1
|
Hempel HL, Engbersen MP, Wakkie J, van Kelckhoven BJ, de Monyé W. Higher agreement between readers with deep learning CAD software for reporting pulmonary nodules on CT. Eur J Radiol Open 2022; 9:100435. [PMID: 35942077 PMCID: PMC9356194 DOI: 10.1016/j.ejro.2022.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim was to evaluate the impact of CAD software on the pulmonary nodule management recommendations of radiologists in a cohort of patients with incidentally detected nodules on CT. Methods For this retrospective study, two radiologists independently assessed 50 chest CT cases for pulmonary nodules to determine the appropriate management recommendation, twice, unaided and aided by CAD with a 6-month washout period. Management recommendations were given in a 4-point grade based on the BTS guidelines. Both reading sessions were recorded to determine the reading times per case. A reduction in reading times per session was tested with a one-tailed paired t-test, and a linear weighted kappa was calculated to assess interobserver agreement. Results The mean age of the included patients was 65.0 ± 10.9. Twenty patients were male (40 %). For both readers 1 and 2, a significant reduction of reading time was observed of 33.4 % and 42.6 % (p < 0.001, p < 0.001). The linear weighted kappa between readers unaided was 0.61. Readers showed a better agreement with the aid of CAD, namely by a kappa of 0.84. The mean reading time per case was 226.4 ± 113.2 and 320.8 ± 164.2 s unaided and 150.8 ± 74.2 and 184.2 ± 125.3 s aided by CAD software for readers 1 and 2, respectively. Conclusion A dedicated CAD system for aiding in pulmonary nodule reporting may help improve the uniformity of management recommendations in clinical practice.
Collapse
Affiliation(s)
- H L Hempel
- Department of Radiology, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands.,Aidence B.V., Amsterdam, the Netherlands
| | - M P Engbersen
- Department of Radiology, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands.,Aidence B.V., Amsterdam, the Netherlands
| | - J Wakkie
- Department of Radiology, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands.,Aidence B.V., Amsterdam, the Netherlands
| | - B J van Kelckhoven
- Department of Radiology, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands.,Aidence B.V., Amsterdam, the Netherlands
| | - W de Monyé
- Department of Radiology, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands.,Aidence B.V., Amsterdam, the Netherlands
| |
Collapse
|
2
|
Madan K, Rastogi R, Bhargava R, Dagar V, Singla V, Sahu A, Singh P, Garg P, Aggarwal B, Singh RK. Is Fatty Liver Associated with Increased Mortality and Morbidity in Coronavirus Disease 2019 (COVID-19) Pneumonia? J Clin Exp Hepatol 2022; 12:1320-1327. [PMID: 35469129 PMCID: PMC9020647 DOI: 10.1016/j.jceh.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fatty liver has been shown to be associated with severe COVID-19 disease without any impact on mortality. This is based on heterogenous criteria for defining both fatty liver as well as the severity parameters. This study aimed to study the impact of fatty liver on the mortality and severity of disease in patients with COVID-19 pneumonia. METHODS In a case control study design, patients with COVID-19 pneumonia (COVID-19 computed tomography severity index [CTSI] on high-resolution computed tomography chest of ≥1) with fatty liver (defined as liver to spleen attenuation index ≤5 on noncontrast computed tomography cuts of upper abdomen) were compared with those without fatty liver. The primary outcome measure was in-hospital mortality, and the secondary outcome measures were CTSI score, need for intensive care unit (ICU) care, need for ventilatory support, duration of ICU stay, and duration of hospital stay. RESULTS Of 446 patients with COVID-19 pneumonia, 289 (64.7%)admitted to Max Hospital, Saket, India, between January 1, 2021, and October 30, 2021, had fatty liver. Fifty-nine of 446 patients died during the index admission. In-hospital mortality was not different between patients with fatty liver (38 [13.24%]) or without fatty liver (21 [13.81%]). COVID-19 CTSI score was found to be significantly higher among patients who had fatty liver (13.40 [5.16] vs 11.81 [5.50]; P = 0.003). There was no difference in the requirement of ICU (94 [32%] vs 62 [39.49%]; P = 0.752), requirement of ventilatory support (27 [9.34%] vs 14 [8.91%]; P = 0.385), duration of ICU stay (8.29 [6.87] vs 7.07 [5.71] days; P = 0.208), and duration of hospital stay (10.10 [7.14] vs 10.69 [8.13] days; P = 0.430) between the groups with fatty liver or no fatty liver. Similarly, no difference was found in primary or secondary outcomes measure between the group with severe fatty liver vs mild/moderate or no fatty liver. High total leucocyte count and Fibrosis-4 (FIB-4) index were independently associated with mortality. CONCLUSIONS Fatty liver may not be associated with increased mortality or clinical morbidity in patients who have COVID-19 pneumonia.
Collapse
Affiliation(s)
- Kaushal Madan
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
- Address for correspondence: Dr Kaushal Madan, Principal Director and Head, Clinical Hepatology, Centre for Gastroenterology, Hepatology & Endoscopy, Max Institute of Liver and GI Sciences, Max Hospitals, Saket, New Delhi 110017, India.
| | - Ruchi Rastogi
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Richa Bhargava
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Vineeta Dagar
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Vikas Singla
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Amit Sahu
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Pankaj Singh
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Pallavi Garg
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Bharat Aggarwal
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | | |
Collapse
|
3
|
Gupta A, Kikano EG, Bera K, Baruah D, Saboo SS, Lennartz S, Hokamp NG, Gholamrezanezhad A, Gilkeson RC, Laukamp KR. Dual energy imaging in cardiothoracic pathologies: A primer for radiologists and clinicians. Eur J Radiol Open 2021; 8:100324. [PMID: 33532519 PMCID: PMC7822965 DOI: 10.1016/j.ejro.2021.100324] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Recent advances in dual-energy imaging techniques, dual-energy subtraction radiography (DESR) and dual-energy CT (DECT), offer new and useful additional information to conventional imaging, thus improving assessment of cardiothoracic abnormalities. DESR facilitates detection and characterization of pulmonary nodules. Other advantages of DESR include better depiction of pleural, lung parenchymal, airway and chest wall abnormalities, detection of foreign bodies and indwelling devices, improved visualization of cardiac and coronary artery calcifications helping in risk stratification of coronary artery disease, and diagnosing conditions like constrictive pericarditis and valvular stenosis. Commercially available DECT approaches are classified into emission based (dual rotation/spin, dual source, rapid kilovoltage switching and split beam) and detector-based (dual layer) systems. DECT provide several specialized image reconstructions. Virtual non-contrast images (VNC) allow for radiation dose reduction by obviating need for true non contrast images, low energy virtual mono-energetic images (VMI) boost contrast enhancement and help in salvaging otherwise non-diagnostic vascular studies, high energy VMI reduce beam hardening artifacts from metallic hardware or dense contrast material, and iodine density images allow quantitative and qualitative assessment of enhancement/iodine distribution. The large amount of data generated by DECT can affect interpreting physician efficiency but also limit clinical adoption of the technology. Optimization of the existing workflow and streamlining the integration between post-processing software and picture archiving and communication system (PACS) is therefore warranted.
Collapse
Key Words
- AI, artificial intelligence
- BT, blalock-taussig
- CAD, computer-aided detection
- CR, computed radiography
- DECT, dual-energy computed tomography
- DESR, dual-energy subtraction radiography
- Dual energy CT
- Dual energy radiography
- NIH, national institute of health
- NPV, negative predictive value
- PACS, picture archiving and communication system
- PCD, photon-counting detector
- PET, positron emission tomography
- PPV, positive predictive value
- Photoelectric effect
- SNR, signal to noise ratio
- SPECT, single photon emission computed tomography
- SVC, superior vena cava
- TAVI, transcatheter aortic valve implantation
- TNC, true non contrast
- VMI, virtual mono-energetic images
- VNC, virtual non-contrast images
- eGFR, estimated glomerular filtration rate
- kV, kilo volt
- keV, kilo electron volt
Collapse
Affiliation(s)
- Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Elias G Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Dhiraj Baruah
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Sachin S Saboo
- Department of Radiology, University Of Texas Health Science Center, San Antonio, TX, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert C Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kai R Laukamp
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
4
|
Sapienza LG, Nasra K, Calsavara VF, Little TB, Narayana V, Abu-Isa E. Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography - A novel translational approach using a radiation oncology contour software. Eur J Radiol Open 2021; 8:100322. [PMID: 33432297 PMCID: PMC7787507 DOI: 10.1016/j.ejro.2021.100322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023] Open
Abstract
Each unit percent of lung involved resulted in a 3.6 % increase in the chance of in-hospital mortality (OR 1.036, P = 0.007). The quantitative lung consolidation was also associated with ocurrence of major adverse hospital events (OR 1.025. P = 0.002). These associations between lung involvement and outcomes were statistically significant after adjusting for relevant clinical parameters.
Purpose To determine whether the percentage of lung involvement at the initial chest computed tomography (CT) is related to the subsequent risk of in-hospital death in patients with coronavirus disease-2019 (Covid-19). Materials and methods Using a cohort of 154 laboratory-confirmed Covid-19 pneumonia cases that underwent chest CT between February and April 2020, we performed a volumetric analysis of the lung opacities. The impact of relative lung involvement on outcomes was evaluated using multivariate logistic regression. The primary endpoint was the in-hospital mortality rate. The secondary endpoint was major adverse hospitalization events (intensive care unit admission, use of mechanical ventilation, or death). Results The median age of the patients was 65 years: 50.6 % were male, and 36.4 % had a history of smoking. The median relative lung involvement was 28.8 % (interquartile range 9.5–50.3). The overall in-hospital mortality rate was 16.2 %. Thirty-six (26.3 %) patients were intubated. After adjusting for significant clinical factors, there was a 3.6 % increase in the chance of in-hospital mortality (OR 1.036; 95 % confidence interval, 1.010–1.063; P = 0.007) and a 2.5 % increase in major adverse hospital events (OR 1.025; 95 % confidence interval, 1.009–1.042; P = 0.002) per percentage unit of lung involvement. Advanced age (P = 0.013), DNR/DNI status at admission (P < 0.001) and smoking (P = 0.008) also increased in-hospital mortality. Older (P = 0.032) and male patients (P = 0.026) had an increased probability of major adverse hospitalization events. Conclusions Among patients hospitalized with Covid-19, more lung consolidation on chest CT increases the risk of in-hospital death, independently of confounding clinical factors.
Collapse
Affiliation(s)
- Lucas G. Sapienza
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States
- Corresponding author at: Department of Radiation Oncology, Baylor College of Medicine, 1 Baylor Plaza, 77030, Houston, TX, United States.
| | - Karim Nasra
- Department of Radiology, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States
| | - Vinícius F. Calsavara
- Department of Epidemiology and Statistics, A.C.Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Tania B. Little
- Department of Infectious Diseases, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States
| | - Vrinda Narayana
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Eyad Abu-Isa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
5
|
AlNaemi H, Tsapaki V, Omar AJ, AlKuwari M, AlObadli A, Alkhazzam S, Aly A, Kharita MH. Towards establishment of diagnostic reference levels based on clinical indication in the state of Qatar. Eur J Radiol Open 2020; 7:100282. [PMID: 33145375 PMCID: PMC7596105 DOI: 10.1016/j.ejro.2020.100282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objectives of this study were to: 1) evaluate patient radiation exposure in CT and 2) establish CT Diagnostic Reference Levels (DRL)s based on clinical indication (CI) in Qatar. MATERIALS AND METHODS Patient data for 13 CIs were collected using specially designed collection forms from the dose management software (DMS) of Hamad Medical Corporation (HMC), the main Qatar healthcare provider. The methodology described in the International Commission on Radiological Protection (ICRP) Report 135 was followed to establish national clinical DRLs in terms of Volumetric Computed Tomography Dose Index (CTDIvol) and total Dose Length Product (DLPt). Effective dose (Ef) was estimated by DMS using DLPt and appropriate conversion factors and was analyzed for comparison purposes. RESULTS Data were retrospectively collected for 896 adult patients undergoing CT examinations in 4 hospitals and 7 CT scanners. CT for Diffuse infiltrative lung disease imparted the lowest radiation in terms of CTDIvol (5 mGy), DLPt (181 mGy.cm) and Ef (3.6 mSv). Total body CT for severe trauma imparted the highest DLPt (3137 mGy.cm) and Ef (38.6 mSv) of all CIs with a CTDIvol of 15 mGy. Rounded Third quartile CTDIvol and DLPt values were defined as the Qatar CT clinical DRLs. Comparison was limited due to sparse international literature. When this was possible data were lower or comparable with other studies. CONCLUSIONS This is the first study reporting national clinical DRLs in Asia and second one internationally after UK. For accurate comparison between studies, systemized CI nomenclature must be followed by researchers.
Collapse
Key Words
- CIs, Clinical Indications
- CT, Computed Tomography
- CTDI, Computed tomography dose index
- Clinical indication
- Clinical protocols
- Computed tomography
- DLP, Dose length product
- DMS, Dose Management Software
- DRL, Diagnostic reference level
- Diagnostic reference levels
- Ef, Effective dose
- HMC, Hamad Medical Corporation
- ICRP, International Commission on Radiological Protection
- JCI, Joint Commission International
- PACS, picture archiving and communication system
- Radiation exposure
- TAVI, Transcatheter Aortic Valve Implantation
- cDRLs, clinical diagnostic reference levels
Collapse
Affiliation(s)
- Huda AlNaemi
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
| | | | | | | | - Amal AlObadli
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
| | | | - Antar Aly
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
| | | |
Collapse
|
6
|
Zhong H, Bianchi CM, Patel SJ, Wolfe AR, Visvikis GA. Intracranial migration of intraocular silicone oil following repetitive head trauma. Radiol Case Rep 2019; 14:1163-1166. [PMID: 31360280 PMCID: PMC6642226 DOI: 10.1016/j.radcr.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/28/2019] [Accepted: 06/29/2019] [Indexed: 11/15/2022] Open
Abstract
Intraocular injection of silicone oil as a tamponade agent is a commonly used technique for the treatment of retinal detachment. An incompletely understood phenomenon which can occur after injection is the migration of silicone oil from the vitreous chamber to the intracranial space. Because the appearance of silicone oil can mimic hemorrhage or other pathologies on CT and MRI, careful comparison with prior studies is necessary to avoid unnecessary follow-up studies. We report a case of intracranial migration of intraocular silicone oil following repetitive head trauma.
Collapse
Affiliation(s)
- Han Zhong
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Christina M. Bianchi
- NYU Langone Hospital, Brooklyn, Department of Radiation Oncology, 150, 55th Street, Brooklyn, NY 11220, USA
| | - Soham J. Patel
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Allen R. Wolfe
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - George A. Visvikis
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| |
Collapse
|
7
|
Kang Z, Wang N, Xu A, Wang L. Digital subtract angiography and lipiodol deposits following embolization in cirrhotic nodules of LIRADS category ≥3. Eur J Radiol Open 2019; 6:106-112. [PMID: 30899770 PMCID: PMC6405901 DOI: 10.1016/j.ejro.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/01/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To assess the correlation between Liver Imaging Reporting and Data System (LIRADS) and digital substract angiography (DSA) and lipiodol deposits in cirrhotic nodules of LIRADS category ≥3 receiving interventional treatment. METHODS From June 2014 to June 2016, patients with cirrhotic nodules were identified retrospectively and MR images were reviewed by sub-specialty radiologists according to modified LIRADS v2014. Correlation between nodules of LIRADS category ≥3 and DSA findings and lipiodol deposits were analyzed. RESULTS 71 cirrhotic nodules were evaluated in 33 patients. 39/71 nodules were classified as LR-3, 9/71 nodules were categorized as LR-4, 23/71 nodules were grouped into LR-5. 43 nodules presented positive DSA, 37 nodules showed presence of lipiodol deposits during follow up. With the upgrade of LIRADS category of cirrhotic nodules, DSA and lipiodol deposits became more conspicuous. Spearman analysis demonstrated positive correlations between LIRADS and DSA (r = 0.567, P = 0.000) as well as LIRADS and lipiodol deposits (r = 0.616, P = 0.000). ROC analysis revealed a cut-off value of LR ≥ 4 resulted in a sensitivity of 67.4% and specificity of 89.3% in predicting positive DSA (RUC = 0.799, P < 0.0001), and a sensitivity of 75.7% and specificity of 88.2% in predicting lipiodol deposits (RUC = 0.818, P < 0.0001). Of 39 lesions of LR-3, 64.1% (25/39) showed negative DSA, and 76.9% (30/39) showed absence of lipiodol deposits during follow up. Logistic regression analysis identified arterial enhancement (OR = 26.837, P = 0.002) and lesion size (OR = 1.325, P = 0.022) were independently associated with positive DSA in nodule of LIRADS category ≥3, while no factors were associated with lipiodol deposits. CONCLUSION The LIRADS can be used to predict DSA findings and lipiodol deposits in nodules with LIRADS score 3 and above. LIRADS 3 nodules tend to be DSA-negative and have less lipiodol deposits. DSA and lipiodol deposits become more conspicuous in nodules from LIRADS 3 to 5.
Collapse
Key Words
- BCLC, Barcelona Clinic Liver Cancer
- DN, dysplastic nodules
- DSA, digital subtract angiography
- DWI, diffusion weighted imaging
- Digital substract angiography
- HCC, hepatocellular carcinoma
- LIRADS, Liver Imaging Reporting and Data System
- LR-M, probably or definitely malignant but not specific for HCC
- Lipiodol deposits
- Liver imaging reporting and data system
- PACS, picture archiving and communication system
- PWI, perfusion weighted imaging
- RIS, radiology information system
- RN, regenerative nodules
- T1WI, T1 weighted imaging
- T2WI, T2 weighted imaging
- TACE, transcatheter arterial chemoembolization
- TAE, transcatheter arterial embolization
Collapse
|
8
|
Bae JH, Lee SY. Filter tilting and retrievability of the Celect and Denali inferior vena cava filters using propensity score-matching analysis. Eur J Radiol Open 2018; 5:153-158. [PMID: 30211254 PMCID: PMC6134324 DOI: 10.1016/j.ejro.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the filter tilting and outcomes of the Celect and Denali inferior vena cava (IVC) filters by using a propensity score-matching analysis. Materials and methods From January 2009 to November 2017, 181 Celect and 58 Denali filters were inserted in our institution. To assess filter tilt, filter tip abutment or penetration of the IVC wall, and retrieval outcome, independent variables, including age, sex, IVC long diameter, IVC angulation, and proximity of the filter to renal vein insertion, were entered in the propensity model. Comparative analyses were performed before and after propensity score-matching analysis. Results Thirty-one patients were enrolled in each group for the final propensity score-matching analysis. The mean filter indwelling time was not significantly different between the groups (26 ± 22 days in Celect and 27 ± 23 days in Denali). After propensity score adjustment, the mean degree of filter tilt was higher in the Celect group (9.5° ± 7.4° vs 5.6° ± 6.7°). Filter tip abutment or penetration of the IVC wall was more common in the Celect group (39% [12/31, abutment: 12, penetration: 0] vs 13% [4/31, abutment: 3, penetration: 1]). The retrieval outcomes were not significantly different before and after propensity score adjustment in both filters. Conclusion The Denali IVC filter showed less tilt and low rate of filter tip abutment to the IVC wall after propensity score-matching analysis. The retrieval rate was not significantly different in the short-term filter indwelling setting. More large-scale, long-term follow-up studies are needed to verify these results.
Collapse
Affiliation(s)
- Jae Heung Bae
- Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.,Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| |
Collapse
|
9
|
Lee SY, Lee J. Is external compression on the IVC a risk factor for IVC filter abutment? A single center experience of 141 infrarenal celect filter insertions. Eur J Radiol Open 2018; 5:73-78. [PMID: 30014012 PMCID: PMC6043891 DOI: 10.1016/j.ejro.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/18/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022] Open
Abstract
Tilt of the IVC filter is the major problem for the filter retrieval rate. External compression on the IVC wall can cause filter tilting. Identifying external compression factors are necessary before insertion of IVC filter.
Objectives To investigate risk factors for inferior vena cava (IVC) filter abutment, including external compression on the IVC wall, using venous phase computed tomography (CT). Methods One-hundred-forty-one cases of Celect IVC filter insertion between January 2009 and April 2017 were retrospectively reviewed. On pre-procedural CT, IVC diameter and morphological classifications were measured. Filter tilt angle, IVC angle, vertical position, and filter tip abutment to the IVC wall were analyzed on post-procedural CT. IVC compression was examined by pre- and post-procedural CT analysis. Multiple logistic regression analysis was conducted to find factors related to IVC filter abutment. Results Of 141 IVC filter insertion cases, 52 were classified in the filter tip abutment group and 89 in the non-abutting group. IVC tilt angle (11.7 ± 5.5° vs. 6.4 ± 5.4°), presence of external compression (14/52, 27% vs. 9/89, 9%), and IVC morphology were different between the groups (p < 0.05). In multiple logistic regression analysis, filter-tilt angle over 9.25° and external compression on the IVC were found to be independent predictors of filter abutment (odds ratios: 4.56, 10.18, respectively). Conclusion IVC filter tilt, external compression on IVC wall, and IVC morphology were significantly different between the filter tip abutment and non-abutment groups. External compression and filter tilt over 9.25° were risk factors for filter tip abutment in multiple logistic regression analysis. By identifying these factors, we may be able to reduce filter tilting by preventing the filter from being deployed in a dangerous area.
Collapse
Affiliation(s)
- Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Corresponding author at: Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
| |
Collapse
|