1
|
Washington L, O'Sullivan-Murphy B, Christensen JD, McAdams HP. Radiographic Imaging of Community-Acquired Pneumonia: A Case-Based Review. Infect Dis Clin North Am 2024; 38:19-33. [PMID: 38280764 DOI: 10.1016/j.idc.2023.12.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The chest radiograph is the most common imaging examination performed in most radiology departments, and one of the more common indications for these studies is suspected infection. Radiologists must therefore be aware of less common radiographic patterns of pulmonary infection if they are to add value in the interpretation of chest radiographs for this indication. This review uses a case-based format to illustrate a range of imaging findings that can be associated with acute pulmonary infection and highlight findings that should prompt investigation for diseases other than community-acquired pneumonia to prevent misdiagnosis and delays in appropriate management.
Collapse
Affiliation(s)
- Lacey Washington
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA.
| | - Bryan O'Sullivan-Murphy
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - Jared D Christensen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - H Page McAdams
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| |
Collapse
|
2
|
Strickland LR, Henry TS, McAdams HP, Tailor TD, O'Sullivan-Murphy B, Heyneman LE. Portable Chest Radiography: Must-Know Findings and Mimics. Radiographics 2023; 43:e220132. [PMID: 37651275 DOI: 10.1148/rg.220132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Leah R Strickland
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Travis S Henry
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - H Page McAdams
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Tina D Tailor
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Bryan O'Sullivan-Murphy
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Laura E Heyneman
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| |
Collapse
|
3
|
Cheng KA, Nichols H, McAdams HP, Henry TS, Washington L. Imaging of Smoking and Vaping Related Diffuse Lung Injury. Radiol Clin North Am 2022; 60:941-950. [DOI: 10.1016/j.rcl.2022.06.004] [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: 11/30/2022]
|
4
|
Washington L, O'Sullivan-Murphy B, Christensen JD, McAdams HP. Radiographic Imaging of Community-Acquired Pneumonia. Radiol Clin North Am 2022; 60:371-381. [DOI: 10.1016/j.rcl.2022.01.011] [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: 11/25/2022]
|
5
|
Mummy DG, Bier EA, Wang Z, Korzekwinski J, Morrison L, Barkauskas C, McAdams HP, Tighe RM, Driehuys B, Mammarappallil JG. Hyperpolarized 129Xe MRI and Spectroscopy of Gas-Exchange Abnormalities in Nonspecific Interstitial Pneumonia. Radiology 2021; 301:211-220. [PMID: 34313473 DOI: 10.1148/radiol.2021204149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Recent studies demonstrate that antifibrotic drugs previously reserved for idiopathic pulmonary fibrosis (IPF) may slow progression in other interstitial lung diseases (ILDs), creating an urgent need for tools that can sensitively assess disease activity, progression, and therapy response across ILDs. Hyperpolarized xenon 129 (129Xe) MRI and spectroscopy have provided noninvasive measurements of regional gas-exchange abnormalities in IPF. Purpose To assess gas exchange function using 129Xe MRI in a group of study participants with nonspecific interstitial pneumonia (NSIP) compared with healthy control participants. Materials and Methods In this prospective study, participants with NSIP and healthy control participants were enrolled between November 2017 and February 2020 and underwent 129Xe MRI and spectroscopy. Quantitative imaging provided three-dimensional maps of ventilation, interstitial barrier uptake, and transfer into the red blood cell (RBC) compartment. Spectroscopy provided parameters of the static RBC and barrier uptake compartments, as well as cardiogenic oscillations in RBC signal amplitude and chemical shift. Differences between NSIP and healthy control participants were assessed using the Wilcoxon rank-sum test. Results Thirty-six participants with NSIP (mean age, 57 years ± 11 [standard deviation]; 27 women) and 15 healthy control participants (mean age, 39 years ± 18; two women) were evaluated. Participants with NSIP had no difference in ventilation compared with healthy control participants (median, 4.4% [first quartile, 1.5%; third quartile, 8.7%] vs 6.0% [first quartile, 2.8%; third quartile, 6.9%]; P = .91), but they had a higher barrier uptake (median, 6.2% [first quartile, 1.8%; third quartile, 23.9%] vs 0.53% [first quartile, 0.33%; third quartile, 2.9%]; P = .003) and an increased RBC transfer defect (median, 20.6% [first quartile, 11.6%; third quartile, 27.8%] vs 2.8% [first quartile, 2.3%; third quartile, 4.9%]; P < .001). NSIP participants also had a reduced ratio of RBC-to-barrier peaks (median, 0.24 [first quartile, 0.19; third quartile, 0.31] vs 0.57 [first quartile, 0.52; third quartile, 0.67]; P < .001) and a reduced RBC chemical shift (median, 217.5 ppm [first quartile, 217.0 ppm; third quartile, 218.0 ppm] vs 218.2 ppm [first quartile, 217.9 ppm; third quartile, 218.6 ppm]; P = .001). Conclusion Participants with nonspecific interstitial pneumonia had increased barrier uptake and decreased red blood cell (RBC) transfer compared with healthy controls measured using xenon 129 gas-exchange MRI and reduced RBC-to-barrier ratio and RBC chemical shift measured using spectroscopy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Wild in this issue.
Collapse
Affiliation(s)
- David G Mummy
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Elianna A Bier
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Ziyi Wang
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Jennifer Korzekwinski
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Lake Morrison
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Christina Barkauskas
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - H Page McAdams
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Robert M Tighe
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Bastiaan Driehuys
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| | - Joseph G Mammarappallil
- From the Department of Radiology (D.G.M., J.K., B.D., J.G.M.), Center for In Vivo Microscopy (D.G.M., B.D.), Department of Biomedical Engineering (E.A.B., Z.W., B.D.), Department of Medicine (L.M., C.B., H.P.M., R.T.), and Department of Medical Physics (B.D.), Duke University, DUMC Box 3302, Durham, NC 27710
| |
Collapse
|
6
|
Munden RF, Black WC, Hartman TE, MacMahon H, Ko JP, Dyer DS, Naidich D, Rossi SE, McAdams HP, Goodman EM, Brown K, Kent M, Carter BW, Chiles C, Leung AN, Boiselle PM, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2021; 18:1267-1279. [PMID: 34246574 DOI: 10.1016/j.jacr.2021.04.014] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022]
Abstract
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
Collapse
Affiliation(s)
- Reginald F Munden
- Professor, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina; Chair, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - William C Black
- Professor of Radiology, Emeritus, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Heber MacMahon
- Professor of Radiology, Section of Thoracic Imaging, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Jane P Ko
- Professor of Radiology, Department of Radiology, NYU Langone Health, New York, New York; Fellowship Director, Cardiothoracic Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | - Debra S Dyer
- Professor, Department of Radiology, National Jewish Health, Denver, Colorado; Chair, Department of Radiology, National Jewish Health, Denver, Colorado
| | - David Naidich
- Professor, Emeritus, NYU-Langone Health, New York, New York; Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Santiago E Rossi
- Chairman, Centro Rossi, Buenos Aires, Argentina; Chest Section Head, Hospital Cetrángolo, Buenos Aires, Argentina
| | - H Page McAdams
- Professor of Radiology, Duke University Health System, Durham, North Carolina
| | - Eric M Goodman
- Assistant Professor, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; Associate Program Director, Diagnostic Radiology, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Kathleen Brown
- Professor, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Section Chief, Thoracic Imaging, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Assistant Dean, Equity and Diversity Inclusion, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael Kent
- Associate Professor of Surgery, Harvard Medical School, Boston, Massachusetts; Director, Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brett W Carter
- Associate Professor, Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Clinical Operations, University of Texas MD Anderson Cancer Center, Houston, Texas; Chief Patient Safety and Quality Officer, Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chiles
- Professor, Department of Radiology, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Ann N Leung
- Professor, Clinical Affairs, Stanford University Medical Center, Stanford, California; Associate Chair, Clinical Affairs, Stanford University Medical Center, Stanford, California; Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Phillip M Boiselle
- Professor, Quinnipiac's Frank H. Netter MD School of Medicine, North Haven, Connecticut; Dean, Quinnipiac's Frank H. Netter MD School of Medicine, William and Barbara Weldon Dean's Chair of Medicine, North Haven, Connecticut
| | - Ella A Kazerooni
- Professor of Radiology, Division of Cardiothoracic Radiology and Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lincoln L Berland
- Professor Emeritus, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Director, MGH Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Associate Chair, Integrated Imaging & Imaging Sciences, MGH Radiology, Massachusetts General Hospital, Boston, Massachusetts; Executive Director, Clinical Enterprise Integration, Mass General Brigham (MGB) Radiology, Massachusetts General Hospital, Boston, Massachusetts; Associate Professor of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
7
|
Ebner L, Virgincar RS, He M, Choudhury KR, Robertson SH, Christe A, Mileto A, Mammarapallil JG, McAdams HP, Driehuys B, Roos JE. Multireader Determination of Clinically Significant Obstruction Using Hyperpolarized 129Xe-Ventilation MRI. AJR Am J Roentgenol 2019; 212:758-765. [PMID: 30779661 PMCID: PMC7079551 DOI: 10.2214/ajr.18.20036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to identify the magnitude and distribution of ventilation defect scores (VDSs) derived from hyperpolarized (HP) 129Xe-MRI associated with clinically relevant airway obstruction. MATERIALS AND METHODS From 2012 to 2015, 76 subjects underwent HP 129Xe-MRI (48 healthy volunteers [mean age ± SD, 54 ± 17 years]; 20 patients with asthma [mean age, 44 ± 20 years]; eight patients with chronic obstructive pulmonary disease [mean age, 67 ± 5 years]). All subjects underwent spirometry 1 day before MRI to establish the presence of airway obstruction (forced expiratory volume in 1 second-to-forced vital capacity ratio [FEV1/FVC] < 70%). Five blinded readers assessed the degree of ventilation impairment and assigned a VDS (range, 0-100%). Interreader agreement was assessed using the Fleiss kappa statistic. Using FEV1/FVC as the reference standard, the optimum VDS threshold for the detection of airway obstruction was estimated using ROC curve analysis with 10-fold cross-validation. RESULTS Compared with the VDSs in healthy subjects, VDSs in patients with airway obstruction were significantly higher (p < 0.0001) and significantly correlated with disease severity (r = 0.66, p < 0.0001). Ventilation defects in subjects with airway obstruction did not show a location-specific pattern (p = 0.158); however, defects in healthy control subjects were more prevalent in the upper lungs (p = 0.014). ROC curve analysis yielded an optimal threshold of 12.4% ± 6.1% (mean ± SD) for clinically significant VDS. Interreader agreement for 129Xe-MRI was substantial (κ = 0.71). CONCLUSION This multireader study of a diverse cohort of patients and control subjects suggests a 129Xe-ventilation MRI VDS of 12.4% or greater represents clinically significant obstruction.
Collapse
Affiliation(s)
- Lukas Ebner
- 1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
- 2 Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rohan S Virgincar
- 3 Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC
| | - Mu He
- 3 Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC
- 4 Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kingshuk R Choudhury
- 1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Scott H Robertson
- 3 Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC
- 4 Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Andreas Christe
- 2 Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Achille Mileto
- 5 Department of Radiology, Cantonal Hospital, Lucerne, Switzerland
| | - Joseph G Mammarapallil
- 1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - H Page McAdams
- 1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Bastiaan Driehuys
- 1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
- 2 Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 3 Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC
- 5 Department of Radiology, Cantonal Hospital, Lucerne, Switzerland
| | - Justus E Roos
- 6 Department of Radiology and Nuclear Medicine, Cantonal Hospital, Lucerne, Switzerland
| |
Collapse
|
8
|
Bier EA, Robertson SH, Schrank G, Rackley C, Mammarappallil JG, Rajagopal S, McAdams HP, Driehuys B. A protocol for quantifying cardiogenic oscillations in dynamic 129 Xe gas exchange spectroscopy: The effects of idiopathic pulmonary fibrosis. NMR Biomed 2019; 32:e4029. [PMID: 30457202 PMCID: PMC6447038 DOI: 10.1002/nbm.4029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 05/12/2023]
Abstract
The spectral parameters of hyperpolarized 129 Xe exchanging between airspaces, interstitial barrier, and red blood cells (RBCs) are sensitive to pulmonary pathophysiology. This study sought to evaluate whether the dynamics of 129 Xe spectroscopy provide additional insight, with particular focus on quantifying cardiogenic oscillations in the RBC resonance. 129 Xe spectra were dynamically acquired in eight healthy volunteers and nine subjects with idiopathic pulmonary fibrosis (IPF). 129 Xe FIDs were collected every 20 ms (TE = 0.932 ms, 512 points, dwell time = 32 μs, flip angle ≈ 20°) during a 16 s breathing maneuver. The FIDs were pre-processed using the spectral improvement by Fourier thresholding technique (SIFT) and fit in the time domain to determine the airspace, interstitial barrier, and RBC spectral parameters. The RBC and gas resonances were fit to a Lorentzian lineshape, while the barrier was fit to a Voigt lineshape to account for its greater structural heterogeneity. For each complex resonance the amplitude, chemical shift, linewidth(s), and phase were calculated. The time-averaged spectra confirmed that the RBC to barrier amplitude ratio (RBC:barrier ratio) and RBC chemical shift are both reduced in IPF subjects. Their temporal dynamics showed that all three 129 Xe resonances are affected by the breathing maneuver. Most notably, several RBC spectral parameters exhibited prominent oscillations at the cardiac frequency, and their peak-to-peak variation differed between IPF subjects and healthy volunteers. In the IPF cohort, oscillations were more prominent in the RBC amplitude (16.8 ± 5.2 versus 9.7 ± 2.9%; P = 0.008), chemical shift (0.43 ± 0.33 versus 0.083 ± 0.05 ppm; P < 0.001), and phase (7.7 ± 5.6 versus 1.4 ± 0.8°; P < 0.001). Dynamic 129 Xe spectroscopy is a simple and sensitive tool that probes the temporal variability of gas exchange and may prove useful in discerning the underlying causes of its impairment.
Collapse
Affiliation(s)
- Elianna A. Bier
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Scott H. Robertson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Geoffry Schrank
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Craig Rackley
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - H. Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
9
|
Munden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, McAdams HP, Rossi SE, Leung AN, Boiselle PM, Kent MS, Brown K, Dyer DS, Hartman TE, Goodman EM, Naidich DP, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2018; 15:1087-1096. [PMID: 29941240 DOI: 10.1016/j.jacr.2018.04.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.
Collapse
Affiliation(s)
- Reginald F Munden
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chiles
- Wake Forest University Health Sciences Center, Winston-Salem, North Carolina
| | | | - William C Black
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jane P Ko
- NYU Langone Health, New York, New York
| | | | | | - Ann N Leung
- Stanford University Medical Center, Stanford, California
| | - Phillip M Boiselle
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Michael S Kent
- Beth Israel Deaconess Medical Center, Division of Thoracic Surgery and Interventional Pulmonology, Boston, Massachusetts
| | - Kathleen Brown
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Eric M Goodman
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
| | | | | | - Lincoln L Berland
- Professor Emeritus, University of Alabama at Birmingham, Birmingham, Alabama
| | | |
Collapse
|
10
|
Mahmood K, Ebner L, He M, Robertson SH, Wang Z, McAdams HP, Wahidi MM, Shofer SL, Huang YCT, Driehuys B. Novel Magnetic Resonance Imaging for Assessment of Bronchial Stenosis in Lung Transplant Recipients. Am J Transplant 2017; 17:1895-1904. [PMID: 28371091 PMCID: PMC5508859 DOI: 10.1111/ajt.14287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/22/2016] [Revised: 02/19/2017] [Accepted: 03/13/2017] [Indexed: 01/25/2023]
Abstract
Bronchial stenosis in lung transplant recipients is a common disorder that adversely affects clinical outcomes. It is evaluated by spirometry, CT scanning, and bronchoscopy with significant limitations. We hypothesize that MRI using both ultrashort echo time (UTE) scans and hyperpolarized (HP) 129 Xe gas can offer structural and functional assessment of bronchial stenosis seen after lung transplantation. Six patients with lung transplantation-related bronchial stenosis underwent HP 129 Xe MRI and UTE MRI in the same session. Three patients subsequently underwent airway stent placement and had repeated MRI at 4-week follow-up. HP 129 Xe MRI depicted decreased ventilation distal to the stenotic airway. After airway stent placement, MRI showed that low-ventilation regions had decreased (35% vs. 27.6%, p = 0.006) and normal-ventilation regions had increased (17.9% vs. 27.6%, p = 0.04) in the stented lung. Improved gas transfer was also seen on 129 Xe MRI. There was a good correlation between UTE MRI and independent bronchoscopic airway diameter assessment (Pearson correlation coefficient = 0.92). This pilot study shows that UTE and HP 129 Xe MRI are feasible in patients with bronchial stenosis related to lung transplantation and may provide structural and functional airway assessment to guide treatment. These conclusions need to be confirmed with larger studies.
Collapse
Affiliation(s)
- Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, NC
| | - Lukas Ebner
- Center for in vivo microscopy CIVM, Duke University, Durham, NC,Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC
| | - Mu He
- Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC,Duke University Department of Computer and Electrical Engineering, Durham, NC
| | - Scott Haile Robertson
- Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC,Duke University Medical Physics Program, Durham, NC
| | - Ziyi Wang
- Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC,Duke University Department of Biomedical Engineering, Durham, NC
| | - H Page McAdams
- Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC
| | - Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, NC
| | - Scott L Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, NC
| | - Yuh-Chin T Huang
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, NC
| | - Bastiaan Driehuys
- Center for in vivo microscopy CIVM, Duke University, Durham, NC,Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC
| |
Collapse
|
11
|
Wang Z, Robertson SH, Wang J, He M, Virgincar RS, Schrank GM, Bier EA, Rajagopal S, Huang YC, O'Riordan TG, Rackley CR, McAdams HP, Driehuys B. Quantitative analysis of hyperpolarized129Xe gas transfer MRI. Med Phys 2017; 44:2415-2428. [DOI: 10.1002/mp.12264] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ziyi Wang
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
| | - Scott Haile Robertson
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Medical Physics Graduate Program; Duke University; Durham NC 27705 USA
| | - Jennifer Wang
- School of Medicine; Duke University; Durham NC 27710 USA
| | - Mu He
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Department of Electrical and Computer Engineering; Duke University; Durham NC 27708 USA
| | - Rohan S. Virgincar
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
| | - Geoffry M. Schrank
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
| | - Elianna A. Bier
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Medical Physics Graduate Program; Duke University; Durham NC 27705 USA
| | | | - Yuh Chin Huang
- Department of Medicine; Division of Pulmonary, Allergy and Critical Care; Duke University Medical Center; Durham NC 27710 USA
| | | | - Craig R. Rackley
- Department of Medicine; Division of Pulmonary, Allergy and Critical Care; Duke University Medical Center; Durham NC 27710 USA
| | - H Page McAdams
- Department of Radiology; Duke University Medical Center; Durham NC 27710 USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy; Duke University Medical Center; Durham NC 27710 USA
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
- Medical Physics Graduate Program; Duke University; Durham NC 27705 USA
- Department of Radiology; Duke University Medical Center; Durham NC 27710 USA
| |
Collapse
|
12
|
Kim TH, Park CM, Lee SM, McAdams HP, Kim YT, Goo JM. Percutaneous transthoracic localization of pulmonary nodules under C-arm cone-beam CT virtual navigation guidance. Diagn Interv Radiol 2017; 22:224-30. [PMID: 27015318 DOI: 10.5152/dir.2015.15297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system. METHODS From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8-25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described. RESULTS All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7). CONCLUSION PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.
Collapse
Affiliation(s)
- Tae Ho Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|
13
|
Robertson SH, Virgincar RS, Bier EA, He M, Schrank GM, Smigla RM, Rackley C, McAdams HP, Driehuys B. Uncovering a third dissolved-phase 129 Xe resonance in the human lung: Quantifying spectroscopic features in healthy subjects and patients with idiopathic pulmonary fibrosis. Magn Reson Med 2016; 78:1306-1315. [PMID: 28940334 DOI: 10.1002/mrm.26533] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 05/23/2016] [Revised: 09/12/2016] [Accepted: 10/06/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this work was to accurately characterize the spectral properties of hyperpolarized 129 Xe in patients with idiopathic pulmonary fibrosis (IPF) compared to healthy volunteers. METHODS Subjects underwent hyperpolarized 129 Xe breath-hold spectroscopy, during which 38 dissolved-phase free induction decays (FIDs) were acquired after reaching steady state (echo time/repetition time = 0.875/50 ms; bandwidth = 8.06 kHz; flip angle≈22 °). FIDs were averaged and then decomposed into multiple spectral components using time-domain curve fitting. The resulting amplitudes, frequencies, line widths, and starting phases of each component were compared among groups using a Mann-Whitney-Wilcoxon U test. RESULTS Three dissolved-phase resonances, consisting of red blood cells (RBCs) and two barrier compartments, were consistently identified in all subjects. In subjects with IPF relative to healthy volunteers, the RBC frequency was 0.70 parts per million (ppm) more negative (P = 0.05), the chemical shift of barrier 2 was 0.6 ppm more negative (P = 0.009), the line widths of both barrier peaks were ∼2 ppm narrower (P < 0.001), and the starting phase of barrier 1 was 20.3 ° higher (P = 0.01). Moreover, the ratio RBC:barriers was reduced by 52.9% in IPF (P < 0.001). CONCLUSIONS The accurate decomposition of 129 Xe spectra not only has merit for developing a global metric of pulmonary function, but also provides necessary insights to optimize phase-sensitive methods for imaging 129 Xe gas transfer. Magn Reson Med 78:1306-1315, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- Scott H Robertson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA.,Medical Physics Graduate Program, Duke University, Durham, North Carolina, USA
| | - Rohan S Virgincar
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Elianna A Bier
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA.,Medical Physics Graduate Program, Duke University, Durham, North Carolina, USA
| | - Mu He
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Geoffrey M Schrank
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA
| | - Rose Marie Smigla
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Craig Rackley
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - H Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA.,Medical Physics Graduate Program, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
14
|
Dobbins JT, McAdams HP, Sabol JM, Chakraborty DP, Kazerooni EA, Reddy GP, Vikgren J, Båth M. Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules. Radiology 2016; 282:236-250. [PMID: 27439324 DOI: 10.1148/radiol.2016150497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- James T Dobbins
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - H Page McAdams
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - John M Sabol
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Dev P Chakraborty
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Ella A Kazerooni
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Gautham P Reddy
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Jenny Vikgren
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Magnus Båth
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| |
Collapse
|
15
|
Kaushik SS, Robertson SH, Freeman MS, He M, Kelly KT, Roos JE, Rackley CR, Foster WM, McAdams HP, Driehuys B. Single-breath clinical imaging of hyperpolarized 129
xe in the airspaces, barrier, and red blood cells using an interleaved 3D radial 1-point Dixon acquisition. Magn Reson Med 2016. [DOI: 10.1002/mrm.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. Sivaram Kaushik
- Center for In Vivo Microscopy; Duke University; Durham North Carolina USA
- Department of Biomedical Engineering; Duke University; Durham North Carolina USA
| | - Scott H. Robertson
- Center for In Vivo Microscopy; Duke University; Durham North Carolina USA
- Graduate Program in Medical Physics; Duke University; Durham North Carolina USA
| | - Matthew S. Freeman
- Center for In Vivo Microscopy; Duke University; Durham North Carolina USA
- Graduate Program in Medical Physics; Duke University; Durham North Carolina USA
| | - Mu He
- Center for In Vivo Microscopy; Duke University; Durham North Carolina USA
- Department of Electrical Engineering; Duke University; Durham North Carolina USA
| | - Kevin T. Kelly
- Department of Radiation Oncology; Duke University; Durham North Carolina USA
| | - Justus E. Roos
- Department of Radiology; Duke University; Durham North Carolina USA
| | - Craig R. Rackley
- Department of Radiology; Duke University; Durham North Carolina USA
| | - W. Michael Foster
- Department of Pulmonary and Critical Care Medicine; Duke University; Durham North Carolina USA
| | - H. Page McAdams
- Department of Radiology; Duke University; Durham North Carolina USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy; Duke University; Durham North Carolina USA
- Department of Biomedical Engineering; Duke University; Durham North Carolina USA
- Graduate Program in Medical Physics; Duke University; Durham North Carolina USA
- Department of Radiology; Duke University; Durham North Carolina USA
| |
Collapse
|
16
|
Samei E, Lin Y, Choudhury KR, McAdams HP. Automated characterization of perceptual quality of clinical chest radiographs: validation and calibration to observer preference. Med Phys 2015; 41:111918. [PMID: 25370651 DOI: 10.1118/1.4899183] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019-7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. METHODS Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual quality assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib-lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm-lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable ranges. RESULTS The observer study indicated that, for each image quality attribute, the averaged observer ranking strongly correlated with the algorithmic ranking (linear correlation coefficient R > 0.92), with highest correlation (R = 1) for lung gray level and the lowest (R = 0.92) for mediastinum noise. There was a strong concordance between the observers in terms of their rankings (i.e., Kendall's tau agreement > 0.84). The observers also generally indicated similar tolerance and preference levels in terms of acceptable ranges, as 85% of the values were close to the overall tolerance or preference levels and the differences were smaller than 0.15. CONCLUSIONS The observer study indicates that the previously proposed technique provides a robust reflection of the perceptual image quality in clinical images. The results established the range of algorithmic outputs for each metric that can be used to quantitatively assess and qualify the appearance quality of clinical chest radiographs.
Collapse
Affiliation(s)
- Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology, Physics, Biomedical Engineering, Electrical and Computer Engineering, Medical Physics Graduate Program, Duke Clinical Imaging Physics Group, Duke University, Durham, North Carolina 27710
| | - Yuan Lin
- Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology and Physics, Duke University, Durham, North Carolina 27710
| | - Kingshuk R Choudhury
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology and Biostatistics and Bioinformatics, Duke University, Durham, North Carolina 27710
| | - H Page McAdams
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, North Carolina 27710
| |
Collapse
|
17
|
Kaushik SS, Robertson SH, Freeman MS, He M, Kelly KT, Roos JE, Rackley CR, Foster WM, McAdams HP, Driehuys B. Single-breath clinical imaging of hyperpolarized (129)Xe in the airspaces, barrier, and red blood cells using an interleaved 3D radial 1-point Dixon acquisition. Magn Reson Med 2015; 75:1434-43. [PMID: 25980630 DOI: 10.1002/mrm.25675] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [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: 10/07/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE We sought to develop and test a clinically feasible 1-point Dixon, three-dimensional (3D) radial acquisition strategy to create isotropic 3D MR images of (129)Xe in the airspaces, barrier, and red blood cells (RBCs) in a single breath. The approach was evaluated in healthy volunteers and subjects with idiopathic pulmonary fibrosis (IPF). METHODS A calibration scan determined the echo time at which (129)Xe in RBCs and barrier were 90° out of phase. At this TE, interleaved dissolved and gas-phase images were acquired using a 3D radial acquisition and were reconstructed separately using the NUFFT algorithm. The dissolved-phase image was phase-shifted to cast RBC and barrier signal into the real and imaginary channels such that the image-derived RBC:barrier ratio matched that from spectroscopy. The RBC and barrier images were further corrected for regional field inhomogeneity using a phase map created from the gas-phase (129)Xe image. RESULTS Healthy volunteers exhibited largely uniform (129)Xe-barrier and (129)Xe-RBC images. By contrast, (129)Xe-RBC images in IPF subjects exhibited significant signal voids. These voids correlated qualitatively with regions of fibrosis visible on CT. CONCLUSIONS This study illustrates the feasibility of acquiring single-breath, 3D isotropic images of (129)Xe in the airspaces, barrier, and RBCs using a 1-point Dixon 3D radial acquisition.
Collapse
Affiliation(s)
- S Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Scott H Robertson
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA.,Graduate Program in Medical Physics, Duke University, Durham, North Carolina, USA
| | - Matthew S Freeman
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA.,Graduate Program in Medical Physics, Duke University, Durham, North Carolina, USA
| | - Mu He
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA.,Department of Electrical Engineering, Duke University, Durham, North Carolina, USA
| | - Kevin T Kelly
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Justus E Roos
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Craig R Rackley
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - W Michael Foster
- Department of Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - H Page McAdams
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Graduate Program in Medical Physics, Duke University, Durham, North Carolina, USA.,Department of Radiology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
18
|
He M, Robertson SH, Kaushik SS, Freeman MS, Virgincar RS, Davies J, Stiles J, Foster WM, McAdams HP, Driehuys B. Dose and pulse sequence considerations for hyperpolarized (129)Xe ventilation MRI. Magn Reson Imaging 2015; 33:877-85. [PMID: 25936684 DOI: 10.1016/j.mri.2015.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 02/19/2015] [Revised: 04/15/2015] [Accepted: 04/19/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effect of hyperpolarized (129)Xe dose on image signal-to-noise ratio (SNR) and ventilation defect conspicuity on both multi-slice gradient echo and isotropic 3D-radially acquired ventilation MRI. MATERIALS AND METHODS Ten non-smoking older subjects (ages 60.8±7.9years) underwent hyperpolarized (HP) (129)Xe ventilation MRI using both GRE and 3D-radial acquisitions, each tested using a 71ml (high) and 24ml (low) dose equivalent (DE) of fully polarized, fully enriched (129)Xe. For all images SNR and ventilation defect percentage (VDP) were calculated. RESULTS Normalized SNR (SNRn), obtained by dividing SNR by voxel volume and dose was higher for high-DE GRE acquisitions (SNRn=1.9±0.8ml(-2)) than low-DE GRE scans (SNRn=0.8±0.2ml(-2)). Radially acquired images exhibited a more consistent, albeit lower SNRn (High-DE: SNRn=0.5±0.1ml(-2), low-DE: SNRn=0.5±0.2ml(-2)). VDP was indistinguishable across all scans. CONCLUSIONS These results suggest that images acquired using the high-DE GRE sequence provided the highest SNRn, which was in agreement with previous reports in the literature. 3D-radial images had lower SNRn, but have advantages for visual display, monitoring magnetization dynamics, and visualizing physiological gradients. By evaluating normalized SNR in the context of dose-equivalent formalism, it should be possible to predict (129)Xe dose requirements and quantify the benefits of more efficient transmit/receive coils, field strengths, and pulse sequences.
Collapse
Affiliation(s)
- Mu He
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Scott H Robertson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Medical Physics Graduate Program, Duke University, Durham, NC, USA
| | - S Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Matthew S Freeman
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Medical Physics Graduate Program, Duke University, Durham, NC, USA
| | - Rohan S Virgincar
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - John Davies
- Department of Medicine Pulmonary, Duke University Medical Center, Durham, NC, USA
| | - Jane Stiles
- Department of Medicine Pulmonary, Duke University Medical Center, Durham, NC, USA
| | - William M Foster
- Department of Medicine Pulmonary, Duke University Medical Center, Durham, NC, USA
| | - H Page McAdams
- Medical Physics Graduate Program, Duke University, Durham, NC, USA; Department of Medicine Pulmonary, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Radiology, Duke University Medical Center, Durham, NC, USA; Medical Physics Graduate Program, Duke University, Durham, NC, USA.
| |
Collapse
|
19
|
He M, Kaushik SS, Robertson SH, Freeman MS, Virgincar RS, McAdams HP, Driehuys B. Extending semiautomatic ventilation defect analysis for hyperpolarized (129)Xe ventilation MRI. Acad Radiol 2014; 21:1530-41. [PMID: 25262951 DOI: 10.1016/j.acra.2014.07.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Clinical deployment of hyperpolarized (129)Xe magnetic resonance imaging requires accurate quantification and visualization of the ventilation defect percentage (VDP). Here, we improve the robustness of our previous semiautomated analysis method to reduce operator dependence, correct for B1 inhomogeneity and vascular structures, and extend the analysis to display multiple intensity clusters. MATERIALS AND METHODS Two segmentation methods were compared-a seeded region-growing method, previously validated by expert reader scoring, and a new linear-binning method that corrects the effects of bias field and vascular structures. The new method removes nearly all operator interventions by rescaling the (129)Xe magnetic resonance images to the 99th percentile of the cumulative distribution and applying fixed thresholds to classify (129)Xe voxels into four clusters: defect, low, medium, and high intensity. The methods were applied to 24 subjects including patients with chronic obstructive pulmonary disease (n = 8), age-matched controls (n = 8), and healthy normal subjects (n = 8). RESULTS Linear-binning enabled a faster and more reproducible workflow and permitted analysis of an additional 0.25 ± 0.18 L of lung volume by accounting for vasculature. Like region-growing, linear-binning VDP correlated strongly with reader scoring (R(2) = 0.93, P < .0001), but with less systematic bias. Moreover, linear-binning maps clearly depict regions of low and high intensity that may prove useful for phenotyping subjects with chronic obstructive pulmonary disease. CONCLUSIONS Corrected linear-binning provides a robust means to quantify (129)Xe ventilation images yielding VDP values that are indistinguishable from expert reader scores, while exploiting the entire dynamic range to depict multiple image clusters.
Collapse
|
20
|
Kaushik SS, Freeman MS, Yoon SW, Liljeroth MG, Stiles JV, Roos JE, Foster WM, Rackley CR, McAdams HP, Driehuys B. Measuring diffusion limitation with a perfusion-limited gas--hyperpolarized 129Xe gas-transfer spectroscopy in patients with idiopathic pulmonary fibrosis. J Appl Physiol (1985) 2014; 117:577-85. [PMID: 25038105 DOI: 10.1152/japplphysiol.00326.2014] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although xenon is classically taught to be a "perfusion-limited" gas, (129)Xe in its hyperpolarized (HP) form, when detected by magnetic resonance (MR), can probe diffusion limitation. Inhaled HP (129)Xe diffuses across the pulmonary blood-gas barrier, and, depending on its tissue environment, shifts its resonant frequency relative to the gas-phase reference (0 ppm) by 198 ppm in tissue/plasma barrier and 217 ppm in red blood cells (RBCs). In this work, we hypothesized that in patients with idiopathic pulmonary fibrosis (IPF), the ratio of (129)Xe spectroscopic signal in the RBCs vs. barrier would diminish as diffusion-limitation delayed replenishment of (129)Xe magnetization in RBCs. To test this hypothesis, (129)Xe spectra were acquired in 6 IPF subjects as well as 11 healthy volunteers to establish a normal range. The RBC:barrier ratio was 0.55 ± 0.13 in healthy volunteers but was 3.3-fold lower in IPF subjects (0.16 ± 0.03, P = 0.0002). This was caused by a 52% reduction in the RBC signal (P = 0.02) and a 58% increase in the barrier signal (P = 0.01). Furthermore, the RBC:barrier ratio strongly correlated with lung diffusing capacity for carbon monoxide (DLCO) (r = 0.89, P < 0.0001). It exhibited a moderate interscan variability (8.25%), and in healthy volunteers it decreased with greater lung inflation (r = -0.78, P = 0.005). This spectroscopic technique provides a noninvasive, global probe of diffusion limitation and gas-transfer impairment and forms the basis for developing 3D MR imaging of gas exchange.
Collapse
Affiliation(s)
- S Sivaram Kaushik
- Department of Biomedical Engineering, Duke University, Durham, North Carolina; Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina;
| | - Matthew S Freeman
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina; Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | - Suk W Yoon
- Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | | | - Jane V Stiles
- Department of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and
| | - Justus E Roos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - W Michael Foster
- Department of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and
| | - Craig R Rackley
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - H P McAdams
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Bastiaan Driehuys
- Department of Biomedical Engineering, Duke University, Durham, North Carolina; Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina; Medical Physics Graduate Program, Duke University, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
21
|
Halaweish AF, Moon RE, Foster WM, Soher BJ, McAdams HP, MacFall JR, Ainslie MD, MacIntyre NR, Charles HC. Perfluoropropane gas as a magnetic resonance lung imaging contrast agent in humans. Chest 2014; 144:1300-1310. [PMID: 23722696 DOI: 10.1378/chest.12-2597] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Fluorine-enhanced MRI is a relatively inexpensive and straightforward technique that facilitates regional assessments of pulmonary ventilation. In this report, we assess its suitability through the use of perfluoropropane (PFP) in a cohort of human subjects with normal lungs and subjects with lung disease. METHODS Twenty-eight subjects between the ages of 18 and 71 years were recruited for imaging and were classified based on spirometry findings and medical history. Imaging was carried out on a Siemens TIM Trio 3T MRI scanner using two-dimensional, gradient echo, fast low-angle shot and three-dimensional gradient echo, volumetric, interpolated, breath-hold examination sequences for proton localizers and PFP functional scans, respectively. Respiratory waveforms and physiologic signals of interest were monitored throughout the imaging sessions. A region-growing algorithm was applied to the proton localizers to define the lung field of view for analysis of the PFP scans. RESULTS All subjects tolerated the gas mixture well with no adverse side effects. Images of healthy lungs demonstrated a homogeneous distribution of the gas with sufficient signal-to-noise ratios, while lung images from asthmatic and emphysematous lungs demonstrated increased heterogeneity and ventilation defects. CONCLUSIONS Fluorine-enhanced MRI using a normoxic PFP gas mixture is a well-tolerated, radiation-free technique for regionally assessing pulmonary ventilation. The inherent physical characteristics and applicability of the gaseous agent within a magnetic resonance setting facilitated a clear differentiation between normal and diseased lungs.
Collapse
Affiliation(s)
- Ahmed F Halaweish
- Department of Radiology, Durham NC; Department of Radiology, Duke Image Analysis Laboratory, Duke University School of Medicine, Durham NC
| | - Richard E Moon
- Department of Medicine, Division of Pulmonary Medicine, Durham NC; Department of Anesthesiology, GVTU Division, Durham NC
| | - W Michael Foster
- Department of Medicine, Division of Pulmonary Medicine, Durham NC
| | | | - H Page McAdams
- Department of Radiology, Division of Chest Radiology, Durham NC
| | | | - Maureen D Ainslie
- Department of Radiology, Durham NC; Department of Radiology, Duke Image Analysis Laboratory, Duke University School of Medicine, Durham NC
| | - Neil R MacIntyre
- Department of Medicine, Division of Pulmonary Medicine, Durham NC
| | - H Cecil Charles
- Department of Radiology, Durham NC; Department of Radiology, Duke Image Analysis Laboratory, Duke University School of Medicine, Durham NC.
| |
Collapse
|
22
|
Godfrey DJ, McAdams HP, Dobbins JT. The effect of averaging adjacent planes for artifact reduction in matrix inversion tomosynthesis. Med Phys 2013; 40:021907. [PMID: 23387755 DOI: 10.1118/1.4773891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Matrix inversion tomosynthesis (MITS) uses linear systems theory and knowledge of the imaging geometry to remove tomographic blur that is present in conventional backprojection tomosynthesis reconstructions, leaving in-plane detail rendered clearly. The use of partial-pixel interpolation during the backprojection process introduces imprecision in the MITS modeling of tomographic blur, and creates low-contrast artifacts in some MITS planes. This paper examines the use of MITS slabs, created by averaging several adjacent MITS planes, as a method for suppressing partial-pixel artifacts. METHODS Human chest tomosynthesis projection data, acquired as part of an IRB-approved pilot study, were used to generate MITS planes, three-plane MITS slabs (MITSa3), five-plane MITS slabs (MITSa5), and seven-plane MITS slabs (MITSa7). These were qualitatively examined for partial-pixel artifacts and the visibility of normal and abnormal anatomy. Additionally, small (5 mm) subtle pulmonary nodules were simulated and digitally superimposed upon human chest tomosynthesis projection images, and their visibility was qualitatively assessed in the different reconstruction techniques. Simulated images of a thin wire were used to generate modulation transfer function (MTF) and slice-sensitivity profile curves for the different MITS and MITS slab techniques, and these were examined for indications of partial-pixel artifacts and frequency response uniformity. Finally, mean-subtracted, exposure-normalized noise power spectra (ENNPS) estimates were computed and compared for MITS and MITS slab reconstructions, generated from 10 sets of tomosynthesis projection data of an acrylic slab. The simulated in-plane MTF response of each technique was also combined with the square root of the ENNPS estimate to yield stochastic signal-to-noise ratio (SNR) information about the different reconstruction techniques. RESULTS For scan angles of 20° and 5 mm plane separation, seven MITS planes must be averaged to sufficiently remove partial-pixel artifacts. MITSa7 does appear to subtly reduce the contrast of high-frequency "edge" information, but the removal of partial-pixel artifacts makes the appearance of low-contrast, fine-detail anatomy even more conspicuous in MITSa7 slices. MITSa7 also appears to render simulated subtle 5 mm pulmonary nodules with greater visibility than MITS alone, in both the open lung and regions overlying the mediastinum. Finally, the MITSa7 technique reduces stochastic image variance, though the in-plane stochastic SNR (for very thin objects which do not span multiple MITS planes) is only improved at spatial frequencies between 0.05 and 0.20 cycles∕mm. CONCLUSIONS The MITSa7 method is an improvement over traditional single-plane MITS for thoracic imaging and the pulmonary nodule detection task, and thus the authors plan to use the MITSa7 approach for all future MITS research at the authors' institution.
Collapse
Affiliation(s)
- Devon J Godfrey
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27705, USA.
| | | | | |
Collapse
|
23
|
Kaushik SS, Freeman MS, Cleveland ZI, Davies J, Stiles J, Virgincar RS, Robertson SH, He M, Kelly KT, Foster WM, McAdams HP, Driehuys B. Probing the regional distribution of pulmonary gas exchange through single-breath gas- and dissolved-phase 129Xe MR imaging. J Appl Physiol (1985) 2013; 115:850-60. [PMID: 23845983 DOI: 10.1152/japplphysiol.00092.2013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 11/22/2022] Open
Abstract
Although some central aspects of pulmonary function (ventilation and perfusion) are known to be heterogeneous, the distribution of diffusive gas exchange remains poorly characterized. A solution is offered by hyperpolarized 129Xe magnetic resonance (MR) imaging, because this gas can be separately detected in the lung's air spaces and dissolved in its tissues. Early dissolved-phase 129Xe images exhibited intensity gradients that favored the dependent lung. To quantitatively corroborate this finding, we developed an interleaved, three-dimensional radial sequence to image the gaseous and dissolved 129Xe distributions in the same breath. These images were normalized and divided to calculate "129Xe gas-transfer" maps. We hypothesized that, for healthy volunteers, 129Xe gas-transfer maps would retain the previously observed posture-dependent gradients. This was tested in nine subjects: when the subjects were supine, 129Xe gas transfer exhibited a posterior-anterior gradient of -2.00 ± 0.74%/cm; when the subjects were prone, the gradient reversed to 1.94 ± 1.14%/cm (P < 0.001). The 129Xe gas-transfer maps also exhibited significant heterogeneity, as measured by the coefficient of variation, that correlated with subject total lung capacity (r = 0.77, P = 0.015). Gas-transfer intensity varied nonmonotonically with slice position and increased in slices proximal to the main pulmonary arteries. Despite substantial heterogeneity, the mean gas transfer for all subjects was 1.00 ± 0.01 while supine and 1.01 ± 0.01 while prone (P = 0.25), indicating good "matching" between gas- and dissolved-phase distributions. This study demonstrates that single-breath gas- and dissolved-phase 129Xe MR imaging yields 129Xe gas-transfer maps that are sensitive to altered gas exchange caused by differences in lung inflation and posture.
Collapse
Affiliation(s)
- S Sivaram Kaushik
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Virgincar RS, Cleveland ZI, Kaushik SS, Freeman MS, Nouls J, Cofer GP, Martinez-Jimenez S, He M, Kraft M, Wolber J, McAdams HP, Driehuys B. Quantitative analysis of hyperpolarized 129Xe ventilation imaging in healthy volunteers and subjects with chronic obstructive pulmonary disease. NMR Biomed 2013; 26:424-35. [PMID: 23065808 PMCID: PMC3624045 DOI: 10.1002/nbm.2880] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 05/12/2023]
Abstract
In this study, hyperpolarized (129) Xe MR ventilation and (1) H anatomical images were obtained from three subject groups: young healthy volunteers (HVs), subjects with chronic obstructive pulmonary disease (COPD) and age-matched controls (AMCs). Ventilation images were quantified by two methods: an expert reader-based ventilation defect score percentage (VDS%) and a semi-automated segmentation-based ventilation defect percentage (VDP). Reader-based values were assigned by two experienced radiologists and resolved by consensus. In the semi-automated analysis, (1) H anatomical images and (129) Xe ventilation images were both segmented following registration to obtain the thoracic cavity volume and ventilated volume, respectively, which were then expressed as a ratio to obtain the VDP. Ventilation images were also characterized by generating signal intensity histograms from voxels within the thoracic cavity volume, and heterogeneity was analyzed using the coefficient of variation (CV). The reader-based VDS% correlated strongly with the semi-automatically generated VDP (r = 0.97, p < 0.0001) and with CV (r = 0.82, p < 0.0001). Both (129) Xe ventilation defect scoring metrics readily separated the three groups from one another and correlated significantly with the forced expiratory volume in 1 s (FEV1 ) (VDS%: r = -0.78, p = 0.0002; VDP: r = -0.79, p = 0.0003; CV: r = -0.66, p = 0.0059) and other pulmonary function tests. In the healthy subject groups (HVs and AMCs), the prevalence of ventilation defects also increased with age (VDS%: r = 0.61, p = 0.0002; VDP: r = 0.63, p = 0.0002). Moreover, ventilation histograms and their associated CVs distinguished between subjects with COPD with similar ventilation defect scores, but visibly different ventilation patterns.
Collapse
Affiliation(s)
- Rohan S. Virgincar
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Zackary I. Cleveland
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - S. Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Matthew S. Freeman
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Medical Physics Graduate Program, Duke University, Durham, NC, USA
| | - John Nouls
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Gary P. Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Mu He
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Monica Kraft
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jan Wolber
- GE Healthcare, The Grove Center, White Lion Rd, Amersham, UK
- Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - H. Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Medical Physics Graduate Program, Duke University, Durham, NC, USA
| |
Collapse
|
25
|
Pollard BJ, Samei E, Chawla AS, Beam C, Heyneman LE, Koweek LMH, Martinez-Jimenez S, Washington L, Hashimoto N, McAdams HP. The effects of ambient lighting in chest radiology reading rooms. J Digit Imaging 2012; 25:520-6. [PMID: 22349990 DOI: 10.1007/s10278-012-9459-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Under typical dark chest radiography reading room conditions, a radiologist's pupils contract and dilate as their visual focus intermittently shifts between the high luminance monitor and the darker background wall, resulting in increased visual fatigue and degradation of diagnostic performance. A controlled increase of ambient lighting may minimize these visual adjustments and potentially improve comfort and accuracy. This study was designed to determine the effect of a controlled increase of ambient lighting on chest radiologist nodule detection performance. Four chest radiologists read 100 radiographs (50 normal and 50 containing a subtle nodule) under low (E=1 lx) and elevated (E=50 lx) ambient lighting levels on a DICOM-calibrated, medical-grade liquid crystal display. Radiologists were asked to identify nodule locations and rate their detection confidence. A receiver operating characteristic (ROC) analysis of radiologist results was performed and area under ROC curve (AUC) values calculated for each ambient lighting level. Additionally, radiologist selection times under both illuminance conditions were determined. Average AUC values did not significantly differ (p>0.05) between ambient lighting levels (estimated mean difference=-0.03; 95% CI, (-0.08, 0.03)). Average selection times decreased or remained constant with increased illuminance. The most considerable decreases occurred for false positive identification times (35.4±18.8 to 26.2±14.9 s) and true positive identification times (29.7±18.3 to 24.5±15.5 s). No performance differences were statistically significant. Study findings suggest that a controlled increase of ambient lighting within darkly lit chest radiology reading rooms, to a level more suitable for performance of common radiological tasks, does not appear to have a statistically significant effect on nodule detection performance.
Collapse
Affiliation(s)
- Benjamin J Pollard
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Duke University, Durham, NC 27705, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Lin Y, Luo H, Dobbins JT, Page McAdams H, Wang X, Sehnert WJ, Barski L, Foos DH, Samei E. An image-based technique to assess the perceptual quality of clinical chest radiographs. Med Phys 2012; 39:7019-31. [DOI: 10.1118/1.4760886] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
27
|
Lungren MP, Samei E, Barnhart H, McAdams HP, Leder RA, Christensen JD, Wylie JD, Tan JW, Li X, Hurwitz LM. Gray-scale inversion radiographic display for the detection of pulmonary nodules on chest radiographs. Clin Imaging 2012; 36:515-21. [DOI: 10.1016/j.clinimag.2012.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/20/2011] [Accepted: 01/05/2012] [Indexed: 10/28/2022]
|
28
|
Guo W, Li Q, Boyce SJ, McAdams HP, Shiraishi J, Doi K, Samei E. A computerized scheme for lung nodule detection in multiprojection chest radiography. Med Phys 2012; 39:2001-12. [PMID: 22482621 DOI: 10.1118/1.3694096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Our previous study indicated that multiprojection chest radiography could significantly improve radiologists' performance for lung nodule detection in clinical practice. In this study, the authors further verify that multiprojection chest radiography can greatly improve the performance of a computer-aided diagnostic (CAD) scheme. METHODS Our database consisted of 59 subjects, including 43 subjects with 45 nodules and 16 subjects without nodules. The 45 nodules included 7 real and 38 simulated ones. The authors developed a conventional CAD scheme and a new fusion CAD scheme to detect lung nodules. The conventional CAD scheme consisted of four steps for (1) identification of initial nodule candidates inside lungs, (2) nodule candidate segmentation based on dynamic programming, (3) extraction of 33 features from nodule candidates, and (4) false positive reduction using a piecewise linear classifier. The conventional CAD scheme processed each of the three projection images of a subject independently and discarded the correlation information between the three images. The fusion CAD scheme included the four steps in the conventional CAD scheme and two additional steps for (5) registration of all candidates in the three images of a subject, and (6) integration of correlation information between the registered candidates in the three images. The integration step retained all candidates detected at least twice in the three images of a subject and removed those detected only once in the three images as false positives. A leave-one-subject-out testing method was used for evaluation of the performance levels of the two CAD schemes. RESULTS At the sensitivities of 70%, 65%, and 60%, our conventional CAD scheme reported 14.7, 11.3, and 8.6 false positives per image, respectively, whereas our fusion CAD scheme reported 3.9, 1.9, and 1.2 false positives per image, and 5.5, 2.8, and 1.7 false positives per patient, respectively. The low performance of the conventional CAD scheme may be attributed to the high noise level in chest radiography, and the small size and low contrast of most nodules. CONCLUSIONS This study indicated that the fusion of correlation information in multiprojection chest radiography can markedly improve the performance of CAD scheme for lung nodule detection.
Collapse
Affiliation(s)
- Wei Guo
- Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Driehuys B, Martinez-Jimenez S, Cleveland ZI, Metz GM, Beaver DM, Nouls JC, Kaushik SS, Firszt R, Willis C, Kelly KT, Wolber J, Kraft M, McAdams HP. Chronic obstructive pulmonary disease: safety and tolerability of hyperpolarized 129Xe MR imaging in healthy volunteers and patients. Radiology 2011; 262:279-89. [PMID: 22056683 DOI: 10.1148/radiol.11102172] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the safety and tolerability of inhaling multiple 1-L volumes of undiluted hyperpolarized xenon 129 ((129)Xe) followed by up to a 16-second breath hold and magnetic resonance (MR) imaging. MATERIALS AND METHODS This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained. Forty-four subjects (19 men, 25 women; mean age, 46.1 years ± 18.8 [standard deviation]) were enrolled, consisting of 24 healthy volunteers, 10 patients with chronic obstructive pulmonary disease (COPD), and 10 age-matched control subjects. All subjects received three or four 1-L volumes of undiluted hyperpolarized (129)Xe, followed by breath-hold MR imaging. Oxygen saturation, heart rate and rhythm, and blood pressure were continuously monitored. These parameters, along with respiratory rate and subjective symptoms, were assessed after each dose. Subjects' serum biochemistry and hematology were recorded at screening and at 24-hour follow-up. A 12-lead electrocardiogram (ECG) was obtained at these times and also within 2 hours prior to and 1 hour after (129)Xe MR imaging. Xenon-related symptoms were evaluated for relationship to subject group by using a χ(2) test and to subject age by using logistic regression. Changes in vital signs were tested for significance across subject group and time by using a repeated-measures multivariate analysis of variance test. RESULTS The 44 subjects tolerated all xenon inhalations, no subjects withdrew, and no serious adverse events occurred. No significant changes in vital signs (P > .27) were observed, and no subjects exhibited changes in laboratory test or ECG results at follow-up that were deemed clinically important or required intervention. Most subjects (91%) did experience transient xenon-related symptoms, most commonly dizziness (59%), paresthesia (34%), euphoria (30%), and hypoesthesia (30%). All symptoms resolved without clinical intervention in 1.6 minutes ± 0.9. CONCLUSION Inhalation of hyperpolarized (129)Xe is well tolerated in healthy subjects and in those with mild or moderate COPD. Subjects do experience mild, transient, xenon-related symptoms, consistent with its known anesthetic properties.
Collapse
Affiliation(s)
- Bastiaan Driehuys
- Department of Radiology, Center for In-Vivo Microscopy, Duke University Medical Center, 311 Research Dr, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kaushik SS, Cleveland ZI, Cofer GP, Metz G, Beaver D, Nouls J, Kraft M, Auffermann W, Wolber J, McAdams HP, Driehuys B. Diffusion-weighted hyperpolarized 129Xe MRI in healthy volunteers and subjects with chronic obstructive pulmonary disease. Magn Reson Med 2010; 65:1154-65. [PMID: 21413080 DOI: 10.1002/mrm.22697] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/13/2010] [Accepted: 10/03/2010] [Indexed: 01/24/2023]
Abstract
Given its greater availability and lower cost, (129) Xe apparent diffusion coefficient (ADC) MRI offers an alternative to (3) He ADC MRI. To demonstrate the feasibility of hyperpolarized (129) Xe ADC MRI, we present results from healthy volunteers (HV), chronic obstructive pulmonary disease (COPD) subjects, and age-matched healthy controls (AMC). The mean parenchymal ADC was 0.036 ± 0.003 cm(2) sec(-1) for HV, 0.043 ± 0.006 cm(2) sec(-1) for AMC, and 0.056 ± 0.008 cm(2) sec(-1) for COPD subjects with emphysema. In healthy individuals, but not the COPD group, ADC decreased significantly in the anterior-posterior direction by ∼ 22% (P = 0.006, AMC; 0.0059, HV), likely because of gravity-induced tissue compression. The COPD group exhibited a significantly larger superior-inferior ADC reduction (∼ 28%) than the healthy groups (∼ 24%) (P = 0.00018, HV; P = 3.45 × 10(-5) , AMC), consistent with smoking-related tissue destruction in the superior lung. Superior-inferior gradients in healthy subjects may result from regional differences in xenon concentration. ADC was significantly correlated with pulmonary function tests (forced expiratory volume in 1 sec, r = -0.77, P = 0.0002; forced expiratory volume in 1 sec/forced vital capacity, r = -0.77, P = 0.0002; diffusing capacity of carbon monoxide in the lung/alveolar volume (V(A) ), r = -0.77, P = 0.0002). In healthy groups, ADC increased with age by 0.0002 cm(2) sec(-1) year(-1) (r = 0.56, P = 0.02). This study shows that (129) Xe ADC MRI is clinically feasible, sufficiently sensitive to distinguish HV from subjects with emphysema, and detects age- and posture-dependent changes.
Collapse
Affiliation(s)
- S Sivaram Kaushik
- Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina 27710, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Martinez-Jimenez S, Heyneman LE, McAdams HP, Jasinowodolinski D, Rossi SE, Restrepo CS, Washington L. Nonsurgical Extracardiac Vascular Shunts in the Thorax: Clinical and Imaging Characteristics. Radiographics 2010; 30:e41. [DOI: 10.1148/rg.e41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
32
|
Cleveland ZI, Cofer GP, Metz G, Beaver D, Nouls J, Kaushik SS, Kraft M, Wolber J, Kelly KT, McAdams HP, Driehuys B. Hyperpolarized Xe MR imaging of alveolar gas uptake in humans. PLoS One 2010; 5:e12192. [PMID: 20808950 PMCID: PMC2922382 DOI: 10.1371/journal.pone.0012192] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [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: 01/20/2010] [Accepted: 07/20/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the central physiological functions of the lungs is to transfer inhaled gases from the alveoli to pulmonary capillary blood. However, current measures of alveolar gas uptake provide only global information and thus lack the sensitivity and specificity needed to account for regional variations in gas exchange. METHODS AND PRINCIPAL FINDINGS Here we exploit the solubility, high magnetic resonance (MR) signal intensity, and large chemical shift of hyperpolarized (HP) (129)Xe to probe the regional uptake of alveolar gases by directly imaging HP (129)Xe dissolved in the gas exchange tissues and pulmonary capillary blood of human subjects. The resulting single breath-hold, three-dimensional MR images are optimized using millisecond repetition times and high flip angle radio-frequency pulses, because the dissolved HP (129)Xe magnetization is rapidly replenished by diffusive exchange with alveolar (129)Xe. The dissolved HP (129)Xe MR images display significant, directional heterogeneity, with increased signal intensity observed from the gravity-dependent portions of the lungs. CONCLUSIONS The features observed in dissolved-phase (129)Xe MR images are consistent with gravity-dependent lung deformation, which produces increased ventilation, reduced alveolar size (i.e., higher surface-to-volume ratios), higher tissue densities, and increased perfusion in the dependent portions of the lungs. Thus, these results suggest that dissolved HP (129)Xe imaging reports on pulmonary function at a fundamental level.
Collapse
Affiliation(s)
- Zackary I. Cleveland
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gary P. Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gregory Metz
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Denise Beaver
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - John Nouls
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - S. Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Monica Kraft
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Kevin T. Kelly
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - H. Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| |
Collapse
|
33
|
Abstract
Digital tomosynthesis is a radiographic technique that can produce an arbitrary number of section images of a patient from a single pass of the X-ray tube. It utilizes a conventional X-ray tube, a flat-panel detector, a computer-controlled tube mover, and special reconstruction algorithms to produce section images. While it does not have the depth resolution of computed tomography (CT), tomosynthesis provides some of the tomographic benefits of CT but at lower cost and radiation dose than CT. Compared to conventional chest radiography, chest tomosynthesis results in improved visibility of normal structures such as vessels, airway and spine. By reducing visual clutter from overlying normal anatomy, it also enhances detection of small lung nodules. This review article outlines the components of a tomosynthesis system, discusses results regarding improved lung nodule detection from the recent literature, and presents examples of nodule detection from a clinical trial in human subjects. Possible implementation strategies for use in clinical chest imaging are discussed.
Collapse
Affiliation(s)
- James T Dobbins
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
| | | |
Collapse
|
34
|
Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L. Imaging appearances of the sternum and sternoclavicular joints. Radiographics 2009; 29:839-59. [PMID: 19448119 DOI: 10.1148/rg.293055136] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.
Collapse
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex., USA
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Matrix inversion tomosynthesis (MITS) uses known imaging geometry and linear systems theory to deterministically separate in-plane detail from residual tomographic blur in a set of conventional tomosynthesis ("shift-and-add") planes. A previous investigation explored the effect of scan angle (ANG), number of projections (N), and number of reconstructed planes (NP) on the MITS impulse response and modulation transfer function characteristics, and concluded that ANG = 20 degrees, N = 71, and NP = 69 is the optimal MITS imaging technique for chest imaging on our prototype tomosynthesis system. This article examines the effect of ANG, N, and NP on the MITS exposure-normalized noise power spectra (ENNPS) and seeks to confirm that the imaging parameters selected previously by an analysis of the MITS impulse response also yield reasonable stochastic properties in MITS reconstructed planes. ENNPS curves were generated for experimentally acquired mean-subtracted projection images, conventional tomosynthesis planes, and MITS planes with varying combinations of the parameters ANG, N, and NP. Image data were collected using a prototype tomosynthesis system, with 11.4 cm acrylic placed near the image receptor to produce lung-equivalent beam hardening and scattered radiation. Ten identically acquired tomosynthesis data sets (realizations) were collected for each selected technique and used to generate ensemble mean images that were subtracted from individual image realizations prior to noise power spectra (NPS) estimation. NPS curves were normalized to account for differences in entrance exposure (as measured with an ion chamber), yielding estimates of the ENNPS for each technique. Results suggest that mid- and high-frequency noise in MITS planes is fairly equivalent in magnitude to noise in conventional tomosynthesis planes, but low-frequency noise is amplified in the most anterior and posterior reconstruction planes. Selecting the largest available number of projections (N = 71) does not incur any appreciable additive electronic noise penalty compared to using fewer projections for roughly equivalent cumulative exposure. Stochastic noise is minimized by maximizing N and NP but increases with increasing ANG. The noise trend results for NP and ANG are contrary to what would be predicted by simply considering the MITS matrix conditioning and likely result from the interplay between noise correlation and the polarity of the MITS filters. From this study, the authors conclude that the previously determined optimal MITS imaging strategy based on impulse response considerations produces somewhat suboptimal stochastic noise characteristics, but is probably still the best technique for MITS imaging of the chest.
Collapse
Affiliation(s)
- Devon J Godfrey
- Department of Radiology, Duke Advanced Imaging Laboratories, Duke University, DUMC 3295, Durham, North Carolina 27710, USA.
| | | | | |
Collapse
|
36
|
Chawla AS, Boyce S, Washington L, McAdams HP, Samei E. Design and Development of a New Multi-Projection X-Ray System for Chest Imaging. IEEE Trans Nucl Sci 2009; 56:36-45. [PMID: 29375155 PMCID: PMC5783642 DOI: 10.1109/tns.2008.2008647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Overlapping anatomical structures may confound the detection of abnormal pathology, including lung nodules, in conventional single-projection chest radiography. To minimize this fundamental limiting factor, a dedicated digital multi-projection system for chest imaging was recently developed at the Radiology Department of Duke University. We are reporting the design of the multi-projection imaging system and its initial performance in an ongoing clinical trial. The system is capable of acquiring multiple full-field projections of the same patient along both the horizontal and vertical axes at variable speeds and acquisition frame rates. These images acquired in rapid succession from slightly different angles about the posterior-anterior (PA) orientation can be correlated to minimize the influence of overlying anatomy. The developed system has been tested for repeatability and motion blur artifacts to investigate its robustness for clinical trials. Excellent geometrical consistency was found in the tube motion, with positional errors for clinical settings within 1%. The effect of tube-motion on the image quality measured in terms of impact on the Modulation Transfer Function (MTF) was found to be minimal. The system was deemed clinic-ready and a clinical trial was subsequently launched. The flexibility of image acquisition built into the system provides a unique opportunity to easily modify it for different clinical applications, including tomosynthesis, correlation imaging (CI), and stereoscopic imaging.
Collapse
Affiliation(s)
- Amarpreet S Chawla
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, NC 27705 USA
| | - Sarah Boyce
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, NC 27705 USA
| | | | - H Page McAdams
- Department of Radiology and the Division of Thoracic Imaging, Duke University, Durham, NC 27705 USA
| | - Ehsan Samei
- Departments of Biomedical Engineering, Physics, Medical Physics, and of Radiology, Duke University, Durham, NC 27705 USA
| |
Collapse
|
37
|
Martinez S, Heyneman LE, McAdams HP, Rossi SE, Restrepo CS, Eraso A. Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Radiographics 2008; 28:1369-82. [PMID: 18794313 DOI: 10.1148/rg.285075212] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucoid impaction is a relatively common finding at chest radiography and computed tomography (CT). Both congenital and acquired abnormalities may cause mucoid impaction of the large airways that often manifests as tubular opacities known as the finger-in-glove sign. The congenital conditions in which this sign most often appears are segmental bronchial atresia and cystic fibrosis. The sign also may be observed in many acquired conditions, include inflammatory and infectious diseases (allergic bronchopulmonary aspergillosis, broncholithiasis, and foreign body aspiration), benign neoplastic processes (bronchial hamartoma, lipoma, and papillomatosis), and malignancies (bronchogenic carcinoma, carcinoid tumor, and metastases). To point to the correct diagnosis, the radiologist must be familiar with the key radiographic and CT features that enable differentiation among the various likely causes. CT is more useful than chest radiography for differentiating between mucoid impaction and other disease processes, such as arteriovenous malformation, and for directing further diagnostic evaluation. In addition, knowledge of the patient's medical history, clinical symptoms and signs, and predisposing factors is important.
Collapse
Affiliation(s)
- Santiago Martinez
- Department of Radiology, Duke University Medical Center, Erwin Rd, Durham NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
38
|
James TD, McAdams HP, Song JW, Li CM, Godfrey DJ, DeLong DM, Paik SH, Martinez-Jimenez S. Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial. Med Phys 2008; 35:2554-7. [PMID: 18649488 DOI: 10.1118/1.2937277] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The authors report interim clinical results from an ongoing NIH-sponsored trial to evaluate digital chest tomosynthesis for improving detectability of small lung nodules. Twenty-one patients undergoing computed tomography (CT) to follow up lung nodules were consented and enrolled to receive an additional digital PA chest radiograph and digital tomosynthesis exam. Tomosynthesis was performed with a commercial CsI/a-Si flat-panel detector and a custom-built tube mover. Seventy-one images were acquired in 11 s, reconstructed with the matrix inversion tomosynthesis algorithm at 5-mm plane spacing, and then averaged (seven planes) to reduce noise and low-contrast artifacts. Total exposure for tomosynthesis imaging was equivalent to that of 11 digital PA radiographs (comparable to a typical screen-film lateral radiograph or two digital lateral radiographs). CT scans (1.25-mm section thickness) were reviewed to confirm presence and location of nodules. Three chest radiologists independently reviewed tomosynthesis images and PA chest radiographs to confirm visualization of nodules identified by CT. Nodules were scored as: definitely visible, uncertain, or not visible. 175 nodules (diameter range 3.5-25.5 mm) were seen by CT and grouped according to size: < 5, 5-10, and > 10 mm. When considering as true positives only nodules that were scored definitely visible, sensitivities for all nodules by tomosynthesis and PA radiography were 70% (+/- 5%) and 22% (+/- 4%), respectively, (p < 0.0001). Digital tomosynthesis showed significantly improved sensitivity of detection of known small lung nodules in all three size groups, when compared to PA chest radiography.
Collapse
|
39
|
Abstract
OBJECTIVE The purpose of this article is to review clinical and radiologic manifestations of pulmonary nontuberculous mycobacterial infection. CONCLUSION Common and well-recognized patterns of infection include cavitary and bronchiectatic disease and infection in AIDS patients. Less common or well-recognized manifestations include nodules or masses mimicking malignancy, hypersensitivity pneumonitis, and others. Definitive diagnosis can be difficult and patterns may overlap. Timely diagnosis requires a high index of suspicion and knowledge of the spectrum of clinical and radiologic features.
Collapse
Affiliation(s)
- Santiago Martinez
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | | | | |
Collapse
|
40
|
Affiliation(s)
- Jonathon A Leipsic
- Department of Radiology, Duke University Medical Center, PO Box 3808, Durham, NC 27710, USA
| | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE The purpose of this study was the development and preliminary evaluation of multiprojection correlation imaging with 3D computer-aided detection (CAD) on chest radiographs for cost- and dose-effective improvement of early detection of pulmonary nodules. SUBJECTS AND METHODS Digital chest radiographs of 10 configurations of a chest phantom and of seven human subjects were acquired in multiple angular projections with an acquisition time of 11 seconds (single breath-hold) and total exposure comparable with that of a posteroanterior chest radiograph. An initial 2D CAD algorithm with two difference-of-gaussians filters and multilevel thresholds was developed with an independent database of 44 single-view chest radiographs with confirmed lesions. This 2D CAD algorithm was used on each projection image to find likely suspect nodules. The CAD outputs were reconstructed in 3D, reinforcing signals associated with true nodules while simultaneously decreasing false-positive findings produced by overlapping anatomic features. The performance of correlation imaging was tested on two to 15 projection images. RESULTS Optimum performance of correlation imaging was attained when nine projection images were used. Compared with conventional, single-view CAD, correlation imaging decreased as much as 79% the frequency of false-positive findings in phantom cases at a sensitivity level of 65%. The corresponding reduction in false-positive findings in the cases of human subjects was 78%. CONCLUSION Although limited by a relatively simple CAD implementation and a small number of cases, the findings suggest that correlation imaging performs substantially better than single-view CAD and may greatly enhance identification of subtle solitary pulmonary nodules on chest radiographs.
Collapse
Affiliation(s)
- Ehsan Samei
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, 2424 Erwin Rd., Suite 302, Durham, NC 27705, USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
There have been many remarkable advances in conventional thoracic imaging over the past decade. Perhaps the most remarkable is the rapid conversion from film-based to digital radiographic systems. Computed radiography is now the preferred imaging modality for bedside chest imaging. Direct radiography is rapidly replacing film-based chest units for in-department posteroanterior and lateral examinations. An exciting aspect of the conversion to digital radiography is the ability to enhance the diagnostic capabilities and influence of chest radiography. Opportunities for direct computer-aided detection of various lesions may enhance the radiologist's accuracy and improve efficiency. Newer techniques such as dual-energy and temporal subtraction radiography show promise for improved detection of subtle and often obscured or overlooked lung lesions. Digital tomosynthesis is a particularly promising technique that allows reconstruction of multisection images from a short acquisition at very low patient dose. Preliminary data suggest that, compared with conventional radiography, tomosynthesis may also improve detection of subtle lung lesions. The ultimate influence of these new technologies will, of course, depend on the outcome of rigorous scientific validation.
Collapse
Affiliation(s)
- H Page McAdams
- Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
43
|
Godfrey DJ, McAdams HP, Dobbins JT. Optimization of the matrix inversion tomosynthesis (MITS) impulse response and modulation transfer function characteristics for chest imaging. Med Phys 2006; 33:655-67. [PMID: 16878569 DOI: 10.1118/1.2170398] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Matrix inversion tomosynthesis (MITS) uses linear systems theory, along with a priori knowledge of the imaging geometry, to deterministically distinguish between true structure and overlying tomographic blur in a set of conventional tomosynthesis planes. In this paper we examine the effect of total scan angle (ANG), number of input projections (N), and plane separation/number of reconstructed planes (NP) on the MITS impulse response (IR) and modulation transfer function (MTF), with the purpose of optimizing MITS imaging of the chest. MITS IR and MTF data were generated by simulating the imaging of a very thin wire, using various combinations of ANG, N, and NP. Actual tomosynthesis data of an anthropomorphic chest phantom were acquired with a prototype experimental system, using the same imaging parameter combinations as those in the simulations. Thoracic projection data from two human subjects were collected for corroboration of the system response analysis in vivo. Results suggest that ANG=20 degrees, N=71, NP=69 is the optimal combination for MITS chest imaging given the inherent constraints of our prototype system. MITS chest data from human subjects demonstrates that the selected imaging strategy can effectively produce high-quality MITS thoracic images in vivo.
Collapse
Affiliation(s)
- Devon J Godfrey
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University, DUMC 3302, Durham, North Carolina 27710, USA
| | | | | |
Collapse
|
44
|
Steele MP, Speer MC, Loyd JE, Brown KK, Herron A, Slifer SH, Burch LH, Wahidi MM, Phillips JA, Sporn TA, McAdams HP, Schwarz MI, Schwartz DA. Clinical and pathologic features of familial interstitial pneumonia. Am J Respir Crit Care Med 2005; 172:1146-52. [PMID: 16109978 PMCID: PMC2718398 DOI: 10.1164/rccm.200408-1104oc] [Citation(s) in RCA: 272] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 08/16/2005] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Several lines of evidence suggest that genetic factors and environmental exposures play a role in the development of pulmonary fibrosis. OBJECTIVES We evaluated families with 2 or more cases of idiopathic interstitial pneumonia among first-degree family members (familial interstitial pneumonia, or FIP), and identified 111 families with FIP having 309 affected and 360 unaffected individuals. METHODS The presence of probable or definite FIP was based on medical record review in 28 cases (9.1%); clinical history, diffusing capacity of carbon monoxide (DL(CO)), and chest X-ray in 16 cases (5.2%); clinical history, DL(CO), and high-resolution computed tomography chest scan in 191 cases (61.8%); clinical history and surgical lung biopsy in 56 cases (18.1%); and clinical history and autopsy in 18 cases (5.8%). RESULTS Older age (68.3 vs. 53.1; p < 0.0001), male sex (55.7 vs. 37.2%; p < 0.0001), and having ever smoked cigarettes (67.3 vs. 34.1%; p < 0.0001) were associated with the development of FIP. After controlling for age and sex, having ever smoked cigarettes remained strongly associated with the development of FIP (odds ratio(adj), 3.6; 95% confidence interval, 1.3-9.8). Evidence of aggregation of disease was highly significant (p < 0.001) among sibling pairs, and 20 pedigrees demonstrated vertical transmission, consistent with autosomal dominant inheritance. Forty-five percent of pedigrees demonstrated phenotypic heterogeneity, with some pedigrees demonstrating several subtypes of idiopathic interstitial pneumonia occurring within the same families. CONCLUSIONS These findings suggest that FIP may be caused by an interaction between a specific environmental exposure and a gene (or genes) that predisposes to the development of several subtypes of idiopathic interstitial pneumonia.
Collapse
Affiliation(s)
- Mark P Steele
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- Lynne M Hurwitz
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | | | | |
Collapse
|
46
|
Samei E, Lo JY, Yoshizumi TT, Jesneck JL, Dobbins JT, Floyd CE, McAdams HP, Ravin CE. Comparative scatter and dose performance of slot-scan and full-field digital chest radiography systems. Radiology 2005; 235:940-9. [PMID: 15845791 DOI: 10.1148/radiol.2353040516] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the scatter, dose, and effective detective quantum efficiency (DQE) performance of a slot-scan digital chest radiography system compared with that of a full-field digital radiography system. MATERIALS AND METHODS Scatter fraction of a slot-scan system was measured for an anthropomorphic and a geometric phantom by using a posterior beam-stop technique at 117 and 140 kVp. Measurements were repeated with a full-field digital radiography system with and without a 13:1 antiscatter grid at 120 and 140 kVp. For both systems, the effective dose was measured on posteroanterior and lateral views for standard clinical techniques by using dosimeters embedded in a female phantom. The effective DQEs of the two systems were assessed by taking into account the scatter performance and the DQE of each system. The statistical significance of all the comparative differences was ascertained by means of t test analysis. RESULTS The slot-scan system and the full-field system with grid yielded scatter fractions of 0.13-0.14 and 0.42-0.48 in the lungs and 0.30-0.43 and 0.69-0.78 in the mediastinum, respectively. The sum of the effective doses for posteroanterior and lateral views for the slot-scan system (0.057 mSv +/- 0.003 [+/- standard deviation]) was 34% lower than that for the full-field system (0.086 mSv +/- 0.001, P < .05) at their respective clinical peak voltages (140 and 120 kVp, respectively). The effective DQE of the slot-scan system was equivalent to that of the full-field system in the lung region but was 37% higher in the dense regions (P < .05). CONCLUSION The slot-scan design leads to marked scatter reduction compared with the more conventional full-field geometries with a grid. The improved scatter performance of a slot-scan geometry can effectively compensate for low DQE and lead to improved image quality.
Collapse
Affiliation(s)
- Ehsan Samei
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, DUMC 3302, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE To retrospectively establish normal values for pulmonary vein diameter, cross-sectional area, and shape depicted at computed tomography (CT). MATERIALS AND METHODS Institutional review board waived patient consent requirement and approved the study. Thin-section contrast material-enhanced spiral chest CT scans in 104 patients, 68 women and 36 men (age range, 19-86 years; mean, 49 years) referred to exclude pulmonary embolism, were retrospectively reviewed. Short-axis diameter and cross-sectional area of the four major pulmonary veins (right inferior and superior, left inferior and superior) were measured at a workstation by using oblique reconstructions. Each vein was measured at six locations, 5 mm apart, starting at atrial ostium. Each measurement was performed three times by an experienced thoracic radiologist, and the mean value was recorded. Roundness was estimated by comparing the ratio of the calculated cross-sectional area to that measured. Mixed effects model was used to compare men and women relative to the distribution of diameters and surface areas and to compare roundness of the right and left veins. RESULTS Mean pulmonary vein diameters at the ostia were variable: right superior, 11.4-12.4 mm; left superior, 9.6-10.5 mm; right inferior, 12.3-13.1 mm; and left inferior, 9.0-9.9 mm. Diameter and cross-sectional area of the left superior pulmonary vein were significantly larger in men than in women (P < .005). As expected, the caliber of three of the four veins gradually increased as they approached the left atrium. Caliber of the left inferior pulmonary vein decreased as it entered the left atrium. None of the veins were round; all were ovoid. Left-sided veins and venous ostia were less round than right-sided veins (P < .001). CONCLUSION Pulmonary vein diameter, cross-sectional area, and shape vary. Particular care must be taken when the left inferior pulmonary vein is evaluated for stenosis, as it normally narrows as it enters the left atrium.
Collapse
Affiliation(s)
- Yun-Hyeon Kim
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
| | | | | | | |
Collapse
|
48
|
Marom EM, McAdams HP, Butnor KJ, Coleman RE. Positron Emission Tomography With Fluoro-2-deoxy-D-glucose (FDG-PET) in the Staging of Post Transplant Lymphoproliferative Disorder in Lung Transplant Recipients. J Thorac Imaging 2004; 19:74-8. [PMID: 15071322 DOI: 10.1097/00005382-200404000-00002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Posttransplantation lymphoproliferative disorder (PTLD) is a histologic heterogeneous disease that complicates 4 to 8% of lung transplant recipients. Disease extent is an important prognostic factor and may affect therapy. Positron emission tomography with fluoro-2-deoxy-D-glucose (FDG-PET) has proven useful for staging high-grade lymphomas but is less accurate for staging low-grade and extranodal lymphoma. This study examined our initial experience using FDG-PET imaging to stage lung transplant recipients with posttransplantation lymphoproliferative disorder. FDG can show foci of uptake, particularly in extrathoracic sites, not seen by conventional imaging, which allows more accurate staging of disease thereby yielding useful prognostic information and guiding therapy.
Collapse
Affiliation(s)
- Edith M Marom
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | | | |
Collapse
|
49
|
Abstract
PURPOSE To evaluate and classify the various drainage patterns of the pulmonary veins as depicted with thin-section chest computed tomography (CT). MATERIALS AND METHODS Thin-section (2.5-mm collimation) contrast material-enhanced CT scans of 201 consecutive patients obtained over a 3-month period for diagnosis of pulmonary embolism (n = 197), pulmonary vein stenosis (n = 2), or aortic injury (n = 2) were routinely reviewed in transverse and (if necessary) coronal and coronal-oblique imaging planes. A classification was formulated based on both the number of venous ostia on each side and the drainage patterns of pulmonary veins. The frequency of each pattern was determined, and association with atrial arrhythmia was assessed with the chi(2) and Fisher exact tests. RESULTS Most patients (n = 142, 71%) had two ostia on the right side for upper and lower lobe veins. Fifty-six patients (28%) had three to five ostia on the right side, which were due to one or two separate middle lobe vein ostia in 52 (26%) patients. Three patients (2%) had a single venous ostium on the right side. Most patients (n = 173, 86%) had two ostia on the left side for upper and lower lobe veins. The remainder (n = 28, 14%) had a single ostium. There was no significant association between any particular venous drainage pattern and atrial arrhythmia; however, patients with a separate ostia for the right middle lobe pulmonary vein(s) tended to have a higher frequency of atrial arrhythmia than those with other patterns (P =.053). CONCLUSION A classification system to succinctly describe pulmonary venous drainage patterns was developed. Right-sided venous drainage was more variable than left-sided venous drainage. One-quarter of patients had more than two venous ostia on the right side.
Collapse
Affiliation(s)
- Edith M Marom
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | | | | | | |
Collapse
|
50
|
Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2004; 23:1509-19. [PMID: 14615561 DOI: 10.1148/rg.236035101] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The "crazy-paving" pattern is a common finding at thin-section computed tomography (CT) of the lungs. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, differences in the location of the characteristic attenuation in the lungs, as well as the presence of additional radiologic findings, the patient's history, and the clinical presentation, can often be useful in suggesting the appropriate diagnosis.
Collapse
Affiliation(s)
- Santiago E Rossi
- Department of Radiology, Centro de Diagnostico Dr Enrique Rossi, Arenales 2777, Buenos Aires 1425, Argentina.
| | | | | | | | | | | |
Collapse
|