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Dave M, Dev A, Somoza RA, Zhao N, Viswanath S, Mina PR, Chirra P, Obmann VC, Mahabeleshwar GH, Menghini P, Durbin-Johnson B, Nolta J, Soto C, Osme A, Khuat LT, Murphy WJ, Caplan AI, Cominelli F. MSCs mediate long-term efficacy in a Crohn's disease model by sustained anti-inflammatory macrophage programming via efferocytosis. NPJ Regen Med 2024; 9:6. [PMID: 38245543 PMCID: PMC10799947 DOI: 10.1038/s41536-024-00347-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
Mesenchymal stem cells (MSCs) are novel therapeutics for the treatment of Crohn's disease. However, their mechanism of action is unclear, especially in disease-relevant chronic models of inflammation. Thus, we used SAMP-1/YitFc (SAMP), a chronic and spontaneous murine model of small intestinal inflammation, to study the therapeutic effects and mechanism of action of human bone marrow-derived MSCs (hMSC). hMSC dose-dependently inhibited naïve T lymphocyte proliferation via prostaglandin E2 (PGE2) secretion and reprogrammed macrophages to an anti-inflammatory phenotype. We found that the hMSCs promoted mucosal healing and immunologic response early after administration in SAMP when live hMSCs are present (until day 9) and resulted in a complete response characterized by mucosal, histological, immunologic, and radiological healing by day 28 when no live hMSCs are present. hMSCs mediate their effect via modulation of T cells and macrophages in the mesentery and mesenteric lymph nodes (mLN). Sc-RNAseq confirmed the anti-inflammatory phenotype of macrophages and identified macrophage efferocytosis of apoptotic hMSCs as a mechanism that explains their long-term efficacy. Taken together, our findings show that hMSCs result in healing and tissue regeneration in a chronic model of small intestinal inflammation and despite being short-lived, exert long-term effects via sustained anti-inflammatory programming of macrophages via efferocytosis.
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Affiliation(s)
- Maneesh Dave
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, USA.
- Institute for Regenerative Cures, University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Atul Dev
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Rodrigo A Somoza
- Skeletal Research Center, Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Nan Zhao
- Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Satish Viswanath
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Pooja Rani Mina
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Prathyush Chirra
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ganapati H Mahabeleshwar
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Paola Menghini
- Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Blythe Durbin-Johnson
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Jan Nolta
- Institute for Regenerative Cures, University of California Davis School of Medicine, Sacramento, CA, USA
- Division of Malignant Hematology/Cell and Marrow Transplantation, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, USA
| | - Christopher Soto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Abdullah Osme
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lam T Khuat
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - William J Murphy
- Division of Malignant Hematology/Cell and Marrow Transplantation, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, USA
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Arnold I Caplan
- Skeletal Research Center, Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Fabio Cominelli
- Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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Zbinden L, Catucci D, Suter Y, Hulbert L, Berzigotti A, Brönnimann M, Ebner L, Christe A, Obmann VC, Sznitman R, Huber AT. Automated liver segmental volume ratio quantification on non-contrast T1-Vibe Dixon liver MRI using deep learning. Eur J Radiol 2023; 167:111047. [PMID: 37690351 DOI: 10.1016/j.ejrad.2023.111047] [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] [Received: 04/04/2023] [Revised: 07/29/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To evaluate the effectiveness of automated liver segmental volume quantification and calculation of the liver segmental volume ratio (LSVR) on a non-contrast T1-vibe Dixon liver MRI sequence using a deep learning segmentation pipeline. METHOD A dataset of 200 liver MRI with a non-contrast 3 mm T1-vibe Dixon sequence was manually labeledslice-by-sliceby an expert for Couinaud liver segments, while portal and hepatic veins were labeled separately. A convolutional neural networkwas trainedusing 170 liver MRI for training and 30 for evaluation. Liver segmental volumes without liver vessels were retrieved and LSVR was calculated as the liver segmental volumes I-III divided by the liver segmental volumes IV-VIII. LSVR was compared with the expert manual LSVR calculation and the LSVR calculated on CT scans in 30 patients with CT and MRI within 6 months. RESULTS Theconvolutional neural networkclassified the Couinaud segments I-VIII with an average Dice score of 0.770 ± 0.03, ranging between 0.726 ± 0.13 (segment IVb) and 0.810 ± 0.09 (segment V). The calculated mean LSVR with liver MRI unseen by the model was 0.32 ± 0.14, as compared with manually quantified LSVR of 0.33 ± 0.15, resulting in a mean absolute error (MAE) of 0.02. A comparable LSVR of 0.35 ± 0.14 with a MAE of 0.04 resulted with the LSRV retrieved from the CT scans. The automated LSVR showed significant correlation with the manual MRI LSVR (Spearman r = 0.97, p < 0.001) and CT LSVR (Spearman r = 0.95, p < 0.001). CONCLUSIONS A convolutional neural network allowed for accurate automated liver segmental volume quantification and calculation of LSVR based on a non-contrast T1-vibe Dixon sequence.
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Affiliation(s)
- Lukas Zbinden
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Yannick Suter
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Leona Hulbert
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Brönnimann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland.
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Dave M, Dev A, Somoza RA, Zhao N, Viswanath S, Mina PR, Chirra P, Obmann VC, Mahabeleshwar GH, Menghini P, Johnson BD, Nolta J, Soto C, Osme A, Khuat LT, Murphy W, Caplan AI, Cominelli F. Mesenchymal stem cells ameliorate inflammation in an experimental model of Crohn's disease via the mesentery. bioRxiv 2023:2023.05.22.541829. [PMID: 37292753 PMCID: PMC10245893 DOI: 10.1101/2023.05.22.541829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective Mesenchymal stem cells (MSCs) are novel therapeutics for treatment of Crohn's disease. However, their mechanism of action is unclear, especially in disease-relevant chronic models of inflammation. Thus, we used SAMP-1/YitFc, a chronic and spontaneous murine model of small intestinal inflammation, to study the therapeutic effect and mechanism of human bone marrow-derived MSCs (hMSC). Design hMSC immunosuppressive potential was evaluated through in vitro mixed lymphocyte reaction, ELISA, macrophage co-culture, and RT-qPCR. Therapeutic efficacy and mechanism in SAMP were studied by stereomicroscopy, histopathology, MRI radiomics, flow cytometry, RT-qPCR, small animal imaging, and single-cell RNA sequencing (Sc-RNAseq). Results hMSC dose-dependently inhibited naïve T lymphocyte proliferation in MLR via PGE 2 secretion and reprogrammed macrophages to an anti-inflammatory phenotype. hMSC promoted mucosal healing and immunologic response early after administration in SAMP model of chronic small intestinal inflammation when live hMSCs are present (until day 9) and resulted in complete response characterized by mucosal, histological, immunologic, and radiological healing by day 28 when no live hMSCs are present. hMSC mediate their effect via modulation of T cells and macrophages in the mesentery and mesenteric lymph nodes (mLN). Sc-RNAseq confirmed the anti-inflammatory phenotype of macrophages and identified macrophage efferocytosis of apoptotic hMSCs as a mechanism of action that explains their long-term efficacy. Conclusion hMSCs result in healing and tissue regeneration in a chronic model of small intestinal inflammation. Despite being short-lived, exert long-term effects via macrophage reprogramming to an anti-inflammatory phenotype. Data Transparency Statement Single-cell RNA transcriptome datasets are deposited in an online open access repository 'Figshare' (DOI: https://doi.org/10.6084/m9.figshare.21453936.v1 ).
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Silva W, Gonçalves T, Härmä K, Schröder E, Obmann VC, Barroso MC, Poellinger A, Reyes M, Cardoso JS. Author Correction: Computer-aided diagnosis through medical image retrieval in radiology. Sci Rep 2023; 13:1470. [PMID: 36702842 PMCID: PMC9879916 DOI: 10.1038/s41598-023-28523-1] [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: 01/27/2023] Open
Affiliation(s)
- Wilson Silva
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
| | - Tiago Gonçalves
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
| | - Kirsi Härmä
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erich Schröder
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena Carola Obmann
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - María Cecilia Barroso
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Poellinger
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauricio Reyes
- grid.5734.50000 0001 0726 5157ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jaime S. Cardoso
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
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Silva W, Gonçalves T, Härmä K, Schröder E, Obmann VC, Barroso MC, Poellinger A, Reyes M, Cardoso JS. Computer-aided diagnosis through medical image retrieval in radiology. Sci Rep 2022; 12:20732. [PMID: 36456605 PMCID: PMC9715673 DOI: 10.1038/s41598-022-25027-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Currently, radiologists face an excessive workload, which leads to high levels of fatigue, and consequently, to undesired diagnosis mistakes. Decision support systems can be used to prioritize and help radiologists making quicker decisions. In this sense, medical content-based image retrieval systems can be of extreme utility by providing well-curated similar examples. Nonetheless, most medical content-based image retrieval systems work by finding the most similar image, which is not equivalent to finding the most similar image in terms of disease and its severity. Here, we propose an interpretability-driven and an attention-driven medical image retrieval system. We conducted experiments in a large and publicly available dataset of chest radiographs with structured labels derived from free-text radiology reports (MIMIC-CXR-JPG). We evaluated the methods on two common conditions: pleural effusion and (potential) pneumonia. As ground-truth to perform the evaluation, query/test and catalogue images were classified and ordered by an experienced board-certified radiologist. For a profound and complete evaluation, additional radiologists also provided their rankings, which allowed us to infer inter-rater variability, and yield qualitative performance levels. Based on our ground-truth ranking, we also quantitatively evaluated the proposed approaches by computing the normalized Discounted Cumulative Gain (nDCG). We found that the Interpretability-guided approach outperforms the other state-of-the-art approaches and shows the best agreement with the most experienced radiologist. Furthermore, its performance lies within the observed inter-rater variability.
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Affiliation(s)
- Wilson Silva
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
| | - Tiago Gonçalves
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
| | - Kirsi Härmä
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erich Schröder
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena Carola Obmann
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - María Cecilia Barroso
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Poellinger
- grid.5734.50000 0001 0726 5157Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauricio Reyes
- grid.5734.50000 0001 0726 5157ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jaime S. Cardoso
- grid.20384.3d0000 0004 0500 6380INESC TEC, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Engineering, University of Porto, Porto, Portugal
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Obmann VC, Catucci D, Berzigotti A, Gräni C, Ebner L, Heverhagen JT, Christe A, Huber AT. T1 reduction rate with Gd-EOB-DTPA determines liver function on both 1.5 T and 3 T MRI. Sci Rep 2022; 12:4716. [PMID: 35304554 PMCID: PMC8933426 DOI: 10.1038/s41598-022-08659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance T1 mapping before and after Gd-EOB-DTPA administration allows quantification of the T1 reduction rate as a non-invasive surrogate marker of liver function. A major limitation of T1 relaxation time measurement is its dependency on MRI field strengths. Since T1 reduction rate is calculated as the relative shortening of T1 relaxation time before and after contrast administration, we hypothesized that the T1 reduction rate is comparable between 1.5 and 3 T. We thus compared liver T1 relaxation times between 1.5 and 3 T in a total of 243 consecutive patients (124, 1.5 T and 119, 3 T) between 09/2018 and 07/2019. T1 reduction rates were compared between patients with no cirrhosis and patients with cirrhosis Child-Pugh A-C. There was no significant difference of T1 reduction rate between 1.5 and 3 T in any patient group (p-value 0.126-0.861). On both 1.5 T and 3 T, T1 reduction rate allowed to differentiate between patients with no cirrhosis and patients with liver cirrhosis Child A-C (p < 0.001). T1 reduction rate showed a good performance to predict liver cirrhosis Child A (AUC = 0.83, p < 0.001), Child B (AUC = 0.83, p < 0.001) and Child C (AUC = 0.92, p < 0.001). In conclusion, T1 reduction rate allows to determine liver function on Gd-EOB-DTPA MRI with comparable values on 1.5 T and 3 T.
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Affiliation(s)
- Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Abstract
ABSTRACT A 70-year-old man presented with unspecific abdominal symptoms and weight loss was referred for a sonographic examination. Sonography revealed 3 cystic hepatic masses in an otherwise unremarkable liver. Contrast-enhanced MRI of the liver was performed to characterize the hepatic lesions and elucidate their etiology. The differential diagnosis was primarily parasitic disease or metastases with cystic transformations. 68Ga-DOTATOC PET/CT revealed the neuroendocrine origin of these lesions, confirmed by biopsy. However, the primary site of the neuroendocrine tumor remained unclear, leaving primary hepatic neuroendocrine tumor and neuroendocrine cancer of unknown primary as possible diagnostic options.
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Affiliation(s)
- Fabian Haupt
- From the Departments of Diagnostic, Interventional, and Pediatric Radiology
| | - Ali Afshar-Oromieh
- Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Martin Maurer
- From the Departments of Diagnostic, Interventional, and Pediatric Radiology
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Catucci D, Obmann VC, Berzigotti A, Gräni C, Guensch DP, Fischer K, Ebner L, Heverhagen JT, Christe A, Huber AT. Noninvasive assessment of clinically significant portal hypertension using ΔT1 of the liver and spleen and ECV of the spleen on routine Gd-EOB-DTPA liver MRI. Eur J Radiol 2021; 144:109958. [PMID: 34571458 DOI: 10.1016/j.ejrad.2021.109958] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/23/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the predictive value of ΔT1 of the liver and spleen as well as the extracellular volume fraction (ECV) of the spleen as noninvasive biomarkers for the determination of clinically significant portal hypertension (CSPH) on routine Gd-EOB-DTPA liver MRI. METHOD 195 consecutive patients with known or suspected chronic liver disease from 9/2018 to 7/2019 with Gd-EOB-DTPA liver MRI and abdominal T1 mapping were retrospectively included. Based on the presence of splenomegaly with thrombocytopenia, ascites and portosystemic collaterals, the patients were divided into noCSPH (n = 113), compensated CSPH (cCSPH, ≥1 finding without ascites; n = 55) and decompensated CSPH (dCSPH, ascites ± other findings; n = 27). T1 times were measured in the liver, spleen and abdominal aorta in the unenhanced and contrast-enhanced T1 maps. Native T1 times and ΔT1 of the liver and spleen as well as ECV of the spleen were compared between groups using the Kruskal-Wallis test with Dunn's post hoc test. Furthermore, cutoff values for group differentiation were calculated using ROC analysis with Youden's index. RESULTS ΔT1 of the liver was significantly lower in patients with cCSPH and dCSPH (p < 0.001) compared to patients with noCSPH. In the ROC analyses for differentiation between noCSPH and CSPH (cCSPH + dCSPH), a cutoff of < 0.67 for ΔT1 of the liver (AUC = 0.79) performed better than ΔT1 (AUC = 0.69) and ECV (AUC = 0.63) of the spleen with cutoffs of > 0.29 and > 41.9, respectively. CONCLUSION ΔT1 of the liver and spleen in addition to ECV of the spleen allow for determination of CSPH on routine Gd-EOB-DTPA liver MRI.
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Affiliation(s)
- Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Dominik Paul Guensch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Obmann VC, Grosse-Hokamp N, Alberts I, Fulton N, Rassouli N, Siegel C, Avril N, Herrmann KA. Diagnosis and staging of hepatobiliary malignancies: Potential incremental value of (18)F-FDG-PET/MRI compared to MRI of the liver. Nuklearmedizin 2021; 60:355-367. [PMID: 34102690 DOI: 10.1055/a-1486-3671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the potential added value of 18F-FDG-PET/MRI (functional information derived from PET) over standard diagnostic liver MRI (excellent soft tissue characterization) in diagnosing and staging suspected primary hepatobiliary malignancies including extrahepatic cholangiocarcinoma (ECC), intrahepatic cholangiocellular carcinoma (ICC) and gallbladder cancer (GBCA). METHODS Twenty consecutive patients with suspected hepatobiliary malignancy were included in this retrospective study. All patients underwent combined whole-body (WB) 18F-FDG-PET/MRI including contrast-enhanced MRI of the liver, contrast-enhanced WB-MRI and WB 18F-FDG-PET. Two experienced readers staged hepatobiliary disease using TNM criteria: first based on MRI alone and then based on combined 18F-FDG-PET/MRI. Subsequently, the impact of FDG-PET/MRI on clinical management compared to MRI alone was recorded. Histopathologic proof served as the reference standard. RESULTS Hepatobiliary neoplasms were present in 16/20 patients (ECC n = 3, ICC n = 8, GBCA n = 5), two patients revealed benign disease, two were excluded. TNM staging with 18F-FDG-PET/MRI was identical to MRI alone in 11/18 (61.1 %) patients and correctly changed the stage in 4/18 (22.2 %), resulting in a change in management for 2/4 patients (11.1 %). 18F-FDG-PET/MRI was false-positive in 3/18 cases (16.7 %). Both MRI and 18F-FDG-PET/MRI were falsely positive in 1 case without malignancy. CONCLUSIONS A small incremental benefit of 18F-FDG-PET/MRI over standard MRI of the liver was observed. However, in some cases 18F-FDG-PET/MRI may lead to false-positive findings. Overall there is seemingly limited role of 18F-FDG-PET/MRI in patients with suspected hepatobiliary malignancy.
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Affiliation(s)
- Verena Carola Obmann
- Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital, University of Bern, Switzerland.,Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
| | - Nils Grosse-Hokamp
- Department of Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Germany.,Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
| | - Ian Alberts
- Nuclear Medicine, Inselspital University Hospital Bern, Switzerland
| | | | - Negin Rassouli
- Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
| | - Christopher Siegel
- Department of General Surgery, Cleveland Clinic Foundation, Hillcrest Hospital, Mayfield Heights, United States
| | - Norbert Avril
- Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
| | - Karin Anna Herrmann
- Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
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Hausmann D, Maher A, Sieroń DA, Huber AT, Obmann VC, Ebner L, Christe A. Detection of Pulmonary Embolism on CT-Angiography Using Contrast Attenuation of Pulmonary Veins. Acta Angiologica 2021. [DOI: 10.5603/aa.2021.0001] [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] Open
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11
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Gupta A, Obmann VC, Jordan M, Lennartz S, Obmann MM, Große Hokamp N, Zopfs D, Pennig L, Fürtjes G, Ramaiya N, Gilkeson R, Laukamp KR. CT artifacts after contrast media injection in chest imaging: evaluation of post-processing algorithms, virtual monoenergetic images and their combination for artifact reduction. Quant Imaging Med Surg 2021; 11:226-239. [PMID: 33392024 DOI: 10.21037/qims-20-435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background After injection into a brachial vein, high contrast media concentration in axillary and subclavian veins can cause artifacts that impair diagnostic utility. This study assessed artifact reduction by artifact-reduction-algorithms (ARA) and virtual-monoenergetic-images (VMI), as well as their combination (VMIARA) compared to conventional CT-images (CI). Methods Forty-six spectral-detector-CT (SDCT) examinations of patients that received ARA-reconstructions due to perivenous-artifacts were included in this retrospective study. CI, ARA, VMI, and VMIARA (range: 70-200 keV) were reconstructed. Objective analysis was performed with ROI-based assessment of mean and standard deviation of attenuation (HU) in hypo- and hyperdense artifacts and impaired muscle and arteries as well as artifact-free reference-tissue. Extent of artifact reduction, assessment of surrounding soft tissue and vessels, and appearance of new artifacts were rated visually by two radiologists. Results Hypo- and hyperdense artifacts showed significant improvement as evidenced by decreasing attenuation differences between artifact impaired and artifact-free reference tissue in ARA, VMI ≥80 keV, and VMIARA between 70-200 keV (e.g., CI/ARA/VMI100keV/VMIARA100keV: hypodense artifacts, (-)264.8±150.9/(-)87.1±78.9/(-)48.6±64.6/9.9±63.9 HU; P<0.001); hyperdense artifacts, 164.2±51.1/82.1±73.2/7.9±34.7/(-)17.3±50.7 HU; P<0.001). Artifacts impairing surrounding muscle and arteries were also reduced by all three approaches. In visual assessment, ARA, VMI ≥100 keV, and VMIARA between 70-200 keV also showed significant artifact reduction and improved assessment; however, for assessment of arteries improvement was not significant using ARA alone. New artifacts were reported, particularly at higher keV-values. Conclusions In presence of perivenous-artifacts, ARA, VMI and their combination allow for significant artifact reduction; however, their combination and VMI as a standalone approach yielded best results and should therefore be used, if available.
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Affiliation(s)
- Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Verena Carola Obmann
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michelle Jordan
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Michael Obmann
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nils Große Hokamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gina Fürtjes
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Kai Roman Laukamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Obmann VC, Berzigotti A, Catucci D, Ebner L, Gräni C, Heverhagen JT, Christe A, Huber AT. T1 mapping of the liver and the spleen in patients with liver fibrosis-does normalization to the blood pool increase the predictive value? Eur Radiol 2020; 31:4308-4318. [PMID: 33313965 PMCID: PMC8128789 DOI: 10.1007/s00330-020-07447-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Purpose To analyze whether the T1 relaxation time of the liver is a good predictor of significant liver fibrosis and whether normalization to the blood pool improves the predictive value. Methods This prospective study was conducted between 03/2016 and 02/2018. One hundred seventy-three patients underwent multiparametric liver MRI at 3 T. The T1 relaxation time was measured in the liver and the spleen, in the aorta, the portal vein, and the inferior vena cava (IVC). T1 relaxation times with and without normalization to the blood pool were compared between patients with (n = 26) and without (n = 141) significant liver fibrosis, based on a cutoff value of 3.5 kPa in MRE as the noninvasive reference standard. For statistics, Student’s t test, receiver operating characteristic (ROC) curve analysis, and Pearson’s correlation were used. Results The T1 relaxation time of the liver was significantly longer in patients with liver fibrosis, both with and without blood pool normalization (p < 0.001). T1 relaxation time of the liver allowed prediction of significant liver fibrosis (AUC = 0.88), while normalization to the IVC resulted in a slightly lower performance (AUC = 0.82). The lowest performance was achieved when the T1 relaxation times of the liver were normalized to the aorta (AUC = 0.66) and to the portal vein (AUC = 0.62). The T1 relaxation time of the spleen detected significant liver fibrosis with an AUC of 0.68, and 0.51–0.64 with normalization to the blood pool. Conclusion The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. However, normalization of the blood pool did not improve the predictive value. Key Points • The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. • Normalization to the blood pool did not improve the predictive value of T1 mapping. • If the blood pool normalization was weighted 30% to the aorta and 70% to the portal vein, the performance was better than normalization to the aorta alone but still lower than normalization to the IVC.
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Affiliation(s)
- Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Laukamp KR, Ho V, Obmann VC, Herrmann K, Gupta A, Borggrefe J, Lennartz S, Große Hokamp N, Ramaiya N. Virtual non-contrast for evaluation of liver parenchyma and vessels: results from 25 patients using multi-phase spectral-detector CT. Acta Radiol 2020; 61:1143-1152. [PMID: 31856581 DOI: 10.1177/0284185119893094] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/20/2022]
Abstract
BACKGROUND In abdominal imaging, contrast-enhanced computed tomography (CT) examinations are most commonly applied; however, unenhanced examinations are still needed for several clinical questions but require additional scanning and radiation exposure. PURPOSE To evaluate accuracy of virtual non-contrast (VNC) from arterial and venous phase spectral-detector CT (SDCT) scans compared to true-unenhanced (TNC) images for the evaluation of liver parenchyma and vessels. MATERIAL AND METHODS A total of 25 patients undergoing triphasic SDCT examinations were included. VNC was reconstructed from arterial and venous phases and compared to TNC images. Quantitative image analysis was performed by region of interest (ROI)-based assessment of mean and SD of attenuation (HU) in each liver segment, spleen, portal vein, common hepatic artery, and abdominal aorta. Subjectively, iodine subtraction and diagnostic assessment were rated on 5-point Likert scales. RESULTS Attenuation and image noise measured in the liver from VNC were not significantly different from TNC (TNC: 54.6 ± 10.8 HU, VNC arterial phase: 55.7 ± 10.8 HU; VNC venous phase: 58.3 ± 10.0 HU; P > 0.05). VNC also showed accurate results regarding attenuation and image noise for spleen, portal vein, and abdominal aorta. Only iodine subtraction in the common hepatic artery in the arterial phase was insufficient which was confirmed by the subjective reading. Apart from that, subjective reading showed accurate iodine subtraction and comparable diagnostic assessment. CONCLUSION VNC from the arterial and venous phases were very similar to TNC yielding mostly negligible differences in attenuation, image noise, and diagnostic utility. Inadequate iodine subtraction occurred in hepatic arteries in the arterial phase.
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Affiliation(s)
- Kai Roman Laukamp
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vivian Ho
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
| | - Verena Carola Obmann
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland
| | - Karin Herrmann
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
| | - Amit Gupta
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
| | - Jan Borggrefe
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikhil Ramaiya
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
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Laukamp KR, Große Hokamp N, Alabar O, Obmann VC, Lennartz S, Zopfs D, Gilkeson R, Ramaiya N, Gupta A. Metal artifacts from sternal wires: evaluation of virtual monoenergetic images from spectral-detector CT for artifact reduction. Clin Imaging 2020; 60:249-256. [DOI: 10.1016/j.clinimag.2019.12.018] [Citation(s) in RCA: 3] [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] [Received: 05/07/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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Laukamp KR, Gupta A, Große Hokamp N, Obmann VC, Graner FP, Ho V, Ros P, Ramaiya N, Gilkeson R. Role of spectral-detector CT in reduction of artifacts from contrast media in axillary and subclavian veins: single institution study in 50 patients. Acta Radiol 2020; 61:450-460. [PMID: 31423809 DOI: 10.1177/0284185119868904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background In CT imaging, a high concentration of iodinated contrast media in axillary and subclavian veins after brachial application can cause perivenous artifacts impairing diagnostic assessment of local vascular structures and soft tissue. Purpose To investigate reduction of perivenous hypo- and hyperattenuating artifacts of the axillary and subclavian veins using virtual monoenergetic images (VMI) in comparison to conventional CT images (CI), acquired on spectral-detector CT. Material and Methods 50 spectral-detector CT datasets of patients with perivenous artifacts from contrast media were included in this retrospective, institutional review board-approved study. CT images and virtual monoenergetic images (range 40–200 keV, 10-keV increments) were reconstructed from the same scans. Quantitative analysis was performed by region of interest-based assessment of mean attenuation (HU) and standard deviation in most pronounced hypo- and hyperdense artifacts and artifact-impaired arteries as well as muscle. Visually, artifact reduction, assessment of vessels, and surrounding soft tissue were rated on 5-point Likert-scales by two radiologists. Results In comparison to CT images, virtual monoenergetic images of ≥90 keV showed a significant reduction of hypo- and hyperattenuating artifacts (hypodense: CI -220.0±171.2 HU; VMI130keV -13.4±49.1 HU; hyperdense: CI 274.6±184.4 HU; VMI130keV 24.2±84.9 HU; P<0.001). Subjective analysis confirmed that virtual-monoenergetic images of ≥100 keV significantly reduced artifacts (hypodense: CI 2[1–3]; VMI130keV 5[4–5], hyperdense: CI 2[1–4]; VMI130keV 5[5–5], P<0.001) and improved diagnostic assessment. Best results for diagnostic assessment were noted for virtual monoenergetic images at 130 keV. Overcorrection of artifacts was observed at higher keV values. Interrater agreement was excellent for each evaluation and keV value (intraclass correlation coefficient 0.89). Conclusion Higher keV virtual monoenergetic images yielded significant reduction of contrast media artifacts and led to improved assessment of vessels and surrounding soft tissue. Recommended keV values for best diagnostic assessment are in the range of 100–160 keV.
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Affiliation(s)
- Kai Roman Laukamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Nils Große Hokamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Verena Carola Obmann
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Intitute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Switzerland
| | - Frank Philipp Graner
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Vivian Ho
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Pablo Ros
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
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Obmann VC, Mertineit N, Marx C, Berzigotti A, Ebner L, Heverhagen JT, Christe A, Huber AT. Liver MR relaxometry at 3T - segmental normal T 1 and T 2* values in patients without focal or diffuse liver disease and in patients with increased liver fat and elevated liver stiffness. Sci Rep 2019; 9:8106. [PMID: 31147588 PMCID: PMC6542826 DOI: 10.1038/s41598-019-44377-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/10/2019] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance (MR) T1 and T2* mapping allows quantification of liver relaxation times for non-invasive characterization of diffuse liver disease. We hypothesized that liver relaxation times are not only influenced by liver fibrosis, inflammation and fat, but also by air in liver segments adjacent to the lung – especially in MR imaging at 3T. A total of 161 study participants were recruited, while 6 patients had to be excluded due to claustrophobia or technically uninterpretable MR elastography. Resulting study population consisted of 12 healthy volunteers and 143 patients who prospectively underwent multiparametric MR imaging at 3T. Of those 143 patients, 79 had normal liver stiffness in MR elastography (shear modulus <2.8 kPa, indicating absence of fibrosis) and normal proton density fat fraction (PDFF < 10%, indicating absence of steatosis), defined as reference population. T1 relaxation times in these patients were significantly shorter in liver segments adjacent to the lung than in those not adjacent to the lung (p < 0.001, mean of differences 33 ms). In liver segments not adjacent to the lung, T1 allowed to differentiate significantly between the reference population and patients with steatosis and/or fibrosis (p ≤ 0.011), while there was no significant difference of T1 between the reference population and healthy volunteers. In conclusion, we propose to measure T1 relaxation times in liver segments not adjacent to the lung. Otherwise, we recommend taking into account slightly shorter T1 values in liver segments adjacent to the lung.
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Affiliation(s)
- V C Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - N Mertineit
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - C Marx
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, INO A, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - L Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - J T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Obmann VC, Klink T, Heverhagen JT, Stork A, Laqmani A, Adam G, Begemann PGC. Impact of Hybrid Iterative Reconstruction on Agatston Coronary Artery Calcium Scores in Comparison to Filtered Back Projection in Native Cardiac CT. ROFO-FORTSCHR RONTG 2015; 187:372-9. [PMID: 25962672 DOI: 10.1055/s-0034-1398850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate whether the effects of hybrid iterative reconstruction (HIR) on coronary artery calcium (CAC) measurements using the Agatston score lead to changes in assignment of patients to cardiovascular risk groups compared to filtered back projection (FBP). MATERIALS AND METHODS 68 patients (mean age 61.5 years; 48 male; 20 female) underwent prospectively ECG-gated, non-enhanced, cardiac 256-MSCT for coronary calcium scoring. Scanning parameters were as follows: Tube voltage, 120 kV; Mean tube current time-product 63.67 mAs (50 - 150 mAs); collimation, 2 × 128 × 0.625 mm. Images were reconstructed with FBP and with HIR at all levels (L1 to L7). Two independent readers measured Agatston scores of all reconstructions and assigned patients to cardiovascular risk groups. Scores of HIR and FBP reconstructions were correlated (Spearman). Interobserver agreement and variability was assessed with ĸ-statistics and Bland-Altmann-Plots. RESULTS Agatston scores of HIR reconstructions were closely correlated with FBP reconstructions (L1, R = 0.9996; L2, R = 0.9995; L3, R = 0.9991; L4, R = 0.986; L5, R = 0.9986; L6, R = 0.9987; and L7, R = 0.9986). In comparison to FBP, HIR led to reduced Agatston scores between 97 % (L1) and 87.4 % (L7) of the FBP values. Using HIR iterations L1 - L3, all patients were assigned to identical risk groups as after FPB reconstruction. In 5.4 % of patients the risk group after HIR with the maximum iteration level was different from the group after FBP reconstruction. CONCLUSION There was an excellent correlation of Agatston scores after HIR and FBP with identical risk group assignment at levels 1 - 3 for all patients. Hence it appears that the application of HIR in routine calcium scoring does not entail any disadvantages. Thus, future studies are needed to demonstrate whether HIR is a reliable method for reducing radiation dose in coronary calcium scoring.
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Affiliation(s)
- V C Obmann
- University Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital - University Hospital Bern, Switzerland
| | - T Klink
- Institute of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - J T Heverhagen
- University Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital - University Hospital Bern, Switzerland
| | - A Stork
- Röntgeninstitut Düsseldorf, Düsseldorf, Germany
| | - A Laqmani
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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