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Wu H, Wang J, Zhou M, Wang Y, Cui C, Zhou C, Chen X, Wang Z. Application of bolus tracking: The effect of ROI positions on the images quality of cervicocerebral CT angiography. Heliyon 2024; 10:e29260. [PMID: 38617933 PMCID: PMC11015132 DOI: 10.1016/j.heliyon.2024.e29260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Background Cervicocerebral CT angiography (CTA) using the bolus tracking technique has been widely used for the assessment of cerebrovascular diseases. Regions of interest (ROI) can be placed in the descending aorta, ascending aorta, and the aortic arch. However, no study has compared the arteries and veins display when when the region of interest (ROI) is placed at different sites. In this study, we showed the impact of ROI positions on the image quality of cervicocerebral CTA. Methods Two hundred and seventy patients who underwent cervicocerebral CTA with bolus tracking technique were randomly divided into three groups based on the position of the ROI placement: ascending aorta (Group 1, n = 90), aortic arch (Group 2, n = 90), and descending aorta (Group 3, n = 90). The scanning parameters and contrast agent injection protocols were consistent across all groups. Three observers independently assessed the objective image quality, while two observers jointly assessed the subjective image quality using a grade scale: poor (grade 1), average (grade 2), good (grade 3), and excellent (grade 4). The differences in intravascular CT values, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), AVCR (arterial venous contrast ratio), and subjective image quality scores were compared among the three groups. Results The CT values of the intracranial veins (superior sagittal sinus, ethmoid sinus and great cerebral vein) in group 1 were significantly lower than those in group 3 (p < 0.001). However, no significant differences were observed in CT values, SNR and CNR in the internal carotid artery and middle cerebral artery among the three groups. The proportion of images with grade 4 was significantly higher in group 1 than group 2 and 3 (41.1% vs 15.6% and 13.3%, p < 0.001). The proportion of images with grade 1 was significantly lower in group 1 than group 2 and 3 (1.1% vs 6.6% and 17.8%, p < 0.001). Conclusion The ROI positions for cervicocerebral CTA did not affect the arterial image quality, but venous structures imaging was affected when the ROI was placed in the ascending aorta.
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Affiliation(s)
- Huiming Wu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Maodong Zhou
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Yajie Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Can Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Changsheng Zhou
- Department of Radiology, Jinling Hospital Nanjing University, 305 Zhongshan East road, Nanjing, 210029, China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing, 210029, China
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Feng C, Xiong Z, Sun X, Zhou H, Wang T, Wang Y, Bai HX, Lei P, Liao W. Beyond antioxidation: Harnessing the CeO 2 nanoparticles as a renoprotective contrast agent for in vivo spectral CT angiography. Biomaterials 2023; 299:122164. [PMID: 37229807 DOI: 10.1016/j.biomaterials.2023.122164] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
It is a challenging task to develop a contrast agent that not only provides excellent image contrast but also protects impaired kidneys from oxidative-related stress during angiography. Clinically approved iodinated CT contrast media are associated with potential renal toxicity, making it necessary to develop a renoprotective contrast agent. Here, we develop a CeO2 nanoparticles (NPs)-mediated three-in-one renoprotective imaging strategy, namely, i) renal clearable CeO2 NPs serve as a one-stone-two-birds antioxidative contrast agent, ii) low contrast media dose, and iii) spectral CT, for in vivo CT angiography (CTA). Benefiting from the merits of advanced sensitivity of spectral CT and K-edge energy of Cerium (Ce, 40.4 keV), an improved image quality of in vivo CTA is successfully achieved with a 10 times reduction of contrast agent dosage. In parallel, the sizes of CeO2 NPs and broad catalytic activities are suitable to be filtered via glomerulus thus directly alleviating the oxidative stress and the accompanying inflammatory injury of the kidney tubules. In addition, the low dosage of CeO2 NPs reduces the hypoperfusion stress of renal tubules induced by concentrated contrast agents used in angiography. This three-in-one renoprotective imaging strategy helps prevent kidney injury from being worsened during the CTA examination.
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Affiliation(s)
- Cai Feng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zongling Xiong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xianting Sun
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hao Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Tianming Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ying Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Harrison X Bai
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Peng Lei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China; Molecular Imaging Research Center of Central South University, Changsha, 410008, China.
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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Higashigaito K, Mergen V, Eberhard M, Jungblut L, Hebeisen M, Rätzer S, Zanini B, Kobe A, Martini K, Euler A, Alkadhi H. CT Angiography of the Aorta Using Photon-counting Detector CT with Reduced Contrast Media Volume. Radiol Cardiothorac Imaging 2023; 5:e220140. [PMID: 36860835 PMCID: PMC9969214 DOI: 10.1148/ryct.220140] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Abstract
Purpose To develop and evaluate a low-volume contrast media protocol for thoracoabdominal CT angiography (CTA) with photon-counting detector (PCD) CT. Materials and Methods This prospective study included consecutive participants (April-September 2021) who underwent CTA with PCD CT of the thoracoabdominal aorta and previous CTA with energy-integrating detector (EID) CT at equal radiation doses. In PCD CT, virtual monoenergetic images (VMI) were reconstructed in 5-keV intervals from 40 to 60 keV. Attenuation of the aorta, image noise, and contrast-to-noise ratio (CNR) were measured, and subjective image quality was rated by two independent readers. In the first group of participants, the same contrast media protocol was used for both scans. CNR gain in PCD CT compared with EID CT served as the reference for contrast media volume reduction in the second group. Noninferiority analysis was used to test noninferior image quality of the low-volume contrast media protocol with PCD CT. Results The study included 100 participants (mean age, 75 years ± 8 [SD]; 83 men). In the first group (n = 40), VMI at 50 keV provided the best trade-off between objective and subjective image quality, achieving 25% higher CNR compared with EID CT. Contrast media volume in the second group (n = 60) was reduced by 25% (52.5 mL). Mean differences in CNR and subjective image quality between EID CT and PCD CT at 50 keV were above the predefined boundaries of noninferiority (-0.54 [95% CI: -1.71, 0.62] and -0.36 [95% CI: -0.41, -0.31], respectively). Conclusion CTA of the aorta with PCD CT was associated with higher CNR, which was translated into a low-volume contrast media protocol demonstrating noninferior image quality compared with EID CT at the same radiation dose.Keywords: CT Angiography, CT-Spectral, Vascular, Aorta, Contrast Agents-Intravenous, Technology Assessment© RSNA, 2023See also the commentary by Dundas and Leipsic in this issue.
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Affiliation(s)
- Kai Higashigaito
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Victor Mergen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Lisa Jungblut
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Monika Hebeisen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Susan Rätzer
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Bettina Zanini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Katharina Martini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
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Hu Y, Wang Y, Wang R, Zhang W, Hua R. Designing stimuli-responsive upconversion nanoparticles based on an inner filter effect mimetic immunoassay for phenylketonuria accuracy diagnosis. Colloids Surf B Biointerfaces 2022; 217:112642. [PMID: 35728371 DOI: 10.1016/j.colsurfb.2022.112642] [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: 03/27/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
Phenylketonuria (PKU) is the most common inborn error of amino acid metabolism caused by an inherited deficiency in L-phenylalanine-4-hydroxylase (PAH) activity. It is usually controlled by diet and monitored regularly with markers, as PKU is not curable. However, conventional methods for target biomarker analysis are invasive and labor intensive. Here, we report a rapid and sensitive, mimetic immunoassay for detecting phenylpyruvate (PhPY) based on stimuli-responsive upconversion nanoparticles with an inner filter effect (IFE). The strong and specific binding of PhPY and Fe3+ forms a complex with maximum absorption at approximately 640 nm. Upon the addition of LiYF4:Er,Ho@LiYF4 UCNPs (maximum emission at 699 nm), the inner filter effect is triggered along with a concurrent decrease in fluorescence. The proposed method demonstrates ultra sensitivity with a detection limit of 79.63 μg L-1, which is superior to most reported methods, thereby enabling phenylpyruvate assays on human urine.
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Affiliation(s)
- Yang Hu
- College of Life Sciences, Dalian Minzu University, Dalian 116600, Liaoning, PR China
| | - Yiting Wang
- College of Life Sciences, Dalian Minzu University, Dalian 116600, Liaoning, PR China
| | - Ru Wang
- College of Life Sciences, Dalian Minzu University, Dalian 116600, Liaoning, PR China
| | - Wei Zhang
- College of Life Sciences, Dalian Minzu University, Dalian 116600, Liaoning, PR China
| | - Ruinian Hua
- College of Life Sciences, Dalian Minzu University, Dalian 116600, Liaoning, PR China.
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Malayeri AA. Optimizing the Bolus Trigger Threshold for Dual-Energy CT Angiography. Radiology 2021; 300:624-625. [PMID: 34128729 DOI: 10.1148/radiol.2021211098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ashkan A Malayeri
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, 1C352, Bethesda, MD 20892
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