Evaluation of Thick-Slab Overlapping MIP Images of Contrast-Enhanced 3D T1-Weighted CUBE for Detection of Intracranial Metastases: A Pilot Study for Comparison of Lesion Detection, Interpretation Time, and Sensitivity with Nonoverlapping CUBE MIP, CUBE, and Inversion-Recovery-Prepared Fast-Spoiled Gradient Recalled Brain Volume

BACKGROUND AND PURPOSE

Early and accurate identification of cerebral metastases is important for prognostication and treatment planning although this process is often time consuming and labor intensive, especially with the hundreds of images associated with 3D volumetric imaging. This study aimed to evaluate the benefits of thick-slab overlapping MIPs constructed from contrast-enhanced T1-weighted CUBE (overlapping CUBE MIP) for the detection of brain metastases in comparison with traditional CUBE and inversion-recovery prepared fast-spoiled gradient recalled brain volume (IR-FSPGR-BRAVO) and nonoverlapping CUBE MIP.

MATERIALS AND METHODS

A retrospective review of 48 patients with cerebral metastases was performed at our institution from June 2016 to October 2017. Brain MRIs, which were acquired on multiple 3T scanners, included gadolinium-enhanced T1-weighted IR-FSPGR-BRAVO and CUBE, with subsequent generation of nonoverlapping CUBE MIP and overlapping CUBE MIP. Two blinded radiologists identified the total number and location of metastases on each image type. The Cohen κ was used to determine interrater agreement. Sensitivity, interpretation time, and lesion contrast-to-noise ratio were assessed.

RESULTS

Interrater agreement for identification of metastases was fair-to-moderate for all image types (κ = 0.222-0.598). The total number of metastases identified was not significantly different across the image types. Interpretation time for CUBE MIPs was significantly shorter than for CUBE and IR-FSPGR-BRAVO, saving at least 50 seconds per case on average (P < .001). The mean lesion contrast-to-noise ratio for both CUBE MIPs was higher than for IR-FSPGR-BRAVO. The mean contrast-to-noise ratio for small lesions (<4 mm) was lower for nonoverlapping CUBE MIP (1.55) than for overlapping CUBE MIP (2.35). For both readers, the sensitivity for lesion detection was high for all image types but highest for overlapping CUBE MIP and CUBE (0.93-0.97).

CONCLUSIONS

This study suggests that the use of overlapping CUBE MIP or nonoverlapping CUBE MIP for the detection of brain metastases can reduce interpretation time without sacrificing sensitivity, though the contrast-to-noise ratio of lesions is highest for overlapping CUBE MIP.

Antimicrobial resistance and R factors in Salmonella isolated from humans and animals in Georgia and South Carolina

Three hundred and five strains of Salmonella isolated from humans and 152 strains isolated from animals in Georgia and South Carolina during 1973 were examined for resistance to 14 antimicrobial agents. S typhimurium was the most frequently isolated serotype (30% of human isolates and 13% of animal isolates). The overall incidence of antimicrobial resistance was 16% in human starins and 21% in animal strains. The most commonly found resistance were to streptomycin (11% in human strains and 16% in animal strains) and tetracycline (10% in both human and animal isolates). A higher prevalence of resistance to streptomycin, spectinomycin, and nitrofurantoin, which are currently used primarily in veterinary medicine, was found in animal Salmonella. Conversely, resistance to ampicillin, cephalothin, and kanamycin, which are used mainly in human medicine, was found more frequently in human Salmonella. No resistance to nalidixic acid, gentamicin, tobramycin, rifampin, or trimethoprim was detected. Sixty-five percent of resistant strains from humans and 60% of resistant strains from animals transferred their resistance patterns partially or in toto.