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Urban T, Sauter AP, Frank M, Willer K, Noichl W, Bast H, Schick R, Herzen J, Koehler T, Gassert FT, Bodden JH, Fingerle AA, Gleich B, Renger B, Makowski MR, Pfeiffer F, Pfeiffer D. Dark-Field Chest Radiography Outperforms Conventional Chest Radiography for the Diagnosis and Staging of Pulmonary Emphysema. Invest Radiol 2023; 58:775-781. [PMID: 37276130 PMCID: PMC10581407 DOI: 10.1097/rli.0000000000000989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Dark-field chest radiography (dfCXR) has recently reached clinical trials. Here we compare dfCXR to conventional radiography for the detection and staging of pulmonary emphysema. MATERIALS AND METHODS Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05. RESULTS A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema. CONCLUSIONS Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.
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Sauter AP, Proksa R, Knipfer A, Reischl S, Braren RF, Nadjiri J, Kopp F, Noël PB, Makowski MR, Rummeny EJ, Fingerle AA. CT-Guided Liver Biopsy: Evaluation of Spectral Data From Dual-Layer Detector CT for Improved Lesion Detection. Cardiovasc Intervent Radiol 2023; 46:1621-1631. [PMID: 37759090 PMCID: PMC10615904 DOI: 10.1007/s00270-023-03550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Evaluation of dual-layer spectral computed tomography (CT) for contrast enhancement during image-guided biopsy of liver lesions using virtual monoenergetic images (VMI) and virtual non-contrast (VNC) images. METHODS Spectral CT data of 20 patients receiving CT-guided needle biopsy of focal liver lesions were used to generate VMI at energy levels from 40 to 200 keV and VNC images. Images were analyzed objectively regarding contrast-to-noise ratio between lesion center (CNRcent) or periphery (CNRperi) and normal liver parenchyma. Lesion visibility and image quality were evaluated on a 4-point Likert scale by two radiologists. RESULTS Using VMI/VNC images, readers reported an increased visibility of the lesion compared to the conventional CT images in 18/20 cases. In 75% of cases, the highest visibility was derived by VMI-40. Showing all reconstructions simultaneously, VMI-40 offered the highest visibility in 75% of cases, followed by VNC in 12.5% of cases. Either CNRcent (17/20) or/and CNRperi (17/20) was higher (CNR increase > 50%) in 19/20 cases for VMI-40 or VNC images compared to conventional CT images. VMI-40 showed the highest CNRcent in 14 cases and the highest CNRperi in 12 cases. High image quality was present for all reconstructions with a minimum median of 3.5 for VMI-40 and VMI-50. CONCLUSIONS When implemented in the CT scanner software, automated contrast enhancement of liver lesions during image-guided biopsy may facilitate the procedure.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | | | - Andreas Knipfer
- Department of Radiology, Helios Klinikum München West, Munich, Germany
| | - Stefan Reischl
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jonathan Nadjiri
- Department of Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Markus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Kantonsspital Münsterlingen, Muensterlingen, Switzerland
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Gassert FT, Urban T, Frank M, Willer K, Noichl W, Buchberger P, Schick R, Koehler T, von Berg J, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer D, Pfeiffer F. X-ray Dark-Field Chest Imaging: Qualitative and Quantitative Results in Healthy Humans. Radiology 2023; 306:e229037. [PMID: 36689348 DOI: 10.1148/radiol.229037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ernst E, Andreisek G, Fingerle AA. [An MRI for Every Patient with Back Pain?]. Ther Umsch 2023; 80:204-208. [PMID: 37122179 DOI: 10.1024/0040-5930/a001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
An MRI for Every Patient with Back Pain? Abstract. Imaging in spinal disorders has changed in the past years. Improved MRI techniques allow for better image interpretation. Unchanged, however, close correlation between clinical evaluation and imaging results remains crucial for correct diagnoses and subsequent therapeutical decisions. Reimbursement cuts have made MRI more affordable in Switzerland while being widely available. This allows - if used according to guidelines - for optimal treatment of patients with spinal disorders.
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Affiliation(s)
- Elena Ernst
- Institut für Radiologie, Spital Thurgau, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
| | - Gustav Andreisek
- Institut für Radiologie, Spital Thurgau, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
- Medizinische Fakultät, Universität Zürich, Schweiz
| | - Alexander A Fingerle
- Institut für Radiologie, Spital Thurgau, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
- Departement für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Deutschland
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Gassert FT, Frank M, De Marco F, Willer K, Urban T, Herzen J, Fingerle AA, Sauter AP, Makowski MR, Kriner F, Fischer F, Braun C, Pfeiffer F, Pfeiffer D. Assessment of Inflation in a Human Cadaveric Lung with Dark-Field Chest Radiography. Radiol Cardiothorac Imaging 2022; 4:e220093. [PMID: 36601456 PMCID: PMC9806722 DOI: 10.1148/ryct.220093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 12/16/2022]
Abstract
Dark-field chest radiography signal intensity appeared to correlate with inflation status in a cadaveric lung.
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Gassert FT, Burkhardt R, Gora T, Pfeiffer D, Fingerle AA, Sauter AP, Schilling D, Rummeny EJ, Schmid TE, Combs SE, Wilkens JJ, Pfeiffer F. X-ray Dark-Field CT for Early Detection of Radiation-induced Lung Injury in a Murine Model. Radiology 2022; 303:696-698. [PMID: 35348380 DOI: 10.1148/radiol.212332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Online supplemental material is available for this article.
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Affiliation(s)
- Florian T Gassert
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Rico Burkhardt
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Thomas Gora
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Daniela Pfeiffer
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Alexander A Fingerle
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Andreas P Sauter
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Daniela Schilling
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Ernst J Rummeny
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Thomas E Schmid
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Stephanie E Combs
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Jan J Wilkens
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
| | - Franz Pfeiffer
- From the Departments of Diagnostic and Interventional Radiology (F.T.G., D.P., A.A.F., A.P.S., E.J.R., F.P.) and Radiation Oncology (R.B., T.G., D.S., T.E.S., S.E.C., J.J.W.), Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Ismaningerstr 22, 81675 Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany (R.B., D.S., T.E.S., S.E.C.); Department of Biomedical Physics (R.B., J.J.W., F.P.) and Munich Institute of Biomedical Engineering (F.P.), Technical University of Munich, Garching, Germany; Institute for Advanced Study, Garching, Germany (D.P., F.P.); and Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany (S.E.C.)
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Bodden J, Neumann J, Rasper M, Fingerle AA, Knebel C, von Eisenhart-Rothe R, Specht K, Mogler C, Bollwein C, Schwaiger BJ, Gersing AS, Woertler K. Diagnosis of joint invasion in patients with malignant bone tumors: value and reproducibility of direct and indirect signs on MR imaging. Eur Radiol 2022; 32:4738-4748. [PMID: 35258673 PMCID: PMC9213276 DOI: 10.1007/s00330-022-08586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the performance and reproducibility of MR imaging features in the diagnosis of joint invasion (JI) by malignant bone tumors. METHODS MR images of patients with and without JI (n = 24 each), who underwent surgical resection at our institution, were read by three radiologists. Direct (intrasynovial tumor tissue (ITT), intraarticular destruction of cartilage/bone, invasion of capsular/ligamentous insertions) and indirect (tumor size, signal alterations of epiphyseal/transarticular bone (bone marrow replacement/edema-like), synovial contrast enhancement, joint effusion) signs of JI were assessed. Odds ratios, sensitivity, specificity, PPV, NPV, and reproducibilities (Cohen's and Fleiss' κ) were calculated for each feature. Moreover, the diagnostic performance of combinations of direct features was assessed. RESULTS Forty-eight patients (28.7 ± 21.4 years, 26 men) were evaluated. All readers reliably assessed the presence of JI (sensitivity = 92-100 %; specificity = 88-100%, respectively). Best predictors for JI were direct visualization of ITT (OR = 186-229, p < 0.001) and destruction of intraarticular bone (69-324, p < 0.001). Direct visualization of ITT was also highly reliable in assessing JI (sensitivity, specificity, PPV, NPV = 92-100 %), with excellent reproducibility (κ = 0.83). Epiphyseal bone marrow replacement and synovial contrast enhancement were the most sensitive indirect signs, but lacked specificity (29-54%). By combining direct signs with high specificity, sensitivity was increased (96 %) and specificity (100 %) was maintained. CONCLUSION JI by malignant bone tumors can reliably be assessed on preoperative MR images with high sensitivity, specificity, and reproducibility. Particularly direct visualization of ITT, destruction of intraarticular bone, and a combination of highly specific direct signs were valuable, while indirect signs were less predictive and specific. KEY POINTS • Direct visualization of intrasynovial tumor was the single most sensitive and specific (92-100%) MR imaging sign of joint invasion. • Indirect signs of joint invasion, such as joint effusion or synovial enhancement, were less sensitive and specific compared to direct signs. • A combination of the most specific direct signs of joint invasion showed best results with perfect specificity and PPV (both 100%) and excellent sensitivity and NPV (both 96 %).
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Affiliation(s)
- Jannis Bodden
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA, 94107, USA.
| | - Jan Neumann
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rasper
- Department of Radiology, Kantonsspital Muensterlingen, Spitalcampus 1, 8596, Muensterlingen, Switzerland
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katja Specht
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Mogler
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Bollwein
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Göktuna SI, Canli O, Bollrath J, Fingerle AA, Horst D, Diamanti MA, Pallangyo C, Bennecke M, Nebelsiek T, Mankan AK, Lang R, Artis D, Hu Y, Patzelt T, Ruland J, Kirchner T, Taketo MM, Chariot A, Arkan MC, Greten FR. IKKα Promotes Intestinal Tumorigenesis by Limiting Recruitment of M1-like Polarized Myeloid Cells. Cell Rep 2022; 38:110471. [PMID: 35235803 DOI: 10.1016/j.celrep.2022.110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Urban T, Gassert FT, Frank M, Willer K, Noichl W, Buchberger P, Schick RC, Koehler T, Bodden JH, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer F, Pfeiffer D. Qualitative and Quantitative Assessment of Emphysema Using Dark-Field Chest Radiography. Radiology 2022; 303:119-127. [PMID: 35014904 DOI: 10.1148/radiol.212025] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Dark-field chest radiography allows for assessment of lung alveolar structure by exploiting wave optical properties of x-rays. Purpose To evaluate the qualitative and quantitative features of dark-field chest radiography in participants with pulmonary emphysema as compared with those in healthy control subjects. Materials and Methods In this prospective study conducted from October 2018 to October 2020, participants aged at least 18 years who underwent clinically indicated chest CT were screened for participation. Inclusion criteria were an ability to consent to the procedure and stand upright without help. Exclusion criteria were pregnancy, serious medical conditions, and any lung condition besides emphysema that was visible on CT images. Participants were examined with a clinical dark-field chest radiography prototype that simultaneously acquired both attenuation-based radiographs and dark-field chest radiographs. Dark-field coefficients were tested for correlation with each participant's CT-based emphysema index using the Spearman correlation test. Dark-field coefficients of adjacent groups in the semiquantitative Fleischner Society emphysema grading system were compared using a Wilcoxon Mann-Whitney U test. The capability of the dark-field coefficient to enable detection of emphysema was evaluated with receiver operating characteristics curve analysis. Results A total of 83 participants (mean age, 65 years ± 12 [standard deviation]; 52 men) were studied. When compared with images from healthy participants, dark-field chest radiographs in participants with emphysema had a lower and inhomogeneous dark-field signal intensity. The locations of focal signal intensity loss on dark-field images corresponded well with emphysematous areas found on CT images. The dark-field coefficient was negatively correlated with the quantitative CT-based emphysema index (r = -0.54, P < .001). Participants with Fleischner Society grades of mild, moderate, confluent, or advanced destructive emphysema exhibited a lower dark-field coefficient than those without emphysema (eg, 1.3 m-1 ± 0.6 for participants with confluent or advanced destructive emphysema vs 2.6 m-1 ± 0.4 for participants without emphysema; P < .001). The area under the receiver operating characteristic curve for detection of mild emphysema was 0.79. Conclusion Pulmonary emphysema leads to reduced signal intensity on dark-field chest radiographs, showing the technique has potential as a diagnostic tool in the assessment of lung diseases. © RSNA, 2022 See also the editorial by Hatabu and Madore in this issue.
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Affiliation(s)
- Theresa Urban
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Florian T Gassert
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Manuela Frank
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Konstantin Willer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Wolfgang Noichl
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Philipp Buchberger
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Rafael C Schick
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Thomas Koehler
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Jannis H Bodden
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Alexander A Fingerle
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Andreas P Sauter
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Marcus R Makowski
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Franz Pfeiffer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Daniela Pfeiffer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
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Gassert FT, Urban T, Frank M, Willer K, Noichl W, Buchberger P, Schick R, Koehler T, von Berg J, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer D, Pfeiffer F. X-ray Dark-Field Chest Imaging: Qualitative and Quantitative Results in Healthy Humans. Radiology 2021; 301:389-395. [PMID: 34427464 DOI: 10.1148/radiol.2021210963] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background X-ray dark-field radiography takes advantage of the wave properties of x-rays, with a relatively high signal in the lungs due to the many air-tissue interfaces in the alveoli. Purpose To describe the qualitative and quantitative characteristics of x-ray dark-field images in healthy human subjects. Materials and Methods Between October 2018 and January 2020, patients of legal age who underwent chest CT as part of their diagnostic work-up were screened for study participation. Inclusion criteria were a normal chest CT scan, the ability to consent, and the ability to stand upright without help. Exclusion criteria were pregnancy, serious medical conditions, and changes in the lung tissue, such as those due to cancer, pleural effusion, atelectasis, emphysema, infiltrates, ground-glass opacities, or pneumothorax. Images of study participants were obtained by using a clinical x-ray dark-field prototype, recently constructed and commissioned at the authors' institution, to simultaneously acquire both attenuation-based and dark-field thorax radiographs. Each subject's total dark-field signal was correlated with his or her lung volume, and the dark-field coefficient was correlated with age, sex, weight, and height. Results Overall, 40 subjects were included in this study (average age, 62 years ± 13 [standard deviation]; 26 men, 14 women). Normal human lungs have high signal, while the surrounding osseous structures and soft tissue have very low and no signal, respectively. The average dark-field signal was 2.5 m-1 ± 0.4 of examined lung tissue. There was a correlation between the total dark-field signal and the lung volume (r = 0.61, P < .001). No difference was found between men and women (P = .78). Also, age (r = -0.18, P = .26), weight (r = 0.24, P = .13), and height (r = 0.01, P = .96) did not influence dark-field signal. Conclusion This study introduces qualitative and quantitative values for x-ray dark-field imaging in healthy human subjects. The quantitative x-ray dark-field coefficient is independent from demographic subject parameters, emphasizing its potential in diagnostic assessment of the lung. ©RSNA, 2021 See also the editorial by Hatabu and Madore in this issue.
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Affiliation(s)
- Florian T Gassert
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Theresa Urban
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Manuela Frank
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Konstantin Willer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Wolfgang Noichl
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Philipp Buchberger
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Rafael Schick
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Thomas Koehler
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Jens von Berg
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Alexander A Fingerle
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Andreas P Sauter
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Marcus R Makowski
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Daniela Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Franz Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
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Willer K, Fingerle AA, Noichl W, De Marco F, Frank M, Urban T, Schick R, Gustschin A, Gleich B, Herzen J, Koehler T, Yaroshenko A, Pralow T, Zimmermann GS, Renger B, Sauter AP, Pfeiffer D, Makowski MR, Rummeny EJ, Grenier PA, Pfeiffer F. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. Lancet Digit Health 2021; 3:e733-e744. [PMID: 34711378 PMCID: PMC8565798 DOI: 10.1016/s2589-7500(21)00146-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). METHODS In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison. FINDINGS Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV1)/functional vital capacity is 0·25, for FEV1% of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42. INTERPRETATION X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders. FUNDING European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility.
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Affiliation(s)
- Konstantin Willer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Noichl
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alex Gustschin
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Thomas Koehler
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Philips Research Hamburg, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC Hamburg, Hamburg, Germany
| | - Gregor S Zimmermann
- Department of Cardiology, Angiology, and Pneumology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, Paris, France
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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12
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Burkhardt R, Gora T, Fingerle AA, Sauter AP, Meurer F, Gassert FT, Dobiasch S, Schilling D, Feuchtinger A, Walch AK, Multhoff G, Herzen J, Noël PB, Rummeny EJ, Combs SE, Schmid TE, Pfeiffer F, Wilkens JJ. In-vivo X-ray dark-field computed tomography for the detection of radiation-induced lung damage in mice. Phys Imaging Radiat Oncol 2021; 20:11-16. [PMID: 34611553 PMCID: PMC8476771 DOI: 10.1016/j.phro.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
Radiation-induced lung damage was observed using X-ray dark-field tomography. In this pre-clinical study, mouse lungs were irradiated and subsequently imaged. We report increased sensitivity of X-ray dark-field tomography over absorption-based tomography.
Background and Purpose Radiotherapy of thoracic tumours can lead to side effects in the lung, which may benefit from early diagnosis. We investigated the potential of X-ray dark-field computed tomography by a proof-of-principle murine study in a clinically relevant radiotherapeutic setting aiming at the detection of radiation-induced lung damage. Material and Methods Six mice were irradiated with 20 Gy to the entire right lung. Together with five unirradiated control mice, they were imaged using computed tomography with absorption and dark-field contrast before and 16 weeks post irradiation. Mean pixel values for the right and left lung were calculated for both contrasts, and the right-to-left-ratio R of these means was compared. Radiologists also assessed the tomograms acquired 16 weeks post irradiation. Sensitivity, specificity, inter- and intra-reader accuracy were evaluated. Results In absorption contrast the group-average of R showed no increase in the control group and increased by 7% (p = 0.005) in the irradiated group. In dark-field contrast, it increased by 2% in the control group and by 14% (p = 0.005) in the irradiated group. Specificity was 100% for both contrasts but sensitivity was almost four times higher using dark-field tomography. Two cases were missed by absorption tomography but were detected by dark-field tomography. Conclusions The applicability of X-ray dark-field computed tomography for the detection of radiation-induced lung damage was demonstrated in a pre-clinical mouse model. The presented results illustrate the differences between dark-field and absorption contrast and show that dark-field tomography could be advantageous in future clinical settings.
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Affiliation(s)
- Rico Burkhardt
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Physics Department, Technical University of Munich, Garching, Germany
| | - Thomas Gora
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Feuchtinger
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel K Walch
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,TranslaTUM, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Julia Herzen
- Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Physics Department, Technical University of Munich, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
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13
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Sauter AP, Andrejewski J, Frank M, Willer K, Herzen J, Meurer F, Fingerle AA, Makowski MR, Pfeiffer F, Pfeiffer D. Correlation of image quality parameters with tube voltage in X-ray dark-field chest radiography: a phantom study. Sci Rep 2021; 11:14130. [PMID: 34239040 PMCID: PMC8266828 DOI: 10.1038/s41598-021-93716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Grating-based X-ray dark-field imaging is a novel imaging modality with enormous technical progress during the last years. It enables the detection of microstructure impairment as in the healthy lung a strong dark-field signal is present due to the high number of air-tissue interfaces. Using the experience from setups for animal imaging, first studies with a human cadaver could be performed recently. Subsequently, the first dark-field scanner for in-vivo chest imaging of humans was developed. In the current study, the optimal tube voltage for dark-field radiography of the thorax in this setup was examined using an anthropomorphic chest phantom. Tube voltages of 50–125 kVp were used while maintaining a constant dose-area-product. The resulting dark-field and attenuation radiographs were evaluated in a reader study as well as objectively in terms of contrast-to-noise ratio and signal strength. We found that the optimum tube voltage for dark-field imaging is 70 kVp as here the most favorable combination of image quality, signal strength, and sharpness is present. At this voltage, a high image quality was perceived in the reader study also for attenuation radiographs, which should be sufficient for routine imaging. The results of this study are fundamental for upcoming patient studies with living humans.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Markus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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14
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Riederer I, Fingerle AA, Zimmer C, Noël PB, Makowski MR, Pfeiffer D. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients. Clin Imaging 2021; 79:158-164. [PMID: 33962188 DOI: 10.1016/j.clinimag.2021.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND One possible complication after mechanical thrombectomy is hemorrhage. In conventional CT it is often difficult to differ between extravasation of iodinated contrast medium and blood. This differentiation, however, is essential for treatments with anticoagulants and antiplatelets. PURPOSE To evaluate dual-layer spectral Computed Tomography (DLSCT) for the differentiation between intracranial hemorrhage and iodinated contrast medium in ischemic stroke patients after mechanical thrombectomy. MATERIALS AND METHODS First, in vitro experiments were performed. Then, head CT images of 47 patients after mechanical thrombectomy were analyzed. Virtual non-contrast (VNC) images and iodine density maps (IDM) were calculated and evaluated. Region of interests (ROIs) analyses were performed. Sensitivity and specificity as well as ROC curves were calculated. RESULTS IDM and VNC images enabled clear differentiation between blood and iodine and reliable quantification of different iodine concentrations in vitro. A total of 23 hyperdense areas were detected in 13 patients, classified as hemorrhage (n = 7), iodinated contrast medium (n = 4) and a mixture of both (n = 12). Sensitivity and specificity for the detection of blood was 100%. CONCLUSION DLSCT enables differentiation between intracranial hemorrhage and iodinated contrast medium in patients after mechanical thrombectomy and might improve diagnostic imaging in post-interventional stroke patients.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, One Silverstein, Philadelphia, PA 19104, USA
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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15
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Andrejewski J, De Marco F, Willer K, Noichl W, Gustschin A, Koehler T, Meyer P, Kriner F, Fischer F, Braun C, Fingerle AA, Herzen J, Pfeiffer F, Pfeiffer D. Whole-body x-ray dark-field radiography of a human cadaver. Eur Radiol Exp 2021; 5:6. [PMID: 33495889 PMCID: PMC7835263 DOI: 10.1186/s41747-020-00201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Grating-based x-ray dark-field and phase-contrast imaging allow extracting information about refraction and small-angle scatter, beyond conventional attenuation. A step towards clinical translation has recently been achieved, allowing further investigation on humans. METHODS After the ethics committee approval, we scanned the full body of a human cadaver in anterior-posterior orientation. Six measurements were stitched together to form the whole-body image. All radiographs were taken at a three-grating large-object x-ray dark-field scanner, each lasting about 40 s. Signal intensities of different anatomical regions were assessed. The magnitude of visibility reduction caused by beam hardening instead of small-angle scatter was analysed using different phantom materials. Maximal effective dose was 0.3 mSv for the abdomen. RESULTS Combined attenuation and dark-field radiography are technically possible throughout a whole human body. High signal levels were found in several bony structures, foreign materials, and the lung. Signal levels were 0.25 ± 0.13 (mean ± standard deviation) for the lungs, 0.08 ± 0.06 for the bones, 0.023 ± 0.019 for soft tissue, and 0.30 ± 0.02 for an antibiotic bead chain. We found that phantom materials, which do not produce small-angle scatter, can generate a strong visibility reduction signal. CONCLUSION We acquired a whole-body x-ray dark-field radiograph of a human body in few minutes with an effective dose in a clinical acceptable range. Our findings suggest that the observed visibility reduction in the bone and metal is dominated by beam hardening and that the true dark-field signal in the lung is therefore much higher than that of the bone.
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Affiliation(s)
- Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Alex Gustschin
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | | | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Fabian Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Florian Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Christian Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
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16
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Zimmermann GS, Fingerle AA, Müller-Leisse C, Gassert F, von Schacky CE, Ibrahim T, Laugwitz KL, Geisler F, Spinner C, Haller B, Makowski MR, Nadjiri J. Coronary calcium scoring assessed on native screening chest CT imaging as predictor for outcome in COVID-19: An analysis of a hospitalized German cohort. PLoS One 2020; 15:e0244707. [PMID: 33378410 PMCID: PMC7773182 DOI: 10.1371/journal.pone.0244707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the outbreak of the COVID-19 pandemic, a number of risk factors for a poor outcome have been identified. Thereby, cardiovascular comorbidity has a major impact on mortality. We investigated whether coronary calcification as a marker for coronary artery disease (CAD) is appropriate for risk prediction in COVID-19. METHODS Hospitalized patients with COVID-19 (n = 109) were analyzed regarding clinical outcome after native computed tomography (CT) imaging for COVID-19 screening. CAC (coronary calcium score) and clinical outcome (need for intensive care treatment or death) data were calculated following a standardized protocol. We defined three endpoints: critical COVID-19 and transfer to ICU, fatal COVID-19 and death, composite endpoint critical and fatal COVID-19, a composite of ICU treatment and death. We evaluated the association of clinical outcome with the CAC. Patients were dichotomized by the median of CAC. Hazard ratios and odds ratios were calculated for the events death or ICU or a composite of death and ICU. RESULTS We observed significantly more events for patients with CAC above the group's median of 31 for critical outcome (HR: 1.97[1.09,3.57], p = 0.026), for fatal outcome (HR: 4.95[1.07,22.9], p = 0.041) and the composite endpoint (HR: 2.31[1.28,4.17], p = 0.0056. Also, odds ratio was significantly increased for critical outcome (OR: 3.01 [1.37, 6.61], p = 0.01) and for fatal outcome (OR: 5.3 [1.09, 25.8], p = 0.02). CONCLUSION The results indicate a significant association between CAC and clinical outcome in COVID-19. Our data therefore suggest that CAC might be useful in risk prediction in patients with COVID-19.
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Affiliation(s)
- Gregor S. Zimmermann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander A. Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christina Müller-Leisse
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claudio E. von Schacky
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tareq Ibrahim
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Spinner
- Department of Internal Medicine II, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Markus R. Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonathan Nadjiri
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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17
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Burkhardt R, Gora T, Fingerle AA, Sauter AP, Meurer F, Umkehrer S, von Teuffenbach M, Kampfer S, Schilling D, Feuchtinger A, Walch AK, Rummeny E, Combs SE, Schmid TE, Pfeiffer F, Wilkens JJ, Herzen J. Early detection of radiation-induced lung damage with X-ray dark-field radiography in mice. Eur Radiol 2020; 31:4175-4183. [PMID: 33211140 PMCID: PMC8128748 DOI: 10.1007/s00330-020-07459-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Assessing the advantage of x-ray dark-field contrast over x-ray transmission contrast in radiography for the detection of developing radiation-induced lung damage in mice. METHODS Two groups of female C57BL/6 mice (irradiated and control) were imaged obtaining both contrasts monthly for 28 weeks post irradiation. Six mice received 20 Gy of irradiation to the entire right lung sparing the left lung. The control group of six mice was not irradiated. A total of 88 radiographs of both contrasts were evaluated for both groups based on average values for two regions of interest, covering (irradiated) right lung and healthy left lung. The ratio of these average values, R, was distinguished between healthy and damaged lungs for both contrasts. The time-point when deviations of R from healthy lung exceeded 3σ was determined and compared among contrasts. The Wilcoxon-Mann-Whitney test was used to test against the null hypothesis that there is no difference between both groups. A selection of 32 radiographs was assessed by radiologists. Sensitivity and specificity were determined in order to compare the diagnostic potential of both contrasts. Inter-reader and intra-reader accuracy were rated with Cohen's kappa. RESULTS Radiation-induced morphological changes of lung tissue caused deviations from the control group that were measured on average 10 weeks earlier with x-ray dark-field contrast than with x-ray transmission contrast. Sensitivity, specificity, and accuracy doubled using dark-field radiography. CONCLUSION X-ray dark-field radiography detects morphological changes of lung tissue associated with radiation-induced damage earlier than transmission radiography in a pre-clinical mouse model. KEY POINTS • Significant deviations from healthy lung due to irradiation were measured after 16 weeks with x-ray dark-field radiography (p = 0.004). • Significant deviations occur on average 10 weeks earlier for x-ray dark-field radiography in comparison to x-ray transmission radiography. • Sensitivity and specificity doubled when using x-ray dark-field radiography instead of x-ray transmission radiography.
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Affiliation(s)
- Rico Burkhardt
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany. .,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany. .,Physics Department, Technical University of Munich, Garching, Germany.
| | - Thomas Gora
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephan Umkehrer
- Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
| | | | - Severin Kampfer
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Feuchtinger
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel K Walch
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
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18
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Zimmermann GS, Fingerle AA, Willer K, Noichl W, Schick R, Urban T, Frank M, Sauter AP, Haller B, Koehler T, Von Berg J, Engel KJ, Pfeiffer D, Herzen J, Rummeny E, Pfeiffer F. X-ray Darkfield Chest Radiography: Correlation of First Results from COPD-Patients with Lung Function Tests. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Shapira N, Fokuhl J, Schultheiß M, Beck S, Kopp FK, Pfeiffer D, Dangelmaier J, Pahn G, Sauter AP, Renger B, Fingerle AA, Rummeny EJ, Albarqouni S, Navab N, Noël PB. Liver lesion localisation and classification with convolutional neural networks: a comparison between conventional and spectral computed tomography. Biomed Phys Eng Express 2020; 6:015038. [DOI: 10.1088/2057-1976/ab6e18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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20
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Kimm MA, Willner M, Drecoll E, Herzen J, Noël PB, Rummeny EJ, Pfeiffer F, Fingerle AA. Grating-based phase-contrast CT (PCCT): histopathological correlation of human liver cirrhosis and hepatocellular carcinoma specimen. J Clin Pathol 2020; 73:483-487. [PMID: 31941652 DOI: 10.1136/jclinpath-2019-206380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023]
Abstract
AIMS To correlate signal intensities in grating-based phase-contrast CT (PCCT) images obtained at a synchrotron light source and a conventional X-ray source with tissue components in human liver cirrhosis and hepatocellular carcinoma (HCC) specimen. METHODS Study approval was obtained by the institutional review board. Human specimen of liver cirrhosis and HCC were imaged at experimental grating-based PCCT setups using either a synchrotron radiation source or a conventional X-ray tube. Tissue samples were sectioned and processed for H&E and Elastica van Gieson staining. PCCT and histological images were manually correlated. Depending on morphology and staining characteristics tissue components like fibrosis, HCC, inflammation, connective tissue and necrosis were differentiated and visually correlated with signal intensity in PCCT images using a 5-point Likert scale with normal liver parenchyma as a reference. RESULTS Grating-based PCCT images of human cirrhotic liver and HCC specimen showed high soft-tissue contrast allowing correlation with histopathological sections. Signal intensities were similar in both setups independent of the nature of the radiation source. Connective tissue and areas of haemorrhage displayed the highest signal intensities, fibrotic liver tissue the lowest. CONCLUSIONS Grating-based PCCT provides comparable results for the characterisation of human specimen of liver cirrhosis and HCC using either a synchrotron light source or a conventional X-ray tube. Due to its high soft-tissue contrast and its applicability to conventional X-ray tubes grating-based PCCT holds potential for preclinical research and virtual histology applications.
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Affiliation(s)
- Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marian Willner
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Enken Drecoll
- Department of Pathology, School of Medicine & Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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21
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Sauter AP, Andrejewski J, De Marco F, Willer K, Gromann LB, Noichl W, Kriner F, Fischer F, Braun C, Koehler T, Meurer F, Fingerle AA, Pfeiffer D, Rummeny E, Herzen J, Pfeiffer F. Optimization of tube voltage in X-ray dark-field chest radiography. Sci Rep 2019; 9:8699. [PMID: 31213645 PMCID: PMC6582156 DOI: 10.1038/s41598-019-45256-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
Grating-based X-ray dark-field imaging is a novel imaging modality which has been refined during the last decade. It exploits the wave-like behaviour of X-radiation and can nowadays be implemented with existing X-ray tubes used in clinical applications. The method is based on the detection of small-angle X-ray scattering, which occurs e.g. at air-tissue-interfaces in the lung or bone-fat interfaces in spongy bone. In contrast to attenuation-based chest X-ray imaging, the optimal tube voltage for dark-field imaging of the thorax has not yet been examined. In this work, dark-field scans with tube voltages ranging from 60 to 120 kVp were performed on a deceased human body. We analyzed the resulting images with respect to subjective and objective image quality, and found that the optimum tube voltage for dark-field thorax imaging at the used setup is at rather low energies of around 60 to 70 kVp. Furthermore, we found that at these tube voltages, the transmission radiographs still exhibit sufficient image quality to correlate dark-field information. Therefore, this study may serve as an important guideline for the development of clinical dark-field chest X-ray imaging devices for future routine use.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany.
| | - Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Lukas B Gromann
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Fabian Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Florian Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Christian Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
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22
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Sauter AP, Kopp FK, Bippus R, Dangelmaier J, Deniffel D, Fingerle AA, Meurer F, Pfeiffer D, Proksa R, Rummeny EJ, Noël PB. Sparse sampling computed tomography (SpSCT) for detection of pulmonary embolism: a feasibility study. Eur Radiol 2019; 29:5950-5960. [DOI: 10.1007/s00330-019-06217-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/01/2019] [Accepted: 04/02/2019] [Indexed: 02/02/2023]
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23
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Riederer I, Si-Mohamed S, Ehn S, Bar-Ness D, Noël PB, Fingerle AA, Pfeiffer F, Rummeny EJ, Douek P, Pfeiffer D. Differentiation between blood and iodine in a bovine brain-Initial experience with Spectral Photon-Counting Computed Tomography (SPCCT). PLoS One 2019; 14:e0212679. [PMID: 30802258 PMCID: PMC6388929 DOI: 10.1371/journal.pone.0212679] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/07/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the accuracy of Spectral Photon-Counting Computed Tomography (SPCCT) in the quantification of iodine concentrations and its potential for the differentiation between blood and iodine. Methods Tubes with blood and a concentration series of iodine were scanned with a preclinical SPCCT system (both in vitro and in an ex vivo bovine brain tissue sample). Iodine density maps (IDM) and virtual non-contrast (VNC) images were generated using the multi-bin spectral information to perform material decomposition. Region-of-interest (ROI) analysis was performed within the tubes to quantitatively determine the absolute content of iodine (mg/ml). Results In conventional CT images, ROI analysis showed similar Hounsfield Unit (HU) values for the tubes with blood and iodine (59.9 ± 1.8 versus 59.2 ± 1.5). Iodine density maps enabled clear differentiation between blood and iodine in vitro, as well as in the bovine brain model. Quantitative measurements of the different iodine concentrations matched well with those of actual known concentrations even for very small iodine concentrations with values below 1mg/ml (RMSE = 0.19). Conclusions SPCCT providing iodine maps and virtual non-contrast images allows material decomposition, differentiation between blood and iodine in vitro and ex vivo in a bovine brain model and reliably quantifies the iodine concentration.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Salim Si-Mohamed
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Sebastian Ehn
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniel Bar-Ness
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexander A. Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Philippe Douek
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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24
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Laugerette A, Schwaiger BJ, Brown K, Frerking LC, Kopp FK, Mei K, Sellerer T, Kirschke J, Baum T, Gersing AS, Pfeiffer D, Fingerle AA, Rummeny EJ, Proksa R, Noël PB, Pfeiffer F. DXA-equivalent quantification of bone mineral density using dual-layer spectral CT scout scans. Eur Radiol 2019; 29:4624-4634. [PMID: 30758656 DOI: 10.1007/s00330-019-6005-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/06/2018] [Accepted: 01/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To develop and evaluate a method for areal bone mineral density (aBMD) measurement based on dual-layer spectral CT scout scans. METHODS A post-processing algorithm using a pair of 2D virtual mono-energetic scout images (VMSIs) was established in order to semi-automatically compute the aBMD at the spine similarly to DXA, using manual soft tissue segmentation, semi-automatic segmentation for the vertebrae, and automatic segmentation for the background. The method was assessed based on repetitive measurements of the standardized European Spine Phantom (ESP) using the standard scout scan tube current (30 mA) and other tube currents (10 to 200 mA), as well as using fat-equivalent extension rings simulating different patient habitus, and was compared to dual-energy X-ray absorptiometry (DXA). Moreover, the feasibility of the method was assessed in vivo in female patients. RESULTS Derived from standard scout scans, aBMD values measured with the proposed method significantly correlated with DXA measurements (r = 0.9925, p < 0.001), and mean accuracy (DXA, 4.12%; scout, 1.60%) and precision (DXA, 2.64%; scout, 2.03%) were comparable between the two methods. Moreover, aBMD values assessed at different tube currents did not differ significantly (p ≥ 0.20 for all), suggesting that the presented method could be applied to scout scans with different settings. Finally, data derived from sample patients were concordant with BMD values from a reference age-matched population. CONCLUSIONS Based on dual-layer spectral scout scans, aBMD measurements were fast and reliable and significantly correlated with the according DXA measurements in phantoms. Considering the number of CT acquisitions performed worldwide, this method could allow truly opportunistic osteoporosis screening. KEY POINTS • 2D scout scans (localizer radiographs) from a dual-layer spectral CT scanner, which are mandatory parts of a CT examination, can be used to automatically determine areal bone mineral density (aBMD) at the spine. • The presented method allowed fast (< 25 s/patient), semi-automatic, and reliable DXA-equivalent aBMD measurements for state-of-the-art DXA phantoms at different tube settings and for various patient habitus, as well as for sample patients. • Considering the number of CT scout scan acquisitions performed worldwide on a daily basis, the presented technique could enable truly opportunistic osteoporosis screening with DXA-equivalent metrics, without involving higher radiation exposure since it only processes existing data that is acquired during each CT scan.
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Affiliation(s)
- Alexis Laugerette
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | | | | | - Felix K Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Kai Mei
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Thorsten Sellerer
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Jan Kirschke
- Section of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Section of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | | | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
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25
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Kopp FK, Daerr H, Si-Mohamed S, Sauter AP, Ehn S, Fingerle AA, Brendel B, Pfeiffer F, Roessl E, Rummeny EJ, Pfeiffer D, Proksa R, Douek P, Noël PB. Evaluation of a preclinical photon-counting CT prototype for pulmonary imaging. Sci Rep 2018; 8:17386. [PMID: 30478300 PMCID: PMC6255779 DOI: 10.1038/s41598-018-35888-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to investigate a preclinical spectral photon-counting CT (SPCCT) prototype compared to conventional CT for pulmonary imaging. A custom-made lung phantom, including nodules of different sizes and shapes, was scanned with a preclinical SPCCT and a conventional CT in standard and high-resolution (HR-CT) mode. Volume estimation was evaluated by linear regression. Shape similarity was evaluated with the Dice similarity coefficient. Spatial resolution was investigated via MTF for each imaging system. In-vivo rabbit lung images from the SPCCT system were subjectively reviewed. Evaluating the volume estimation, linear regression showed best results for the SPCCT compared to CT and HR-CT with a root mean squared error of 21.3 mm3, 28.5 mm3 and 26.4 mm3 for SPCCT, CT and HR-CT, respectively. The Dice similarity coefficient was superior for SPCCT throughout nodule shapes and all nodule sizes (mean, SPCCT: 0.90; CT: 0.85; HR-CT: 0.85). 10% MTF improved from 10.1 LP/cm for HR-CT to 21.7 LP/cm for SPCCT. Visual investigation of small pulmonary structures was superior for SPCCT in the animal study. In conclusion, the SPCCT prototype has the potential to improve the assessment of lung structures due to higher resolution compared to conventional CT.
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Affiliation(s)
- Felix K Kopp
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany.
| | - Heiner Daerr
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Salim Si-Mohamed
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Andreas P Sauter
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Sebastian Ehn
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technische Universität München, 85748, Garching, Germany
| | - Alexander A Fingerle
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Bernhard Brendel
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technische Universität München, 85748, Garching, Germany
| | - Ewald Roessl
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Ernst J Rummeny
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Daniela Pfeiffer
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Philippe Douek
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Peter B Noël
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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26
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Noël PB, Engels S, Köhler T, Muenzel D, Franz D, Rasper M, Rummeny EJ, Dobritz M, Fingerle AA. Evaluation of an iterative model-based CT reconstruction algorithm by intra-patient comparison of standard and ultra-low-dose examinations. Acta Radiol 2018; 59:1225-1231. [PMID: 29320863 DOI: 10.1177/0284185117752551] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The explosive growth of computer tomography (CT) has led to a growing public health concern about patient and population radiation dose. A recently introduced technique for dose reduction, which can be combined with tube-current modulation, over-beam reduction, and organ-specific dose reduction, is iterative reconstruction (IR). Purpose To evaluate the quality, at different radiation dose levels, of three reconstruction algorithms for diagnostics of patients with proven liver metastases under tumor follow-up. Material and Methods A total of 40 thorax-abdomen-pelvis CT examinations acquired from 20 patients in a tumor follow-up were included. All patients were imaged using the standard-dose and a specific low-dose CT protocol. Reconstructed slices were generated by using three different reconstruction algorithms: a classical filtered back projection (FBP); a first-generation iterative noise-reduction algorithm (iDose4); and a next generation model-based IR algorithm (IMR). Results The overall detection of liver lesions tended to be higher with the IMR algorithm than with FBP or iDose4. The IMR dataset at standard dose yielded the highest overall detectability, while the low-dose FBP dataset showed the lowest detectability. For the low-dose protocols, a significantly improved detectability of the liver lesion can be reported compared to FBP or iDose4 ( P = 0.01). The radiation dose decreased by an approximate factor of 5 between the standard-dose and the low-dose protocol. Conclusion The latest generation of IR algorithms significantly improved the diagnostic image quality and provided virtually noise-free images for ultra-low-dose CT imaging.
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Affiliation(s)
- Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
| | - Stephan Engels
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Michael Rasper
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Martin Dobritz
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
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27
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Willer K, Fingerle AA, Gromann LB, De Marco F, Herzen J, Achterhold K, Gleich B, Muenzel D, Scherer K, Renz M, Renger B, Kopp F, Kriner F, Fischer F, Braun C, Auweter S, Hellbach K, Reiser MF, Schroeter T, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Noël PB. X-ray dark-field imaging of the human lung-A feasibility study on a deceased body. PLoS One 2018; 13:e0204565. [PMID: 30261038 PMCID: PMC6160109 DOI: 10.1371/journal.pone.0204565] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/11/2018] [Indexed: 12/24/2022] Open
Abstract
Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60–85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.
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Affiliation(s)
- Konstantin Willer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alexander A. Fingerle
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas B. Gromann
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Klaus Achterhold
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniela Muenzel
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kai Scherer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Martin Renz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Kriner
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Fischer
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Schroeter
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | | | | | | | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | | | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Peter B. Noël
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Kopp FK, Catalano M, Pfeiffer D, Fingerle AA, Rummeny EJ, Noël PB. CNN as model observer in a liver lesion detection task for x-ray computed tomography: A phantom study. Med Phys 2018; 45:4439-4447. [PMID: 30137658 DOI: 10.1002/mp.13151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The purpose of this study was the evaluation of anthropomorphic model observers trained with neural networks for the prediction of a human observer's performance. METHODS To simulate liver lesions, a phantom with contrast targets (acrylic spheres, varying diameters, +30 HU) was repeatedly scanned on a computed tomography scanner. Image data labeled with confidence ratings assessed in a reader study for a detection task of liver lesions were used to build several anthropomorphic model observers. Models were trained with images reconstructed with iterative reconstruction and evaluated with images reconstructed with filtered backprojection. A neural network, based on softmax regression (SR-MO), and convolutional neural networks (CNN-MO) were used to predict the performance of a human observer and compared to a channelized Hotelling observer [with Gabor channels and internal channel noise (CHOi)]. Model observers were evaluated by a receiver operating characteristic curve analysis and compared to the results in the reader study. Two strategies were used to train the SR-MO and CNN-MO: A) building a separate model for each lesion size; B) building one model that was applied to lesions of all sizes. RESULTS All tested model observers and the human observer were highly correlated at each lesion size and dose level. With strategy A, Pearson's product-moment correlation coefficients r were 0.926 (95% confidence interval (CI): 0.679-0.985) for SR-MO and 0.979 (95% CI: 0.902-0.996) for CNN-MO. With strategy B, r was 0.860 (95% CI: 0.454-0.970) for SR-MO and 0.918 (95% CI: 0.651-0.983) for CNN-MO. For CHOi, r was 0.945 (95% CI: 0.755-0.989). With strategy A, mean absolute percentage differences (MAPD) between the model observers and the human observer were 3.7% for SR-MO and 1.2% for CNN-MO. With strategy B, MAPD were 3.7% for SR-MO and 3.0% for CNN-MO. For the CHOi the MAPD was 2.2%. CONCLUSION Convolutional neural network model observers can accurately predict the performance of a human observer for all lesion sizes and dose levels in the evaluated signal detection task.
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Affiliation(s)
- Felix K Kopp
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, 81675, Germany
| | - Marco Catalano
- Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan, 20090, Italy
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, 81675, Germany.,Chair of Biomedical Physics, Technische Universität München, Garching b. München, 85748, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, 81675, Germany.,Chair of Biomedical Physics, Technische Universität München, Garching b. München, 85748, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, 81675, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, 81675, Germany.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Mei K, Ehn S, Oechsner M, Kopp FK, Pfeiffer D, Fingerle AA, Pfeiffer F, Combs SE, Wilkens JJ, Rummeny EJ, Noël PB. Dual-layer spectral computed tomography: measuring relative electron density. Eur Radiol Exp 2018; 2:20. [PMID: 30175319 PMCID: PMC6103960 DOI: 10.1186/s41747-018-0051-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background X-ray and particle radiation therapy planning requires accurate estimation of local electron density within the patient body to calculate dose delivery to tumour regions. We evaluate the feasibility and accuracy of electron density measurement using dual-layer computed tomography (DLCT), a recently introduced dual-energy CT technique. Methods Two calibration phantoms were scanned with DLCT and virtual monoenergetic images (VMIs) at 50 keV and 200 keV were generated. We investigated two approaches to obtain relative electron densities from these VMIs: to fit an analytic interaction cross-sectional model and to empirically calibrate a conversion function with one of the phantoms. Knowledge of the emitted x-ray spectrum was not required for the presented work. Results The results from both methods were highly correlated to the nominal values (R > 0.999). Except for the water and lung inserts, the error was within 1.79% (average 1.53%) for the cross-sectional model and 1.61% (average 0.87%) for the calibrated conversion. Different radiation doses did not have a significant influence on the measurement (p = 0.348, 0.167), suggesting that the methods are reproducible. Further, we applied these methods to routine clinical data. Conclusions Our study shows a high validity of electron density estimation based on DLCT, which has potential to improve the procedure and accuracy of measuring electron density in clinical practice.
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Affiliation(s)
- Kai Mei
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ehn
- 2Department of Physics and Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix K Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,2Department of Physics and Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,2Department of Physics and Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,2Department of Physics and Munich School of BioEngineering, Technical University of Munich, Munich, Germany
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30
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Riederer I, Fingerle AA, Baum T, Kirschke JS, Rummeny EJ, Noël PB, Pfeiffer D. Acute infarction after mechanical thrombectomy is better delineable in virtual non-contrast compared to conventional images using a dual-layer spectral CT. Sci Rep 2018; 8:9329. [PMID: 29921942 PMCID: PMC6008394 DOI: 10.1038/s41598-018-27437-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
Abstract
The aim was to evaluate Virtual Non-Contrast (VNC)-CT images for the detection of acute infarcts in the brain after mechanical thrombectomy using a dual-layer spectral CT. 29 patients between September 2016 and February 2017 with unenhanced head spectral-CT after mechanical thrombectomy and available follow-up images (MRI, n:26; CT, n:3) were included. VNC-CT and conventional CT (CT) images were reconstructed using dedicated software. Based on those, contrast-to-noise ratio (CNR), and the volume of infarction were measured semi-automatically in VNC-CT, CT and MRI. Furthermore, two readers independently assessed the VNC-CT and CT images in a randomized order by using the ASPECT score, and inter-rater reliability, sensitivity and specificity were calculated. CNR was significantly higher in VNC-CT compared to CT (3.1 ± 1.5 versus 1.1 ± 1.1, p < 0.001). The mean estimated volume of infarction was significantly higher in VNC-CT compared to CT (72% versus 55% of the volume measured in MRI, p < 0.005). Inter-rater reliability was higher in VNC-CT compared to CT (0.751 versus 0.625) and sensitivity was higher in VNC-CT compared to CT (73% versus 55%). In conclusion, acute ischemic lesions after mechanical thrombectomy are better definable in VNC-CT compared to CT images using a dual-layer spectral CT system.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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31
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Sauter AP, Muenzel D, Dangelmaier J, Braren R, Pfeiffer F, Rummeny EJ, Noël PB, Fingerle AA. Dual-layer spectral computed tomography: Virtual non-contrast in comparison to true non-contrast images. Eur J Radiol 2018; 104:108-114. [PMID: 29857855 DOI: 10.1016/j.ejrad.2018.05.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/09/2018] [Accepted: 05/05/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate virtual-non-contrast (VNC) images obtained from clinical triphasic scans with a dual-layer spectral computed tomography system regarding accuracy of iodine subtraction. MATERIAL AND METHODS From September to December 2016, 62 consecutive patients who underwent a clinical routine triphasic CT examination were included into this retrospective study. VNC images based on the arterial and portal venous phase were generated. For every patient and every contrast phase, a region-of-interest (ROI) was defined in aorta, liver, renal cortex, spongious bone, fat, muscle and fluid (i.e. gallbladder, urinary bladder), resulting in 2170 ROIs. VNC images were compared to true-non-contrast (TNC) images regarding difference in attenuation. Consistency between VNC images obtained from the arterial and portal venous phase as well as the influence of the initial attenuation on respective VNC images were evaluated. RESULTS Comparison of HU in VNC and TNC images showed a high accuracy of iodine elimination. Mean difference between TNC and VNC images was only 0.5 ± 8.5 HU and >90% of all comparisons showed a difference of less than 15 HU. For all tissues but spongious bone, mean absolute difference between TNC and VNC images was below 10 HU. VNC images derived from the arterial and the portal venous phase showed excellent correlation. The quality of iodine removal in VNC images was not influenced by the original contrast enhancement. However, VNC images cannot be used for evaluation of iodine removal in bone as bone and iodine can hardly be differentiated via spectral CT. CONCLUSION VNC imaging in DL-CT is a promising tool for daily clinical routine. As non-enhanced CT images are essential in multiple clinical situations, the permanent availability of VNC images with dual-layer spectral CT will result in a substantial reduction of radiation exposure and an increased diagnostic value of monophasic contrast-enhanced CT scans.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany.
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Julia Dangelmaier
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Technische Universität München, Garching, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
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32
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Schoeppe F, Sommer WH, Nörenberg D, Verbeek M, Bogner C, Westphalen CB, Dreyling M, Rummeny EJ, Fingerle AA. Structured reporting adds clinical value in primary CT staging of diffuse large B-cell lymphoma. Eur Radiol 2018; 28:3702-3709. [PMID: 29600475 DOI: 10.1007/s00330-018-5340-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate whether template-based structured reports (SRs) add clinical value to primary CT staging in patients with diffuse large B-cell lymphoma (DLBCL) compared to free-text reports (FTRs). METHODS In this two-centre study SRs and FTRs were acquired for 16 CT examinations. Thirty-two reports were independently scored by four haematologists using a questionnaire addressing completeness of information, structure, guidance for patient management and overall quality. The questionnaire included yes-no, 10-point Likert scale and 5-point scale questions. Altogether 128 completed questionnaires were evaluated. Non-parametric Wilcoxon signed-rank test and McNemar's test were used for statistical analysis. RESULTS SRs contained information on affected organs more often than FTRs (95 % vs. 66 %). More SRs commented on extranodal involvement (91 % vs. 62 %). Sufficient information for Ann-Arbor classification was included in more SRs (89 % vs. 64 %). Information extraction was quicker from SRs (median rating on 10-point Likert scale=9 vs. 6; 7-10 vs. 4-8 interquartile range). SRs had better comprehensibility (9 vs. 7; 8-10 vs. 5-8). Contribution of SRs to clinical decision-making was higher (9 vs. 6; 6-10 vs. 3-8). SRs were of higher quality (p < 0.001). All haematologists preferred SRs over FTRs. CONCLUSIONS Structured reporting of CT examinations for primary staging in patients with DLBCL adds clinical value compared to FTRs by increasing completeness of reports, facilitating information extraction and improving patient management. KEY POINTS • Structured reporting in CT helps clinicians to assess patients with lymphoma. • This two-centre study showed that structured reporting improves information content and extraction. • Patient management may be improved by structured reporting. • Clinicians preferred structured reports over free-text reports.
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Affiliation(s)
- Franziska Schoeppe
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany.
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany
| | - Dominik Nörenberg
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany
| | - Mareike Verbeek
- III. Department of Internal Medicine and Comprehensive Cancer Center, Technical University of Munich (TUM), Munich, Germany
| | - Christian Bogner
- III. Department of Internal Medicine and Comprehensive Cancer Center, Technical University of Munich (TUM), Munich, Germany
| | - C Benedikt Westphalen
- Department of Internal Medicine III and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Martin Dreyling
- Department of Internal Medicine III and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Ernst J Rummeny
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich (TUM), Munich, Germany
| | - Alexander A Fingerle
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich (TUM), Munich, Germany
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33
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Dangelmaier J, Bar-Ness D, Daerr H, Muenzel D, Si-Mohamed S, Ehn S, Fingerle AA, Kimm MA, Kopp FK, Boussel L, Roessl E, Pfeiffer F, Rummeny EJ, Proksa R, Douek P, Noël PB. Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair. Eur Radiol 2018; 28:3318-3325. [PMID: 29460069 PMCID: PMC6028848 DOI: 10.1007/s00330-017-5252-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
Objectives After endovascular aortic repair (EVAR), discrimination of endoleaks and intra-aneurysmatic calcifications within the aneurysm often requires multiphase computed tomography (CT). Spectral photon-counting CT (SPCCT) in combination with a two-contrast agent injection protocol may provide reliable detection of endoleaks with a single CT acquisition. Methods To evaluate the feasibility of SPCCT, the stent-lined compartment of an abdominal aortic aneurysm phantom was filled with a mixture of iodine and gadolinium mimicking enhanced blood. To represent endoleaks of different flow rates, the adjacent compartments contained either one of the contrast agents or calcium chloride to mimic intra-aneurysmatic calcifications. After data acquisition with a SPCCT prototype scanner with multi-energy bins, material decomposition was performed to generate iodine, gadolinium and calcium maps. Results In a conventional CT slice, Hounsfield units (HU) of the compartments were similar ranging from 147 to 168 HU. Material-specific maps differentiate the distributions within the compartments filled with iodine, gadolinium or calcium. Conclusion SPCCT may replace multiphase CT to detect endoleaks without sacrificing diagnostic accuracy. It is a unique feature of our method to capture endoleak dynamics and allow reliable distinction from intra-aneurysmatic calcifications in a single scan, thereby enabling a significant reduction of radiation exposure. Key Points • SPCCT might enable advanced endoleak detection. • Material maps derived from SPCCT can differentiate iodine, gadolinium and calcium. • SPCCT may potentially reduce radiation burden for EVAR patients under post-interventional surveillance.
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Affiliation(s)
- Julia Dangelmaier
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | | | - Heiner Daerr
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Salim Si-Mohamed
- CREATIS, CNRS UMR 5220, INSERM U1206, INSA, Lyon, France.,Radiology Department, Lyon University Hospital, Lyon, France.,University Lyon1 Claude Bernard, Lyon, France
| | - Sebastian Ehn
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technische Universität München, 85748 Garching, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Felix K Kopp
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Loic Boussel
- CREATIS, CNRS UMR 5220, INSERM U1206, INSA, Lyon, France.,Radiology Department, Lyon University Hospital, Lyon, France.,University Lyon1 Claude Bernard, Lyon, France
| | - Ewald Roessl
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technische Universität München, 85748 Garching, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Philippe Douek
- CREATIS, CNRS UMR 5220, INSERM U1206, INSA, Lyon, France.,Radiology Department, Lyon University Hospital, Lyon, France.,University Lyon1 Claude Bernard, Lyon, France
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technische Universität München, 85748 Garching, Germany
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34
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Ehn S, Sellerer T, Muenzel D, Fingerle AA, Kopp F, Duda M, Mei K, Renger B, Herzen J, Dangelmaier J, Schwaiger BJ, Sauter A, Riederer I, Renz M, Braren R, Rummeny EJ, Pfeiffer F, Noël PB. Assessment of quantification accuracy and image quality of a full-body dual-layer spectral CT system. J Appl Clin Med Phys 2018; 19:204-217. [PMID: 29266724 PMCID: PMC5768037 DOI: 10.1002/acm2.12243] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/24/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022] Open
Abstract
The performance of a recently introduced spectral computed tomography system based on a dual-layer detector has been investigated. A semi-anthropomorphic abdomen phantom for CT performance evaluation was imaged on the dual-layer spectral CT at different radiation exposure levels (CTDIvol of 10 mGy, 20 mGy and 30 mGy). The phantom was equipped with specific low-contrast and tissue-equivalent inserts including water-, adipose-, muscle-, liver-, bone-like materials and a variation in iodine concentrations. Additionally, the phantom size was varied using different extension rings to simulate different patient sizes. Contrast-to-noise (CNR) ratio over the range of available virtual mono-energetic images (VMI) and the quantitative accuracy of VMI Hounsfield Units (HU), effective-Z maps and iodine concentrations have been evaluated. Central and peripheral locations in the field-of-view have been examined. For all evaluated imaging tasks the results are within the calculated theoretical range of the tissue-equivalent inserts. Especially at low energies, the CNR in VMIs could be boosted by up to 330% with respect to conventional images using iDose/spectral reconstructions at level 0. The mean bias found in effective-Z maps and iodine concentrations averaged over all exposure levels and phantom sizes was 1.9% (eff. Z) and 3.4% (iodine). Only small variations were observed with increasing phantom size (+3%) while the bias was nearly independent of the exposure level (±0.2%). Therefore, dual-layer detector based CT offers high quantitative accuracy of spectral images over the complete field-of-view without any compromise in radiation dose or diagnostic image quality.
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Affiliation(s)
- Sebastian Ehn
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
| | - Thorsten Sellerer
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
| | - Daniela Muenzel
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Alexander A. Fingerle
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Felix Kopp
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Manuela Duda
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
| | - Kai Mei
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Bernhard Renger
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Julia Herzen
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Julia Dangelmaier
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Benedikt J. Schwaiger
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Andreas Sauter
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Isabelle Riederer
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Martin Renz
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Rickmer Braren
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Ernst J. Rummeny
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Franz Pfeiffer
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
| | - Peter B. Noël
- Chair of Biomedical PhysicsDepartment of Physics and Munich School of BioEngineeringTechnical University of MunichGarchingGermany
- Department of diagnostic and interventional RadiologyTechnical University of MunichMunichGermany
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Muenzel D, Daerr H, Proksa R, Fingerle AA, Kopp FK, Douek P, Herzen J, Pfeiffer F, Rummeny EJ, Noël PB. Simultaneous dual-contrast multi-phase liver imaging using spectral photon-counting computed tomography: a proof-of-concept study. Eur Radiol Exp 2017; 1:25. [PMID: 29708205 PMCID: PMC5909366 DOI: 10.1186/s41747-017-0030-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background To assess the feasibility of dual-contrast spectral photon-counting computed tomography (SPCCT) for liver imaging. Methods We present an SPCCT in-silico study for simultaneous mapping of the complementary distribution in the liver of two contrast agents (CAs) subsequently intravenously injected: a gadolinium-based contrast agent and an iodine-based contrast agent. Four types of simulated liver lesions with a characteristic arterial and portal venous pattern (haemangioma, hepatocellular carcinoma, cyst, and metastasis) are presented. A material decomposition was performed to reconstruct quantitative iodine and gadolinium maps. Finally, a multi-dimensional classification algorithm for automatic lesion detection is presented. Results Our simulations showed that with a single-scan SPCCT and an adapted contrast injection protocol, it was possible to reconstruct contrast-enhanced images of the liver with arterial distribution of the iodine-based CA and portal venous phase of the gadolinium-based CA. The characteristic patterns of contrast enhancement were visible in all liver lesions. The approach allowed for an automatic detection and classification of liver lesions using a multi-dimensional analysis. Conclusions Dual-contrast SPCCT should be able to visualise the characteristic arterial and portal venous enhancement with a single scan, allowing for an automatic lesion detection and characterisation, with a reduced radiation exposure.
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Affiliation(s)
- Daniela Muenzel
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Heiner Daerr
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Roland Proksa
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Alexander A Fingerle
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Felix K Kopp
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Philippe Douek
- 3Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
| | - Julia Herzen
- 4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Franz Pfeiffer
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany.,5Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Peter B Noël
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
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Mei K, Schwaiger BJ, Kopp FK, Ehn S, Gersing AS, Kirschke JS, Muenzel D, Fingerle AA, Rummeny EJ, Pfeiffer F, Baum T, Noël PB. Bone mineral density measurements in vertebral specimens and phantoms using dual-layer spectral computed tomography. Sci Rep 2017; 7:17519. [PMID: 29235542 PMCID: PMC5727524 DOI: 10.1038/s41598-017-17855-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022] Open
Abstract
To assess whether phantomless calcium-hydroxyapatite (HA) specific bone mineral density (BMD) measurements with dual-layer spectral computed tomography are accurate in phantoms and vertebral specimens. Ex-vivo human vertebrae (n = 13) and a phantom containing different known HA concentrations were placed in a semi-anthropomorphic abdomen phantom with different extension rings simulating different degrees of obesity. Phantomless dual-layer spectral CT was performed at different tube current settings (500, 250, 125 and 50 mAs). HA-specific BMD was derived from spectral-based virtual monoenergetic images at 50 keV and 200 keV. Values were compared to the HA concentrations of the phantoms and conventional qCT measurements using a reference phantom, respectively. Above 125 mAs, errors for phantom measurements ranged between -1.3% to 4.8%, based on spectral information. In vertebral specimens, high correlations were found between BMD values assessed with spectral CT and conventional qCT (r ranging between 0.96 and 0.99; p < 0.001 for all) with different extension rings, and a high agreement was found in Bland Altman plots. Different degrees of obesity did not have a significant influence on measurements (P > 0.05 for all). These results suggest a high validity of HA-specific BMD measurements based on dual-layer spectral CT examinations in setups simulating different degrees of obesity without the need for a reference phantom, thus demonstrating their feasibility in clinical routine.
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Affiliation(s)
- Kai Mei
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Felix K Kopp
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ehn
- Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Muenzel
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
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Gromann LB, De Marco F, Willer K, Noël PB, Scherer K, Renger B, Gleich B, Achterhold K, Fingerle AA, Muenzel D, Auweter S, Hellbach K, Reiser M, Baehr A, Dmochewitz M, Schroeter TJ, Koch FJ, Meyer P, Kunka D, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Herzen J. In-vivo X-ray Dark-Field Chest Radiography of a Pig. Sci Rep 2017; 7:4807. [PMID: 28684858 PMCID: PMC5500502 DOI: 10.1038/s41598-017-05101-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022] Open
Abstract
X-ray chest radiography is an inexpensive and broadly available tool for initial assessment of the lung in clinical routine, but typically lacks diagnostic sensitivity for detection of pulmonary diseases in their early stages. Recent X-ray dark-field (XDF) imaging studies on mice have shown significant improvements in imaging-based lung diagnostics. Especially in the case of early diagnosis of chronic obstructive pulmonary disease (COPD), XDF imaging clearly outperforms conventional radiography. However, a translation of this technique towards the investigation of larger mammals and finally humans has not yet been achieved. In this letter, we present the first in-vivo XDF full-field chest radiographs (32 × 35 cm2) of a living pig, acquired with clinically compatible parameters (40 s scan time, approx. 80 µSv dose). For imaging, we developed a novel high-energy XDF system that overcomes the limitations of currently established setups. Our XDF radiographs yield sufficiently high image quality to enable radiographic evaluation of the lungs. We consider this a milestone in the bench-to-bedside translation of XDF imaging and expect XDF imaging to become an invaluable tool in clinical practice, both as a general chest X-ray modality and as a dedicated tool for high-risk patients affected by smoking, industrial work and indoor cooking.
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Affiliation(s)
- Lukas B Gromann
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter B Noël
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Kai Scherer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Bernhard Gleich
- Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Alexander A Fingerle
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Daniela Muenzel
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Andrea Baehr
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Michaela Dmochewitz
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Tobias J Schroeter
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Frieder J Koch
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Danays Kunka
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Andre Yaroshenko
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | | | - Karsten Rindt
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
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Muenzel D, Bar-Ness D, Roessl E, Blevis I, Bartels M, Fingerle AA, Ruschke S, Coulon P, Daerr H, Kopp FK, Brendel B, Thran A, Rokni M, Herzen J, Boussel L, Pfeiffer F, Proksa R, Rummeny EJ, Douek P, Noël PB. Spectral Photon-counting CT: Initial Experience with Dual–Contrast Agent K-Edge Colonography. Radiology 2017; 283:723-728. [DOI: 10.1148/radiol.2016160890] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Richter V, Willner MS, Henningsen J, Birnbacher L, Marschner M, Herzen J, Kimm MA, Noël PB, Rummeny EJ, Pfeiffer F, Fingerle AA. Ex vivo characterization of pathologic fluids with quantitative phase-contrast computed tomography. Eur J Radiol 2016; 86:99-104. [PMID: 28027773 DOI: 10.1016/j.ejrad.2016.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/04/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE X-ray phase-contrast imaging (PCI) provides additional information beyond absorption characteristics by detecting the phase shift of the X-ray beam passing through material. The grating-based system works with standard polychromatic X-ray sources, promising a possible clinical implementation. PCI has been shown to provide additional information in soft-tissue samples. The aim of this study was to determine if ex vivo quantitative phase-contrast computed tomography (PCCT) may differentiate between pathologic fluid collections. MATERIALS AND METHODS PCCT was performed with the grating interferometry method. A protein serial dilution, human blood samples and 17 clinical samples of pathologic fluid retentions were imaged and correlated with clinical chemistry measurements. Conventional and phase-contrast tomography images were reconstructed. Phase-contrast Hounsfield Units (HUp) were used for quantitative analysis analogously to conventional HU. The imaging was analyzed using overall means, ROI values as well as whole-volume-histograms and vertical gradients. Contrast to noise ratios were calculated between different probes and between imaging methods. RESULTS HUp showed a very good linear correlation with protein concentration in vitro. In clinical samples, HUp correlated rather well with cell count and triglyceride content. PCI was better than absorption imaging at differentiating protein concentrations in the protein samples as well as at differentiating blood plasma from cellular components. PCI also allowed for differentiation of watery samples (such as lymphoceles) from pus. CONCLUSION Phase-contrast computed tomography is a promising tool for the differentiation of pathologic fluids that appear homogenous with conventional attenuation imaging.
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Affiliation(s)
- Vivien Richter
- Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Weg 3, 72076 Tuebingen, Germany.
| | - Marian S Willner
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - John Henningsen
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - Lorenz Birnbacher
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - Mathias Marschner
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - Julia Herzen
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Franz Pfeiffer
- Department of Physics & Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748 Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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Sauter A, Koehler T, Fingerle AA, Brendel B, Richter V, Rasper M, Rummeny EJ, Noël PB, Münzel D. Ultra Low Dose CT Pulmonary Angiography with Iterative Reconstruction. PLoS One 2016; 11:e0162716. [PMID: 27611830 PMCID: PMC5017721 DOI: 10.1371/journal.pone.0162716] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/26/2016] [Indexed: 01/01/2023] Open
Abstract
Objective Evaluation of a new iterative reconstruction algorithm (IMR) for detection/rule-out of pulmonary embolism (PE) in ultra-low dose computed tomography pulmonary angiography (CTPA). Methods Lower dose CT data sets were simulated based on CTPA examinations of 16 patients with pulmonary embolism (PE) with dose levels (DL) of 50%, 25%, 12.5%, 6.3% or 3.1% of the original tube current setting. Original CT data sets and simulated low-dose data sets were reconstructed with three reconstruction algorithms: the standard reconstruction algorithm “filtered back projection” (FBP), the first generation iterative reconstruction algorithm iDose and the next generation iterative reconstruction algorithm “Iterative Model Reconstruction” (IMR). In total, 288 CTPA data sets (16 patients, 6 tube current levels, 3 different algorithms) were evaluated by two blinded radiologists regarding image quality, diagnostic confidence, detectability of PE and contrast-to-noise ratio (CNR). Results iDose and IMR showed better detectability of PE than FBP. With IMR, sensitivity for detection of PE was 100% down to a dose level of 12.5%. iDose and IMR showed superiority to FBP regarding all characteristics of subjective (diagnostic confidence in detection of PE, image quality, image noise, artefacts) and objective image quality. The minimum DL providing acceptable diagnostic performance was 12.5% (= 0.45 mSv) for IMR, 25% (= 0.89 mSv) for iDose and 100% (= 3.57 mSv) for FBP. CNR was significantly (p < 0.001) improved by IMR compared to FBP and iDose at all dose levels. Conclusion By using IMR for detection of PE, dose reduction for CTPA of up to 75% is possible while maintaining full diagnostic confidence. This would result in a mean effective dose of approximately 0.9 mSv for CTPA.
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Affiliation(s)
- Andreas Sauter
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Thomas Koehler
- Philips GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Alexander A Fingerle
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Bernhard Brendel
- Philips GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Vivien Richter
- Department of diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Rasper
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Peter B Noël
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany.,Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Daniela Münzel
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
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Willner M, Fior G, Marschner M, Birnbacher L, Schock J, Braun C, Fingerle AA, Noël PB, Rummeny EJ, Pfeiffer F, Herzen J. Phase-Contrast Hounsfield Units of Fixated and Non-Fixated Soft-Tissue Samples. PLoS One 2015; 10:e0137016. [PMID: 26322638 PMCID: PMC4556454 DOI: 10.1371/journal.pone.0137016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022] Open
Abstract
X-ray phase-contrast imaging is a novel technology that achieves high soft-tissue contrast. Although its clinical impact is still under investigation, the technique may potentially improve clinical diagnostics. In conventional attenuation-based X-ray computed tomography, radiological diagnostics are quantified by Hounsfield units. Corresponding Hounsfield units for phase-contrast imaging have been recently introduced, enabling a setup-independent comparison and standardized interpretation of imaging results. Thus far, the experimental values of few tissue types have been reported; these values have been determined from fixated tissue samples. This study presents phase-contrast Hounsfield units for various types of non-fixated human soft tissues. A large variety of tissue specimens ranging from adipose, muscle and connective tissues to liver, kidney and pancreas tissues were imaged by a grating interferometer with a rotating-anode X-ray tube and a photon-counting detector. Furthermore, we investigated the effects of formalin fixation on the quantitative phase-contrast imaging results.
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Affiliation(s)
- Marian Willner
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
- * E-mail:
| | - Gabriel Fior
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Mathias Marschner
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Lorenz Birnbacher
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Jonathan Schock
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Christian Braun
- Institute of Forensic Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alexander A. Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Julia Herzen
- Department of Physics & Institute of Medical Engineering, Technische Universität München, Garching, Germany
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Maegerlein C, Fingerle AA, Souvatzoglou M, Rummeny EJ, Holzapfel K. Detection of liver metastases in patients with adenocarcinomas of the gastrointestinal tract: comparison of 18F-FDG PET/CT and MR imaging. ACTA ACUST UNITED AC 2014; 40:1213-22. [DOI: 10.1007/s00261-014-0283-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Noël PB, Köhler T, Fingerle AA, Brown KM, Zabic S, Münzel D, Haller B, Baum T, Henninger M, Meier R, Rummeny EJ, Dobritz M. Evaluation of an iterative model-based reconstruction algorithm for low-tube-voltage (80 kVp) computed tomography angiography. J Med Imaging (Bellingham) 2014; 1:033501. [PMID: 26158054 DOI: 10.1117/1.jmi.1.3.033501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/03/2014] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to investigate the improvement in diagnostic quality of an iterative model-based reconstruction (IMBR) algorithm for low-tube-voltage (80-kVp) and low-tube-current in abdominal computed tomography angiography (CTA). A total of 11 patients were imaged on a 256-slice multidetector computed tomography for visualization of the aorta. For all patients, three different reconstructions from the low-tube-voltage data are generated: filtered backprojection (FBP), IMBR, and a mixture of both [Formula: see text]. To determine the diagnostic value of IMBR-based reconstructions, the image quality was assessed. With IMBR-based reconstructions, image noise could be significantly reduced, which was confirmed by a highly improved contrast-to-noise ratio. In the image quality assessment, radiologists were able to reliably detect more third-order and higher aortic branches in the IMBR reconstructions compared to FBP reconstructions. The effective dose level was, on average, 3.0 mSv for 80-kVp acquisitions. Low-tube-voltage CTAs significantly improve vascular contrast as presented by others; however, this effect in combination with IMBR enabled yet another substantial improvement of diagnostic quality. For IMBR, a significant improvement of image quality and a decreased radiation dose at low-tube-voltage can be reported.
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Affiliation(s)
- Peter B Noël
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Thomas Köhler
- Philips Research Laboratories , Hamburg 22335, Germany
| | | | - Kevin M Brown
- Philips Healthcare , Cleveland, Ohio 44143, United States
| | | | - Daniela Münzel
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Bernhard Haller
- Technische Universität München , Institute of Medical Statistics and Epidemiology, Munich 81675, Germany
| | - Thomas Baum
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Martin Henninger
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Reinhard Meier
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Ernst J Rummeny
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Martin Dobritz
- Technische Universität München , Department of Radiology, Munich 81675, Germany
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Muenzel D, Koehler T, Brown K, Žabić S, Fingerle AA, Waldt S, Bendik E, Zahel T, Schneider A, Dobritz M, Rummeny EJ, Noël PB. Validation of a low dose simulation technique for computed tomography images. PLoS One 2014; 9:e107843. [PMID: 25247422 PMCID: PMC4172631 DOI: 10.1371/journal.pone.0107843] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/21/2014] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Evaluation of a new software tool for generation of simulated low-dose computed tomography (CT) images from an original higher dose scan. MATERIALS AND METHODS Original CT scan data (100 mAs, 80 mAs, 60 mAs, 40 mAs, 20 mAs, 10 mAs; 100 kV) of a swine were acquired (approved by the regional governmental commission for animal protection). Simulations of CT acquisition with a lower dose (simulated 10-80 mAs) were calculated using a low-dose simulation algorithm. The simulations were compared to the originals of the same dose level with regard to density values and image noise. Four radiologists assessed the realistic visual appearance of the simulated images. RESULTS Image characteristics of simulated low dose scans were similar to the originals. Mean overall discrepancy of image noise and CT values was -1.2% (range -9% to 3.2%) and -0.2% (range -8.2% to 3.2%), respectively, p>0.05. Confidence intervals of discrepancies ranged between 0.9-10.2 HU (noise) and 1.9-13.4 HU (CT values), without significant differences (p>0.05). Subjective observer evaluation of image appearance showed no visually detectable difference. CONCLUSION Simulated low dose images showed excellent agreement with the originals concerning image noise, CT density values, and subjective assessment of the visual appearance of the simulated images. An authentic low-dose simulation opens up opportunity with regard to staff education, protocol optimization and introduction of new techniques.
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Affiliation(s)
- Daniela Muenzel
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Thomas Koehler
- Philips Technologie GmbH, Innovative Technologies, Hamburg, Germany
| | - Kevin Brown
- Philips Healthcare, Cleveland, Ohio, United States of America
| | - Stanislav Žabić
- Philips Healthcare, Cleveland, Ohio, United States of America
| | | | - Simone Waldt
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Edgar Bendik
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Tina Zahel
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Armin Schneider
- MITI - Minimal-invasive Interdisciplinary therapeutic intervention research group, Technische Universitaet Muenchen, Munich, Germany
| | - Martin Dobritz
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Peter B. Noël
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
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Muenzel D, Noël PB, Gramer BM, Leber V, Schneider A, Leber A, Vembar M, Fingerle AA, Rummeny EJ, Huber A. Dynamic CT perfusion imaging of the myocardium using a wide-detector scanner: a semiquantitative analysis in an animal model. Clin Imaging 2014; 38:675-80. [DOI: 10.1016/j.clinimag.2014.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022]
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Fingerle AA, Willner M, Herzen J, Münzel D, Hahn D, Rummeny EJ, Noël PB, Pfeiffer F. Simulated Cystic Renal Lesions: Quantitative X-ray Phase-Contrast CT—An in Vitro Phantom Study. Radiology 2014; 272:739-48. [DOI: 10.1148/radiol.14130876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Göktuna SI, Canli O, Bollrath J, Fingerle AA, Horst D, Diamanti MA, Pallangyo C, Bennecke M, Nebelsiek T, Mankan AK, Lang R, Artis D, Hu Y, Patzelt T, Ruland J, Kirchner T, Taketo MM, Chariot A, Arkan MC, Greten FR. IKKα promotes intestinal tumorigenesis by limiting recruitment of M1-like polarized myeloid cells. Cell Rep 2014; 7:1914-25. [PMID: 24882009 DOI: 10.1016/j.celrep.2014.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 12/18/2022] Open
Abstract
The recruitment of immune cells into solid tumors is an essential prerequisite of tumor development. Depending on the prevailing polarization profile of these infiltrating leucocytes, tumorigenesis is either promoted or blocked. Here, we identify IκB kinase α (IKKα) as a central regulator of a tumoricidal microenvironment during intestinal carcinogenesis. Mice deficient in IKKα kinase activity are largely protected from intestinal tumor development that is dependent on the enhanced recruitment of interferon γ (IFNγ)-expressing M1-like myeloid cells. In IKKα mutant mice, M1-like polarization is not controlled in a cell-autonomous manner but, rather, depends on the interplay of both IKKα mutant tumor epithelia and immune cells. Because therapies aiming at the tumor microenvironment rather than directly at the mutated cancer cell may circumvent resistance development, we suggest IKKα as a promising target for colorectal cancer (CRC) therapy.
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Affiliation(s)
- Serkan I Göktuna
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Unit of Signal Transduction (GIGA-ST), GIGA-R, University of Liege and WELBIO, CHU, Sart-Tilman, 4000 Liege, Belgium
| | - Ozge Canli
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt am Main, Germany
| | - Julia Bollrath
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - David Horst
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany
| | - Michaela A Diamanti
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt am Main, Germany
| | - Charles Pallangyo
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt am Main, Germany
| | - Moritz Bennecke
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Tim Nebelsiek
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Arun K Mankan
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Roland Lang
- Institute of Clinical Microbiology, Immunology and Hygiene, University Hospital Erlangen, 91054 Erlangen, Germany
| | - David Artis
- Department of Microbiology and Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yinling Hu
- Laboratory of Experimental Immunology, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD 21701, USA
| | - Thomas Patzelt
- Department of Clinical Chemistry, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Jürgen Ruland
- Department of Clinical Chemistry, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Thomas Kirchner
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - M Mark Taketo
- Department of Pharmacology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Alain Chariot
- Unit of Signal Transduction (GIGA-ST), GIGA-R, University of Liege and WELBIO, CHU, Sart-Tilman, 4000 Liege, Belgium
| | - Melek C Arkan
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Florian R Greten
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt am Main, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Maegerlein C, Fingerle AA, Souvatzoglou M, Rummeny EJ, Holzapfel K. Detektion von Lebermetastasen bei Patienten mit Adenokarzinomen des Gastrointestinaltraktes: Vergleich von [18F]FDG-PET-CT und MRTs. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Herzen J, Willner MS, Fingerle AA, Noël PB, Köhler T, Drecoll E, Rummeny EJ, Pfeiffer F. Imaging liver lesions using grating-based phase-contrast computed tomography with bi-lateral filter post-processing. PLoS One 2014; 9:e83369. [PMID: 24465378 PMCID: PMC3894935 DOI: 10.1371/journal.pone.0083369] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/02/2013] [Indexed: 12/21/2022] Open
Abstract
X-ray phase-contrast imaging shows improved soft-tissue contrast compared to standard absorption-based X-ray imaging. Especially the grating-based method seems to be one promising candidate for clinical implementation due to its extendibility to standard laboratory X-ray sources. Therefore the purpose of our study was to evaluate the potential of grating-based phase-contrast computed tomography in combination with a novel bi-lateral denoising method for imaging of focal liver lesions in an ex vivo feasibility study. Our study shows that grating-based phase-contrast CT (PCCT) significantly increases the soft-tissue contrast in the ex vivo liver specimens. Combining the information of both signals – absorption and phase-contrast – the bi-lateral filtering leads to an improvement of lesion detectability and higher contrast-to-noise ratios. The normal and the pathological tissue can be clearly delineated and even internal structures of the pathological tissue can be visualized, being invisible in the absorption-based CT alone. Histopathology confirmed the presence of the corresponding findings in the analyzed tissue. The results give strong evidence for a sufficiently high contrast for different liver lesions using non-contrast-enhanced PCCT. Thus, ex vivo imaging of liver lesions is possible with a polychromatic X-ray source and at a spatial resolution of ∼100 µm. The post-processing with the novel bi-lateral denoising method improves the image quality by combining the information from the absorption and the phase-contrast images.
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Affiliation(s)
- Julia Herzen
- Institute of Materials Science, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
- * E-mail:
| | - Marian S. Willner
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | | | - Peter B. Noël
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Thomas Köhler
- Philips Technologie GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Enken Drecoll
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Franz Pfeiffer
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
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Muenzel D, Kabus S, Gramer B, Leber V, Vembar M, Schmitt H, Wildgruber M, Fingerle AA, Rummeny EJ, Huber A, Noël PB. Dynamic CT perfusion imaging of the myocardium: a technical note on improvement of image quality. PLoS One 2013; 8:e75263. [PMID: 24130697 PMCID: PMC3793993 DOI: 10.1371/journal.pone.0075263] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/13/2013] [Indexed: 11/28/2022] Open
Abstract
Objective To improve image and diagnostic quality in dynamic CT myocardial perfusion imaging (MPI) by using motion compensation and a spatio-temporal filter. Methods Dynamic CT MPI was performed using a 256-slice multidetector computed tomography scanner (MDCT). Data from two different patients–with and without myocardial perfusion defects–were evaluated to illustrate potential improvements for MPI (institutional review board approved). Three datasets for each patient were generated: (i) original data (ii) motion compensated data and (iii) motion compensated data with spatio-temporal filtering performed. In addition to the visual assessment of the tomographic slices, noise and contrast-to-noise-ratio (CNR) were measured for all data. Perfusion analysis was performed using time-density curves with regions-of-interest (ROI) placed in normal and hypoperfused myocardium. Precision in definition of normal and hypoperfused areas was determined in corresponding coloured perfusion maps. Results The use of motion compensation followed by spatio-temporal filtering resulted in better alignment of the cardiac volumes over time leading to a more consistent perfusion quantification and improved detection of the extend of perfusion defects. Additionally image noise was reduced by 78.5%, with CNR improvements by a factor of 4.7. The average effective radiation dose estimate was 7.1±1.1 mSv. Conclusion The use of motion compensation and spatio-temporal smoothing will result in improved quantification of dynamic CT MPI using a latest generation CT scanner.
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Affiliation(s)
- Daniela Muenzel
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Sven Kabus
- Philips Research Laboratories, Digital Imaging Department, Hamburg, Germany
| | - Bettina Gramer
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Vivian Leber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Mani Vembar
- Philips Healthcare, CT Clinical Science, Cleveland, Ohio, United States of America
| | - Holger Schmitt
- Philips Research Laboratories, Digital Imaging Department, Hamburg, Germany
| | - Moritz Wildgruber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Alexander A. Fingerle
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Armin Huber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Peter B. Noël
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
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