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Journal of Computer Assisted Tomography
Journal Prestige (SJR): 0.648  Citation Impact (citeScore): 1 Number of Followers: 2  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0363-8715 - ISSN (Online) 1532-3145 Published by LWW Wolters Kluwer  [330 journals]
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- Can Anterior Osteophyte Fractures Be Distinguished From Fracture Mimics in
the Subaxial Cervical Spine' A Retrospective Analysis Evaluating Reported
Fractures With Clinical Management Correlation-
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Authors: Rao; Dinesh; Godreau, Jean-Paul; Jenson, Matthew; Rahmathulla, Gazanfar; Fiester, Peter; Patel, Jeet; Hernandez, Mauricio
Abstract:
Objective This study aimed to retrospectively distinguish true- from false-positive fractures of anterior subaxial cervical osteophytes, which were reported on noncontrast computed tomography reports, and to correlate the imaging findings with patient symptoms and analyze the downstream impact on management of both true and false positive fractures.Methods A total of 127 patients had computed tomography reports of anterior osteophyte fractures. Radiology reports and imaging studies were evaluated to distinguish true fractures from fracture mimics. We analyzed imaging features including rigid spine (RS), prevertebral soft tissue swelling (PVSTS), and instability. We categorized symptoms and examination findings into 3 groups (0, asymptomatic; 1, neck pain; 2, neurological symptoms). Management was categorized into 3 groups (0, no treatment; 1, external bracing; 2, surgery). Associations between imaging features, fracture classification, clinical symptoms, magnetic resonance imaging utilization, and management were calculated using χ2 with Cramer V test to determine effect size.Results Eighty patients had false-positive fractures, and 47 were true positive. There were significant associations between magnetic resonance imaging utilization and fracture classification (P ≤ 0.001), PVSTS (P ≤ 0.005), patient symptoms (P ≤ 0.001), and patient management (P ≤ 0.001). There were significant associations between patient management and fracture classification (P ≤ 0.001), patient symptoms (P ≤ 0.001), PVSTS (P ≤ 0.001), imaging findings of instability (P ≤ 0.001), and RS (P ≤ 0.021). There were significant associations between fracture classification and patient symptoms (P ≤ 0.045), and RS (P ≤ 0.006).Conclusions Subaxial isolated anterior osteophyte fractures fell into 3 major categories. By our methodology, if a suspected fracture was determined to be a fracture mimic in an asymptomatic patient, it was unlikely to be clinically significant. Isolated anterior osteophyte fractures without neurological symptoms or more concerning imaging findings can be treated conservatively. Finally, fractures that demonstrate indirect signs of instability or are associated with RS are more associated with surgical management.
PubDate: Mon, 01 May 2023 00:00:00 GMT-
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- Feasibility of Bone Mineral Density and Bone Microarchitecture Assessment
Using Deep Learning With a Convolutional Neural Network-
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Authors: Yoshida; Kazuki; Tanabe, Yuki; Nishiyama, Hikaru; Matsuda, Takuya; Toritani, Hidetaka; Kitamura, Takuya; Sakai, Shinichiro; Watamori, Kunihiko; Takao, Masaki; Kimura, Eizen; Kido, Teruhito
Abstract:
Objectives We evaluated the feasibility of using deep learning with a convolutional neural network for predicting bone mineral density (BMD) and bone microarchitecture from conventional computed tomography (CT) images acquired by multivendor scanners.Methods We enrolled 402 patients who underwent noncontrast CT examinations, including L1–L4 vertebrae, and dual-energy x-ray absorptiometry (DXA) examination. Among these, 280 patients (3360 sagittal vertebral images), 70 patients (280 sagittal vertebral images), and 52 patients (208 sagittal vertebral images) were assigned to the training data set for deep learning model development, the validation, and the test data set, respectively. Bone mineral density and the trabecular bone score (TBS), an index of bone microarchitecture, were assessed by DXA. BMDDL and TBSDL were predicted by deep learning with a convolutional neural network (ResNet50). Pearson correlation tests assessed the correlation between BMDDL and BMD, and TBSDL and TBS. The diagnostic performance of BMDDL for osteopenia/osteoporosis and that of TBSDL for bone microarchitecture impairment were evaluated using receiver operating characteristic curve analysis.Results BMDDL and BMD correlated strongly (r = 0.81, P < 0.01), whereas TBSDL and TBS correlated moderately (r = 0.54, P < 0.01). The sensitivity and specificity of BMDDL for identifying osteopenia or osteoporosis were 93% and 90%, and 100% and 94%, respectively. The sensitivity and specificity of TBSDL for identifying patients with bone microarchitecture impairment were 73% for all values.Conclusions The BMDDL and TBSDL derived from conventional CT images could identify patients who should undergo DXA, which could be a gatekeeper tool for detecting latent osteoporosis/osteopenia or bone microarchitecture impairment.
PubDate: Mon, 01 May 2023 00:00:00 GMT-
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- A Characterization of Deep Learning Reconstruction Applied to Dual-Energy
Computed Tomography Monochromatic and Material Basis Images-
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Authors: Nikolau; Ethan P.; Toia, Giuseppe V.; Nett, Brian; Tang, Jie; Szczykutowicz, Timothy P.
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Objective Advancements in computed tomography (CT) reconstruction have enabled image quality improvements and dose reductions. Previous advancements have included iterative and model-based reconstruction. The latest image reconstruction advancement uses deep learning, which has been evaluated for polychromatic imaging only. This article characterizes a commercially available deep learning imaging reconstruction applied to dual-energy CT.Methods Monochromatic, iodine basis, and water basis images were reconstructed with filtered back projection (FBP), iterative (ASiR-V), and deep learning (DLIR) methods in a phantom experiment. Slice thickness, contrast-to-noise ratio, modulation transfer function, and noise power spectrum metrics were used to characterize ASiR-V and DLIR relative to FBP over a range of dose levels, phantom sizes, and iodine concentrations.Results Slice thicknesses for ASiR-V and DLIR demonstrated no statistically significant difference relative to FBP for all measurement conditions. Contrast-to-noise ratio performance for DLIR-high and ASiR-V 40% at 2 mg I/mL on 40-keV images were 162% and 30% higher than FBP, respectively. Task-based modulation transfer function measurements demonstrated no clinically significant change between FBP and ASiR-V and DLIR on monochromatic or iodine basis images.Conclusions Deep learning image reconstruction enabled better image quality at lower monochromatic energies and on iodine basis images where image contrast is maximized relative to polychromatic or high-energy monochromatic images. Deep learning image reconstruction did not demonstrate thicker slices, decreased spatial resolution, or poor noise texture (ie, “plastic”) relative to FBP.
PubDate: Wed, 22 Mar 2023 00:00:00 GMT-
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- Discrimination of Liver Metastases of Digestive System Neuroendocrine
Tumors From Neuroendocrine Carcinoma by Computed Tomography–Based
Radiomics Analysis-
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Authors: Gu; Xiao-Lei; Cui, Yong; Zhu, Hai-Tao; Li, Xiao-Ting; Pei, Xiang; He, Xiao-Xiao; Yang, Li; Lu, Ming; Li, Zhong-Wu; Sun, Ying-Shi
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Objective The aim of the study is to investigate the value of computed tomography (CT) radiomics features to discriminate the liver metastases (LMs) of digestive system neuroendocrine tumors (NETs) from neuroendocrine carcinoma (NECs).Methods Ninety-nine patients with LMs of digestive system neuroendocrine neoplasms from 2 institutions were included. Radiomics features were extracted from the portal venous phase CT images by the Pyradiomics and then selected by using the t test, Pearson correlation analysis, and least absolute shrinkage and selection operator method. The radiomics score (Rad score) for each patient was constructed by linear combination of the selected radiomics features. The radiological model was constructed by radiological features using the multivariable logistic regression. Then, the combined model was constructed by combining Rad score and the radiological model into logistic regression. The performance of all models was evaluated by the receiver operating characteristic curves with the area under curve (AUC).Results In the radiological model, only the enhancement degree (odds ratio, 8.299; 95% confidence interval, 2.070–32.703; P = 0.003) was an independent predictor for discriminating the LMs of digestive system NETs from those of NECs. The combined model constructed by the Rad score in combination with the enhancement degree showed good discrimination performance, with AUCs of 0.893, 0.841, and 0.740 in the training, testing, and external validation groups, respectively. In addition, it performed better than radiological model in the training and testing groups (AUC, 0.893 vs 0.726; AUC, 0.841 vs 0.621).Conclusions The CT radiomics might be useful for discrimination LMs of digestive system NECs from NETs.
PubDate: Thu, 09 Mar 2023 00:00:00 GMT-
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- Carotid Plaque Diagnosis With 3-Dimensional Computed Tomography
Angiography: A Comparison With Magnetic Resonance Imaging–Based Plaque
Diagnosis-
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Authors: Omi; Tatsuo; Hayakawa, Motoharu; Adachi, Kazuhide; Ohba, Shigeo; Sadato, Akiyo; Hasebe, Akiko; Ishihara, Takuma; Nakahara, Ichiro; Hirose, Yuichi
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Objective Although a qualitative diagnosis of plaque causing carotid stenosis has been attempted with carotid computed tomography angiography (CaCTA), no clear findings have been reported. We examined the correlation between the plaque CT values and plaque images obtained by magnetic resonance imaging to derive a qualitative diagnosis of the plaque using CaCTA.Methods Preoperative CaCTA images acquired from patients stented for carotid stenosis were retrospectively analyzed with respect to magnetization-prepared rapid acquisition with gradient echo and time-of-flight magnetic resonance angiography data. Carotid plaques in the stenosed region were quantified in terms of CT density and the plaque/muscle ratio (magnetization-prepared rapid acquisition with gradient echo), and correlations between these 2 features were determined. Plaques were classified as stable or unstable based on the plaque/muscle ratio, with the smallest plaque/muscle ratio observed among plaques positive for intraplaque hemorrhage set as the cutoff value (1.76).Results A total of 165 patients (179 plaques) were included. Perioperative complications included minor stroke (n = 3), major stroke (n = 1, fatal), and hyperperfusion (n = 2). The correlation between CT density and the plaque/muscle ratio was nonlinear (P = 0.0139) and negative (P < 0.0001). The cutoff point (1.76) corresponded to a CT density of 83 HU, supporting this value as a standard reference for plaque stability.Conclusions Computed tomography density exhibits a nonlinear (P = 0.0139) and highly negative correlation (P < 0.0001) with the plaque/muscle ratio. Our results demonstrate that plaque characteristics can be meaningfully diagnosed based on CaCTA image data.
PubDate: Thu, 09 Mar 2023 00:00:00 GMT-
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- Computer-Aided Detection of Subsolid Nodules on Chest Computed Tomography:
Assessment of Visualization on Vessel-Suppressed Images-
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Authors: Yoshida; Kotaro; Takamatsu, Atsushi; Toshima, Fumihito; Kozaka, Kazuto; Kitagawa, Taichi; Kobayashi, Takeshi; Gabata, Toshifumi
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Objectives This study aimed to clarify the performance of automatic detection of subsolid nodules by commercially available software on computed tomography (CT) images of various slice thicknesses and compare it with visualization on the accompanying vessel-suppression CT (VS-CT) images.Methods A total of 95 subsolid nodules from 84 CT examinations of 84 patients were included. The reconstructed CT image series of each case with 3-, 2-, and 1-mm slice thicknesses were loaded into a commercially available software application (ClearRead CT) for automatic detection of subsolid nodules and generation of VS-CT images. Automatic nodule detection sensitivity was assessed for 95 nodules on each series of images acquired at 3 slice thicknesses. Four radiologists subjectively evaluated visual assessment of the nodules on VS-CT.Results ClearRead CT automatically detected 69.5% (66/95 nodules), 68.4% (65/95 nodules), and 70.5% (67/95 nodules) of all subsolid nodules in 3-, 2-, and 1-mm slices, respectively. The detection rate was higher for part-solid nodules than for pure ground-glass nodules at all slice thicknesses. In the visualization assessment on VS-CT, 3 nodules at each slice thickness (3.2%) were judged as invisible, while 26 of 29 (89.7%), 27 of 30 (90.0%), and 25 of 28 (89.3%) nodules, which were missed by computer-aided detection, were judged as visible in 3-, 2-, and 1-mm slices, respectively.Conclusions The automatic detection rate of subsolid nodules by ClearRead CT was approximately 70% at all slice thicknesses. More than 95% of subsolid nodules were visualized on VS-CT, including nodules undetected by the automated software. Computed tomography acquisition at slices thinner than 3 mm did not confer any benefits.
PubDate: Fri, 03 Mar 2023 00:00:00 GMT-
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- The Computed Tomography Findings and Follow-up Course of Pulmonary
Nocardiosis-
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Authors: Su; Ruihua; Wen, Yanhua; Liufu, Yuling; Pan, Xiaohuan; Guan, Yubao
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Objective Our study aimed to elucidate the computed tomography (CT) features and follow-up course of pulmonary nocardiosis patients to improve the understanding and diagnostic accuracy of this disease.Methods The chest CT findings and clinical data of patients diagnosed with pulmonary nocardiosis by culture or histopathological examination in our hospital between 2010 and 2019 were retrospectively analyzed.Results A total of 34 cases of pulmonary nocardiosis were included in our study. Thirteen patients were on long-term immunosuppressant therapy, among whom 6 had disseminated nocardiosis. Among the immunocompetent patients, 16 had chronic lung diseases or a history of trauma. Multiple or solitary nodules represented the most common CT feature (n = 32, 94.12%), followed by ground-glass opacities (n = 26, 76.47%), patchy consolidations (n = 25, 73.53%), cavitations (n = 18, 52.94%), and masses (n = 11, 32.35%). There were 20 cases (61.76%) with mediastinal and hilar lymphadenopathy, 18 (52.94%) with pleural thickening, 15 (44.12%) with bronchiectasis, and 13 (38.24%) with pleural effusion. Significantly higher rates of cavitations were observed among immunosuppressed patients (85% vs 29%, P = 0.005). At follow-up, 28 patients (82.35%) clinically improved with treatment, while 5 (14.71%) had disease progression, and 1 (2.94%) died.Conclusions Chronic structural lung diseases and long-term immunosuppressant use were found as risk factors for pulmonary nocardiosis. While the CT manifestations were highly heterogeneous, clinical suspicion should be raised upon findings of coexisting nodules, patchy consolidations, and cavitations, particularly in the presence of extrapulmonary infections such as those of the brain and subcutaneous tissues. A significant incidence of cavitations may be observed among immunosuppressed patients.
PubDate: Fri, 03 Mar 2023 00:00:00 GMT-
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- How Do Cancer-Specific Computed Tomography Protocols Compare With the
American College of Radiology Dose Index Registry' An Analysis of Computed
Tomography Dose at 2 Cancer Centers-
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Authors: Szczykutowicz; Timothy P.; Ahmad, Moiz; Liu, Xinming; Pozniak, Myron A.; Lubner, Meghan G.; Jensen, Corey T.
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Background Little guidance exists on how to stratify radiation dose according to diagnostic task. Changing dose for different cancer types is currently not informed by the American College of Radiology Dose Index Registry dose survey.Methods A total of 9602 patient examinations were pulled from 2 National Cancer Institute designated cancer centers. Computed tomography dose (CTDIvol) was extracted, and patient water equivalent diameter was calculated. N-way analysis of variance was used to compare the dose levels between 2 protocols used at site 1, and three protocols used at site 2.Results Sites 1 and 2 both independently stratified their doses according to cancer indications in similar ways. For example, both sites used lower doses (P < 0.001) for follow-up of testicular cancer, leukemia, and lymphoma. Median dose at median patient size from lowest to highest dose level for site 1 were 17.9 (17.7–18.0) mGy (mean [95% confidence interval]) and 26.8 (26.2–27.4) mGy. For site 2, they were 12.1 (10.6–13.7) mGy, 25.5 (25.2–25.7) mGy, and 34.2 (33.8–34.5) mGy. Both sites had higher doses (P < 0.001) between their routine and high-image-quality protocols, with an increase of 48% between these doses for site 1 and 25% for site 2. High-image-quality protocols were largely applied for detection of low-contrast liver lesions or subtle pelvic pathology.Conclusions We demonstrated that 2 cancer centers independently choose to stratify their cancer doses in similar ways. Sites 1 and 2 dose data were higher than the American College of Radiology Dose Index Registry dose survey data. We thus propose including a cancer-specific subset for the dose registry.
PubDate: Fri, 03 Mar 2023 00:00:00 GMT-
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- Myeloid Sarcoma: A Primer for Radiologists
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Authors: Chiu; Austin M.; Yoon, Justin G.; Tirumani, Sree H.; Ramaiya, Nikhil H.; Smith, Daniel A.
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Myeloid sarcoma (MS) is a rare extramedullary neoplasm that can present in association with acute myeloid leukemia, most commonly in children younger than 15 years. This unique extramedullary malignancy may involve a variety of different organ systems and can present following, preceding, simultaneous with, or in insolation to acute myeloid leukemia. Common areas of extramedullary involvement include soft tissues, bones, lymph nodes, and the peritoneum. Imaging plays a critical role in the diagnosis and management of MS, with commonly used modalities including positron emission tomography-computed tomography, magnetic resonance imaging, computerized tomography, and ultrasound. The purpose of this review article is to provide radiologists with a comprehensive guide summarizing the relevant imaging and clinical features of MS, with emphasis on the role of imaging in the diagnosis, treatment, and follow-up of patients with MS. The relevant pathophysiology, epidemiology, clinical presentations, and differential diagnosis of MS will be reviewed. The relevance of different imaging modalities in diagnosis, monitoring of treatment response, and assessment of treatment-related complications will also be outlined. Through summarizing these topics, this review article aims to provide radiologists with a guide for understanding the existing knowledge of MS in the literature and the current role of imaging in the management of this unique malignancy.
PubDate: Fri, 03 Mar 2023 00:00:00 GMT-
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- Comparison of 3 CT Perfusion Software Packages in Estimation of Ischemic
Lesions in Acute Ischemic Stroke Patients-
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Authors: Li; Xiang; Zeng, Chen; Li, Yige; Liu, Huan; Liu, Ling; Zeng, Wenbing; Yang, Ran
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Objective The aim of this study was to compare 3 computed tomography perfusion (CTP) software packages in the estimation of infarct core volumes, hypoperfusion volumes, and mismatch volumes.Methods Forty-three patients with large vessel occlusion in the anterior circulation who underwent CTP imaging were postprocessed by 3 software packages: RAPID, advantage workstation (AW), and NovoStroke Kit (NSK). Infarct core volumes and hypoperfusion volumes were generated by RAPID with default settings. The AW and NSK threshold settings were the following: infarct core (cerebral blood flow [CBF]
PubDate: Fri, 03 Mar 2023 00:00:00 GMT-
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- Can 3-Phase Computed Tomography Urography Be Used to Characterize Adrenal
Nodules' Results in 145 Patients-
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Authors: Franco; Felipe B.; Souza, Daniel A.T.; Glazer, Daniel I.; Ali, Naiim S.; Mayo-Smith, William W.
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Objective The aim of the study is to determine whether computed tomography (CT) urography (CTU) can characterize incidental adrenal nodules.Methods This retrospective cohort study was performed at an academic medical center. Patients were identified by free text search of CTU reports that contained the terms “adrenal mass” “adrenal nodule” and “adrenal lesion.” Computed tomography urography technique consisted of unenhanced images and postcontrast images obtained at 100 seconds and 15 minutes. The final cohort included 145 patients with 151 adrenal nodules. Nodules were considered lipid-rich adenomas or myelolipomas based on unenhanced imaging characteristics. Absolute and relative washout values were calculated for the remaining nodules, using a cutoff of 60% and 40%, respectively, to diagnose adenomas. Reference standard for lipid-poor adenomas and malignant nodules was histopathology or imaging/clinical follow-up. Mann-Whitney U test was used for comparison of continuous variables, and Fisher exact test was used for categorical variables.Results One hundred nodules were lipid-rich adenomas and 3 were myelolipomas. Forty-eight nodules were indeterminate at unenhanced CT, corresponding to 39 lipid-poor adenomas and 9 malignant nodules based on reference standards. Both absolute and relative washout correctly characterized 71% of nodules (34/48), with a sensitivity of 67% and specificity of 89%. Overall, 91% of all adrenal nodules (137/151) were correctly characterized by CTU alone. Lipid-poor adenomas were smaller than malignant nodules (P < 0.01) and were lower in attenuation on unenhanced and delayed images (P < 0.01).Conclusions Adrenal nodules detected at 3-phase CTU can be accurately characterized, potentially eliminating the need for subsequent adrenal protocol CT or magnetic resonance imaging.
PubDate: Fri, 10 Feb 2023 00:00:00 GMT-
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- Differentiating Benign From Malignant Cystic Renal Masses: A Feasibility
Study of Computed Tomography Texture-Based Machine Learning Algorithms-
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Authors: Miskin; Nityanand; Qin, Lei; Silverman, Stuart G.; Shinagare, Atul B.
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Objective The Bosniak classification attempts to predict the likelihood of renal cell carcinoma (RCC) among cystic renal masses but is subject to interobserver variability and often requires multiphase imaging. Artificial intelligence may provide a more objective assessment. We applied computed tomography texture–based machine learning algorithms to differentiate benign from malignant cystic renal masses.Methods This is an institutional review board–approved, Health Insurance Portability and Accountability Act–compliant retrospective study of 147 patients (mean age, 62.4 years; range, 28–89 years; 94 men) with 144 cystic renal masses (93 benign, 51 RCC); 69 were pathology proven (51 RCC, 18 benign), and 75 were considered benign based on more than 4 years of stability at follow-up imaging. Using a single image from a contrast-enhanced abdominal computed tomography scan, mean, SD, mean value of positive pixels, entropy, skewness, and kurtosis radiomics features were extracted. Random forest, multivariate logistic regression, and support vector machine models were used to classify each mass as benign or malignant with 10-fold cross validation. Receiver operating characteristic curves assessed algorithm performance in the aggregated test data.Results For the detection of malignancy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were 0.61, 0.87, 0.72, 0.80, and 0.79 for the random forest model; 0.59, 0.87, 0.71, 0.79, and 0.80 for the logistic regression model; and 0.55, 0.86, 0.68, 0.78, and 0.76 for the support vector machine model.Conclusion Computed tomography texture–based machine learning algorithms show promise in differentiating benign from malignant cystic renal masses. Once validated, these may serve as an adjunct to radiologists' assessments.
PubDate: Fri, 10 Feb 2023 00:00:00 GMT-
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- Three-Dimensional Gradient-Echo–Based Amide Proton Transfer-Weighted
Imaging of Brain Tumors: Comparison With Two-Dimensional Spin-Echo–Based
Amide Proton Transfer-Weighted Imaging-
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Authors: Murayama; Kazuhiro; Ohno, Yoshiharu; Yui, Masao; Yamamoto, Kaori; Ikedo, Masato; Ohba, Shigeo; Hanamatsu, Satomu; Iwase, Akiyoshi; Ikeda, Hirotaka; Hirose, Yuichi; Toyama, Hiroshi
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Objective Although amide proton transfer–weighted (APTw) imaging is reported by 2-dimensional (2D) spin-echo–based sequencing, 3-dimensional (3D) APTw imaging can be obtained by gradient-echo–based sequencing. The purpose of this study was to compare the efficacy of APTw imaging between 2D and 3D imaging in patients with various brain tumors.Methods A total of 49 patients who had undergone 53 examinations [5 low-grade gliomas (LGG), 16 high-grade gliomas (HGG), 6 malignant lymphomas, 4 metastases, and 22 meningiomas] underwent APTw imaging using 2D and 3D sequences. The magnetization transfer ratio asymmetry (MTRasym) was assessed by means of region of interest measurements. Pearson correlation was performed to determine the relationship between MTRasym for the 2 methods, and Student's t test to compare MTRasym for LGG and HGG. The diagnostic accuracy to differentiate HGG from LGG of the 2 methods was compared by means of the McNemar test.Results Three-dimensional APTw imaging showed a significant correlation with 2D APTw imaging (r = 0.79, P < 0.0001). The limits of agreement between the 2 methods were −0.021 ± 1.42%. The MTRasym of HGG (2D: 1.97 ± 0.96, 3D: 2.11 ± 0.95) was significantly higher than those of LGG (2D: 0.46 ± 0.89%, P < 0.01; 3D: 0.15 ± 1.09%, P < 0.001). The diagnostic performance of the 2 methods to differentiate HGG from LGG was not significantly different (P = 1).Conclusions The potential capability of 3D APTw imaging is equal to or greater than that of 2D APTw imaging and is considered at least as valuable in patients with brain tumors.
PubDate: Fri, 10 Feb 2023 00:00:00 GMT-
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- Imaging Gallbladder Lesions: What Can Positron Emission
Tomography/Computed Tomography Add to the Conventional Imaging Approach'-
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Authors: Sabaté-Llobera; Aida; Reynés-Llompart, Gabriel; Mestres-Martí, Judit; Gràcia-Sánchez, Laura; Lladó, Laura; Serrano, Teresa; Ramos, Emilio; Cortés-Romera, Montserrat
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Objective Incidental gallbladder lesions are common in imaging studies, although it is not always easy to discriminate benign lesions from gallbladder cancer with conventional imaging procedures. The present study aims to assess the capacity of positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG to distinguish between benign and malignant pathology of the gallbladder, compared with conventional imaging techniques (contrast-enhanced CT or magnetic resonance imaging).Methods Positron emission tomography/CT and conventional imaging studies of 53 patients with gallbladder lesions were evaluated and visually classified as benign, malignant, or inconclusive. Agreement between PET/CT and conventional imaging was determined, and imaging findings were correlated with histology or follow-up. Positron emission tomography/CT images were also analyzed semiquantitatively (SUVmax and maximum tumor-to-liver ratio [TLRmax]). The presence of adenopathies and distant metastases was assessed and compared between both imaging procedures.Results According to histology or follow-up, 33 patients (62%) had a malignant process and 20 (38%) had benign lesions. Positron emission tomography/CT and conventional imaging showed a moderate agreement (κ = 0.59). Conventional imaging classified more studies as inconclusive compared with PET/CT (17.0% and 7.5%, respectively), although both procedures showed a similar accuracy. Malignant lesions had significantly higher SUVmax and, especially, TLRmax (0.89 and 2.38 [P = 0.00028] for benign and malignant lesions, respectively). Positron emission tomography/CT identified more pathologic adenopathies and distant metastases, and patients with regional or distant spread had higher SUVmax and TLRmax in the gallbladder.Conclusions Positron emission tomography/CT is accurate to distinguish between benign and malignant pathology of the gallbladder, with a similar performance to conventional imaging procedures but with less inconclusive results. Malignant lesions present higher SUVmax and TLRmax values.
PubDate: Sat, 28 Jan 2023 00:00:00 GMT-
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- Computed Tomography Coronary Angiography on a Detector-Based Spectral
Computed Tomography Platform: Evaluation of Patients With Coronary Artery
Disease Reporting and Data System Score of 3 and Higher-
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Authors: Igi; Mae; Miller, Jenna; Sayers, Kia; Smith, David L.; Toshav, Aran; Batte, Catherine; Spieler, Bradley; Danrad, Raman
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Purpose Computed tomography (CT) coronary angiography performed on a detector-based spectral scanner helps more closely approximate severity of stenosis with nuclear medicine and cardiac catheterization tests compared with single-energy CT (SECT) in patients with an original CAD-RADS score of 3 and higher.Methods This retrospective trial was conducted between January 2017 and December 2019 and included 52 patients with a CAD-RADS score of 3 and higher. Two reading sessions were performed 6 weeks apart. The first reading session was performed using only conventional images and the second reading session was performed using spectral results. Detector-based spectral CT CAD-RADS scores were compared with cardiac stress test and/or cardiac catheterization results for final characterization of stenosis in 41 segments from 32 patients. The mean CAD-RADS score was calculated for both the conventional images and spectral images.Results The CAD-RADS score for SECT and the score for spectral CT for the 41 segments were compared. Available associated stress test and/or cardiac catheterization results were also compared with CAD-RADS scores. In 51% (21/41), a diagnosis concordant with best practices results was achieved with the help of spectral CT results. A mean CAD-RADS score of 3.56 was obtained using spectral results, compared with 3.93 using conventional images. A 2-tailed paired t test determined the difference to be significant with a P value of 0.007.Conclusions Computed tomography coronary angiography is feasible on a detector-based spectral CT scanner and can improve diagnostic confidence over SECT angiography in patients with an original CAD-RADS score of 3 and higher.
PubDate: Sat, 28 Jan 2023 00:00:00 GMT-
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- Microsievert Wide-Volume Versus Spiral Computed Tomography Using an
Automatic Exposure Control System in the Diagnosis of Foreign Body
Aspiration in Children-
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Authors: Sade; Recep; Aydın, Yener; Pirimoglu, Berhan; Yalcin, Ahmet; Abbasguliyev, Hasan; Keskin, Halil; Polat, Gökhan; Ulas, Ali Bilal; Daharli, Coskun; Eroglu, Atila
Abstract:
Background Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA.Objective The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (μSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA.Material and Methods In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, μSv-WV-CT (2016–2021) and group B, MDCT-AEC (2013–2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared.Results The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 μSv, which was significantly lower than that of group B (179.75 ± 114.88 μSv) (P < 0.001).Conclusion In children with suspected FBA, μSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.
PubDate: Sat, 28 Jan 2023 00:00:00 GMT-
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- Prognostic Factors of Pretreatment Magnetic Resonance Imaging for
Predicting Clinical Outcome in Patients With Parotid Gland Cancer-
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Authors: Ando; Tomohiro; Kato, Hiroki; Shibata, Hirofumi; Ogawa, Takenori; Noda, Yoshifumi; Hyodo, Fuminori; Matsuo, Masayuki
Abstract:
Purpose This study aimed to assess the utility of pretreatment magnetic resonance imaging (MRI) in predicting the clinical outcomes of patients with parotid gland cancer.Methods A total of 43 patients with histopathologically confirmed primary parotid gland cancer, who underwent pretreatment MRI, were enrolled in this study. All images were retrospectively reviewed, and MRI features were evaluated as possible prognostic factors influencing the progression-free survival (PFS) using the Kaplan-Meier method and Cox proportional hazards regression model. Cox regression analysis was used to estimate the hazard ratios (HRs) with 95% confidence interval (95% CI) values.Results Kaplan-Meier survival analysis showed that old age (>73 years, P < 0.01), large maximum tumor diameter (>33 mm, P < 0.01), low apparent diffusion coefficient value (≤1.29 ×10−3 mm2/s, P < 0.01), ill-defined margin (P < 0.01), skin invasion (P < 0.01), regional nodal metastasis (P < 0.01), heterogeneous enhancement (P < 0.05), and high signal intensity ratio on gadolinium-enhanced fat-suppressed T1-weighted images (>2.017, P < 0.05) were significant predictors of worse PFS. Cox proportional hazards regression analysis revealed that regional nodal metastasis (HR, 32.02; 95% CI, 6.42–159.84; P < 0.01) and maximum tumor diameter (HR, 1.04; 95% CI, 1.01–1.08; P < 0.05) were independent predictors of PFS.Conclusion Pretreatment MRI parameters could be prognostic factors of patients with parotid gland cancer. In particular, the maximum tumor diameter and regional nodal metastasis, which were closely associated with T and N classifications, were important prognostic factors in predicting the PFS.
PubDate: Sat, 28 Jan 2023 00:00:00 GMT-
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- Differentiating Peripherally Located Pulmonary Noncalcified Hamartoma From
Carcinoid Using CT Radiomics Approaches-
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Authors: Yang; Xiaohuang; Li, Congrui; Hou, Jing; Xiong, Zhengping; Lin, Huashan; Wu, Shihang; Yu, Xiaoping
Abstract:
Objective This article aimed to differentiate noncalcified hamartoma from pulmonary carcinoid preoperatively using computed tomography (CT) radiomics approaches.Materials and Methods The unenhanced CT (UECT) and contrast-enhanced CT (CECT) data of noncalcified hamartoma (n = 73) and pulmonary carcinoid (n = 54; typical/atypical carcinoid = 13/41) were retrospectively analyzed. The patients were randomly divided into the training and validation sets. A total of 396 radiomics features were extracted from UECT and CECT, respectively. The features were selected by using the minimum redundancy maximum relevance and the least absolute shrinkage and selection operator to construct a radiomics model. Clinical factors and radiomics features were integrated to build a nomogram model. The performance of clinical factors, radiomics, and nomogram models on the differential diagnosis between noncalcified hamartoma and carcinoid were investigated. Diagnostic performance of radiologists was also explored.Result In regard to distinguishing noncalcified hamartoma from carcinoid, the areas under the receiver operating characteristic curves of the clinical, radiomics, and nomogram models were 0.88, 0.94, and 0.96 in the training set UECT, and were 0.85, 0.92, and 0.96 in the training set CECT, respectively. The areas under the curve of the 3 models were 0.89, 0.96, and 0.96 in the validation set UECT, and were 0.79, 0.90, and 0.94 in the validation set CECT, respectively. The nomogram model exhibited good calibration and was clinically useful by decision curve analysis. Nomogram did not show significant improvement compared with radiomics, neither for UECT nor for CECT. Diagnostic performance of radiologists was lower than both radiomics and nomogram model.Conclusions Radiomics approaches may be useful in distinguishing peripheral pulmonary noncalcified hamartoma from carcinoid. Radiomics features extracted from CECT provided no significant benefit when compared with UECT.
PubDate: Tue, 17 Jan 2023 00:00:00 GMT-
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- A Computed Tomography Radiomics Nomogram in Differentiating Chordoma From
Giant Cell Tumor in the Axial Skeleton-
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Authors: Nie; Pei; Zhao, Xia; Wang, Ning; Ma, Jinlong; Zuo, Panli; Hao, Dapeng; Yu, Tengbo
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Objective The aim of the study is to develop and validate a computed tomography (CT) radiomics nomogram for preoperatively differentiating chordoma from giant cell tumor (GCT) in the axial skeleton.Methods Seventy-three chordomas and 38 GCTs in axial skeleton were retrospectively included and were divided into a training cohort (n = 63) and a test cohort (n = 48). The radiomics features were extracted from CT images. A radiomics signature was developed by using the least absolute shrinkage and selection operator model, and a radiomics score (Rad-score) was acquired. By combining the Rad-score with independent clinical risk factors using multivariate logistic regression model, a radiomics nomogram was established. Calibration and receiver operator characteristic curves were used to assess the performance of the nomogram.Results Five features were selected to construct the radiomics signature. The radiomics signature showed favorable discrimination in the training cohort (area under the curve [AUC], 0.860; 95% confidence interval [CI], 0.760–0.960) and the test cohort (AUC, 0.830; 95% CI, 0.710–0.950). Age and location were the independent clinical factors. The radiomics nomogram combining the Rad-score with independent clinical factors showed good discrimination capability in the training cohort (AUC, 0.930; 95% CI, 0.880–0.990) and the test cohort (AUC, 0.980; 95% CI, 0.940–1.000) and outperformed the radiomics signature (z = 2.768, P = 0.006) in the test cohort.Conclusions The CT radiomics nomogram shows good predictive efficacy in differentiating chordoma from GCT in the axial skeleton, which might facilitate clinical decision making.
PubDate: Tue, 17 Jan 2023 00:00:00 GMT-
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- Clinical Characteristics and Computed Tomography Findings in Adult
Patients With an Aberrant Right Subclavian Artery: A Single-Center
Retrospective Cohort Study-
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Authors: Cortés; Pedro; Harris, Dana M.; Stancampiano, Fernando F.; Valery, Jose R.; Bi, Yan; Alsafi, Wail; Bakhit, Mohamed; Shaikheldin, Ahmed; Grage, Rolf A.; Stowell, Justin T.; Cid, Omar J.; Heckman, Michael G.; White, Launia; Sonavane, Sushilkumar K.
Abstract:
Objective We sought to determine the prevalence and possible features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery (ARSA).Methods In this single-center retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to assess features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively.Results The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) was the most common symptom. Interobserver agreement was acceptable with most variables having an interclass correlation coefficient or κ>0.80. A patient's height> 158 cm (OR: 2.50, P = 0.03), cross-sectional area> 60 mm2 of ARSA at the level of the esophagus (OR: 2.39, P = 0.046), and angle>108 degrees formed with the aortic arch (OR: 1.99, P = 0.03) were associated with the presence of symptoms on multivariable logistic regression. A distance increase per 1 mm between ARSA and trachea (OR: 0.85, P = 0.02) was associated with decreased odds of symptoms.Conclusions Aberrant right subclavian artery is an incidental finding in most adult patients. The cross-sectional area at the level of the esophagus, angle formed with the medial wall of the aortic arch, distance between the ARSA and the trachea, and a patient's height were features associated with the presence of symptoms.
PubDate: Sat, 14 Jan 2023 00:00:00 GMT-
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- Growth Rates of Pulmonary Carcinoid Tumors and Hamartomas
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Authors: Ryan; James W.; Hammer, Mark M.
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Background Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas.Methods A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400–600 days; and more than 600 days.Results Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas (P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days.Conclusions Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
PubDate: Sat, 14 Jan 2023 00:00:00 GMT-
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- Extramedullary Hematopoiesis: A Forgotten Diagnosis and a Great Mimicker
of Malignancy-
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Authors: Fouladi; Daniel Fadaei; Fishman, Elliot K.; Kawamoto, Satomi
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Radiology errors have been reported in up to 30% of cases when patients have abnormal imaging findings. Although more than half of errors are failures to detect critical findings, over 40% of errors are when findings are recognized but the correct diagnosis or interpretation is not made. One common source of error is when imaging findings from one process simulate imaging findings from another process but the correct diagnosis is not made. This can result in additional imaging studies, unnecessary biopsies, or surgery. Extramedullary hematopoiesis is one of those uncommon disease processes that can produce many imaging findings that may lead to misdiagnosis. The objective of this article is to review the common and uncommon imaging features of extramedullary hematopoiesis while presenting a series of interesting relevant illustrative cases with emphasis on CT.
PubDate: Sat, 14 Jan 2023 00:00:00 GMT-
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- Liver T1 Relaxation Quantification Using a 3-Dimensional Interleaved
Look-Locker Acquisition With T2 Preparation Pulse Sequence (3D-QALAS):
Comparison With Conventional 2-Dimensional MOLLI-
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Authors: Gandhi; Deep B.; Pednekar, Amol; Wang, Hui; Tkach, Jean A.; Dudley, Jonathan A.; Manhard, Mary Kate; Trout, Andrew T.; Dillman, Jonathan R.
Abstract:
Background Changes in liver magnetic resonance imaging T1 relaxation times are associated with histologic inflammation and fibrosis.Objective To compare liver T1 measurements obtained using a novel single-breath-hold 3-dimensional (3D) whole-liver T1 estimation method (3D-QALAS) to standard-of-care 2-dimensional (2D) modified Look-Locker (2D-MOLLI) measurements.Methods With institutional review board approval, research magnetic resonance imaging examinations were performed in 19 participants at 1.5 T. T1 relaxometry of the liver was performed using a novel 3D whole-liver T1 estimation method (3D-QALAS) as well as a 2D modified Look-Locker (2D-MOLLI) method. The 3D method covered the entire liver in a single breath hold, whereas 2D imaging was performed at 4 anatomic levels in 4 consecutive breath holds. T1 measurements from parametric maps were obtained by a single operator, and region-of-interest area-weighted mean T1 values were calculated. Pearson correlation (r) was used to assess correlation between T1 estimation methods, and the paired t test and Bland-Altman analysis were used to compare agreement in T1 measurements.Results In 18 participants (1 participant was excluded from analysis because of respiratory motion artifacts on 3D-QALAS images), 2D-MOLLI and 3D-QALAS mean T1 measurements were strongly correlated (r = 0.95, [95% CI: 0.87–0.98]; P < 0.0001). 2D-MOLLI T1 values were significantly longer than 3D-QALAS values (647.2 ± 87.3 milliseconds vs. 554.7 ± 75.8 milliseconds; P < 0.0001) with mean bias = 92.5 milliseconds (95% limits of agreement, 36.8, 148.2 milliseconds).Conclusion Whole-liver T1 measurements obtained using a novel single-breath-hold 3D T1 estimation method correlate with a standard-of-care multiple consecutive-breath-hold 2D single-slice method but demonstrate systematic bias that should be considered or corrected when used in a clinical or research setting.
PubDate: Tue, 27 Dec 2022 00:00:00 GMT-
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- Diagnosis of Metastatic Lymph Nodes in Patients With Hepatocellular
Carcinoma Using Dual-Energy Computed Tomography-
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Authors: Mo; Huiqiang; Huang, Ruisui; Wei, Xue; Huang, Lifeng; Huang, Jianning; Chen, Jiong; Qin, Mi; Lu, Wei; Yu, Xiaofang; Liu, Manrong; Ding, Ke
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Objective Our study aimed to investigate the role of quantitative parameters derived from dual-energy computed tomography (DECT) in discriminating metastatic from nonmetastatic lymph nodes in hepatocellular carcinoma (HCC).Methods Forty-two patients (34 males; mean age, 53.7 years) with HCC underwent unenhanced computed tomography scans and triple-phase DECT scans of the upper abdomen. A total of 72 suspected lymph nodes were resected, including 43 nonmetastatic and 29 metastatic lymph nodes. The maximum short-axis diameter of the lymph nodes, iodine concentration, normalized iodine concentration (NIC), and slope of the spectral curve were analyzed for the HCC primary lesions and the suspected lymph nodes. Lymph node metastasis was confirmed by pathologic examination.Results A maximum short-axis diameter of>10 mm had a sensitivity and a specificity of 75.9% (22/29) and 53.5% (23/43) in diagnosing metastatic lymph nodes. The iodine concentration, NIC, and slope of the spectral curve of the nonmetastatic lymph nodes were significantly higher than those of the primary HCC lesions and the metastatic lymph nodes (all P < 0.05). Among all the analyzed spectral parameters, the NIC in the arterial phase had the highest sensitivity and specificity of 88.4% and 86.2% in diagnosing metastatic lymph nodes.Conclusions The arterial phase NIC of DECT has superior diagnostic performance than the traditional lymph node size in diagnosing metastatic lymph nodes in HCC.
PubDate: Tue, 27 Dec 2022 00:00:00 GMT-
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- A New Magnetic Resonance Imaging Method for 2 Tissue Suppression: Double
Tissue Suppression With Multiecho Acquisition and Single Inversion Time
Combining High-Intensity Reduction (DOMUST-HIRE)-
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Authors: Sakoda; Kazuya; Baba, Shogo; Nakazono, Rena; Maekawa, Yui; Kuroki, Yuta
Abstract:
Introduction The fluid-attenuated inversion recovery (FLAIR) method is one of the most important magnetic resonance imaging techniques for the brain, and the high-intensity reduction (HIRE) method is an imaging technique to obtain cerebrospinal fluid suppression images by subtracting long echo time images from short echo time images. In contrast, the double inversion recovery technique suppresses 2 types of tissue signals with different T1 values by applying 2 inversion recovery pulses with different inversion times. However, the double inversion recovery method requires the setting of 2 inversion times in a sequence; thus, its use is limited to relatively high-specification equipment. Here, we propose a new sequence called double tissue suppression with multiecho acquisition and single inversion time combining high-intensity reduction (DOMUST-HIRE) that suppresses the 2 tissues by adding single inversion recovery pulses to a sequence based on the HIRE method.Methods In this small clinical study, we performed physical evaluation by imaging a subject's head with FLAIR and DOMUST-HIRE method.Results The DOMUST-HIRE method can increase the contrast ratio and the contrast-to-noise ratio between white matter (WM) and gray matter, whereas the signal-to-noise ratio between WM and gray matter decreased than with FLAIR method.Conclusions The DOMUST-HIRE method can be used to suppress WM and cerebrospinal fluid signals.
PubDate: Wed, 07 Dec 2022 00:00:00 GMT-
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