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Borgheresi A, Cesari E, Agostini A, Badaloni M, Balducci S, Tola E, Consoli V, Palucci A, Burroni L, Carotti M, Giovagnoni A. Pulmonary emphysema: the assessment of lung perfusion with Dual-Energy CT and pulmonary scintigraphy. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01883-y. [PMID: 39256299 DOI: 10.1007/s11547-024-01883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024]
Abstract
AIM To assess the correlation of quantitative data of pulmonary Perfused Blood Volume (PBV) on Dual-Energy CT (DECT) datasets in patients with moderate - severe Pulmonary Emphysema (PE) with Lung Perfusion Scintigraphy (LPS) as the reference standard. The secondary endpoints are the correlation between the CT densitometric analysis and the visual assessment of parenchymal destruction with PBV. MATERIALS AND METHODS Patients with moderate - severe PE candidate to Lung Volumetric Reduction (LVR), with available a pre-procedural LS and a contrast-enhanced DECT were retrospectively included. DECT studies were performed with a 3rd generation Dual-Source CT and the PBV was obtained with a 3-material decomposition algorithm. The CT densitometric analysis was performed with a dedicated commercial software (Pulmo3D). The Goddard Score was used for visual assessment. The perfusion LS were performed after the administration of albumin macroaggregates labeled with 99mTechnetium. The image revision was performed by two radiologists or nuclear medicine physicians blinded, respectively, to LS and DECT data. The statistical analysis was performed with nonparametric tests. RESULTS Thirty-one patients (18 males, median age 69 y.o., interquartile range 62-71 y.o.) with moderate - severe PE (Median Goddard Score 14/20 and 31% of emphysematous parenchyma at quantitative CT) candidate to LVR were retrospectively included. The median enhancement on PBV was 17 HU. Significant correlation coefficients were demonstrated between lung PBV and LS, poor in apical regions (Rho = 0.1-0.2) and fair (Rho = 0.3-0.5) in middle and lower regions. No significant correlations were recorded between the CT densitometric analysis, the visual score, and the PBV. CONCLUSIONS Lung perfusion with PBV on DECT is feasible in patients with moderate - severe PE candidate to LVR, and has a poor to fair agreement with LPS.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Elisa Cesari
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy.
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy.
| | - Myriam Badaloni
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Sofia Balducci
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Elisabetta Tola
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Valeria Consoli
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Palucci
- Department of Radiological Sciences. Division of Nuclear Medicine, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Luca Burroni
- Department of Radiological Sciences. Division of Nuclear Medicine, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
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Remy-Jardin M, Guiffault L, Oufriche I, Duhamel A, Flohr T, Schmidt B, Remy J. Image quality of lung perfusion with photon-counting-detector CT: comparison with dual-source, dual-energy CT. Eur Radiol 2024:10.1007/s00330-024-10888-0. [PMID: 38967660 DOI: 10.1007/s00330-024-10888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE To evaluate the quality of lung perfusion imaging obtained with photon-counting-detector CT (PCD-CT) in comparison with dual-source, dual-energy CT (DECT). METHODS Seventy-one consecutive patients scanned with PCD-CT were compared to a paired population scanned with dual-energy on a 3rd-generation DS-CT scanner using (a) for DS-CT (Group 1): collimation: 64 × 0.6 × 2 mm; pitch: 0.55; (b) for PCD-CT (Group 2): collimation: 144 × 0.4 mm; pitch: 1.5; single-source acquisition. The injection protocol was similar in both groups with the reconstruction of perfusion images by subtraction of high- and low-energy virtual monoenergetic images. RESULTS Compared to Group 1, Group 2 examinations showed: (a) a shorter duration of data acquisition (0.93 ± 0.1 s vs 3.98 ± 0.35 s; p < 0.0001); (b) a significantly lower dose-length-product (172.6 ± 55.14 vs 339.4 ± 75.64 mGy·cm; p < 0.0001); and (c) a higher level of objective noise (p < 0.0001) on mediastinal images. On perfusion images: (a) the mean level of attenuation did not differ (p = 0.05) with less subjective image noise in Group 2 (p = 0.049); (b) the distribution of scores of fissure visualization differed between the 2 groups (p < 0.0001) with a higher proportion of fissures sharply delineated in Group 2 (n = 60; 84.5% vs n = 26; 26.6%); (c) the rating of cardiac motion artifacts differed between the 2 groups (p < 0.0001) with a predominance of examinations rated with mild artifacts in Group 2 (n = 69; 97.2%) while the most Group 1 examinations showed moderate artifacts (n = 52; 73.2%). CONCLUSION PCD-CT acquisitions provided similar morphologic image quality and superior perfusion imaging at lower radiation doses. CLINICAL RELEVANCE STATEMENT The improvement in the overall quality of perfusion images at lower radiation doses opens the door for wider applications of lung perfusion imaging in clinical practice. KEY POINTS The speed of data acquisition with PCD-CT accounts for mild motion artifacts. Sharply delineated fissures are depicted on PCD-CT perfusion images. High-quality perfusion imaging was obtained with a 52% dose reduction.
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Affiliation(s)
- Martine Remy-Jardin
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France.
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, LILLE, France.
- IMALLIANCE-Haut-de-France, Valenciennes, France.
| | - Lucas Guiffault
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
| | - Idir Oufriche
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
| | - Alain Duhamel
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, LILLE, France
- Department of Biostatistics, University of Lille, CHU Lille, LILLE, France
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Bernhard Schmidt
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Jacques Remy
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
- Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France
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Zhang S, Simard M, Lapointe A, Filion É, Campeau MP, Vu TTT, Roberge D, Carrier JF, Blais D, Bedwani S, Bahig H. Evaluation of Radiation Dose Effect on Lung Function Using Iodine Maps Derived From Dual-Energy Computed Tomography. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00609-6. [PMID: 38705488 DOI: 10.1016/j.ijrobp.2024.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE There is interest in using dual-energy computed tomography (DECT) to evaluate organ function before and after radiation therapy (RT). The purpose of this study (trial identifier: NCT04863027) is to assess longitudinal changes in lung perfusion using iodine maps derived from DECT in patients with lung cancer treated with conventional or stereotactic RT. METHODS AND MATERIALS For 48 prospectively enrolled patients with lung cancer, a contrast-enhanced DECT using a dual-source CT simulator was acquired pretreatment and at 6 and 12 months posttreatment. Pulmonary functions tests (PFT) were obtained at baseline and at 6 and 12 months posttreatment. Iodine maps were extracted from the DECT images using a previously described 2-material decomposition framework. Longitudinal iodine maps were normalized using a reference region defined as all voxels with perfusion in the top 10% outside of the 5 Gy isodose volume. Normalized functional responses (NFR) were calculated for 3 dose ranges: <5, 5 to 20, and >20 Gy. Mixed model analysis was used to assess the correlation between dose metrics and NFR. Pearson correlation was used to assess if NFRs were correlated with PFT changes. RESULTS Out of the 48 patients, 21 (44%) were treated with stereotactic body RT and 27 (56%) were treated with conventionally fractionated intensity-modulated RT. Thirty-one out of these 48 patients were ultimately included in data analysis. It was found that NFR is linearly correlated with dose (P < .001) for both groups. The number of months elapsed post-RT was also found to correlate with NFR (P = .029), although this correlation was not observed for the stereotactic body RT subgroup. The NFR was not found to correlate with PFT changes. CONCLUSIONS DECT-derived iodine maps are a promising method for detailed anatomic evaluation of radiation effect on lung function, including potentially subclinical changes.
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Affiliation(s)
- Shen Zhang
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Mikaël Simard
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Département de physique, Université de Montréal, Montréal, Quebec, Canada; Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andréanne Lapointe
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Édith Filion
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Pierre Campeau
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Thi Trinh Thuc Vu
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - David Roberge
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Jean-François Carrier
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Département de physique, Université de Montréal, Montréal, Quebec, Canada
| | - Danis Blais
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Stéphane Bedwani
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Houda Bahig
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
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Iftikhar IH, Iftikhar NH, Naeem M, BaHammam A. SPECT Ventilation/Perfusion Imaging for Acute Pulmonary Embolism: Meta-analysis of Diagnostic Test Accuracy. Acad Radiol 2024; 31:706-717. [PMID: 37487880 DOI: 10.1016/j.acra.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the diagnostic accuracies of ventilation/perfusion-single photon emission computed tomography (V/Q-SPECT) imaging modalities for acute pulmonary embolism (PE). These included, in addition to V/Q-SPECT, V/Q-SPECT with low-dose computed tomography (CT; V/Q-SPECT-CT), Q-SPECT with low-dose CT (Q-SPECT-CT), and Q-SPECT. MATERIALS AND METHODS PubMed, Embase, CINAHL, and Web of Science databases were searched, and studies included if they studied ≥10 adult participants with acute PE and reported data on the imaging tests' diagnostic performance. Data were meta-analyzed using bivariate random effects regression model. RESULTS Data from participants totaling 4146 from 11 V/Q-SPECT studies, 785 from 7 V/Q-SPECT-CT studies, 1196 from 7 Q-SPECT-CT studies, and 728 from five Q-SPECT studies were separately meta-analyzed. The bivariate weighted mean sensitivity and specificity were 0.94 (95% confidence interval [CI]: 0.88-0.97) and 0.95 (95% CI: 0.87-0.98) for V/Q-SPECT, 0.95 (95% CI: 0.88-0.98) and 0.99 (95% CI: 0.92-1.00) for V/Q-SPECT-CT, 0.92 (95% CI: 0.79-0.97) and 0.92 (95% CI: 0.83-0.96) for Q-SPECT-CT, and 0.89 (95% CI: 0.76-0.95) and 0.86 (95% CI: 0.67-0.95) for Q-SPECT studies. The positive and negative likelihood ratios (+LRs and -LRs) were 17.4 (6.9-44.0) and 0.06 (0.03-0.13), 76.7 (11.8-498.0) and 0.06 (0.02-0.13), 11.0 (5.3-22.9) and 0.09 (0.04-0.23), and 6.4 (2.6-15.8) and 0.13 (0.07-0.27) for V/Q-SPECT, V/Q-SPECT-CT, Q-SPECT-CT, and Q-SPECTs, respectively. CONCLUSION In the diagnosis of acute PE, this meta-analysis showed that V/Q-SPECT-CT had the highest specificity and +LR. Conversely, Q-SPECT showed the lowest specificity and an unfavorably high -LR.
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Affiliation(s)
- Imran H Iftikhar
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia (I.H.I.); Atlanta Veterans Affairs Medical Center, Atlanta, Georgia (I.H.I.).
| | - Nauman H Iftikhar
- Department of Radiology, Al-Yamamah Hospital, Riyadh, Saudi Arabia (N.H.I.)
| | - Muhammad Naeem
- Division of Cardiovascular and Thoracic Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia (M.N.)
| | - Ahmed BaHammam
- Department of Medicine, University Sleep Disorders Center, and Pulmonary Service, King Saud University, Riyadh, Saudi Arabia (A.B.); Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Riyadh, Saudi Arabia (A.B.)
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Strotzer QD, Heidemanns S, Mayr V, Stuerzl R, Meiler S, Schmidt D, Blaas S, Grosse J, Hellwig D, Stroszczynski C, Hamer OW. Head-to-Head Comparison of Dual-Source and Split-Beam Filter Multi-Energy CT versus SPECT/CT for Assessing Lobar Lung Perfusion in Emphysema. Radiol Cardiothorac Imaging 2023; 5:e220273. [PMID: 37693196 PMCID: PMC10483249 DOI: 10.1148/ryct.220273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 09/12/2023]
Abstract
Purpose To evaluate dual-source and split-beam filter multi-energy chest CT in assessing pulmonary perfusion on a lobar level in patients with lung emphysema, using perfusion SPECT as the reference standard. Materials and Methods Patients with emphysema evaluated for lung volume reduction therapy between May 2016 and February 2021 were retrospectively included. All patients underwent SPECT and either dual-source or split-beam filter (SBF) multi-energy CT. To calculate the fractional lobar lung perfusion (FLLP), SPECT acquisitions were co-registered with chest CT scans (hereafter, SPECT/CT) and semi-manually segmented. For multi-energy CT scans, lung lobes were automatically segmented using a U-Net model. Segmentations were manually verified. The FLLP was derived from iodine maps computed from the multi-energy data. Statistical analysis included Pearson and intraclass correlation coefficients and Bland-Altman analysis. Results Fifty-nine patients (30 male, 29 female; 31 underwent dual-source CT, 28 underwent SBF CT; mean age for all patients, 67 years ± 8 [SD]) were included. Both multi-energy methods significantly correlated with the SPECT/CT acquisitions for all individual lobes (P < .001). Pearson correlation concerning all lobes combined was significantly better for dual-source (r = 0.88) than for SBF multi-energy CT (r = 0.78; P = .006). On the level of single lobes, Pearson correlation coefficient differed for the right upper lobe only (dual-source CT, r = 0.88; SBF CT, r = 0.58; P = .008). Conclusion Dual-source and SBF multi-energy CT accurately assessed lung perfusion on a lobar level in patients with emphysema compared with SPECT/CT. The overall correlation was higher for dual-source multi-energy CT.Keywords: Chronic Obstructive Pulmonary Disease, Comparative Studies, Computer Applications, CT Spectral Imaging, Image Postprocessing, Lung, Pulmonary Perfusion© RSNA, 2023.
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Affiliation(s)
- Quirin D. Strotzer
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefanie Heidemanns
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Vinzenz Mayr
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Roman Stuerzl
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefanie Meiler
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Daniel Schmidt
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefan Blaas
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Jirka Grosse
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Dirk Hellwig
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Christian Stroszczynski
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Okka W. Hamer
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
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Ozawa Y, Ohno Y, Nagata H, Tamokami K, Nishikimi K, Oshima Y, Hamabuchi N, Matsuyama T, Ueda T, Toyama H. Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel) 2023; 13:2295. [PMID: 37443688 DOI: 10.3390/diagnostics13132295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Dual-energy computed tomography (DECT) can improve the differentiation of material by using two different X-ray energy spectra, and may provide new imaging techniques to diagnostic radiology to overcome the limitations of conventional CT in characterizing tissue. Some techniques have used dual-energy imaging, which mainly includes dual-sourced, rapid kVp switching, dual-layer detectors, and split-filter imaging. In iodine images, images of the lung's perfused blood volume (PBV) based on DECT have been applied in patients with pulmonary embolism to obtain both images of the PE occluding the pulmonary artery and the consequent perfusion defects in the lung's parenchyma. PBV images of the lung also have the potential to indicate the severity of PE, including chronic thromboembolic pulmonary hypertension. Virtual monochromatic imaging can improve the accuracy of diagnosing pulmonary vascular diseases by optimizing kiloelectronvolt settings for various purposes. Iodine images also could provide a new approach in the area of thoracic oncology, for example, for the characterization of pulmonary nodules and mediastinal lymph nodes. DECT-based lung ventilation imaging is also available with noble gases with high atomic numbers, such as xenon, which is similar to iodine. A ventilation map of the lung can be used to image various pulmonary diseases such as chronic obstructive pulmonary disease.
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Affiliation(s)
- Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Keigo Tamokami
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Keitaro Nishikimi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
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Katsuyama Y, Kojima T, Shirasaka T, Kondo M, Kato T. Characteristics of the deep learning-based virtual monochromatic image with fast kilovolt-switching CT: a phantom study. Radiol Phys Technol 2023; 16:77-84. [PMID: 36583827 DOI: 10.1007/s12194-022-00695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE We assessed the physical properties of virtual monochromatic images (VMIs) obtained with different energy levels in various contrast settings and radiation doses using deep learning-based spectral computed tomography (DL-Spectral CT) and compared the results with those from single-energy CT (SECT) imaging. MATERIALS AND METHODS A Catphan® 600 phantom was scanned by DL-Spectral CT at various radiation doses. We reconstructed the VMIs obtained at 50, 70, and 100 keV. SECT (120 kVp) images were acquired at the same radiation doses. The standard deviations of the CT number and noise power spectrum (NPS) were calculated for noise characterization. We evaluated the spatial resolution by determining the 10% task-based transfer function (TTF) level, and we assessed the task-based detectability index (d'). RESULTS Regardless of the radiation dose, the noise was the lowest at 70 keV VMI. The NPS showed that the noise amplitude at all spatial frequencies was the lowest among other VMI and 120 kVp images. The spatial resolution was higher for 70 keV VMI compared to the other VMIs, except for high-contrast objects. The d' of 70 keV VMI was the highest among the VMI and 120 kVp images at all radiation doses and contrast settings. The d' of the 70 keV VMIs at the minimum dose was higher than that at the maximum dose in any other image. CONCLUSION The physical properties of the DL-Spectral CT VMIs varied with the energy level. The 70 keV VMI had the highest detectability by far among the VMI and 120-kVp images. DL-Spectral CT may be useful to reduce radiation doses.
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Affiliation(s)
- Yuna Katsuyama
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan.
| | - Tsukasa Kojima
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan.,Department of Health Sciences, Graduate school of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Takashi Shirasaka
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Masatoshi Kondo
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
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8
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Jeyin N, Desai SR, Padley SPG, Wechalekar K, Gregg S, Sousa T, Shah PL, Allinson JP, Hopkinson NS, Begum S, Jordan S, Kemp SV, Ridge CA. Dual-energy Computed Tomographic Pulmonary Angiography Accurately Estimates Lobar Perfusion Before Lung Volume Reduction for Severe Emphysema. J Thorac Imaging 2023; 38:104-112. [PMID: 36162074 DOI: 10.1097/rti.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR). MATERIALS AND METHODS Patients with severe emphysema (forced expiratory volume in 1 s <49% predicted) undergoing evaluation for LVR between May 2018 and April 2020 imaged with both SPECT-PS and DECTPA were included in this retrospective study. DECTPA perfused blood volume maps were automatically segmented and lobar iodine mass was estimated and compared with lobar technetium (Tc99m) distribution acquired with SPECT-PS. Pearson correlation and Bland-Altman analysis were used for intermodality comparison between DECTPA and SPECT-PS. Univariate and adjusted multivariate linear regression were modelled to ascertain the effect sizes of possible confounders of disease severity, sex, age, and body mass index on the relationship between lobar iodine and Tc99m values. Effective radiation dose and adverse reactions were recorded. RESULTS In all, 123 patients (64.5±8.8 y, 71 men; mean predicted forced expiratory volume in 1 s 32.1 ±12.7%,) were eligible for inclusion. There was a linear relationship between lobar perfusion values acquired using DECTPA and SPECT-PS with statistical significance ( P <0.001). Lobar relative perfusion values acquired using DECTPA and SPECT-PS had a consistent relationship both by linear regression and Bland-Altman analysis (mean bias, -0.01, mean r2 0.64; P <0.0001). Individual lobar comparisons demonstrated moderate correlation ( r =0.79, 0.78, 0.84, 0.78, 0.8 for the right upper, middle, lower, left upper, and lower lobes, respectively, P <0.0001). The relationship between lobar iodine and Tc99m values was not significantly altered after controlling for confounders including symptom and disease severity, age, sex, and body mass index. CONCLUSIONS DECTPA provides an accurate estimation of lobar perfusion, showing good agreement with SPECT-PS and could potentially streamline preoperative assessment for LVR.
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Affiliation(s)
| | - Sujal R Desai
- National Heart and Lung Institute, Imperial College London
- Departments of Imaging
| | - Simon P G Padley
- National Heart and Lung Institute, Imperial College London
- Departments of Imaging
| | | | | | | | - Pallav L Shah
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | | | - Samuel V Kemp
- National Heart and Lung Institute, Imperial College London
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Carole A Ridge
- National Heart and Lung Institute, Imperial College London
- Departments of Imaging
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9
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Gaudreault M, Korte J, Bucknell N, Jackson P, Sakyanun P, McIntosh L, Woon B, Buteau JP, Hofman MS, Mulcahy T, Kron T, Siva S, Hardcastle N. Comparison of dual-energy CT with positron emission tomography for lung perfusion imaging in patients with non-small cell lung cancer. Phys Med Biol 2023; 68. [PMID: 36623318 DOI: 10.1088/1361-6560/acb198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
Objective.Functional lung avoidance (FLA) radiotherapy treatment aims to spare lung regions identified as functional from imaging. Perfusion contributes to lung function and can be measured from the determination of pulmonary blood volume (PBV). An advantageous alternative to the current determination of PBV from positron emission tomography (PET) may be from dual energy CT (DECT), due to shorter examination time and widespread availability. This study aims to determine the correlation between PBV determined from DECT and PET in the context of FLA radiotherapy.Approach.DECT and PET acquisitions at baseline of patients enrolled in the HI-FIVE clinical trial (ID: NCT03569072) were reviewed. Determination of PBV from PET imaging (PBVPET), from DECT imaging generated from a commercial software (Syngo.via, Siemens Healthineers, Forchheim, Germany) with its lowest (PBVsyngoR=1) and highest (PBVsyngoR=10) smoothing level parameter value (R), and from a two-material decomposition (TMD) method (PBVTMDL) with variable median filter kernel size (L) were compared. Deformable image registration between DECT images and the CT component of the PET/CT was applied to PBV maps before resampling to the PET resolution. The Spearman correlation coefficient (rs) between PBV determinations was calculated voxel-wise in lung subvolumes.Main results.Of this cohort of 19 patients, 17 had a DECT acquisition at baseline. PBV maps determined from the commercial software and the TMD method were very strongly correlated [rs(PBVsyngoR=1,PBVTMDL=1) = 0.94 ± 0.01 andrs(PBVsyngoR=10,PBVTMDL=9) = 0.94 ± 0.02].PBVPETwas strongly correlated withPBVTMDL[rs(PBVPET,PBVTMDL=28) = 0.67 ± 0.11]. Perfusion patterns differed along the posterior-anterior direction [rs(PBVPET,PBVTMDL=28) = 0.77 ± 0.13/0.57 ± 0.16 in the anterior/posterior region].Significance. A strong correlation between DECT and PET determination of PBV was observed. Streak and smoothing effects in DECT and gravitational artefacts and misregistration in PET reduced the correlation posteriorly.
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Affiliation(s)
- Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia
| | - James Korte
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Department of Biomedical Engineering, School of Chemical and Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Bucknell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Price Jackson
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia
| | - Pitchaya Sakyanun
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Department of Radiation Oncology, Phramongkutklao Hospital, Bangkok, Thailand
| | - Lachlan McIntosh
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Beverley Woon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - James P Buteau
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Molecular Imaging and Therapeutic Nuclear Medicine; Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC) , Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Molecular Imaging and Therapeutic Nuclear Medicine; Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC) , Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
| | - Tony Mulcahy
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Centre for Medical Radiation Physics, University of Wollongong, NSW, 2522, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.,Centre for Medical Radiation Physics, University of Wollongong, NSW, 2522, Australia
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10
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Correlation between CT Value on Lung Subtraction CT and Radioactive Count on Perfusion Lung Single Photon Emission CT in Chronic Thromboembolic Pulmonary Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12112895. [PMID: 36428955 PMCID: PMC9688979 DOI: 10.3390/diagnostics12112895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Lung subtraction CT (LSCT), the subtraction of noncontrast CT from CT pulmonary angiography (CTPA) without spatial misregistration, is easily applicable by utilizing a software-based deformable image registration technique without additional hardware and permits the evaluation of lung perfusion as iodine accumulation, similar to that observed in perfusion lung single photon emission CT (PL-SPECT). The aim of this study was to use LSCT to newly assess the quantitative correlation between the CT value on LSCT and radioactive count on PL-SPECT as a reference and validate the quantification of lung perfusion by measuring the CT value in chronic thromboembolic pulmonary hypertension (CTEPH). Methods: We prospectively enrolled 47 consecutive patients with CTEPH undergoing both LSCT and PL-SPECT; we used noncontrast CT, CTPA, and LSCT to measure CT values and PL-SPECT to measure radioactive counts in areas representing three different perfusion classes—no perfusion defect, subsegmental perfusion defect, and segmental perfusion defect; we compared CT values on noncontrast CT, CTPA, and LSCT and radioactive counts on PL-SPECT among the three classes, then assessed the correlation between them. Results: Both the CT values and radioactive counts differed significantly among the three classes (p < 0.01 for all) and showed weak correlation (ρ = 0.38) by noncontrast CT, moderate correlation (ρ = 0.61) by CTPA, and strong correlation (ρ = 0.76) by LSCT. Conclusions: The CT value measurement on LSCT is a novel quantitative approach to assess lung perfusion in CTEPH and only correlates strongly with radioactive count measurement on PL-SPECT.
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11
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Lambert L, Michalek P, Burgetova A. The diagnostic performance of CT pulmonary angiography in the detection of chronic thromboembolic pulmonary hypertension-systematic review and meta-analysis. Eur Radiol 2022; 32:7927-7935. [PMID: 35482124 DOI: 10.1007/s00330-022-08804-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the diagnostic performance of CT of the pulmonary artery (CTPA) as a potential first-choice imaging modality in patients with pulmonary arterial hypertension and suspected chronic thromboembolic pulmonary hypertension (CTEPH). METHODS A systematic review and meta-analysis were conducted in accordance with the PRISMA reporting checklist. Six scientific databases and registers (PubMed, EMBASE, Scopus, Web of Science, Cochrane, ClinicalTrials.gov ) were searched for studies evaluating the diagnostic performance of CTPA in suspected CTEPH in adult patients. Results were pooled separately for studies based on the evaluation of the pulmonary artery and those that relied solely on changes in parenchymal perfusion. RESULTS Ten single-center studies with 734 patients were eligible for pooling of the diagnostic performance of CTPA by evaluation of the pulmonary artery. The pooled sensitivity, specificity, PPV, NPV, accuracy, and diagnostic odds ratio (DOR) estimates for CTPA in the detection of CTEPH were 0.98, 0.99, 0.94, 1.00, 0.96, 0.96, and 292. Evaluation of perfusion changes yielded pooled estimates for sensitivity, specificity, PPV, NPV, accuracy, and DOR of 0.99, 0.84, 0.79, 0.98, 0.89, 0.89, and 98 across four studies with 278 patients. Scintigraphy, SPECT, digital subtraction angiography, right heart catheterization, pulmonary endarterectomy, and international guidelines were used to establish the diagnosis. CONCLUSION CTPA has high sensitivity and specificity in the detection of CTEPH when the examination is evaluated by expert radiologists. Evaluation of parenchymal perfusion alone is associated with slightly lower specificity. Further research is needed to determine the diagnostic performance of CTPA in excluding CTEPH in general radiology departments. KEY POINTS • CT pulmonary angiography (CTPA) is recommended in the diagnostic workup of chronic thromboembolic pulmonary hypertension (CTEPH). • CTPA has high sensitivity and specificity in the detection of CTEPH when evaluated by an expert radiologist. • Evaluation of changes in parenchymal perfusion alone is associated with slightly lower specificity. • Little is known about the diagnostic performance of CTPA in the detection of CTEPH in general radiology departments.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
| | - Pavel Michalek
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic
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12
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Higuchi S, Horinouchi H, Aoki T, Nishii T, Ota Y, Ueda J, Tsuji A, Ota H, Ogo T, Fukuda T. Balloon Pulmonary Angioplasty in the Management of Chronic Thromboembolic Pulmonary Hypertension. Radiographics 2022; 42:1881-1896. [DOI: 10.1148/rg.210102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Satoshi Higuchi
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Hiroki Horinouchi
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tatsuo Aoki
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tatsuya Nishii
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Yasutoshi Ota
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Jin Ueda
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Akihiro Tsuji
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Hideki Ota
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Takeshi Ogo
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tetsuya Fukuda
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
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13
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Spectral imaging in the pediatric chest: past, present and future. Pediatr Radiol 2022; 52:1910-1920. [PMID: 35726069 DOI: 10.1007/s00247-022-05404-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 05/14/2022] [Indexed: 12/14/2022]
Abstract
Computed tomography technology continues to undergo evolution and improvement with each passing decade. From its inception in 1971, to the advent of commercially available dual-energy CT just over a decade ago, and now to the latest innovation, photon-counting detector CT, CT's utility for resolving and discriminating tissue types improves. In this review we discuss the impact of spectral imaging, including dual-energy CT and the recently available photon-counting detector CT, on the imaging of the pediatric chest. We describe the current capabilities and future directions of CT imaging, encompassing both the lungs and the surrounding tissues.
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14
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Hermann EA, Motahari A, Hoffman EA, Allen N, Bertoni AG, Bluemke DA, Eskandari A, Gerard SE, Guo J, Hiura GT, Kaczka DW, Michos ED, Nagpal P, Pankow J, Shah S, Smith BM, Stukovsky KH, Sun Y, Watson K, Barr RG. Pulmonary Blood Volume Among Older Adults in the Community: The MESA Lung Study. Circ Cardiovasc Imaging 2022; 15:e014380. [PMID: 35938411 PMCID: PMC9387743 DOI: 10.1161/circimaging.122.014380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m2. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model. RESULTS The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (P<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; P<0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (P=0.04) and greater composite dyspnea symptom scores (P=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history. CONCLUSIONS Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.
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Affiliation(s)
- Emilia A. Hermann
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | - Grant T. Hiura
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | - Prashant Nagpal
- 2. University of Iowa, Iowa City, IA
- 5. University of Wisconsin-Madison, Madison WI
| | - Jim Pankow
- 7. University of Minnesota, Minneapolis, MN
| | | | - Benjamin M Smith
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Yifei Sun
- 9. Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Karol Watson
- 10. University of California, Los Angeles, Los Angeles, CA
| | - R. Graham Barr
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
- 11. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
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15
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Gayen S, Upadhyay V, Kumaran M, Bashir R, Lakhter V, Panaro J, Criner G, Dadparvar S, Rali P. Changes in Lung Perfusion in Patients Treated with Percutaneous Mechanical Thrombectomy for Intermediate-Risk Pulmonary Embolism. Am J Med 2022; 135:1016-1020. [PMID: 35469736 DOI: 10.1016/j.amjmed.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current pulmonary embolism treatment options rely heavily on anatomical clot location. However, anatomical location does not necessarily determine adverse outcomes; rather, clinical severity is secondary to the degree of perfusion impairment. Dual-energy computed tomography pulmonary angiogram (DE-CTPA) can map perfusion at the time of pulmonary embolism diagnosis. Single-photon emission computed tomography ventilation-perfusion scans allow for perfusion tracking similar to DE-CTPA. METHODS We present 3 patients with intermediate-risk pulmonary embolism treated with mechanical thrombectomy using the Inari FlowTriever System (Inari Medical, Irvine, Calif). Lung perfusion scoring was applied to pre-procedure and post-procedure imaging. We graded perfusion of each lobe in 3 planes. If the entire lobe was perfused, a score of 3 was assigned. If lung perfusion is normal, total perfusion score is 15. All patients had pre-procedure and follow-up transthoracic echocardiograms. RESULTS All 3 patients were diagnosed with pulmonary embolism via DE-CTPA that showed right ventricle strain and had deep venous thrombosis. Following mechanical thrombectomy, patients immediately experienced improvement in perfusion score; scores continued to improve at follow-up. All patients also had improvement in right ventricle size or function on follow-up echocardiogram. DISCUSSION Intermediate-risk pulmonary embolism often has large initial clot burden that predicts residual pulmonary vascular obstruction. Residual pulmonary vascular obstruction is associated with increased risk of death, recurrent thrombus, and chronic thromboembolic pulmonary hypertension. Clot removal via thrombectomy may decrease the prevalence of residual pulmonary vascular obstruction by improving lung perfusion. We found that mechanical thrombectomy increased lung perfusion immediately and at follow-up assessments.
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Affiliation(s)
| | | | | | | | | | - Joseph Panaro
- Department of Interventional Radiology, Temple University Hospital, Philadelphia, Pa
| | | | | | - Parth Rali
- Department of Thoracic Medicine and Surgery
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16
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Computed tomography and magnetic resonance imaging for pulmonary embolus evaluation in children: up-to-date review on practical imaging protocols. Pediatr Radiol 2022:10.1007/s00247-022-05451-2. [PMID: 35864243 PMCID: PMC9303848 DOI: 10.1007/s00247-022-05451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/22/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Pulmonary embolism (PE) is a potentially life-threatening condition that requires immediate medical intervention. Although PE was previously thought to occur infrequently in the pediatric population, recent studies have found a higher-than-expected prevalence of PE in the pediatric population of up to 15.5%. The imaging modality of choice for detecting PE in the pediatric population is multi-detector CT angiography, although MRI is assuming a growing and more important role as a potential alternative modality. Given the recent advances in both computed tomography pulmonary angiography (CTPA) and MRI techniques, a growing population of pediatric patients with complex comorbidities (such as children with a history of surgeries for congenital heart disease repair), and the recent waves of coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C), which are associated with increased risk of PE, there is new and increased need for an up-to-date review of practical CT and MRI protocols for PE evaluation in children. This article provides guidance for up-to-date CT and MR imaging techniques, reviews key recent studies on the imaging of pediatric PE, and discusses relevant pediatric PE imaging pearls and pitfalls, in hopes of providing readers with up-to-date and accurate practice for imaging evaluation of PE in children.
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Rezaei-Kalantari K, Samimi K, Zomorodian H, Bakhshandeh H, Jafari M, Farahmand AM, Pourseyedian T, Sharifian M, Qanadli SD. Pulmonary Blood Volume Measured by Dual-Energy Computed Tomography Can Help Distinguish Patients With Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:835655. [PMID: 35865383 PMCID: PMC9294319 DOI: 10.3389/fcvm.2022.835655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the correlation between whole lung enhancement (WLE) and pulmonary blood volume (PBV) obtained through dual energy computed tomography pulmonary angiography (DECTPA) and echocardiography-derived systolic pulmonary arterial pressure (SPAP). Methods Sixty-eight patients who underwent DECTPA were enrolled in the study after giving informed consent. A transthoracic echocardiography was performed for all the subjects within 48 h of their DECTPA study to measure SPAP. The correlation of the two DECTPA-derived parameters, WLE and PBV, with SPAP was assessed. In addition, the predictive strength of these parameters was compared with that of traditional computed tomography (CT) signs of pulmonary hypertension (PH). Results The SPAP value showed a moderate correlation with main pulmonary artery (MPA) diameter (r = 0.48, P < 0.001), while having a weak correlation with WLE (r = −0.33, P = 0.007), PBV (r = −0.31, P = 0.01) and MPA/ascending aorta (MPA/AA) ratio (r = 0.26, P = 0.03). On regression analysis, MPA diameter (B ± SE: 1.8 ± 0.6, P = 0.004) and WLE (B ± SE: −0.5 ± 0.3, P = 0.042) had significant association with SPAP. In addition, SPAP ≥30 mmHg was related to the right to left ventricular diameter (RV/LV) ratio [OR (CI 95%): 24.39 (1.3–573.2), P = 0.04] and reversely associated with PBV [OR (CI 95%): 0.96 (0.93–0.98), P = 0.005]. Acquired cutoff value of 83% for PBV showed sensitivity and specificity of 73% to identify SPAP ≥30 mmHg [AUC (CI 95%):0.727 (0.588–0.866), P = 0.008]. Conclusions Automated postprocessing calculation of iodine distribution analysis by DECTPA could be considered as an adjunctive tool to investigate for PH.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardio-Oncology Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Samimi
- Hazrat Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Zomorodian
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jafari
- Department of Radiology, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Taleb Pourseyedian
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maedeh Sharifian
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- *Correspondence: Maedeh Sharifian
| | - Salah Dine Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Li Y, Fang N, Wang H, Wang R. Multi-Modal Medical Image Fusion With Geometric Algebra Based Sparse Representation. Front Genet 2022; 13:927222. [PMID: 35812744 PMCID: PMC9259973 DOI: 10.3389/fgene.2022.927222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Multi-modal medical image fusion can reduce information redundancy, increase the understandability of images and provide medical staff with more detailed pathological information. However, most of traditional methods usually treat the channels of multi-modal medical images as three independent grayscale images which ignore the correlation between the color channels and lead to color distortion, attenuation and other bad effects in the reconstructed image. In this paper, we propose a multi-modal medical image fusion algorithm with geometric algebra based sparse representation (GA-SR). Firstly, the multi-modal medical image is represented as a multi-vector, and the GA-SR model is introduced for multi-modal medical image fusion to avoid losing the correlation of channels. Secondly, the orthogonal matching pursuit algorithm based on geometric algebra (GAOMP) is introduced to obtain the sparse coefficient matrix. The K-means clustering singular value decomposition algorithm based on geometric algebra (K-GASVD) is introduced to obtain the geometric algebra dictionary, and update the sparse coefficient matrix and dictionary. Finally, we obtain the fused image by linear combination of the geometric algebra dictionary and the coefficient matrix. The experimental results demonstrate that the proposed algorithm outperforms existing methods in subjective and objective quality evaluation, and shows its effectiveness for multi-modal medical image fusion.
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Affiliation(s)
- Yanping Li
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
- Office of Academic Affairs, Shanghai University, Shanghai, China
| | - Nian Fang
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Haiquan Wang
- Department of General Surgery, Shanghai General Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Rui Wang
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
- *Correspondence: Rui Wang,
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Pinilo J, Hutt A, Labreuche J, Faivre JB, Flohr T, Schmidt B, Duhamel A, Remy J, Remy-Jardin M. Evaluation Of a New Reconstruction Technique for Dual-Energy (DECT) Lung Perfusion: Preliminary Experience In 58 Patients. Acad Radiol 2022; 29 Suppl 2:S202-S214. [PMID: 34446359 DOI: 10.1016/j.acra.2021.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/24/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE To compare dual-energy (DE) lung perfused blood volume generated by subtraction of virtual monoenergetic images (Lung Mono) with images obtained by three-compartment decomposition (Lung PBV). MATERIAL AND METHODS The study included 58 patients (28 patients with and 30 patients without PE) with reconstruction of Lung PBV images (i.e., the reference standard) and Lung Mono images. The inter-technique comparison was undertaken at a patient and segment level. RESULTS The distribution of scores of subjective image noise (patient level) significantly differed between the two reconstructions (p<0.0001), with mild noise in 58.6% (34/58) of Lung Mono images vs 25.9% (15/58) of Lung PBV images. Detection of perfusion defects (segment level) was concordant in 1104 segments (no defect: n=968; defects present: n=138) and discordant in 2 segments with a PE-related defect only depicted on Lung Mono images. Among the 28 PE patients, the distribution of gradient of attenuation between perfused areas and defects was significantly higher on Lung Mono images compared to Lung PBV (median= 73.5 HU (QI=65.0; Q3=86.0) vs 24.5 HU (22.0; 30.0); p<0.0001). In all patients, fissures were precisely identified in 77.6% of patients (45/58) on Lung Mono images while blurred (30/58; 51.7%) or not detectable (28/58; 48.3%) on Lung PBV images. CONCLUSION Lung Mono perfusion imaging allows significant improvement in the overall image quality and improved detectability of PE-type perfusion defects.
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Charyyev S, Wang T, Lei Y, Ghavidel B, Beitler JJ, McDonald M, Curran WJ, Liu T, Zhou J, Yang X. Learning-based synthetic dual energy CT imaging from single energy CT for stopping power ratio calculation in proton radiation therapy. Br J Radiol 2022; 95:20210644. [PMID: 34709948 PMCID: PMC8722254 DOI: 10.1259/bjr.20210644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Dual energy CT (DECT) has been shown to estimate stopping power ratio (SPR) map with a higher accuracy than conventional single energy CT (SECT) by obtaining the energy dependence of photon interactions. This work presents a learning-based method to synthesize DECT images from SECT image for proton radiotherapy. METHODS The proposed method uses a residual attention generative adversarial network. Residual blocks with attention gates were used to force the model to focus on the difference between DECT images and SECT images. To evaluate the accuracy of the method, we retrospectively investigated 70 head-and-neck cancer patients whose DECT and SECT scans were acquired simultaneously. The model was trained to generate both a high and low energy DECT image based on a SECT image. The generated synthetic low and high DECT images were evaluated against the true DECT images using leave-one-out cross-validation. To evaluate our method in the context of a practical application, we generated SPR maps from synthetic DECT (sDECT) using a dual-energy based stoichiometric method and compared the SPR maps to those generated from DECT. A dosimetric comparison for dose obtained from DECT was performed against that derived from sDECT. RESULTS The mean of mean absolute error, peak signal-to-noise ratio and normalized cross-correlation for the synthetic high and low energy CT images was 36.9 HU, 29.3 dB, 0.96 and 35.8 HU, 29.2 dB, and 0.96, respectively. The corresponding SPR maps generated from synthetic DECT showed an average normalized mean square deviation of about 1% with reduced noise level and artifacts than those from original DECT. Dose-volume histogram (DVH) metrics for the clinical target volume agree within 1% between the DECT and sDECT calculated dose. CONCLUSION Our method synthesized accurate DECT images and showed a potential feasibility for proton SPR map generation. ADVANCES IN KNOWLEDGE This study investigated a learning-based method to synthesize DECT images from SECT image for proton radiotherapy.
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Affiliation(s)
- Serdar Charyyev
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Beth Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mark McDonald
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Vlahos I, Jacobsen MC, Godoy MC, Stefanidis K, Layman RR. Dual-energy CT in pulmonary vascular disease. Br J Radiol 2022; 95:20210699. [PMID: 34538091 PMCID: PMC8722250 DOI: 10.1259/bjr.20210699] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023] Open
Abstract
Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
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Affiliation(s)
- Ioannis Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rick R Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Degerstedt SG, Winant AJ, Lee EY. Pediatric Pulmonary Embolism: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:69-82. [PMID: 34836567 DOI: 10.1016/j.rcl.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In contrast with the algorithms and screening criteria available for adults with suspected pulmonary embolism, there is a paucity of guidance on the diagnostic approach for children. The incidence of pulmonary embolism in the pediatric population and young adults is higher than thought, and there is an urgent need for updated guidelines for the imaging approach to diagnosis in the pediatric population. This article presents an up-to-date review of imaging techniques, characteristic radiologic findings, and an evidence-based algorithm for the detection of pediatric pulmonary embolism to improve the care of pediatric patients with suspected pulmonary embolism.
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Affiliation(s)
- Spencer G Degerstedt
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Petritsch B, Pannenbecker P, Weng AM, Grunz JP, Veldhoen S, Bley TA, Kosmala A. Split-filter dual-energy CT pulmonary angiography for the diagnosis of acute pulmonary embolism: a study on image quality and radiation dose. Quant Imaging Med Surg 2021; 11:1817-1827. [PMID: 33936967 DOI: 10.21037/qims-20-740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Computed tomography (CT) pulmonary angiography is the diagnostic reference standard in suspected pulmonary embolism (PE). Favorable results for dual-energy CT (DECT) images have been reported for this condition. Nowadays, dual-energy data acquisition is feasible with different technical options, including a single-source split-filter approach. Therefore, the aim of this retrospective study was to investigate image quality and radiation dose of thoracic split-filter DECT in comparison to conventional single-energy CT in patients with suspected PE. Methods A total of 110 CT pulmonary angiographies were accomplished either as standard single-energy CT with automatic tube voltage selection (ATVS) (n=58), or as split-filter DECT (n=52). Objective [pulmonary artery CT attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] and subjective image quality [four-point Likert scale; three readers (R)] were compared among the two study groups. Size-specific dose estimates (SSDE), dose-length-product (DLP) and volume CT dose index (CTDIvol) were assessed for radiation dose analysis. Results Split-filter DECT images yielded 67.7% higher SNR (27.0 vs. 16.1; P<0.001) and 61.9% higher CNR (22.5 vs. 13.9; P<0.001) over conventional single-energy images, whereas CT attenuation was significantly lower (344.5 vs. 428.2 HU; P=0.013). Subjective image quality was rated good or excellent in 93.0%/98.3%/77.6% (R1/R2/R3) of the single-energy CT scans, and 84.6%/82.7%/80.8% (R1/R2/R3) of the split-filter DECT scans. SSDE, DLP and CTDIvol were significantly lower for conventional single-energy CT compared to split-filter DECT (all P<0.05), which was associated with 26.7% higher SSDE. Conclusions In the diagnostic workup of acute PE, the split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners. The existing opportunity to assess pulmonary "perfusion" based on analysis of iodine distribution maps is associated with higher radiation dose in terms of increased SSDE than conventional single-energy CT with ATVS. Moreover, a proportion of up to 3.8% non-diagnostic examinations in the current reference standard test for PE is not negligible.
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Affiliation(s)
- Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Ohira S, Koike Y, Akino Y, Kanayama N, Wada K, Ueda Y, Masaoka A, Washio H, Miyazaki M, Koizumi M, Ogawa K, Teshima T. Improvement of image quality for pancreatic cancer using deep learning-generated virtual monochromatic images: Comparison with single-energy computed tomography. Phys Med 2021; 85:8-14. [PMID: 33940528 DOI: 10.1016/j.ejmp.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To construct a deep convolutional neural network that generates virtual monochromatic images (VMIs) from single-energy computed tomography (SECT) images for improved pancreatic cancer imaging quality. MATERIALS AND METHODS Fifty patients with pancreatic cancer underwent a dual-energy CT simulation and VMIs at 77 and 60 keV were reconstructed. A 2D deep densely connected convolutional neural network was modeled to learn the relationship between the VMIs at 77 (input) and 60 keV (ground-truth). Subsequently, VMIs were generated for 20 patients from SECT images using the trained deep learning model. RESULTS The contrast-to-noise ratio was significantly improved (p < 0.001) in the generated VMIs (4.1 ± 1.8) compared to the SECT images (2.8 ± 1.1). The mean overall image quality (4.1 ± 0.6) and tumor enhancement (3.6 ± 0.6) in the generated VMIs assessed on a five-point scale were significantly higher (p < 0.001) than that in the SECT images (3.2 ± 0.4 and 2.8 ± 0.4 for overall image quality and tumor enhancement, respectively). CONCLUSIONS The quality of the SECT image was significantly improved both objectively and subjectively using the proposed deep learning model for pancreatic tumors in radiotherapy.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Yuhei Koike
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Yuichi Akino
- Division of Medical Physics, Oncology Center, Osaka University Hospital, Suita, Japan
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Wada
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Masaoka
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hayate Washio
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Nguyen ET, Hague C, Manos D, Memauri B, Souza C, Taylor J, Dennie C. Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 2: Technical Issues and Interpretation Pitfalls. Can Assoc Radiol J 2021; 73:214-227. [PMID: 33781102 DOI: 10.1177/08465371211000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The investigation of acute pulmonary embolism is a common task for radiologists in Canada. Technical image quality and reporting quality must be excellent; pulmonary embolism is a life-threatening disease that should not be missed but overdiagnosis and unnecessary treatment should be avoided. The most frequently performed imaging investigation, computed tomography pulmonary angiogram (CTPA), can be limited by poor pulmonary arterial opacification, technical artifacts and interpretative errors. Image quality can be affected by patient factors (such as body habitus, motion artifact and cardiac output), intravenous (IV) contrast protocols (including the timing, rate and volume of IV contrast administration) and common physics artifacts (including beam hardening). Mimics of acute pulmonary embolism can be seen in normal anatomic structures, disease in non-vascular structures and pulmonary artery filling defects not related to acute pulmonary emboli. Understanding these pitfalls can help mitigate error, improve diagnostic quality and optimize patient outcomes. Dual energy computed tomography holds promise to improve imaging diagnosis, particularly in clinical scenarios where routine CTPA may be problematic, including patients with impaired renal function and patients with altered cardiac anatomy.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, 33540Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Hague
- Department of Radiology, 12358University of British Columbia, Vancouver, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brett Memauri
- Cardiothoracic Sciences Division, St. Boniface General Hospital, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolina Souza
- Department of Medical Imaging, 10055The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jana Taylor
- 54473McGill University Health Centre, Montreal, Quebec, Canada
| | - Carole Dennie
- Department of Medical Imaging, 10055The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- 27337Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Ren G, Lam SK, Zhang J, Xiao H, Cheung ALY, Ho WY, Qin J, Cai J. Investigation of a Novel Deep Learning-Based Computed Tomography Perfusion Mapping Framework for Functional Lung Avoidance Radiotherapy. Front Oncol 2021; 11:644703. [PMID: 33842356 PMCID: PMC8024641 DOI: 10.3389/fonc.2021.644703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Abstract
Functional lung avoidance radiation therapy aims to minimize dose delivery to the normal lung tissue while favoring dose deposition in the defective lung tissue based on the regional function information. However, the clinical acquisition of pulmonary functional images is resource-demanding, inconvenient, and technically challenging. This study aims to investigate the deep learning-based lung functional image synthesis from the CT domain. Forty-two pulmonary macro-aggregated albumin SPECT/CT perfusion scans were retrospectively collected from the hospital. A deep learning-based framework (including image preparation, image processing, and proposed convolutional neural network) was adopted to extract features from 3D CT images and synthesize perfusion as estimations of regional lung function. Ablation experiments were performed to assess the effects of each framework component by removing each element of the framework and analyzing the testing performances. Major results showed that the removal of the CT contrast enhancement component in the image processing resulted in the largest drop in framework performance, compared to the optimal performance (~12%). In the CNN part, all the three components (residual module, ROI attention, and skip attention) were approximately equally important to the framework performance; removing one of them resulted in a 3–5% decline in performance. The proposed CNN improved ~4% overall performance and ~350% computational efficiency, compared to the U-Net model. The deep convolutional neural network, in conjunction with image processing for feature enhancement, is capable of feature extraction from CT images for pulmonary perfusion synthesis. In the proposed framework, image processing, especially CT contrast enhancement, plays a crucial role in the perfusion synthesis. This CTPM framework provides insights for relevant research studies in the future and enables other researchers to leverage for the development of optimized CNN models for functional lung avoidance radiation therapy.
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Affiliation(s)
- Ge Ren
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Sai-Kit Lam
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Haonan Xiao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Andy Lai-Yin Cheung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Wai-Yin Ho
- Department of Nuclear Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Jing Qin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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Kojima T, Shirasaka T, Kondo M, Kato T, Nishie A, Ishigami K, Yabuuchi H. A novel fast kilovoltage switching dual-energy CT with deep learning: Accuracy of CT number on virtual monochromatic imaging and iodine quantification. Phys Med 2021; 81:253-261. [PMID: 33508738 DOI: 10.1016/j.ejmp.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE A novel fast kilovoltage switching dual-energy CT with deep learning [Deep learning based-spectral CT (DL-Spectral CT)], which generates a complete sinogram for each kilovolt using deep learning views that complement the measured views at each energy, was commercialized in 2020. The purpose of this study was to evaluate the accuracy of CT numbers in virtual monochromatic images (VMIs) and iodine quantifications at various radiation doses using DL-Spectral CT. MATERIALS AND METHODS Two multi-energy phantoms (large and small) using several rods representing different materials (iodine, calcium, blood, and adipose) were scanned by DL-Spectral CT at varying radiation doses. Images were reconstructed using three reconstruction parameters (body, lung, bone). The absolute percentage errors (APEs) for CT numbers on VMIs at 50, 70, and 100 keV and iodine quantification were compared among different radiation dose protocols. RESULTS The APEs of the CT numbers on VMIs were <15% in both the large and small phantoms, except at the minimum dose in the large phantom. There were no significant differences among radiation dose protocols in computed tomography dose index volumes of 12.3 mGy or larger. The accuracy of iodine quantification provided by the body parameter was significantly better than those obtained with the lung and bone parameters. Increasing the radiation dose did not always improve the accuracy of iodine quantification, regardless of the reconstruction parameter and phantom size. CONCLUSION The accuracy of iodine quantification and CT numbers on VMIs in DL-Spectral CT was not affected by the radiation dose, except for an extremely low radiation dose for body size.
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Affiliation(s)
- Tsukasa Kojima
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan; Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takashi Shirasaka
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Masatoshi Kondo
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Akihiro Nishie
- Departments of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Diagnostic Impact of Quantitative Dual-Energy Computed Tomography Perfusion Imaging for the Assessment of Subsegmental Pulmonary Embolism. J Comput Assist Tomogr 2021; 45:151-156. [PMID: 33186173 DOI: 10.1097/rct.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the quantitative differences of dual-energy computed tomography perfusion imaging measurements in subsegmental pulmonary embolism (SSPE), between normal lung parenchyma (NLP) and hypoperfused segments (HPS) with and without thrombus on computed tomography angiography (CTA). METHODS Lung attenuation, iodine density, and normalized uptake values were measured from HPS and NLP on iodine maps of 43 patients with SSPE. Presence of pulmonary embolism (PE) on CTA was recorded. One-way repeated-measures analysis of variance and Kruskal-Wallis analyses with post hoc comparisons were conducted. RESULTS The numbers of HPS with and without SSPE on CTA were 45 (55.6%) and 36 (44.4%), respectively. Lung attenuation of NLP was significantly different from HPS (P < 0.001). Iodine density and normalized uptake values of HPS with PE were significantly lower than those of HPS without PE, which is significantly lower than NLP (P < 0.001). CONCLUSIONS Subsegmental pulmonary embolism causes HPS on dual-energy computed tomography perfusion imaging, which demonstrates different iodine density and normalized uptake values depending on the presence of thrombus.
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Zhang S, Zhou P, Pan K, Liu Z, Li Y, Sun T. Fast method for computing a system matrix using a polar-coordinate pixel model with concentric annuluses of different radial widths. APPLIED OPTICS 2020; 59:11225-11231. [PMID: 33362043 DOI: 10.1364/ao.410415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Despite better reconstruction quality for incomplete or noisy projection data compared to analytic reconstruction, computed tomography iterative techniques are time-consuming, mainly due to high system matrix computation. A polar-coordinate pixel model with concentric annuluses of different radial widths was established and a fast method for computing the system matrix was presented based on characteristics of this model. Compared with the Siddon algorithm and an efficient Cartesian algorithm introduced by Zhang, the proposed algorithm based on the simultaneous algebraic reconstruction technique shows speed advantages for both numerical simulation and experiment, without noticeable loss of image quality.
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Gopalan D, Gibbs JSR. From Early Morphometrics to Machine Learning-What Future for Cardiovascular Imaging of the Pulmonary Circulation? Diagnostics (Basel) 2020; 10:diagnostics10121004. [PMID: 33255668 PMCID: PMC7760106 DOI: 10.3390/diagnostics10121004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a cardinal role in the diagnosis and management of diseases of the pulmonary circulation. Behind the picture itself, every digital image contains a wealth of quantitative data, which are hardly analysed in current routine clinical practice and this is now being transformed by radiomics. Mathematical analyses of these data using novel techniques, such as vascular morphometry (including vascular tortuosity and vascular volumes), blood flow imaging (including quantitative lung perfusion and computational flow dynamics), and artificial intelligence, are opening a window on the complex pathophysiology and structure-function relationships of pulmonary vascular diseases. They have the potential to make dramatic alterations to how clinicians investigate the pulmonary circulation, with the consequences of more rapid diagnosis and a reduction in the need for invasive procedures in the future. Applied to multimodality imaging, they can provide new information to improve disease characterization and increase diagnostic accuracy. These new technologies may be used as sophisticated biomarkers for risk prediction modelling of prognosis and for optimising the long-term management of pulmonary circulatory diseases. These innovative techniques will require evaluation in clinical trials and may in themselves serve as successful surrogate end points in trials in the years to come.
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Affiliation(s)
- Deepa Gopalan
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Imperial College London, London SW7 2AZ, UK;
- Cambridge University Hospital, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-77-3000-7780
| | - J. Simon R. Gibbs
- Imperial College London, London SW7 2AZ, UK;
- National Heart & Lung Institute, Imperial College London, London SW3 6LY, UK
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Perez-Johnston R, Plodkowski AJ, Halpenny DF, Hayes SA, Capanu M, Araujo-Filho JAB, Weinsaft JW, Ginsberg MS. Perfusion defects on dual-energy CTA in patients with suspected pulmonary embolism correlate with right heart strain and lower survival. Eur Radiol 2020; 31:2013-2021. [PMID: 33048226 DOI: 10.1007/s00330-020-07333-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/19/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the utility of perfusion defects on dual-energy CT angiograms (DECTA) in assessing the clinical severity of pulmonary embolism (PE). METHODS We retrospectively reviewed 1136 consecutive diagnostic DECTA exams performed on patients with suspected PE between January 2014 and September 2014. Presence and location of obstructive and non-obstructive PE, right ventricular to left ventricular ratio (RV/LV ratio), and inferior vena cava (IVC) backflow were recorded. Iodine maps were reviewed to establish the presence of perfusion defect and its extent was determined through a score-based segmental impaired perfusion. Subsequently, the perfusion defect scores were correlated with clinical parameters including vital signs, electrocardiogram (ECG) abnormalities, echocardiogram findings, troponin, and brain natriuretic peptide (bnp) levels. Clinical information regarding primary cancer diagnosis, oncologic stage, and date of death if applicable was also recorded. RESULTS Of the 1136 diagnostic iodine maps, 96 of these patients had perfusion defects on iodine maps. After uni- and multivariate analysis, significant correlation was found between the presence of a perfusion defect and RV/LV ratio (p = 0.05), IVC backflow (p = 0.03), elevated troponin (p = 0.03), and right heart dysfunction as determined on an echocardiogram (p = 0.05). The greater the perfusion defect score, the higher the likelihood of IVC backflow (p = 0.005) and obstructive PE (p = 0.002). When adjusted for oncologic stage, patients with a perfusion defect and a higher perfusion defect score had a higher mortality rate (p = 0.005). CONCLUSION The presence of a perfusion defect correlates with several parameters evaluating PE severity. A perfusion defect and higher perfusion defect score were associated with a lower survival. KEY POINTS • Detection of perfusion defects on dual-energy CT angiograms and its extent correlates with right heart strain in the setting of pulmonary embolism. • The presence and extent of a perfusion defect in patients with pulmonary embolism are associated with lower survival.
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Affiliation(s)
- Rocio Perez-Johnston
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J A B Araujo-Filho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Petritsch B, Pannenbecker P, Weng AM, Veldhoen S, Grunz JP, Bley TA, Kosmala A. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. ROFO-FORTSCHR RONTG 2020; 193:427-436. [PMID: 33003244 DOI: 10.1055/a-1245-0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Comparison of dual-source dual-energy CT (DS-DECT) and split-filter dual-energy CT (SF-DECT) regarding image quality and radiation dose in patients with suspected pulmonary embolism. MATERIALS AND METHODS We retrospectively analyzed pulmonary dual-energy CT angiography (CTPA) scans performed on two different CT scanners in 135 patients with suspected pulmonary embolism (PE). Scan parameters for DS-DECT were 90/Sn150 kV (n = 68 patients), and Au/Sn120 kV for SF-DECT (n = 67 patients). The iodine delivery rate was 1400 mg/s in the DS-DECT group vs. 1750 mg/s in the SF-DECT group. Color-coded iodine distribution maps were generated for both protocols. Objective (CT attenuation of pulmonary trunk [HU], signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective image quality parameters (two readers [R], five-point Likert scale), as well as radiation dose parameters (effective radiation dose, size-specific dose estimations [SSDE]) were compared. RESULTS All CTPA scans in both groups were of diagnostic image quality. Subjective CTPA image quality was rated as good or excellent in 80.9 %/82.4 % (R1 / R2) of DS-DECT scans, and in 77.6 %/76.1 % of SF-DECT scans. For both readers, the image quality of split-filter iodine distribution maps was significantly lower (p < 0.05) with good or excellent ratings in only 43.3 %/46.3 % (R1 / R2) vs. 83.8 %/88.2 % for maps from DS-DECT. The HU values of the pulmonary trunk did not differ between the two techniques (p = n. s.), while both the SNR and CNR were significantly higher in the split-filter group (p < 0.001; p = 0.003). Both effective radiation dose (2.70 ± 1.32 mSv vs. 2.89 ± 0.94 mSv) and SSDE (4.71 ± 1.63 mGy vs. 5.84 ± 1.11 mGy) were significantly higher in the split-filter group (p < 0.05). CONCLUSION The split-filter allows for dual-energy imaging of suspected pulmonary embolism but is associated with lower iodine distribution map quality and higher radiation dose. KEY POINTS · The split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners.. · Compared to the assessed dual-source dual-energy system, split-filter dual-energy imaging of a suspected pulmonary embolism is associated with lower iodine distribution map quality and higher radiation dose.. · Both the split-filter and the dual-source scanner provide diagnostic image quality in CTPA.. CITATION FORMAT · Petritsch B, Pannenbecker P, Weng AM et al. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. Fortschr Röntgenstr 2021; 193: 427 - 436.
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Affiliation(s)
- Bernhard Petritsch
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Aoyama R, Murata T, Ishikawa J, Harada K. Case report of non-ST-segment elevation myocardial infarction diagnosed in spectral detector-based computed tomography performed for the diagnosis of acute pulmonary embolism. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 33426452 PMCID: PMC7780472 DOI: 10.1093/ehjcr/ytaa284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/15/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022]
Abstract
Background Contrast-enhanced spectral detector-based computed tomography (SDCT) allows for the comprehensive and retrospective analysis. We report a case of pulmonary thromboembolism (PE) accompanied by non-ST-segment elevation myocardial infarction (NSTEMI) diagnosed by SDCT. Case summary A 72-year-old man with diabetes mellitus, hypertension, and prostate cancer suddenly developed chest and back pain and had difficulty in breathing at rest. Electrocardiography showed a right bundle branch block without significant ST-segment change. The initial serum troponin I level was 0.05 ng/mL, and the d-dimer level was 14.7 μg/mL. Spectral detector-based computed tomography showed bilateral scattered PE. After admission, his chest pain persisted, and the serum troponin I level 3 h after admission was elevated to 0.90 ng/mL. Reconstruction of SDCT images showed a perfusion defect of the posterolateral left ventricle myocardium. A coronary angiogram showed total occlusion of the obtuse marginal branch (OM); percutaneous coronary intervention was performed. Furthermore, we administered him with oral anticoagulants (OACs) for PE. Spectral detector-based computed tomography tests performed 6 months after the treatment was initiated, until when the dual antiplatelet therapy and OAC therapy were continued, showed improvement in perfusion defects of both pulmonary fields and the myocardium. His treatment was deescalated to single antiplatelet therapy and OAC, and the patient has had a good course. Discussion Non-ST-segment elevation myocardial infarction is sometimes difficult to diagnose accurately, especially in the hyper-acute phase or in the OM branch. The reconstruction of spectral images from enhanced SDCT was helpful to diagnose this unique combination of PE and NSTEMI and may be useful for evaluating therapeutic effects in such patients.
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Affiliation(s)
- Rie Aoyama
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaechou, Itabashi-ku, Tokyo 173-0015, Japan
| | - Teppei Murata
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaechou, Itabashi-ku, Tokyo 173-0015, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaechou, Itabashi-ku, Tokyo 173-0015, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaechou, Itabashi-ku, Tokyo 173-0015, Japan
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Potigailo V, Kohli A, Pakpoor J, Cain DW, Passi N, Mohsen N. Recent Advances in Computed Tomography and MR Imaging. PET Clin 2020; 15:381-402. [PMID: 32888544 DOI: 10.1016/j.cpet.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Numerous advanced MR imaging and computed tomographic techniques have been developed and implemented in clinical practice over the past several years resulting in increased diagnostic accuracy and improved patient care. In this article, the authors highlight recent and emerging imaging techniques in functional and structural MR imaging, perfusion and vascular imaging, standardization of imaging practices, and selected applications of artificial intelligence in clinical practice.
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Affiliation(s)
- Valeria Potigailo
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Ajay Kohli
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jina Pakpoor
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Donald Wesley Cain
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Neena Passi
- University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nancy Mohsen
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Pulmonary perfusion by iodine subtraction maps CT angiography in acute pulmonary embolism: comparison with pulmonary perfusion SPECT (PASEP trial). Eur Radiol 2020; 30:4857-4864. [PMID: 32279113 DOI: 10.1007/s00330-020-06836-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of iodine map computed tomography pulmonary angiography (CTPA), for segment-based evaluation of lung perfusion in patients with acute pulmonary embolism (PE), using perfusion single-photon emission CT (SPECT) imaging as a reference standard. METHODS Thirty participants who have been diagnosed with acute pulmonary embolism on CTPA underwent perfusion SPECT/CT within 24 h. Perfusion SPECT and iodine map were independently interpreted by 2 nuclear medicine physicians and 2 radiologists. For both modalities, each segment was classified as normoperfused or hypoperfused, as defined by a perfusion defect of more than 25% of a segment. The primary end point was the diagnostic accuracy (sensitivity and specificity) of iodine map for segment-based evaluation of lung perfusion, using perfusion SPECT imaging as a reference standard. Following blinded interpretation, a retrospective explanatory analysis was performed to determine potential causes of misinterpretation. RESULTS The median time between CTPA with iodine maps and perfusion SPECT was 14 h (range 2-23 h). A total of 597 segments were analyzed. Sensitivity and specificity of iodine maps with CTPA for the detection of segmental perfusion defects were 231/284 = 81.3% (95% CI 76.4 to 85.4%) and 247/313 = 78.9% (95% CI 74.1 to 83.1%), respectively. In retrospect, false results were explained in 48.7%. CONCLUSION Iodine map CTPA showed promising results for the assessment of pulmonary perfusion in patients with acute PE, with sensitivity of 81.3% and specificity of 78.9%, respectively. Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the accuracy of the test. KEY POINTS • Sensitivity and specificity of iodine subtraction maps for the detection of segmental perfusion defects were 81.3% (95% CI 76.4 to 85.4%) and 78.9% (95% CI 74.1 to 83.1%), respectively. • Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the diagnostic accuracy of the test.
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Si-Mohamed S, Moreau-Triby C, Tylski P, Tatard-Leitman V, Wdowik Q, Boccalini S, Dessouky R, Douek P, Boussel L. Head-to-head comparison of lung perfusion with dual-energy CT and SPECT-CT. Diagn Interv Imaging 2020; 101:299-310. [PMID: 32173289 DOI: 10.1016/j.diii.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the quantitative and qualitative lung perfusion data acquired with dual energy CT (DECT) to that acquired with a large field-of-view cadmium-zinc-telluride camera single-photon emission CT coupled to a CT system (SPECT-CT). MATERIALS AND METHODS A total of 53 patients who underwent both dual-layer DECT angiography and perfusion SPECT-CT for pulmonary hypertension or pre-operative lobar resection surgery were retrospectively included. There were 30 men and 23 women with a mean age of 65.4±17.5 (SD)years (range: 18-88years). Relative lobar perfusion was calculated by dividing the amount (of radiotracer or iodinated contrast agent) per lobe by the total amount in both lungs. Linear regression, Bland-Altman analysis, and Pearson's correlation coefficient were also calculated. Kappa test was used to test agreements in morphology and severity of perfusion defects assessed on SPECT-CT and on DECT iodine maps with a one-month interval. Wilcoxon rank sum test was used to compare the sharpness of perfusion defects and radiation dose among modalities. RESULTS Strong correlations for relative lobar perfusion using linear regression analysis and Pearson's correlation coefficient (r=0.93) were found. Bland-Altman analysis revealed a -0.10 bias, with limits of agreement between [-6.01; 5.81]. With respect to SPECT- CT as standard of reference, the sensitivity, specificity, PPV, NPV, accuracy for lobar perfusion defects were 89.4% (95%
CI: 82.6-93.4%), 96.5% (95% CI: 92.1-98.5%), 95.6% (95% CI:
90.9-97.8%), 91.4% (95% CI: 85.6-94.9%) and 93.0% (95% CI:
87.6-96.1%) respectively. High level of agreement was found for morphology and severity of perfusion defects between modalities (Kappa=0.84 and 0.86 respectively) and on DECT images among readers (Kappa=0.94 and 0.89 respectively). A significantly sharper delineation of perfusion defects was found on DECT images (P<0.0001) using a significantly lower equivalent dose of 4.1±2.3 (SD) mSv (range: 1.9-11.85mSv) compared to an equivalent dose of 5.3±1.1 (SD) mSv (range: 2.8-7.3mSv) for SPECT-CT, corresponding to a 21.2% dose reduction (P=0.0004). CONCLUSION DECT imaging shows strong quantitative correlations and qualitative agreements with SPECT-CT for the evaluation of lung perfusion.
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Affiliation(s)
- S Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France.
| | - C Moreau-Triby
- Department of Nuclear Medicine, Hospices Civils de Lyon, 69500 Bron, France
| | - P Tylski
- Medical Physics and Radioprotection, Hospices Civils de Lyon, 69500 Bron, France
| | - V Tatard-Leitman
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Q Wdowik
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France
| | - S Boccalini
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France
| | - R Dessouky
- Department of Radiology, Faculty of Medicine, Zagazig University, 44519 Zagazig, Egypt
| | - P Douek
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - L Boussel
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
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Haramati A, Haramati LB. Imaging of Chronic Thromboembolic Disease. Lung 2020; 198:245-255. [PMID: 32166427 DOI: 10.1007/s00408-020-00344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity which ranges from asymptomatic imaging sequelae to persistent symptoms. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that can develop in this population and represents the only treatable type of pulmonary hypertension. Recognition of the characteristic findings of chronic pulmonary embolism and CTEPH provides not only diagnostic information, but is also crucial for guiding therapy. The present state-of-the-art review focuses on the multimodality imaging features of chronic pulmonary embolism. Detailed description and illustrations of relevant imaging findings will be demonstrated for ventilation/perfusion (V/Q) scan, CT scan and Dual-Energy CT and MRI and features that distinguish chronic PE from common imaging mimics.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY, USA.
| | - Linda B Haramati
- Departments of Radiology and Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Lysdahlgaard S, Hess S, Gerke O, Weber Kusk M. A systematic literature review and meta-analysis of spectral CT compared to scintigraphy in the diagnosis of acute and chronic pulmonary embolisms. Eur Radiol 2020; 30:3624-3633. [PMID: 32112117 DOI: 10.1007/s00330-020-06735-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 02/07/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To examine the diagnostic accuracy of spectral CT pulmonary angiography (S-CTPA) using ventilation-perfusions lung scintigraphy (V/Q-scan) as a reference standard in the diagnosis of acute or chronic pulmonary embolism (APE/CPE) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS PubMed, Embase, Scopus, and Web of Science were searched for the period from 1 Jan 2006 to 7 Feb 2019; eligible studies had > 10 patients over 18 years old, a diagnostic outcome of PE or CTEPH, and used V/Q scan as a reference standard. Bias and applicability were assessed using QUADAS-2 tools. Sensitivities, specificities, and predictive values were noted or calculated from available information. Meta-analysis employed a fixed-effects model of Mantel and Haenszel. Heterogeneity was assessed with I-squared statistics. RESULTS Four hundred ninety-three unique records were identified. Following screening by title, 53 studies were included in the abstract and full-text assessment. A total of six articles were included; four were suitable for a meta-analysis. Pooled sensitivity was 94.2% (95% CI, 88.3-100%), pooled specificity was 88.5% (95% CI, 81.3-95.6%), and positive and negative predictive values were 87.8% (95% CI, 80.3-95.4%) and 94.5% (95% CI, 89.3-99.7%), respectively. CONCLUSION Data on S-CTPA for PE/CTEPH remains promising, but limited; only small studies with methodological issues are available. Evidence is best for CPE/CTEPH whereas no firm conclusions are possible for APE. There is a need for larger, prospective studies with a robust composite reference standard including state-of-the-art CTPA and V/Q-scans. KEY POINTS • S-CTPA has high sensitivity and specificity for perfusion defects in patients with PE or CPETH. • Methodological issues and diversity of reference standards were found in the small number of included studies. • There is a need for larger prospective studies with more robust composite reference standards.
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Affiliation(s)
- Simon Lysdahlgaard
- Department of Radiology and Nuclear Medicine, University Hospital of Southwest Jutland, Esbjerg, Denmark.
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, University Hospital of Southwest Jutland, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Martin Weber Kusk
- Department of Radiology and Nuclear Medicine, University Hospital of Southwest Jutland, Esbjerg, Denmark
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Shahin Y, Johns C, Karunasaagarar K, Kiely DG, Swift AJ. IodiNe Subtraction mapping in the diagnosis of Pulmonary chronIc thRomboEmbolic disease (INSPIRE): Rationale and methodology of a cross-sectional observational diagnostic study. Contemp Clin Trials Commun 2019; 15:100417. [PMID: 31388600 PMCID: PMC6667787 DOI: 10.1016/j.conctc.2019.100417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/17/2019] [Accepted: 07/18/2019] [Indexed: 10/27/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe but treatable disease that is commonly underdiagnosed. Computed tomography lung subtraction iodine mapping (CT-LSIM) in addition to standard CT pulmonary angiography (CTPA) may improve the evaluation of suspected chronic pulmonary embolism and improve the diagnostic pick up rate. We aim to recruit 100 patients suspected of having CTEPH and perform CT-LSIM scans in addition to the current gold standard test of nuclear medicine test (lung single photon emission computed tomography (SPECT) imaging) as a pilot study which will contribute to and inform the definitive trial. The diagnostic accuracy of CT-LSIM and lung SPECT will be compared. The primary outcome of the full definitive study is non-inferiority of CT-LSIM versus lung SPECT imaging.
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Affiliation(s)
- Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
| | - Christopher Johns
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
| | - Andy J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
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Grob D, Smit E, Prince J, Kist J, Stöger L, Geurts B, Snoeren MM, van Dijk R, Oostveen LJ, Prokop M, Schaefer-Prokop CM, Sechopoulos I, Brink M. Iodine Maps from Subtraction CT or Dual-Energy CT to Detect Pulmonary Emboli with CT Angiography: A Multiple-Observer Study. Radiology 2019; 292:197-205. [DOI: 10.1148/radiol.2019182666] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dagmar Grob
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Ewoud Smit
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Jip Prince
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Jakob Kist
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Lauran Stöger
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Bram Geurts
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Miranda M. Snoeren
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Rogier van Dijk
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Luuk J. Oostveen
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Mathias Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Cornelia M. Schaefer-Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Ioannis Sechopoulos
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Monique Brink
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
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Rajiah P, Tanabe Y, Partovi S, Moore A. State of the art: utility of multi-energy CT in the evaluation of pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1509-1524. [PMID: 31049753 DOI: 10.1007/s10554-019-01615-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022]
Abstract
Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA.
| | - Yuki Tanabe
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA
- Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alastair Moore
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
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Siegel MJ, Ramirez-Giraldo JC. Dual-Energy CT in Children: Imaging Algorithms and Clinical Applications. Radiology 2019; 291:286-297. [PMID: 30912717 DOI: 10.1148/radiol.2019182289] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dual-energy CT enables the simultaneous acquisition of CT images at two different x-ray energy spectra. By acquiring high- and low-energy spectral data, dual-energy CT can provide unique qualitative and quantitative information about tissue composition, allowing differentiation of multiple materials including iodinated contrast agents. The two dual-energy CT postprocessing techniques that best exploit the advantages of dual-energy CT in children are the material-decomposition images (which include virtual nonenhanced, iodine, perfused lung blood volume, lung vessel, automated bone removal, and renal stone characterization images) and virtual monoenergetic images. Clinical applications include assessment of the arterial system, lung perfusion, neoplasm, bowel diseases, renal calculi, tumor response to treatment, and metal implants. Of importance, the radiation exposure level of dual-energy CT is equivalent to or less than that of conventional single-energy CT. In this review, the authors discuss the basic principles of the dual-energy CT technologies and postprocessing techniques and review current clinical applications in the pediatric chest and abdomen.
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Affiliation(s)
- Marilyn J Siegel
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, Mo 63110 (M.J.S.); and Siemens Healthineers, Malvern, Pa (J.C.R.G.)
| | - Juan Carlos Ramirez-Giraldo
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, Mo 63110 (M.J.S.); and Siemens Healthineers, Malvern, Pa (J.C.R.G.)
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Wang T, Ghavidel BB, Beitler JJ, Tang X, Lei Y, Curran WJ, Liu T, Yang X. Optimal virtual monoenergetic image in "TwinBeam" dual-energy CT for organs-at-risk delineation based on contrast-noise-ratio in head-and-neck radiotherapy. J Appl Clin Med Phys 2019; 20:121-128. [PMID: 30693665 PMCID: PMC6370994 DOI: 10.1002/acm2.12539] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Dual-energy computed tomography (DECT) using TwinBeam CT (TBCT) is a new option for radiation oncology simulators. TBCT scanning provides virtual monoenergetic images which are attractive in treatment planning since lower energies offer better contrast for soft tissues, and higher energies reduce noise. A protocol is needed to achieve optimal performance of this feature. In this study, we investigated the TBCT scan schema with the head-and-neck radiotherapy workflow at our clinic and selected the optimal energy with best contrast-noise-ratio (CNR) in organs-at-risks (OARs) delineation for head-and-neck treatment planning. METHODS AND MATERIALS We synthesized monochromatic images from 40 keV to 190 keV at 5 keV increments from data acquired by TBCT. We collected the Hounsfield unit (HU) numbers of OARs (brainstem, mandible, spinal cord, and parotid glands), the HU numbers of marginal regions outside OARs, and the noise levels for each monochromatic image. We then calculated the CNR for the different OARs at each energy level to generate a serial of spectral curves for each OAR. Based on these spectral curves of CNR, the mono-energy corresponding to the max CNR was identified for each OAR of each patient. RESULTS Computed tomography scans of ten patients by TBCT were used to test the optimal monoenergetic image for the CNR of OAR. Based on the maximized CNR, the optimal energy values were 78.5 ± 5.3 keV for the brainstem, 78.0 ± 4.2 keV for the mandible, 78.5 ± 5.7 keV for the parotid glands, and 78.5 ± 5.3 keV for the spinal cord. Overall, the optimal energy for the maximum CNR of these OARs in head-and-neck cancer patients was 80 keV. CONCLUSION We have proposed a clinically feasible protocol that selects the optimal energy level of the virtual monoenergetic image in TBCT for OAR delineation based on the CNR in head-and-neck OAR. This protocol can be applied in TBCT simulation.
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Affiliation(s)
- Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Beth Bradshaw Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
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Johns CS, Wild JM, Rajaram S, Swift AJ, Kiely DG. Current and emerging imaging techniques in the diagnosis and assessment of pulmonary hypertension. Expert Rev Respir Med 2019; 12:145-160. [PMID: 29261337 DOI: 10.1080/17476348.2018.1420478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a challenging condition to diagnose and treat. Over the last two decades, there have been significant advances in therapeutic approaches and imaging technologies. Current guidelines emphasize the importance of cardiac catheterization; however, the increasing availability of non-invasive imaging has the potential to improve diagnostic rates, whilst providing additional information on patient phenotypes. Areas covered: This review discusses the role of imaging in the diagnosis, prognostic assessment and follow-up of patients with PH. Imaging methods, ranging from established investigations (chest radiography, echocardiography, nuclear medicine and computerized tomography (CT)), to emerging modalities (dual energy CT, magnetic resonance imaging (MRI), optical coherence tomography and positron emission tomography (PET)) are reviewed. The value and limitations of the clinical utility of these imaging modalities and their potential clinical application are reviewed. Expert commentary: Imaging plays a key role in the diagnosis and classification of pulmonary hypertension. It also provides valuable prognostic information and emerging evidence supports a role for serial assessments. The authors anticipate an increasing role for imaging in the pulmonary hypertension clinic. This will reduce the need for invasive investigations, whilst providing valuable insights that will improve our understanding of disease facilitate a more targeted approach to treatment.
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Affiliation(s)
| | - Jim M Wild
- a Academic Radiology , The University of Sheffield , Sheffield , UK
| | - Smitha Rajaram
- b Sheffield Pulmonary Vascular Disease Unit , Sheffield Teaching Hospitals , Sheffield , UK
| | - Andy J Swift
- a Academic Radiology , The University of Sheffield , Sheffield , UK
| | - David G Kiely
- b Sheffield Pulmonary Vascular Disease Unit , Sheffield Teaching Hospitals , Sheffield , UK
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Quantitative Dual-Energy Computed Tomography Predicts Regional Perfusion Heterogeneity in a Model of Acute Lung Injury. J Comput Assist Tomogr 2018; 42:866-872. [PMID: 30371620 PMCID: PMC6250290 DOI: 10.1097/rct.0000000000000815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The aims of this study were to investigate the ability of contrast-enhanced dual-energy computed tomography (DECT) for assessing regional perfusion in a model of acute lung injury, using dynamic first-pass perfusion CT (DynCT) as the criterion standard and to evaluate if changes in lung perfusion caused by prone ventilation are similarly demonstrated by DECT and DynCT. Methods This was an institutional review board–approved study, compliant with guidelines for humane care of laboratory animals. A ventilator-induced lung injury protocol was applied to 6 landrace pigs. Perfused blood volume (PBV) and pulmonary blood flow (PBF) were respectively quantified by DECT and DynCT, in supine and prone positions. The lungs were segmented in equally sized regions of interest, namely, dorsal, middle, and ventral. Perfused blood volume and PBF values were normalized by lung density. Regional air fraction (AF) was assessed by triple-material decomposition DECT. Per-animal correlation between PBV and PBF was assessed with Pearson R. Regional differences in PBV, PBF, and AF were evaluated with 1-way analysis of variance and post hoc linear trend analysis (α = 5%). Results Mean correlation coefficient between PBV and PBF was 0.70 (range, 0.55–0.98). Higher PBV and PBF values were observed in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were −10.24 mL/100 g per zone for PBV (P < 0.001) and −223.0 mL/100 g per minute per zone for PBF (P < 0.001). Prone ventilation also revealed higher PBV and PBF in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were −16.16 mL/100 g per zone for PBV (P < 0.001) and −108.2 mL/100 g per minute per zone for PBF (P < 0.001). By contrast, AF was lower in dorsal versus ventral regions in supine position, with dorsal-to-ventral linear trend slope of +5.77%/zone (P < 0.05). Prone ventilation was associated with homogenization of AF distribution among different regions (P = 0.74). Conclusions Dual-energy computed tomography PBV is correlated with DynCT-PBF in a model of acute lung injury, and able to demonstrate regional differences in pulmonary perfusion. Perfusion was higher in the dorsal regions, irrespectively to decubitus, with more homogeneous lung aeration in prone position.
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[Urology - what are the most important trends over the last decade?]. MMW Fortschr Med 2018; 160:99-102. [PMID: 30421185 DOI: 10.1007/s15006-018-1134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Histogram-based comparison between dynamic and static lung perfused blood volume images using dual energy CT. Eur J Radiol 2018; 108:269-275. [PMID: 30396667 DOI: 10.1016/j.ejrad.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/25/2018] [Accepted: 08/12/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the results of a histogram-based analysis of static and dynamic lung perfused blood volume (LPBV) images. METHODS Sixty-five patients (mean age: 61.3 years, 36 male) underwent dynamic and static LPBV for evaluation of pulmonary vascular diseases (n = 11), lung carcinoma (n = 27) or pulmonary thromboembolism (PTE: n = 27). Seven sets of dynamic sequential scans were performed at the pulmonary trunk using dual-energy technique before the static LPBV scan. The image of lung parenchyma that showed the greatest mean attenuation in dynamic series was defined as the peak dynamic LPBV image. The differences and correlations in the mean attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), histogram skewness and histogram kurtosis were evaluated according to the type of disease in static and dynamic LPBV images. RESULTS Static LPBV images showed significantly larger mean attenuation (Rt:24.2, Lt: 24.2), SNR (Rt:2.31, Lt:2.30), and CNR (Rt:2.40, Lt:2.39), and smaller kurtosis values (Rt:1.06, Lt:0.61) values in comparison to dynamic LPBV images (p < 0.001); however, with the exception of kurtosis of the left lung (r = 0.17), these values were well-corrected with that of the dynamic LPBV images in these values (r = 0.4-0.77, p ≤ 0.001) without kurtosis of left lung (r = 0.17) in all patients. The histogram kurtosis of static LPBV image showed a good correlation with that of dynamic LPBV (r = 0.41-0.77, p < 0.05), especially in patients with PTE. CONCLUSION In patients with PTE, the static LPBV image valueswere well correlated with the peak dynamic LPBV images which demonstrated pulmonary artery-dominant flow.
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Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, Moskowitz C, Ginsberg MS. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology 2018; 289:546-553. [PMID: 30204073 DOI: 10.1148/radiol.2018180594] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if there is added benefit of using iodine maps from dual-energy (DE) CT in addition to conventional CT angiography images to diagnose pulmonary embolism (PE). Materials and Methods In this retrospective analysis, 1144 consecutive dual-energy CT angiography examinations performed from January through September 2014 at an oncologic referral center to evaluate for PE were reviewed. The 1144 examinations included 1035 patients (mean age, 58.7 years; range, 15-99 years). First, the location, level, and type (occlusive vs nonocclusive) of PEs on conventional CT angiograms were recorded. Iodine maps were then reviewed for defects suggestive of PE. Last, CT angiograms were rereviewed to detect additional PEs suggested by the iodine map. Consensus reviews were performed for examinations with PEs. The confidence interval of percentages was calculated by using the Clopper-Pearson method. Results On 147 of 1144 (12.8%) CT angiograms, a total of 372 PEs were detected at initial review. After review of the DE CT iodine map, 27 additional PEs were found on 26 of 1144 CT angiograms (2.3%; 95% confidence interval [CI]: 1.5%, 3.3%). Of the 27 additional PEs, six (22.2%) were segmental, 21 (77.8%) were subsegmental, 24 (88.9%) were occlusive, and three (11.1%) were nonocclusive. Eleven of 1144 (1.0%; 95% CI: 0.5%, 1.7%) CT angiograms had a new diagnosis of PE after review of the DE CT iodine maps. Conclusion Dual-energy CT iodine maps show a small incremental benefit for the detection of occlusive segmental and subsegmental pulmonary emboli. © RSNA, 2018.
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Affiliation(s)
- Elizabeth K Weidman
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Andrew J Plodkowski
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Darragh F Halpenny
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Sara A Hayes
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Rocio Perez-Johnston
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Junting Zheng
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Chaya Moskowitz
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Michelle S Ginsberg
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Noschang J, Guimarães MD, Teixeira DFD, Braga JCD, Hochhegger B, Santana PRP, Marchiori E. Pulmonary thromboembolism: new diagnostic imaging techniques. Radiol Bras 2018; 51:178-186. [PMID: 29991840 PMCID: PMC6034731 DOI: 10.1590/0100-3984.2017.0191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The accurate diagnosis of pulmonary thromboembolism is essential to reducing the
morbidity and mortality associated with the disease. The diagnosis of pulmonary
thromboembolism is challenging because of the nonspecific nature of the clinical
profile and the risk factors. Imaging methods provide the definitive diagnosis.
Currently, the imaging method most commonly used in the evaluation of pulmonary
thromboembolism is computed tomography. The recent development of dual-energy
computed tomography has provided a promising tool for the evaluation of
pulmonary perfusion through iodine mapping. In this article, we will review the
importance of diagnosing pulmonary thromboembolism, as well as the imaging
methods employed, primarily dual-energy computed tomography.
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Affiliation(s)
- Julia Noschang
- MD, Resident in Radiology in the Department of Imaging of the A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcos Duarte Guimarães
- MD, PhD, Radiologist in the Department of Imaging of the A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Bruno Hochhegger
- PhD, Adjunct Professor of Radiology at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Edson Marchiori
- Full Professor of Radiology at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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