has improved over the last decades; however, further improvement in management is essential with current 5-year overall survival ranging from 35% to 100%, depending on disease and patient characteristics. In the full patient journey, from diagnosis, staging, management to follow-up after therapy, the paediatric radiologist and nuclear physician are essential members of the multidisciplinary team. Recently, guidelines of the European paediatric Soft tissue sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR), in an ongoing collaboration with the International Soft-Tissue Sarcoma Database Consortium, provided guidance for high-quality imaging. In this educational paper, given as a lecture during the 2022 postgraduate ESPR course, the multi-disciplinary team of our national paediatric oncology centre presents the journey of two patients with rhabdomyosarcoma and discusses the impact on and considerations for the clinical (paediatric) radiologist and nuclear physician. The key learning points of the guidelines and their implementation in clinical practice are highlighted and up-to-date insights provided for all aspects from clinical suspicion of rhabdomyosarcoma and its differential diagnosis, to biopsy, staging, risk stratification, treatment response assessment and follow-up.
Collapse
Affiliation(s)
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laura M E Adriaansen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anneloes E Bohte
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Arthur J A T Braat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Raquel Dávila Fajardo
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Laura S Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marinka L F Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger R G Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Michael T Meister
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ludi E Smeele
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute (NCI), Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bas Vaarwerk
- Department of Paediatrics, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Suite C1-423.1, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
| |
Collapse
|
5
|
Computer-Aided Detection of Subsolid Nodules on Chest Computed Tomography: Assessment of Visualization on Vessel-Suppressed Images. J Comput Assist Tomogr 2023; 47:412-417. [PMID: 36877791 DOI: 10.1097/rct.0000000000001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES This study aimed to clarify the performance of automatic detection of subsolid nodules by commercially available software on computed tomography (CT) images of various slice thicknesses and compare it with visualization on the accompanying vessel-suppression CT (VS-CT) images. METHODS A total of 95 subsolid nodules from 84 CT examinations of 84 patients were included. The reconstructed CT image series of each case with 3-, 2-, and 1-mm slice thicknesses were loaded into a commercially available software application (ClearRead CT) for automatic detection of subsolid nodules and generation of VS-CT images. Automatic nodule detection sensitivity was assessed for 95 nodules on each series of images acquired at 3 slice thicknesses. Four radiologists subjectively evaluated visual assessment of the nodules on VS-CT. RESULTS ClearRead CT automatically detected 69.5% (66/95 nodules), 68.4% (65/95 nodules), and 70.5% (67/95 nodules) of all subsolid nodules in 3-, 2-, and 1-mm slices, respectively. The detection rate was higher for part-solid nodules than for pure ground-glass nodules at all slice thicknesses. In the visualization assessment on VS-CT, 3 nodules at each slice thickness (3.2%) were judged as invisible, while 26 of 29 (89.7%), 27 of 30 (90.0%), and 25 of 28 (89.3%) nodules, which were missed by computer-aided detection, were judged as visible in 3-, 2-, and 1-mm slices, respectively. CONCLUSIONS The automatic detection rate of subsolid nodules by ClearRead CT was approximately 70% at all slice thicknesses. More than 95% of subsolid nodules were visualized on VS-CT, including nodules undetected by the automated software. Computed tomography acquisition at slices thinner than 3 mm did not confer any benefits.
Collapse
|
6
|
Anatomical Description of Loggerhead Turtle ( Caretta caretta) and Green Iguana ( Iguana iguana) Skull by Three-Dimensional Computed Tomography Reconstruction and Maximum Intensity Projection Images. Animals (Basel) 2023; 13:ani13040621. [PMID: 36830407 PMCID: PMC9951731 DOI: 10.3390/ani13040621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023] Open
Abstract
The growing interest in reptiles has posed a challenge to veterinary clinicians due to the lack of a standardized system to perform anatomical studies similar to those used for dogs and cats. In this paper, we have attempted to describe, employing computed tomography and subsequent three-dimensional reconstructions, the normal anatomical features that comprise the skulls of two species of reptiles: the loggerhead turtle (Caretta caretta) and the green iguana (Iguana iguana). Computed tomography (CT) and subsequent image processing allowed the identification of the bony structures that comprise the head of these species. As a result, and based on previous articles, we propose the most significant anatomical differences and similarities between these species.
Collapse
|
7
|
Ko JP, Bagga B, Gozansky E, Moore WH. Solitary Pulmonary Nodule Evaluation: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:230-245. [PMID: 35688534 DOI: 10.1053/j.sult.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung nodules are frequently encountered while interpreting chest CTs and are challenging to detect, characterize, and manage given they can represent both benign or malignant etiologies. An understanding of features associated with malignancy and causes of interpretive pitfalls is helpful to avoid misdiagnoses. This review addresses pertinent topics related to the etiologies for missed lung nodules on radiography and CT. Additionally, CT imaging technical pitfalls and challenges in addition to issues in the evaluation of nodule morphology, attenuation, and size will be discussed. Nodule management guidelines will be addressed as well as recent investigations that further our understanding of lung nodules.
Collapse
Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY.
| | - Barun Bagga
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Elliott Gozansky
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - William H Moore
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| |
Collapse
|
8
|
Chao Z, Xu W. A New General Maximum Intensity Projection Technology via the Hybrid of U-Net and Radial Basis Function Neural Network. J Digit Imaging 2021; 34:1264-1278. [PMID: 34508300 PMCID: PMC8432629 DOI: 10.1007/s10278-021-00504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
Maximum intensity projection (MIP) technology is a computer visualization method that projects three-dimensional spatial data on a visualization plane. According to the specific purposes, the specific lab thickness and direction can be selected. This technology can better show organs, such as blood vessels, arteries, veins, and bronchi and so forth, from different directions, which could bring more intuitive and comprehensive results for doctors in the diagnosis of related diseases. However, in this traditional projection technology, the details of the small projected target are not clearly visualized when the projected target is not much different from the surrounding environment, which could lead to missed diagnosis or misdiagnosis. Therefore, it is urgent to develop a new technology that can better and clearly display the angiogram. However, to the best of our knowledge, research in this area is scarce. To fill this gap in the literature, in the present study, we propose a new method based on the hybrid of convolutional neural network (CNN) and radial basis function neural network (RBFNN) to synthesize the projection image. We first adopted the U-net to obtain feature or enhanced images to be projected; subsequently, the RBF neural network performed further synthesis processing for these data; finally, the projection images were obtained. For experimental data, in order to increase the robustness of the proposed algorithm, the following three different types of datasets were adopted: the vascular projection of the brain, the bronchial projection of the lung parenchyma, and the vascular projection of the liver. In addition, radiologist evaluation and five classic metrics of image definition were implemented for effective analysis. Finally, compared to the traditional MIP technology and other structures, the use of a large number of different types of data and superior experimental results proved the versatility and robustness of the proposed method.
Collapse
Affiliation(s)
- Zhen Chao
- College of Artificial Intelligence and Big Data for Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Huaiyin District, 6699 Qingdao Road, Jinan, 250117, Shandong, China.
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
- Department of Radiation Convergence Engineering, College of Health Science, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 26493, South Korea.
| | - Wenting Xu
- Department of Radiation Convergence Engineering, College of Health Science, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 26493, South Korea
| |
Collapse
|
9
|
Naeem MQ, Darira J, Ahmed MS, Hamid K, Ali M, Shazlee MK. Comparison of Maximum Intensity Projection and Volume Rendering in Detecting Pulmonary Nodules on Multidetector Computed Tomography. Cureus 2021; 13:e14025. [PMID: 33898115 PMCID: PMC8057938 DOI: 10.7759/cureus.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Lung cancer is the most common cancer overall, and the foremost cause of cancer-related mortality. Almost all lung cancers evolve from pulmonary nodules. As multidetector CT (MDCT) scanners are now widely available, there is an increased rate of detection of pulmonary nodules. It is of utmost importance to evaluate pulmonary nodules to rule out the possibility of neoplastic diseases. With advancements in technology, there are various manual and automatic analytic software providing a wide range of post-processing techniques. Maximum intensity projection (MIP) and volume rendering (VR) techniques have been analyzed previously regarding pulmonary nodules but there is a scarcity of data in terms of low-density nodules. This study aims to delineate the comparison and supremacy of both techniques in terms of low-density nodules. Methodology The current prospective study was conducted from June 2019 to June 2020 in the Radiology Department at Dr. Ziauddin Hospital, Karachi. Chest CT scans were performed on 16 slice MDCT (Alexion 16 Multi-slice, Toshiba Medical System Corporation, Houston, TX). A consultant radiologist of six years experience and a postgraduate trainee of three years experience analyzed each patient on a workstation (Vitrea 6.2.0, Vital Images, Minnetonka, MN). SPSS 23.0 (SPSS Inc., Chicago, IL) was incorporated for data analysis. Data were expressed in the median and interquartile range (IQR). Data collected for this study were analyzed using analyzing the median difference in nodule count using Wilcoxon's signed-rank test. A p-value of <0.05 was considered significant. Results After informed consent, 236 patients were recruited for the study. MIP outperformed VR in terms of nodule detection and low-density nodules at each evaluated slab thicknesses (p<0.001). A 10-mm MIP was superior to all other techniques in terms of detection of pulmonary nodules and low-density nodules (p<0.001). MIP was also considered an easier technique as there was excellent inter-rater reliability and agreement. Conclusion This study is robust evidence regarding the supremacy of MIP. MIP outperformed VR on every slab thicknesses. The 10-mm MIP technique was superior to all others evaluated and was recorded to be an easier analyzing technique.
Collapse
Affiliation(s)
| | - Jaideep Darira
- Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK
| | | | - Kamran Hamid
- Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK
| | - Muhammad Ali
- Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK
| | | |
Collapse
|
10
|
Zheng S, Cornelissen LJ, Cui X, Jing X, Veldhuis RNJ, Oudkerk M, van Ooijen PMA. Deep convolutional neural networks for multiplanar lung nodule detection: Improvement in small nodule identification. Med Phys 2021; 48:733-744. [PMID: 33300162 PMCID: PMC7986069 DOI: 10.1002/mp.14648] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Early detection of lung cancer is of importance since it can increase patients' chances of survival. To detect nodules accurately during screening, radiologists would commonly take the axial, coronal, and sagittal planes into account, rather than solely the axial plane in clinical evaluation. Inspired by clinical work, the paper aims to develop an accurate deep learning framework for nodule detection by a combination of multiple planes. METHODS The nodule detection system is designed in two stages, multiplanar nodule candidate detection, multiscale false positive (FP) reduction. At the first stage, a deeply supervised encoder-decoder network is trained by axial, coronal, and sagittal slices for the candidate detection task. All possible nodule candidates from the three different planes are merged. To further refine results, a three-dimensional multiscale dense convolutional neural network that extracts multiscale contextual information is applied to remove non-nodules. In the public LIDC-IDRI dataset, 888 computed tomography scans with 1186 nodules accepted by at least three of four radiologists are selected to train and evaluate our proposed system via a tenfold cross-validation scheme. The free-response receiver operating characteristic curve is used for performance assessment. RESULTS The proposed system achieves a sensitivity of 94.2% with 1.0 FP/scan and a sensitivity of 96.0% with 2.0 FPs/scan. Although it is difficult to detect small nodules (i.e., <6 mm), our designed CAD system reaches a sensitivity of 93.4% (95.0%) of these small nodules at an overall FP rate of 1.0 (2.0) FPs/scan. At the nodule candidate detection stage, results show that the system with a multiplanar method is capable to detect more nodules compared to using a single plane. CONCLUSION Our approach achieves good performance not only for small nodules but also for large lesions on this dataset. This demonstrates the effectiveness of our developed CAD system for lung nodule detection.
Collapse
Affiliation(s)
- Sunyi Zheng
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of Groningen9713 AVGroningenThe Netherlands
| | - Ludo J. Cornelissen
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of Groningen9713 AVGroningenThe Netherlands
| | - Xiaonan Cui
- Department of RadiologyTianjin Medical University Cancer Institute and HospitalNational Clinical Research Centre of Cancer300060TianjinChina
| | - Xueping Jing
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of Groningen9713 AVGroningenThe Netherlands
| | | | - Matthijs Oudkerk
- Faculty of Medical ScienceUniversity of Groningen9713 AVGroningenThe Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of Groningen9713 AVGroningenThe Netherlands
| |
Collapse
|
11
|
Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
Collapse
Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| |
Collapse
|
12
|
Jabeen N, Qureshi R, Sattar A, Baloch M. Diagnostic Accuracy of Maximum Intensity Projection in Diagnosis of Malignant Pulmonary Nodules. Cureus 2019; 11:e6120. [PMID: 31886058 PMCID: PMC6903899 DOI: 10.7759/cureus.6120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Pulmonary nodules are frequently encountered during chest imaging, and its evaluation is usually done by chest radiograph and computed tomography (CT) scan of chest. High resolution of multidetector CT (MDCT) has improved the nodule detection. Post processing techniques such as maximum intensity projection (MIP) can further improve the sensitivity of MDCT for nodule detection. Failure to diagnose malignancy in pulmonary nodules can delay the treatment. Therefore, the aim of this study was to determine the diagnostic accuracy of MIP in the diagnosis of malignant pulmonary nodules taking histopathology findings as gold standard. Materials and methods A retrospective cross-sectional study was conducted at Dow Institute of Radiology, Dow University of Health Sciences, from 1 December 2018 till 30 June 2019. Both male and female patients aged 18 years and above who underwent CT scan of chest with suspicion of pulmonary nodules were included. Patients already diagnosed with malignant pulmonary nodules and presenting for follow-up were excluded. Contrast-enhanced CT chest was performed on a multi-slice scanner. MIP reconstruction and evaluation was performed on the workstation. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MIP were calculated taking histopathology findings as gold standard. Results A total of 202 patients were included in this study. The mean age of the patients was 55.87 ± 13.08 years. A total of 103 patients (51.0%) were males and 99 patients (49.0%) were females. There were 131 (64.9%) nodules with smooth margins and 71 (35.1%) nodules with irregular margins. The mean size of nodule was 3.1 ± 0.7 cm. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MIP in diagnosing malignant pulmonary nodules were found to be 85.82%, 82.35%, 90.55%, 74.67%, and 84.65%, respectively, taking histopathology findings as gold standard. The nodules >3 cm in size had a higher sensitivity for diagnosing malignant pulmonary nodules. Smooth margin nodule had high sensitivity, specificity, and diagnostic accuracy for diagnosing malignant pulmonary nodules. Conclusion MIP images have high sensitivity, specificity, and diagnostic accuracy in the diagnosis of malignant pulmonary nodules. The utilization of MIP images can aid in the detection of malignant pulmonary nodules and help in formulating early treatment strategies for the patients. Other post processing techniques such as volume rendering and computer-aided detection can help in further improving patient care.
Collapse
Affiliation(s)
- Naila Jabeen
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Ruby Qureshi
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Amjad Sattar
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Musarat Baloch
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad/Jamshoro, PAK
| |
Collapse
|