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Tsukui D, Takekawa H, Saito K, Okabe R, Tanaka A, Kobayasi S, Igarasi H, Suzuki K, Hamaguchi H. Usefulness of "AcT ratio" in diagnosis of internal carotid artery stenosis: a multicenter, retrospective, observational study. J Med Ultrason (2001) 2024; 51:347-353. [PMID: 38581557 PMCID: PMC11098927 DOI: 10.1007/s10396-024-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/14/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The ratio of the internal carotid artery (ICA) to the common carotid artery (CCA), especially the "AcT ratio," which is a modified measurement method of acceleration time, is useful for diagnosing ICA-origin stenosis. However, previous studies were single-center studies. Therefore, this multicenter, retrospective, cross-sectional study aimed to determine whether a method using the AcT ratio is useful for estimating stenosis rates. METHODS This study included 461 vessels subjected to carotid artery ultrasonography and evaluation for ICA-origin stenosis via NASCET at four hospitals. The duration from the steep rise point to the inflection point or the first peak was defined as AcT on pulsed wave Doppler. The AcT ratio was calculated as AcT of ICA/AcT of ipsilateral CCA. The AcT ratio and rate of ICA-origin stenosis were analyzed using Pearson's correlation coefficient, simple regression analysis, and ROC curve. RESULTS A significant positive correlation was observed between the AcT ratio and NASCET stenosis. NASCET stenosis of ≥ 50% had a sensitivity, specificity, and negative predictive value (NPV) of 70.2%, 71.6%, and 91.5%, respectively, when the cut-off value of the AcT ratio was 1.17. NASCET stenosis of ≥ 70% had a sensitivity, specificity, and NPV of 70.5%, 72.1%, and 95.9%, respectively, when the cut-off value of the AcT ratio was 1.22. CONCLUSIONS The findings of this multicenter, retrospective, cross-sectional study suggest that the AcT ratio is useful for diagnosing ICA-origin stenosis, especially for diagnosis by exclusion. NASCET stenosis of ≥ 50% was considered unlikely if the Act ratio was ≤ 1.17, whereas NASCET stenosis of ≥ 70% was considered unlikely if it was ≤ 1.22.
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Affiliation(s)
- Daisuke Tsukui
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Hidehiro Takekawa
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
- Center of Medical Ultrasonics, Dokkyo Medical University, Tochigi, Japan.
| | - Kozue Saito
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Ryuta Okabe
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Cardiology, Akiru Municipal Medical Center, Tokyo, Japan
| | - Akito Tanaka
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Saro Kobayasi
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Igarasi
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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An S, Hwang G, Kim R, Cha J, Lee HC, Hwang T. Optimizing contrast protocol for bone-subtraction CT angiography of intracranial arteries in normal dogs using 160-slice CT. Vet Med Sci 2023; 9:2504-2512. [PMID: 37766491 PMCID: PMC10650334 DOI: 10.1002/vms3.1252] [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: 04/18/2023] [Revised: 07/09/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Bone-subtraction computed tomography angiography (CTA) (BSCTA) is a new technique designed to overcome the limitation of three-dimensional CTA, where the vessels surrounded by bone and calcification can be obscured. An optimal contrast CT protocol for intracranial artery visualization with BSCTA has yet to be established in dogs. OBJECTIVES The purpose of this study was to determine the optimal contrast protocol of CTA for visualizing intracranial artery using an automatic bone-subtraction technique in dogs. METHODS Brain CTA was performed four times for each of nine healthy beagle dogs to cover all the contrast protocols: two different contrast iodine concentrations (300 and 370 mgI/mL) and two different contrast media injection rates (2 and 4 mL/s). Bone removal post-processing was performed automatically by subtracting the non-enhanced CT data from the contrast CT data using a dedicated workstation. The bone-subtracted intracranial vessels were analysed for quantitative and qualitative evaluation. RESULTS Quantitative evaluation showed significantly higher CT attenuation values for the group with a 370 mgI/mL iodine content at a rate of 4 mL/s than the two groups with a 300 mgI/mL iodine content at the rates of 2 and 4 mL/s (p < 0.001). Qualitative assessment revealed significantly higher mean scores for the 370 mgI/mL groups than the 300 mgI/mL groups and significantly higher mean scores for the 4 mL/s groups than the 2 mL/s groups (p < 0.05). CONCLUSIONS The optimal contrast protocol for BSCTA suggests that high iodine material concentration and high injection rate should be used for strong arterial attenuation and great visualization of the intracranial arterial structure in dogs.
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Affiliation(s)
- Soyon An
- Institute of Animal MedicineCollege of Veterinary MedicineGyeongsang National UniversityJinjuRepublic of Korea
| | - Gunha Hwang
- Institute of Animal MedicineCollege of Veterinary MedicineGyeongsang National UniversityJinjuRepublic of Korea
| | - Rakhoon Kim
- Institute of Animal MedicineCollege of Veterinary MedicineGyeongsang National UniversityJinjuRepublic of Korea
| | - Jihye Cha
- Animal Genome & BioinformaticsNational Institute of Animal Science, RDAWanjuRepublic of Korea
| | - Hee Chun Lee
- Institute of Animal MedicineCollege of Veterinary MedicineGyeongsang National UniversityJinjuRepublic of Korea
| | - Tae‐Sung Hwang
- Institute of Animal MedicineCollege of Veterinary MedicineGyeongsang National UniversityJinjuRepublic of Korea
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Kostyrko B, Rubarth K, Althoff C, Zibell M, Neizert CA, Poch F, Torsello GF, Gebauer B, Lehmann K, Niehues SM, Mews J, Diekhoff T, Pohlan J. Evaluation of Different Registration Algorithms to Reduce Motion Artifacts in CT-Thermography (CTT). Diagnostics (Basel) 2023; 13:2076. [PMID: 37370971 DOI: 10.3390/diagnostics13122076] [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: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Computed tomography (CT)-based Thermography (CTT) is currently being investigated as a non-invasive temperature monitoring method during ablation procedures. Since multiple CT scans with defined time intervals were acquired during this procedure, interscan motion artifacts can occur between the images, so registration is required. The aim of this study was to investigate different registration algorithms and their combinations for minimizing inter-scan motion artifacts during thermal ablation. Four CTT datasets were acquired using microwave ablation (MWA) of normal liver tissue performed in an in vivo porcine model. During each ablation, spectral CT volume scans were sequentially acquired. Based on initial reconstructions, rigid or elastic registration, or a combination of these, were carried out and rated by 15 radiologists. Friedman's test was used to compare rating results in reader assessments and revealed significant differences for the ablation probe movement rating only (p = 0.006; range, 5.3-6.6 points). Regarding this parameter, readers assessed rigid registration as inferior to other registrations. Quantitative analysis of ablation probe movement yielded a significantly decreased distance for combined registration as compared with unregistered data. In this study, registration was found to have the greatest influence on ablation probe movement, with connected registration being superior to only one registration process.
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Affiliation(s)
- Bogdan Kostyrko
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Kerstin Rubarth
- Institute for Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10178 Berlin, Germany
| | - Christian Althoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Miriam Zibell
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Christina Ann Neizert
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Franz Poch
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Kai Lehmann
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems Europe BV, Global Research & Development Center, 2718 RP Zoetermeer, The Netherlands
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Julian Pohlan
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10178 Berlin, Germany
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Metallic Component Preserving Algorithm Based on the Cerebral Computed Tomography Angiography in Aneurysm Surgery. Diagnostics (Basel) 2022; 12:diagnostics12020338. [PMID: 35204429 PMCID: PMC8871085 DOI: 10.3390/diagnostics12020338] [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: 12/27/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate the viability of the proposed method in preventing the loss of metallic components including the clip and coil in cerebral computed tomography angiography (CTA). Forty patients undergoing surgery for aneurysms carried metallic materials. The proposed method is based on conventional bone subtraction CTA (BS-CTA) system. Briefly, the position of metal components was determined using the threshold value and a region of interest (ROI). An appropriate threshold was used to separate the background from the target materials based on the Otsu method. A three-dimensional (3D) rendering was performed from the proposed BS-CTA data carrying the extracted target information. The accuracy of clip and coil region measured using the dice similarity coefficient (DSC) and bidirectional Hausdorff distance (HD) is reported. The metallic components of the proposed BS-CTA were significantly visualized in various patient cases. Quantitative evaluation using the proposed method is based on the mean DSC of 0.93 with a standard deviation (SD) of ±0.05 (e.g., maximum value = 0.99, minimum value = 0.75, 95% confidence interval (CI) = 0.91 to 0.95, and all p < 0.05). The mean HD was 1.50 voxels with an SD of ± 0.58 (e.g., maximum value = 5.95, minimum value = 0.12, 95% CI = 1.10 to 1.90, and all p < 0.05). The proposed method demonstrates effective segmentation of the metallic component and application to the existing conventional BS-CTA system.
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D'Angelo T, Albrecht MH, Caudo D, Mazziotti S, Vogl TJ, Wichmann JL, Martin S, Yel I, Ascenti G, Koch V, Cicero G, Blandino A, Booz C. Virtual non-calcium dual-energy CT: clinical applications. Eur Radiol Exp 2021; 5:38. [PMID: 34476640 PMCID: PMC8413416 DOI: 10.1186/s41747-021-00228-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Dual-energy CT (DECT) has emerged into clinical routine as an imaging technique with unique postprocessing utilities that improve the evaluation of different body areas. The virtual non-calcium (VNCa) reconstruction algorithm has shown beneficial effects on the depiction of bone marrow pathologies such as bone marrow edema. Its main advantage is the ability to substantially increase the image contrast of structures that are usually covered with calcium mineral, such as calcified vessels or bone marrow, and to depict a large number of traumatic, inflammatory, infiltrative, and degenerative disorders affecting either the spine or the appendicular skeleton. Therefore, VNCa imaging represents another step forward for DECT to image conditions and disorders that usually require the use of more expensive and time-consuming techniques such as magnetic resonance imaging, positron emission tomography/CT, or bone scintigraphy. The aim of this review article is to explain the technical background of VNCa imaging, showcase its applicability in the different body regions, and provide an updated outlook on the clinical impact of this technique, which goes beyond the sole improvement in image quality.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Danilo Caudo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simon Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Fonseca AC, Merwick Á, Dennis M, Ferrari J, Ferro JM, Kelly P, Lal A, Ois A, Olivot JM, Purroy F. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. Eur Stroke J 2021; 6:CLXIII-CLXXXVI. [PMID: 34414299 PMCID: PMC8370080 DOI: 10.1177/2396987321992905] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/16/2021] [Indexed: 01/14/2023] Open
Abstract
The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.
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Affiliation(s)
- Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Áine Merwick
- Department of Neurology, Cork University Hospital & University College Cork, Cork, Ireland
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julia Ferrari
- Department of Neurology, St. John´s of God Hospital, Vienna, Austria
| | - José M Ferro
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter Kelly
- Stroke Service, Mater University Hospital and HRB Stroke Clinical Trials Network Ireland, University College Dublin, Ireland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Angel Ois
- Department of Neurology, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jean Marc Olivot
- Acute Stroke Unit, Clinical Investigation Center and Toulouse Neuro Imaging Center, Toulouse University Medical Center, Toulouse, France
| | - Francisco Purroy
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain
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Qu H, Gao Y, Li M, Zhai S, Zhang M, Lu J. Dual Energy Computed Tomography of Internal Carotid Artery: A Modified Dual-Energy Algorithm for Calcified Plaque Removal, Compared With Digital Subtraction Angiography. Front Neurol 2021; 11:621202. [PMID: 33633659 PMCID: PMC7901888 DOI: 10.3389/fneur.2020.621202] [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: 10/25/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Atherosclerotic disease of the internal carotid artery (ICA) is a common reason for ischemic stroke. Computed tomography angiography (CTA) is a common tool for evaluation of internal carotid artery (ICA) stenosis. However, blooming artifacts caused by calcified plaques might lead to overestimation of the stenosis grade. Furthermore, the intracranial ICA is more vulnerable to calcification than other ICA segments. The proposed technique, dual-energy computed tomography (DECT) with a modified three-material decomposition algorithm may facilitate the removal of calcified plaques and thus increase diagnostic accuracy. Objectives: The objective of the study is to assess the accuracy of the modified three-material decomposition algorithm for grading intracranial ICA stenosis after calcified plaque removal, with digital subtraction angiography (DSA) used as a reference standard. Materials and Methods: In total, 41 patients underwent DECT angiography and DSA. The three-material decomposition DECT algorithm for calcium removal was applied. We evaluated 64 instances of calcified stenosis using conventional CTA, the previous non-modified calcium removal DECT technique, the modified DECT algorithm, and DSA. The correlation coefficient (r2) between the results generated by the modified algorithm and DSA was also calculated. Results: The virtual non-calcium images (VNCa) produced by the previous non-modified calcium removal algorithm were named VNCa 1, and those produced by the modified algorithm were named VNCa 2. The assigned degree of stenosis of VNCa 1 (mean stenosis: 39.33 ± 19.76%) differed significantly from that of conventional CTA images (mean stenosis: 59.03 ± 25.96%; P = 0.001), DSA (13.19 ± 17.12%, P < 0.001). VNCa 1 also significantly differed from VNCa 2 (mean stenosis: 15.35 ± 18.70%, P < 0.001). In addition, there was a significant difference between the degree of stenosis of VNCa 2 and conventional CTA images (P < 0.001). No significant differences were observed between VNCa 2 and DSA (P = 0.076). The correlation coefficient (r2) between the stenosis degree of the VNCa 2 and DSA images was 0.991. Conclusions: The proposed DECT with a modified three-material decomposition algorithm for calcium removal has high sensitivity for the detection of relevant stenoses, and its results were more strongly correlated with DSA than with those of conventional CTA or the previous non-modified algorithm. Further, it overcomes CTA's previous problem of overestimating the degree of stenosis because of blooming artifacts caused by calcified plaques. It is useful to account for calcified plaques while evaluating carotid stenosis.
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Affiliation(s)
- Hongying Qu
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yongan Gao
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Meiling Li
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Shuo Zhai
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Miao Zhang
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Lu
- Department of radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.,Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Higashi M, Yamada N, Imakita S, Yutani C, Ishibashi-Ueda H, Iihara K, Naito H. CT-pathologic correlation of non-calcified atherosclerotic arterial plaques: a study using carotid endarterectomy specimens. Br J Radiol 2020; 93:20190901. [PMID: 31999208 DOI: 10.1259/bjr.20190901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents. METHODS 50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared. RESULTS CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis. CONCLUSION In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability. ADVANCES IN KNOWLEDGE Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.
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Affiliation(s)
- Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoaki Yamada
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Chikao Yutani
- Department of Pathology, Amagasaki Central Hospital, Amagasaki, Japan.,Department of Pathology, Cardiovascular Center Osaka Gyoumeikan Hospital, Osaka, Japan
| | | | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Science Kyushu University, Fukuoka, Japan
| | - Hiroaki Naito
- Department of Radiology, Nippon Life Hospital, Osaka, Japan
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Alharthy A, D’Mello M, Alabsi H, Murray N, Metwally O, Elbanna KY, Mohammed MF, Khosa F. Vascular Imaging: Utilization of Dual-Energy Computed Tomography. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Schulte-Altedorneburg G, Witton-Davies T. [Ultrasound diagnostics of extracranial cerebral arteries]. Radiologe 2019; 59:555-575. [PMID: 31127321 DOI: 10.1007/s00117-019-0544-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Color-coded duplex sonography (CCDS) remains the primary angiological method for most clinical cerebrovascular problems. The application of ultrasound is a non-invasive, cost-effective and arbitrarily repeatable examination technique. Simultaneous acquisition of morphologic B‑mode images and hemodynamic parameters with high temporal and spatial resolution is unequalled by any other neurovascular imaging modality. The correct and reproducible use of CCDS requires knowledge of technical details and adequate examination techniques. Its multiparametric approach uses main and additional criteria to detect and precisely quantify clinically highly relevant stenosis of the proximal internal carotid artery. Quantification of vertebral artery stenosis is performed semiquantitatively due to the generally less reliable sonographic approach. The use of CCDS plays an essential role in supporting endovascular and operative procedures as well as in monitoring hemodynamically relevant dissections.
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Affiliation(s)
- G Schulte-Altedorneburg
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, München Klink Harlaching, Sanatoriumsplatz 2, 81545, München, Deutschland.
| | - T Witton-Davies
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, München Klink Harlaching, Sanatoriumsplatz 2, 81545, München, Deutschland
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Gać P, Jaźwiec P, Mazur G, Poręba R. Exposure to Cigarette Smoke and the Morphology of Atherosclerotic Plaques in the Extracranial Arteries Assessed by Computed Tomography Angiography in Patients with Essential Hypertension. Cardiovasc Toxicol 2017; 17:67-78. [PMID: 26717923 DOI: 10.1007/s12012-015-9357-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of the study was to determine the relationship between exposure to cigarette smoke and the morphology of atherosclerotic plaques in the extracranial arteries assessed by computed tomography angiography in patients with hypertension. The study included 61 hypertensive patients: 17 active smokers (group A), 18 non-smokers, declaring environmental exposure to tobacco smoke (group B), and 26 non-smokers, not declaring exposure to cigarette smoke (group C). The number of segments with plaques was significantly higher in group A compared to groups B and C. The number of segments with non-calcified and mixed plaques was significantly higher in group A and group B than in group C. A positive correlation between cigarette-years and the number of segments with atherosclerotic plaques was noted. In summary, both active smoking and environmental exposure to tobacco smoke appear to increase the number of segments of the extracranial arteries with non-calcified and mixed atherosclerotic plaques.
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Affiliation(s)
- Paweł Gać
- Department of Radiology and Diagnostic Imaging, 4th Military Hospital, Weigla 5, 50-981, Wrocław, Poland. .,Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.
| | - Przemysław Jaźwiec
- Department of Radiology and Diagnostic Imaging, 4th Military Hospital, Weigla 5, 50-981, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
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Abstract
Meningiomas are benign extraaxial tumors of the central nervous system (CNS). Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as true primary extracranial meningioma originating from ectopic arachnoid cells. Only eight cases of primary meningioma in the jaw have been reported to date. Extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The aim of this article was to describe the case of a man with an asymptomatic swelling in the right retromolar area over a period of 2 months. Cone beam computed tomography was performed to determine the extension and involvement of the adjacent structures. Histopathological findings and immunohistochemical analysis aided in the diagnosis of primary extracranial meningioma in the mandible and several aspects of this unusual neoplasm are reviewed. The treatment of choice was a partial resection of the mandible and reconstruction with autogenous iliac tricortical bone. Five years after surgery, the patient remains free of disease.
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Nishii T, Kono AK, Nishio M, Negi N, Fujita A, Kohmura E, Sugimura K. Bone-Subtracted Spinal CT Angiography Using Nonrigid Registration for Better Visualization of Arterial Feeders in Spinal Arteriovenous Fistulas. AJNR Am J Neuroradiol 2015; 36:2400-6. [PMID: 26251431 DOI: 10.3174/ajnr.a4435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/29/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pretreatment diagnosis for the location of shunts and arterial feeders of spinal arteriovenous fistulas is crucial. This study aimed to evaluate the utility of subtracted CT angiography imaging by using nonrigid registration (R-CTA) in patients with spinal arteriovenous fistulas compared with conventional CTA imaging. MATERIALS AND METHODS The records of 15 consecutive subjects (mean age, 65 years; 2 women) who had undergone CTA and digital subtraction angiography for clinically suspected spinal arteriovenous fistula were reviewed. From CTA images obtained at the arterial and late arterial phases, warped images of the late arterial phase were obtained by using nonrigid registration that was adjusted to the arterial phase images. R-CTA images were then obtained by subtracting the warped images from the arterial phase images. The accuracies of using nonrigid registration and conventional spinal CTA and the time required for detecting arterial feeders in spinal arteriovenous fistulas were analyzed for each patient with DSA results as a standard reference. The difference between R-CTA and conventional spinal CTA was assessed by the Welch test and the McNemar χ(2) test. RESULTS R-CTA had a higher accuracy compared with conventional spinal CTA (80% versus 47%, P = .025). The time for interpretation was reduced in R-CTA compared with conventional spinal CTA (45.1 versus 97.1 seconds, P = .002). CONCLUSIONS Our subtracted CTA imaging by using nonrigid registration detects feeders of spinal arteriovenous fistulas more accurately and quickly than conventional CTA.
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Affiliation(s)
- T Nishii
- From the Departments of Radiology (T.N., A.K.K., M.N., K.S.)
| | - A K Kono
- From the Departments of Radiology (T.N., A.K.K., M.N., K.S.)
| | - M Nishio
- From the Departments of Radiology (T.N., A.K.K., M.N., K.S.)
| | - N Negi
- Division of Radiology (N.N.), Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - A Fujita
- Neurosurgery (A.F., E.K.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - E Kohmura
- Neurosurgery (A.F., E.K.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Sugimura
- From the Departments of Radiology (T.N., A.K.K., M.N., K.S.)
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Kramer M, Schwab SA, Nkenke E, Eller A, Kammerer F, May M, Baigger JF, Uder M, Lell M. Whole body magnetic resonance angiography and computed tomography angiography in the vascular mapping of head and neck: an intraindividual comparison. Head Face Med 2014; 10:16. [PMID: 24884580 PMCID: PMC4028100 DOI: 10.1186/1746-160x-10-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/05/2014] [Indexed: 12/15/2022] Open
Abstract
Introduction The aim of the study was to compare the detectability of neck vessels with contrast enhanced magnetic resonance angiography (MRA) in the setting of a whole-body MRA and multislice computed tomography angiography (CTA) for preoperative vascular mapping of head and neck. Methods In 20 patients MRA was performed prior to microvascular reconstruction of the mandible with osteomyocutaneous flaps. CTA of the neck served as the method of reference. 1.5 T contrast enhanced magnetic resonance angiograms were acquired to visualize the vascular structures of the neck in the setting of a whole-body MRA examination. 64-slice spiral computed tomography was performed with a dual-phase protocol, using the arterial phase images for 3D CTA reconstruction. Maximum intensity projection was employed to visualize MRA and CTA data. To retrieve differences in the detectability of vessel branches between MRA and CTA, a McNemar test was performed. Results All angiograms were of diagnostic quality. There were no statistically significant differences between MRA and CTA for the detection of branches of the external carotid artery that are relevant host vessels for microsurgery (p = 0.118). CTA was superior to MRA if all the external carotid artery branches were included (p < 0.001). Conclusions MRA is a reliable alternative to CTA in vascular mapping of the cervical vasculature for planning of microvascular reconstruction of the mandible. In the setting of whole-body MRA it could serve as a radiation free one-stop-shop tool for preoperative assessment of the arterial system, potentially covering both, the donor and host site in one single examination.
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Affiliation(s)
| | - Siegfried A Schwab
- Institute of Radiology, Maximiliansplatz 1, 91054 Erlangen, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
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Inoue S, Hosoda K, Fujita A, Ohno Y, Fujii M, Sugimura K, Kohmura E. Utility of 320-detector row CT for diagnosis and therapeutic strategy for paraclinoid and intracavernous aneurysms. Acta Neurochir (Wien) 2014; 156:505-14. [PMID: 24445734 DOI: 10.1007/s00701-014-1996-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was (1) to assess the diagnostic accuracy of 320-detector row computed tomography (CT) for paraclinoid and intracavernous aneurysms, and (2) to investigate whether this method provides sufficient information for surgery. METHODS A total of 14 patients with 16 unruptured proximal ICA aneurysms underwent three-dimensional CT angiography (3D-CTA) fusion imaging, which was created by superimposing 3D-CT venography data and/or 3D-bone data onto 3D-CTA data using 320-detector row CT, magnetic resonance imaging (MRI), and 3D digital subtraction angiography (DSA). The images of each modality were assessed using intraoperative findings as the reference standard. RESULTS All aneurysms were clearly visualized on 320-detector row CT. Bone subtraction and arterio-venous discrimination were accurate. On 3D-CTA fusion images, 11 aneurysms were diagnosed as "extracavernous" and five as "intracavernous". No discordance in aneurysm location between the 3D-CTA fusion images and the intraoperative findings was found. In contrast, discordance between MRI and intraoperative findings were found in five of the 16 cases (31%), which was significantly more frequent than with 3D-CTA (p = 0.043). The findings DSA, which was performed in nine patients, were also in excellent agreement with the intraoperative findings. However, 3D-CTA fusion imaging provided more comprehensive information, including venous and osseous structures, than 3D-DSA. The 320-detector row CTA after surgery demonstrated a clear relationship between the clip and aneurysmal neck with notably few artifacts, which suggested the utility of this modality for postoperative assessment. CONCLUSIONS The 320-detector row CT provided high accuracy for the diagnosis of paraclinoid and intracavernous aneurysms. This technique also provided comprehensive depiction of the aneurysms and surrounding structures. Therefore, this modality might be useful for the diagnosis of the paraclinoid and intracavernous aneurysms and for developing a surgical treatment plan.
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Bone Marrow Edema Pattern Identification in Patients With Lytic Bone Lesions Using Digital Subtraction Angiography–Like Bone Subtraction on Large-Area Detector Computed Tomography. Invest Radiol 2014; 49:156-64. [DOI: 10.1097/rli.0000000000000007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Weber J, Veith P, Jung B, Ihorst G, Moske-Eick O, Meckel S, Urbach H, Taschner CA. MR Angiography at 3 Tesla to Assess Proximal Internal Carotid Artery Stenoses: Contrast-Enhanced or 3D Time-of-Flight MR Angiography? Clin Neuroradiol 2014; 25:41-8. [DOI: 10.1007/s00062-013-0279-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
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Chen Y, Xue H, Jin ZY, Zhang J, Sun H, Wang X, Zhang ZH, Zhang DM, Lu GM, Zhang ZQ, Schoepf UJ, Bucher AM, Wolla CD, Wang Y. 128-slice acceletated-pitch dual energy CT angiography of the head and neck: comparison of different low contrast medium volumes. PLoS One 2013; 8:e80939. [PMID: 24260516 PMCID: PMC3834309 DOI: 10.1371/journal.pone.0080939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our study aims to evaluate the image quality and feasibility of 128-slice dual-energy CTA (DE-CTA) for supra-aortic arteries using reduced amounts of contrast medium (CM). METHODS A prospective study was performed in 54 patients receiving CTA of the head and neck with a 128-slice dual-source CT system. Patients were randomized into two groups with a volume of either 40 mL of CM (Group I) or 50 mL of CM (Group II). Arterial and venous enhancements were recorded for quantitative assessment. Qualitative assessments for images without bone removal (BR) were based on a) the visualization of the circle of Willis and b) streak artifacts due to residual CM in the subclavian or internal jugular veins ipsilateral to injection of CM. Qualitative assessment of dual-energy images using BR was based on the presence of bone remnants and vessel integrity. Quantitative data was compared using the Student t test. The χ(2) test was used for the qualitative measurements of streak artifacts in veins while the Mann-Whitney U test was used for the qualitative measurements of images with BR. RESULTS Arterial and venous attenuation was significantly higher in Group II (P=0.000). Image quality regarding the circle of Willis was excellent in both groups (3.90±0.30 for Group I and 4.00±0 for Group II) . Imaging of the internal jugular veins was scored higher in Group I (1.87±0.72) compared with Group II (1.48±0.51) (P=0.021). Within Group I using BR, mean scores for bone remnants did not differ significantly (P>0.05) but mean scores of vessel integrity (P<0.05) did. CONCLUSIONS Contrast-enhanced head and neck CTA is feasible using a scan protocol with low amounts of contrast medium (40 mL) on a 128-slice dual-energy CTA. The 40-mL protocol provides satisfactory image quality before and after dual-energy bone-removal post-processing.
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Affiliation(s)
- Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (HX); (ZYJ)
| | - Zheng-yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (HX); (ZYJ)
| | - Jie Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhu-hua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Da-ming Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guang-ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Zhao-qi Zhang
- Department of Radiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - U. Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Andreas M. Bucher
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Christopher D. Wolla
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Li Q, Lv F, Wei Y, Luo T, Xie P. Automated subtraction CT angiography for visualization of the whole brain vasculature: a feasibility study. Acad Radiol 2013; 20:1009-14. [PMID: 23746383 DOI: 10.1016/j.acra.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To develop an automated computed tomography angiography (CTA) imaging protocol that allows visualization of the whole brain vasculature and evaluate the clinical usefulness of the technique for delineation of intracranial vessels in patients with cerebrovascular disorders. MATERIALS AND METHODS We prospectively included 100 patients who underwent automated subtraction CTA for suspected cerebrovascular disorders. The nonenhanced and contrast enhanced scans were obtained with the same table feeding speed. The x-ray tube start angles of the two scans were matched to enable accurate registration and subtraction of the CTA datasets. Subtracted CTA datasets were reformatted as three-dimensional volume rendering and maximum intensity projection images for further review. Two independent readers assessed the quality of subtraction and delineation of intracranial vessels. The visibility of ophthalmic arteries was also assessed. RESULTS Subtraction was successful in all patients. The image quality of bone removal was rated excellent in 95 patients, with no or minimal bone remnants. Incomplete bone removal was observed in five patients because of severe motions between the scans. In 97 of 100 patients, arterial segments at the circle of Willis could be clearly visualized. Excellent delineation of bilateral ophthalmic arteries was possible in 81 of 100 patients. CONCLUSIONS The whole brain vasculature would be clearly visualized by using the optimized automated CTA protocol. Our automated, single-source, dual-energy subtraction CTA protocol is a fully automated subtraction method that is capable of delineating major intracranial vessels as well as very small arteries.
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Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, 400016 Chongqing, China
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He C, Gu M, Jiang R, Li JH. Noninvasive assessment of the carotid and cerebrovascular atherosclerotic plaques by multidetector CT in type-2 diabetes mellitus patients with transient ischemic attack or stroke. Diabetol Metab Syndr 2013; 5:9. [PMID: 23443053 PMCID: PMC3598273 DOI: 10.1186/1758-5996-5-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/20/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The cerebrovasuclar artery disease as a common complication of type-2 diabetes mellitus (T2DM) caused huge economic burden and lives threatening to patients. We evaluated the prevalence and morphology of carotid and cerebrovascular atherosclerotic plaques in T2DM patients with transient ischemic attack (TIA) or stroke using multidetector CT (MDCT). METHODS 64-MDCT and dual-source CT (DSCT) angiographies were performed in 195 T2DM patients with TIA or stroke (mean age 65.7+/-12.8 years; 118 men) between January 2009 to August 2011. During the process, plaque type, its distribution, extensive and obstructive natures were determined for each segment derived from the patients. RESULTS Atherosclerotic plaques were detected in 183 (93.8%) patients. A total of 1056 segments with plaque were identified, of which 450 (42.6%) were non-calcified, 192 (18.2%) were mixed and 414 (39.2%) calcified ones. Among them, 562 (53.2%) resulted in mild stenosis, 291 (27.6%) moderate stenosis, 170 (16.1%) severe stenosis and 33 (3.1%) occlusion. Non-calcified plaques contributed 91.8% to non-obstructive lumen narrowing, while mixed and calcified plaques contributed 89.0% and 65.0% respectively. CONCLUSIONS MDCT angiography detected a high prevalence of plaques in T2DM patients with TIA or stroke. A relatively high proportion of plaques were non-calcified, as well as with non-obstructive stenosis. MDCT angiography might further enhance the detection and management of carotid and cerebrovascular atherosclerosis in T2DM patients with TIA and stroke.
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Affiliation(s)
- Ci He
- Department of Radiology, Chengdu Military General Hospital, Chengdu, Peoples’ Republic of China
| | - Ming Gu
- Department of Radiology, Chengdu Military General Hospital, Chengdu, Peoples’ Republic of China
| | - Rui Jiang
- Department of Radiology, Chengdu Military General Hospital, Chengdu, Peoples’ Republic of China
| | - Jian-hao Li
- Department of Radiology, Chengdu Military General Hospital, Chengdu, Peoples’ Republic of China
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Abstract
OBJECTIVE Dual-energy CT permits a variety of image reconstructions for the depiction and characterization of vascular disease. Techniques include visualization of low- and high-peak-kilovoltage spectra image datasets and also material-specific reconstructions combining both low- and high-peak-kilovoltage data. CONCLUSION This article focuses on four main vascular areas: the aorta, the major visceral, lower limb, and cervical arteries. For each territory, the current status, potential advantages, and limitations of these techniques are described.
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Yuan L, Zhang L, Ditt H, Ordy V, Pereira F, Chefd'hotel C. Simultaneous label fusion with vessel preserving for bone removal in CT angiography scans. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:5115-5118. [PMID: 24110886 DOI: 10.1109/embc.2013.6610699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
When visualizing vessels with CT angiography scans, the arteries are often obstructed by bones. Traditional methods require an additional non-enhanced scan to acquire a bone mask which is then subtracted from the original CTA scan. In this study, we present an automated bone removal method using only contrast enhanced scans based on simultaneous label fusion. We build an atlas database where each atlas is paired with a bone label and a vessel label. After the atlases are mapped to a subject, we propose a vessel preserving scheme to protect possible vessel areas from bone removal by simultaneous label fusion. Seven clinical data sets were used for validation and the results showed that this method can achieve consistent and thorough bone removal with maximal vessels preservation.
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Biermann C, Tsiflikas I, Thomas C, Kasperek B, Heuschmid M, Claussen CD. Evaluation of computer-assisted quantification of carotid artery stenosis. J Digit Imaging 2012; 25:250-7. [PMID: 21786073 DOI: 10.1007/s10278-011-9413-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. At least 1 day later, they performed quantification using an advanced vessel analysis software including automatic dual-energy bone and hard plaque removal, automatic and semiautomatic vessel segmentation, as well as creation of curved planar reformation. Results were evaluated for the reproducibility of stenosis quantification of different readers by calculating the kappa and correlation values. Consensus reading of the two most experienced readers was used as the standard of reference. For standard imaging interpretation, experienced readers reached very good (k = 0.85) and good (k = 0.78) inter-observer variability. Inexperienced readers achieved moderate (k = 0.6) and fair (k = 0.24) results. Sensitivity values 80%, 91%, 83%, 77% and specificity values 100%, 84%, 82%, 53% were achieved for significant area stenosis >70%. For grading using advanced vessel analysis software, all readers achieved good inter-observer variability (k = 0.77, 0.72, 0.71, and 0.77). Specificity values of 97%, 95%, 95%, 93% and sensitivity values of 84%, 78%, 86%, 92% were achieved. In conclusion, when supported by advanced vessel analysis software, experienced readers are able to achieve good reproducibility. Even inexperienced readers are able to achieve good results in the assessment of carotid artery stenosis when using advanced vessel analysis software.
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Affiliation(s)
- Christina Biermann
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Kim H, Jung TY, Kim IY, Lee JK. Two cases of primary osteolytic intraosseous meningioma of the skull metastasizing to whole skull and the spine. J Korean Neurosurg Soc 2012; 51:151-4. [PMID: 22639712 PMCID: PMC3358602 DOI: 10.3340/jkns.2012.51.3.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/25/2011] [Accepted: 03/14/2012] [Indexed: 11/27/2022] Open
Abstract
We report here two cases of primary intraosseous meningioma with aggressive behavior. A 68-year-old man presented with a one year history of a soft, enlarging mass in the right parietal region. Magnetic resonance image (MRI) revealed a 6 cm sized, heterogeneously-enhancing, bony expansile mass in the right parietal bone, and computed tomograph (CT) showed a bony, destructive lesion. The tumor, including the surrounding normal bone, was totally resected. Dural invasion was not apparent. Diagnosis was atypical meningioma, which extensively metastasized within the skull one year later. A 74-year-old woman presented with a 5-month history of a soft mass on the left frontal area. MRI revealed a 4 cm sized, multilobulated, strongly-enhancing lesion on the left frontal bone, and CT showed a destructive lesion. The mass was adhered tightly to the scalp and dura mater. The lesion was totally removed. Biopsy showed a papillary meningioma. The patient refused adjuvant radiation therapy and later underwent two reoperations for recurred lesions, at 19 and at 45 months postoperative. The patient experienced back pain 5 years later, and MRI showed an osteolytic lesion on the 11th thoracic vertebra. After her operation, a metastatic papillary meningioma was diagnosed. These osteolytic intraosseous meningiomas had atypical/malignant pathologies, which metastasized to whole skull and the spine.
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Affiliation(s)
- Hyool Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011; 57:e16-94. [PMID: 21288679 DOI: 10.1016/j.jacc.2010.11.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011; 42:e464-540. [PMID: 21282493 DOI: 10.1161/str.0b013e3182112cc2] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124:e54-130. [PMID: 21282504 DOI: 10.1161/cir.0b013e31820d8c98] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dual energy CTA of the supraaortic arteries: Technical improvements with a novel dual source CT system. Eur J Radiol 2010; 76:e6-12. [DOI: 10.1016/j.ejrad.2009.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 09/14/2009] [Accepted: 09/18/2009] [Indexed: 11/21/2022]
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Thomas C, Korn A, Krauss B, Ketelsen D, Tsiflikas I, Reimann A, Brodoefel H, Claussen C, Kopp A, Ernemann U, Heuschmid M. Automatic bone and plaque removal using dual energy CT for head and neck angiography: Feasibility and initial performance evaluation. Eur J Radiol 2010; 76:61-7. [DOI: 10.1016/j.ejrad.2009.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/01/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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Menke J. Improving the image quality of contrast-enhanced MR angiography by automated image registration: A prospective study in peripheral arterial disease of the lower extremities. Eur J Radiol 2010; 75:e1-8. [DOI: 10.1016/j.ejrad.2009.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/25/2009] [Indexed: 11/26/2022]
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Lee CW, Huang A, Wang YH, Yang CY, Chen YF, Liu HM. Intracranial dural arteriovenous fistulas: diagnosis and evaluation with 64-detector row CT angiography. Radiology 2010; 256:219-28. [PMID: 20574098 DOI: 10.1148/radiol.10091835] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze the diagnostic effectiveness and application of computed tomographic (CT) angiography by using a new algorithm (hybrid CT angiography) in dural arteriovenous fistulas (AVFs). MATERIALS AND METHODS Institutional review board approval was obtained for retrospectively postprocessing the raw data from CT angiography by using hybrid CT, which is a mixture of a bone subtraction and masking method for bone removal. The study included 22 patients with 24 dural AVFs and 14 control subjects. The grades in patients with dural AVF determined with hybrid CT angiography and digital subtraction angiography (DSA) were compared, and hybrid CT angiography was applied as a tool for planning endovascular treatment. The adjusted Wald method was used to estimate confidence intervals (CIs), and the Cohen kappa statistic was used to assess interobserver agreement. RESULTS Hybrid CT angiography in the 24 dural AVFs revealed asymmetric sinus enhancement in 22 lesions (92%), engorged arteries in 19 (79%), transosseous enhanced vessels in 19 (79%), engorged extracranial veins in 13 (54%), engorged cortical veins in seven (29%), and sinus thrombosis in four (17%). In all 24 lesions, at least two of six imaging signs for diagnosis of dural AVFs were present. The kappa test analysis revealed a high level of interobserver agreement (kappa, 0.56-1.00) in reading the diagnostic imaging signs. The observed agreement between DSA and readers was 100% in the cavernous sinus region and in hypoglossal and clival lesions and 78%-89% in the transverse sigmoid sinus. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 0.93 (95% CI: 0.85, 0.97), 0.98 (95% CI: 0.93, 1.00), 0.97 (95% CI: 0.90, 0.99), and 0.95 (95% CI: 0.90, 0.98), respectively. CONCLUSION Hybrid CT angiography is a promising tool for the diagnosis of dural AVF. It can provide key information necessary for treatment planning.
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Affiliation(s)
- Chung-Wei Lee
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan, Republic of China
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Automatic lumen segmentation in calcified plaques: dual-energy CT versus standard reconstructions in comparison with digital subtraction angiography. AJR Am J Roentgenol 2010; 194:1590-5. [PMID: 20489101 DOI: 10.2214/ajr.09.3550] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Dual-energy CT has the potential to automatically remove calcified plaques from angiographic data sets. The objective of this study is to compare the accuracy of visual grading of stenoses after plaque removal with visual grading in standard reconstructions. Digital subtraction angiography (DSA) was used as a reference standard. SUBJECTS AND METHODS Twenty-five patients underwent dual-energy CT (140 kV and 80 mAs; 80 kV and 234 mAs) angiography and DSA. Plaque and bone removal was performed. Twenty-nine calcified stenoses were quantified using standard reconstructions, plaque and bone removal maximum intensity projections after plaque and bone removal, and DSA images, according to the North American Symptomatic Carotid Endarterectomy Trial criteria. The accuracy of the detection of relevant stenoses (> 70%) and occlusions was assessed. Correlation coefficients of the grades of stenoses with DSA were calculated. The influence of vessel enhancement on the accuracy of plaque removal was analyzed. RESULTS The average postprocessing time was 45 seconds. After plaque removal, all 25 relevant and four nonrelevant stenoses were correctly detected. Six relevant stenoses were overestimated as complete occlusions. With the standard reconstructions, two nonrelevant stenoses were overestimated as relevant. Correlation coefficients (r(2)) for the grading of stenoses after plaque removal and with standard reconstructions versus DSA were 0.7694 and 0.4329, respectively. Vessel contrast enhancement correlated weakly (r(2) = 0.2072) with the accuracy of plaque removal. CONCLUSION Dual-energy CT with plaque removal automatically delivers CT luminograms with a high sensitivity for the detection of relevant stenoses and a higher correlation to DSA than standard reconstructions but frequently leads to an overestimation of high-grade stenoses as occlusions. Thus, dual-energy CT plaque and bone removal should be used complementary to standard reconstructions, and not exclusively.
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Huang A, Lee CW, Yang CY, Liu MY, Liu HM. Using Standard Nonenhanced Axial Scans for Cerebral CT Angiography Bone Elimination. Invest Radiol 2010; 45:225-32. [DOI: 10.1097/rli.0b013e3181d4a010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bone subtraction CTA for transcranial arteries: intra-individual comparison with standard CTA without bone subtraction and TOF-MRA. Clin Radiol 2010; 65:440-6. [PMID: 20451010 DOI: 10.1016/j.crad.2010.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 02/14/2010] [Accepted: 03/02/2010] [Indexed: 11/23/2022]
Abstract
AIM To evaluate the impact of bone subtraction computed tomography angiography (BS-CTA) for the assessment of transcranial arteries in comparison with standard CTA (S-CTA) without bone removal and time-of-flight magnetic resonance angiography (TOF-MRA). MATERIALS AND METHODS Cranial unenhanced CT and S-CTA were performed in 53 patients with suspected cerebrovascular disease. BS-CTA datasets were reconstructed from the S-CTA and unenhanced CT source images. TOF-MRA was performed within 24h after CTA on a 1.5 T MRI system. Two radiologists, in consensus, evaluated the segments of the internal carotid artery (C2-C7), the vertebral artery (V4), and the basilar artery for the degree of stenosis. A five-step scale (0-49, 50-69, 70-89, 90-99% and occlusion) for the degree of stenosis was applied for all segments. Wilcoxon's signed rank test was used for statistical analysis. RESULTS Seven hundred and fifty vessel segments (ICA:636, VA:106, BA:53) were analysed. The degree of stenosis on S-CTA was consistent with TOF-MRA in all segments. BS-CTA showed a trend towards higher stenosis scores in cases of calcified plaques compared to S-CTA (p=0.11) and TOF-MRA (p=0.09), which was not statistically significant. In transcranial segments, BS-CTA revealed equivalent scores compared to S-CTA and TOF-MRA (p=0.25; p=0.20). CONCLUSION BS-CTA produced similar results to TOF-MRA and S-CTA and can be applied as a non-invasive imaging method for the transcranial arteries. However, BS-CTA shows a trend towards overestimation of the degree of stenosis.
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Koutlas IG, Scheithauer BW, Folpe AL. Intraoral perineurioma, soft tissue type: report of five cases, including 3 intraosseous examples, and review of the literature. Head Neck Pathol 2010; 4:113-20. [PMID: 20401642 PMCID: PMC2878625 DOI: 10.1007/s12105-010-0177-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
Soft tissue type perineuriomas (STP) are uncommon tumors, oral examples being very rare. They have been described in the mandible, gingiva, lips, retrotonsillar mucosa and maxillary vestibule. Herein, we report the clinicopathologic features of five STP, two affecting the buccal mucosa and three the mandible. Three patients were women and two men. All tumors were characterized by a proliferation of cytologically bland, mitotically inactive spindled cells with round, ovoid or spindled nuclei, embedded in a variably collagenous and myxoid matrix. Interestingly, two mandibular tumors featured psammoma bodies and one, in addition, contained irregular calcifications. Tumor cells showed the immunohistochemical profile of perineurial cells including epithelial membrane antigen, Glut-1, claudin-1 and collagen type IV. S100 and neurofilament proteins were not expressed by the tumor cells. A few minute, peripherally situated, entrapped nerves were identified. All tumors were reported gross-totally excised and no recurrences have taken place. The clinical characteristics of STP are summarized and its differential diagnosis relative to other spindle cells tumors and meningioma is discussed.
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Affiliation(s)
- Ioannis G. Koutlas
- Division of Oral and Maxillofacial Pathology, University of Minnesota, School of Dentistry, 515 Delaware Street SE #16-206B, Minneapolis, MN 55455 USA
| | | | - Andrew L. Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
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Chang HH, Duckwiler GR, Valentine DJ, Chu WC. Computer-assisted extraction of intracranial aneurysms on 3D rotational angiograms for computational fluid dynamics modeling. Med Phys 2010; 36:5612-21. [PMID: 20095274 DOI: 10.1118/1.3260841] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Three-dimensional rotational angiography (3DRA) is an evolving imaging procedure from traditional digital subtraction angiography and is gaining much interest for detecting intracranial aneurysms. Computational fluid dynamics (CFD) modeling plays an important role in understanding the biomechanical properties and in facilitating the prediction of aneurysm rupture. A successful computational study relies on an accurate description of the vascular geometry that is obtained from volumetric images. METHODS The authors propose a new aneurysm segmentation algorithm to facilitate the study of CFD. This software combines a region-growing segmentation method with the 3D extension of a deformable contour based on a charged fluid model. A charged fluid model essentially consists of a set of charged elements that are governed by the nature of electrostatics. The approach requires no prior knowledge of anatomic structures and automatically segments the vasculature after the end-user selects a vessel section in a plane image. RESULTS Experimental results on 15 cases indicate that aneurysm structures were effectively segmented and in good agreement with manual delineation outcomes. In comparison with the existing methods, the algorithm provided a much higher overlap index with respect to the ground truth. Furthermore, the outcomes of the proposed approach achieved a clean representation of vascular structures that is advantageous for hemodynamics analyses. CONCLUSIONS A new aneurysm segmentation framework in an attempt to automatically segment vascular structures in 3DRA image volumes has been developed. The proposed algorithm demonstrated promising performance and unique characteristics to adequately segment aneurysms in 3DRA image volumes for further study in computational fluid dynamics.
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Affiliation(s)
- Herng-Hua Chang
- Institute of Biomedical Engineering, National Yang-Ming University, 155 Linong Street, Section 2, Beitou, Taipei 112, Taiwan
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Measurement of carotid stenosis on computed tomographic angiography: reliability depends on postprocessing technique. Can Assoc Radiol J 2010; 61:127-32. [PMID: 20060260 DOI: 10.1016/j.carj.2009.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 10/29/2009] [Accepted: 10/29/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We previously demonstrated the validity of axial source (AxS) image quantification of computed tomographic angiography (CTA) visualized carotid stenosis. There is concern that AxS images may not accurately measure stenosis in patients with obliquely orientated stenosis and that measurements on axial oblique (AxO) multiplanar reformats (MPR), maximum intensity projections (MIP) images, or Doppler ultrasound (DUS) are superior. We tested the performance of AxS images against AxO MPRs, MIPs, and DUS techniques for stenosis quantification. METHODS A total of 120 consecutive patients with CTA and DUS detected carotid disease were enrolled; carotids with occlusion, near occlusion, or stenosis <40% were excluded. Proximal and distal carotid diameters and North American Symptomatic Carotid Endarterectomy Trial (NASCET) style ratios were measured independently by 2 neuroradiologists on AxS, AxO, and MIP images on separate occasions in a blinded protocol. Intra- and interobserver agreements were determined for all measurements. The performance of different image types to identify > or =70% stenosis was assessed against a NASCET-style reference standard. RESULTS Intra- and interobserver reliabilities for stenosis measurements were higher for both AxS (interclass correlation coefficients [ICC], 0.87-0.93 and 0.84-0.89) and AxO images (ICCs, 0.82-0.89 and 0.86-0.92) than for MIPs (ICCs, 0.66-0.86 and 0.79-0.82), respectively. Intra- and interobserver agreements on the NASCET ratio tended to be lower than proximal stenosis measurements. AxS and AxO image proximal stenosis measurements most accurately distinguished patients with > or =70% stenosis (0.90), followed by DUS (0.83) and MIP images (0.76). CONCLUSIONS A single AxS image stenosis measurement was highly reproducible and accurate in the estimation of carotid stenosis, which precluded the need for AxO MPRs.
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Siebert E, Bohner G, Dewey M, Bauknecht C, Klingebiel R. Dose related, comparative evaluation of a novel bone-subtraction algorithm in 64-row cervico-cranial CT angiography. Eur J Radiol 2010; 73:168-74. [DOI: 10.1016/j.ejrad.2008.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 11/29/2022]
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Buerke B, Wittkamp G, Seifarth H, Heindel W, Kloska SP. Dual-energy CTA with bone removal for transcranial arteries: intraindividual comparison with standard CTA without bone removal and TOF-MRA. Acad Radiol 2009; 16:1348-55. [PMID: 19608437 DOI: 10.1016/j.acra.2009.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 05/12/2009] [Accepted: 05/14/2009] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Dual-source computed tomography enables bone removal on computed tomographic angiographic data on the basis of simultaneous dual-energy (DE) acquisition. The aim of this study was to evaluate the impact of this technique for the assessment of transcranial arteries. Therefore, the degree of stenosis of the transcranial arteries on DE computed tomographic angiography (CTA) with bone removal was compared to those on standard CTA and time-of-flight (TOF) magnetic resonance angiography (MRA). MATERIALS AND METHODS DE-CTA was performed using a dual-source computed tomographic scanner in 50 patients with suspected cerebrovascular disease. From the source images on DE-CTA, data sets with and without bone removal were reconstructed. TOF-MRA was performed on a 1.5-T scanner. Two blinded radiologists evaluated the segments of the internal carotid artery (C2-C7), the vertebral artery (V4), and the basilar artery for degree of stenosis. A five-step scale (0%-49%, 50%-69%, 70%-89%, 90%-99%, and 100% [occlusion]) for degree of stenosis was applied. Wilcoxon's signed-rank test was used for statistical analysis. RESULTS The degrees of stenosis on standard CTA were consistent with those on TOF-MRA in all segments. In contrast, DE-CTA showed significantly higher degrees of stenosis compared to standard CTA and TOF-MRA in both C2 segments (P < .001). In addition, DE-CTA revealed a significantly higher degree of stenosis compared to standard CTA and TOF-MRA in the left C4 segment (P < .01 and P < .005, respectively). All other segments showed no significant differences of stenosis among TOF-MRA, DE-CTA, and standard CTA. CONCLUSIONS Compared to TOF-MRA, standard CTA showed similar results. In contrast, DE-CTA revealed significant overestimation of stenosis for segments with close relations to bony structures as well as in calcified stenosis. Consequently, such findings on DE-CTA require confirmation with standard CTA or MRA to eliminate false-positive results.
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Affiliation(s)
- Boris Buerke
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
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40
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CT angiography covering both cervical and cerebral arteries using high iodine concentration contrast material with dose reduction on a 16 multidetector-row system. Neuroradiology 2009; 52:291-5. [DOI: 10.1007/s00234-009-0611-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
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Lell MM, Kramer M, Klotz E, Villablanca P, Ruehm SG. Carotid Computed Tomography Angiography With Automated Bone Suppression. Invest Radiol 2009; 44:322-8. [DOI: 10.1097/rli.0b013e31819e8ad9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gandhi D, Pandey A, Ansari SA, Gemmete JJ, Thompson BG, Mukherji SK. Multi-detector row CT angiography with direct intra-arterial contrast injection for the evaluation of neurovascular disease: technique, applications, and initial experience. AJNR Am J Neuroradiol 2009; 30:1054-8. [PMID: 19213819 DOI: 10.3174/ajnr.a1438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to evaluate the usefulness of 64-section multi-detector row CT angiography (CTA) with direct intra-arterial contrast injection (IA-CTA) for the evaluation of neurovascular disease. This technique was used in 11 patients at our institution. All studies were technically successful, and there were no complications. Small vascular malformations were mapped easily on high-resolution IA-CTA images, enabling microsurgical resection or stereotactic radiosurgery. In a similar fashion, additional morphologic features were revealed on IA-CTA images not seen on standard 2D and 3D digital subtraction angiography. Of 11 patients undergoing IA-CTA, 7 patients had further anatomic clarity of the small arteriovenous fistula/malformation and 4 patients had changes in the treatment plan on the basis of the IA-CTA findings.
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Affiliation(s)
- D Gandhi
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Cranial computed tomography angiography with automated bone subtraction: a feasibility study. Invest Radiol 2009; 44:38-43. [PMID: 18836384 DOI: 10.1097/rli.0b013e31818c3d6b] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Computed tomography angiography (CTA) is becoming an increasingly accepted noninvasive alternative to catheter angiography. To display continuous vessel contours without superimposed bone in a similar manner, postprocessing of the CTA data is necessary. Threshold-based techniques often fail in regions of close vessel-bone contact, which frequently requires user interaction to optimize the results. This may be laborious and time consuming. The aim of this study was to assess the feasibility of a fully automated algorithm for bone subtraction in cranial CT angiography. MATERIALS AND METHODS Forty-nine patients underwent cranial CT angiography on 64 slice CT systems. Two scans were performed, one before (mask) and one after (CTA) contrast agent administration. Images were processed with commercially available subtraction software. Two examiners rated the success of overall bone removal and image quality of different vessel segments (n = 34) with a 4-point scale (1 = poor; 4 = excellent); original CTA data served as the reference. RESULTS Subtraction was performed successfully in all cases, overall subtraction quality was high (82% of cases were rated good or excellent). Only 50 of 1666 arterial segments (3%) were rated nondiagnostic. No relevant artificial stenoses of the internal carotid artery (ICA) or vertebral artery along their way through the skull base were detected when comparing CTA source images to bone subtraction computed tomography angiography (BSCTA) images. CONCLUSIONS Automatic subtraction provides diagnostic image quality for 3D visualization of intracranial vessels, free from over projecting bone in a fully automatic way. Aneurysms can be evaluated from all angles, and ICA stenoses at the skull base were easily visualized.
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Uotani K, Watanabe Y, Higashi M, Nakazawa T, Kono AK, Hori Y, Fukuda T, Kanzaki S, Yamada N, Itoh T, Sugimura K, Naito H. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol 2009; 19:2060-5. [DOI: 10.1007/s00330-009-1358-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/24/2008] [Accepted: 01/07/2009] [Indexed: 11/29/2022]
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Contrast-enhanced magnetic resonance angiography in carotid artery disease: does automated image registration improve image quality? Eur Radiol 2009; 19:1232-8. [DOI: 10.1007/s00330-008-1257-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 11/06/2008] [Indexed: 11/25/2022]
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[Acute ischemic stroke. Diagnostic imaging and interventional options]. Radiologe 2008; 48:457-73. [PMID: 18401572 DOI: 10.1007/s00117-008-1663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stroke is the third most common cause of death after myocardial infarction and neoplasms in industrialized countries and the most common cause for permanent disability with impairment of an independent life style. In addition to the socioeconomic problems caused by a disabling stroke, it is to be expected that with an increasing average age of the population, the number of stroke patients will increase as well [4]. The need for effective and widely available therapies against this severe disease is highly evident. Diagnostic imaging is indispensable in order to apply these therapies efficiently and precisely. In addition to the established intravenous thrombolytic therapy with rt-PA within the first 3 h, a therapeutic benefit can also be achieved with thrombolysis inside the time-window 3-6 h, whereas the rate of symptomatic intracerebral hemorrhages increases. Local intraarterial fibrinolysis (LIF) within 6 h is effective and safe and may lead to considerable improvement despite an initially severe medical condition [13]. Besides LIF, interventional techniques for mechanical recanalization of intracranial vessel occlusions are becoming increasingly more established. According to international guidelines for the treatment of acute stroke, computed tomography (CT) is considered to be the most important technical diagnostic tool if available round-the-clock. Alternatively, magnetic resonance tomography (MRT) may primarily be performed if carried out without delay and if the imaging protocol contains a sequence suitable for exclusion of hemorrhages.
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Cervical CT Angiography Comparing Routine Noncontrast and a Late Venous Scan as Masks for Automated Bone Subtraction. Invest Radiol 2008; 43:27-32. [DOI: 10.1097/rli.0b013e31815597ac] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
✓Primary intraosseous meningiomas are a subtype of primary extradural meningiomas and constitute fewer than 2% of meningiomas overall, but they represent approximately two thirds of all extradural meningiomas. These types of meningiomas originate within the bones of the skull and thus can have a clinical presentation and radiographic differential diagnosis that is different from those for intradural meningiomas.
Primary intraosseous meningiomas are classified based on their location and histopathological characteristics. Treatment primarily involves resection with wide margins if possible. Very little literature exists regarding the use of adjuvant therapies such as radiation and chemotherapy for these tumors. In fact, the literature regarding primary intra-osseous meningiomas consists mostly of clinical case reports and case series. This literature is reviewed and summarized in this article.
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Affiliation(s)
| | | | - Chi-Shing Zee
- 3Radiology, University of Southern California, Los Angeles, California
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