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Coppola A, Tessitore L, Fontana F, Piacentino F, Recaldini C, Minenna M, Capogrosso P, Minici R, Laganà D, Ierardi AM, Carrafiello G, D’Angelo F, Carcano G, Cacioppa LM, Dehò F, Venturini M. Dual-Energy Computed Tomography in Urological Diseases: A Narrative Review. J Clin Med 2024; 13:4069. [PMID: 39064110 PMCID: PMC11277677 DOI: 10.3390/jcm13144069] [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: 06/12/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Dual-Energy computed tomography (DECT) with its various advanced techniques, including Virtual Non-Contrast (VNC), effective atomic number (Z-eff) calculation, Z-maps, Iodine Density Index (IDI), and so on, holds great promise in the diagnosis and management of urogenital tumours. In this narrative review, we analyze the current status of knowledge of this technology to provide better lesion characterization, improve the staging accuracy, and give more precise treatment response assessments in relation to urological tumours.
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Affiliation(s)
- Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Luigi Tessitore
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Manuela Minenna
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Paolo Capogrosso
- Urology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Anna Maria Ierardi
- Radiology Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122 Milan, Italy
| | - Fabio D’Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
- Emergency and Transplant Surgery Department, ASST Sette Laghi, 21100 Varese, Italy
| | - Laura Maria Cacioppa
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Federico Dehò
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
- Urology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
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Haag F, Emmrich SS, Hertel A, Rink JS, Nörenberg D, Schoenberg SO, Froelich MF. Virtual Non-Contrast versus True Native in Photon-Counting CT: Stability of Density of Upper Abdominal Organs and Vessels. Diagnostics (Basel) 2024; 14:1130. [PMID: 38893656 PMCID: PMC11171968 DOI: 10.3390/diagnostics14111130] [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: 03/20/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The clinical use of photon-counting CT (PCCT) allows for the generation of virtual non-contrast (VNC) series from contrast-enhanced images. In routine clinical practice, specific issues such as ruling out acute bleeding require non-contrast images. The aim of this study is to evaluate the use of PCCT-derived VNC reconstructions in abdominal imaging. PCCT scans of 17 patients including early arterial, portal venous and native sequences were enrolled. VNC reconstructions have been calculated. In every sequence and VNC reconstruction, 10 ROIs were measured (portal vein, descending aorta, inferior vena cava, liver parenchyma, spleen parenchyma, erector spinae muscle, subcutaneous adipose tissue, first lumbar vertebral body, air, and psoas muscle) and density values were compared. The VNC reconstructions show significant changes in density compared to the contrast-enhanced images. However, there were no significant differences present between the true non-contrast (TNC) and any VNC reconstructions in the observed organs and vessels. Significant differences (p < 0.05) between the measured mean density values in the TNC versus VNC reconstructions were found in fat and bone tissue. The PCCT-derived VNC reconstructions seemed to be comparable to the TNC images, despite some deviations shown in the adipose tissue and bone structures. However, the further benefits in terms of specific clinical issues need to be evaluated.
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Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
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Bellin MF, Valente C, Bekdache O, Maxwell F, Balasa C, Savignac A, Meyrignac O. Update on Renal Cell Carcinoma Diagnosis with Novel Imaging Approaches. Cancers (Basel) 2024; 16:1926. [PMID: 38792005 PMCID: PMC11120239 DOI: 10.3390/cancers16101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
This review highlights recent advances in renal cell carcinoma (RCC) imaging. It begins with dual-energy computed tomography (DECT), which has demonstrated a high diagnostic accuracy in the evaluation of renal masses. Several studies have suggested the potential benefits of iodine quantification, particularly for distinguishing low-attenuation, true enhancing solid masses from hyperdense cysts. By determining whether or not a renal mass is present, DECT could avoid the need for additional imaging studies, thereby reducing healthcare costs. DECT can also provide virtual unenhanced images, helping to reduce radiation exposure. The review then provides an update focusing on the advantages of multiparametric magnetic resonance (MR) imaging performance in the histological subtyping of RCC and in the differentiation of benign from malignant renal masses. A proposed standardized stepwise reading of images helps to identify clear cell RCC and papillary RCC with a high accuracy. Contrast-enhanced ultrasound may represent a promising diagnostic tool for the characterization of solid and cystic renal masses. Several combined pharmaceutical imaging strategies using both sestamibi and PSMA offer new opportunities in the diagnosis and staging of RCC, but their role in risk stratification needs to be evaluated. Although radiomics and tumor texture analysis are hampered by poor reproducibility and need standardization, they show promise in identifying new biomarkers for predicting tumor histology, clinical outcomes, overall survival, and the response to therapy. They have a wide range of potential applications but are still in the research phase. Artificial intelligence (AI) has shown encouraging results in tumor classification, grade, and prognosis. It is expected to play an important role in assessing the treatment response and advancing personalized medicine. The review then focuses on recently updated algorithms and guidelines. The Bosniak classification version 2019 incorporates MRI, precisely defines previously vague imaging terms, and allows a greater proportion of masses to be placed in lower-risk classes. Recent studies have reported an improved specificity of the higher-risk categories and better inter-reader agreement. The clear cell likelihood score, which adds standardization to the characterization of solid renal masses on MRI, has been validated in recent studies with high interobserver agreement. Finally, the review discusses the key imaging implications of the 2017 AUA guidelines for renal masses and localized renal cancer.
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Affiliation(s)
- Marie-France Bellin
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
- Faculté de Médecine, University of Paris-Saclay, 63 Rue Gabriel Péri, 94276 Le Kremlin-Bicêtre, France
- BioMaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94805 Villejuif, France
| | - Catarina Valente
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
| | - Omar Bekdache
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
| | - Florian Maxwell
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
| | - Cristina Balasa
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
| | - Alexia Savignac
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
| | - Olivier Meyrignac
- Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; (C.V.); (O.B.); (F.M.); (A.S.); (O.M.)
- Faculté de Médecine, University of Paris-Saclay, 63 Rue Gabriel Péri, 94276 Le Kremlin-Bicêtre, France
- BioMaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94805 Villejuif, France
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Fontana F, Piacentino F, Gnesutta A, Macchi E, Coppola A, Saccomanno A, Gatta T, Recaldini C, Minenna M, Tamborini C, Dossi F, Ascenti V, Barbera S, Cicero G, Carcano G, Ascenti G, Castiglioni B, Venturini M. Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media. J Clin Med 2024; 13:524. [PMID: 38256659 PMCID: PMC10816911 DOI: 10.3390/jcm13020524] [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: 12/01/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Aroa Gnesutta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Angiola Saccomanno
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Tonia Gatta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Manuela Minenna
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Claudio Tamborini
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Filippo Dossi
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, Italy;
| | - Simone Barbera
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giuseppe Cicero
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Battistina Castiglioni
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
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