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Gruenberg B, Crane G, Arnold DH, Harrison NJ, Levine M. Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology. Am J Emerg Med 2024; 78:18-21. [PMID: 38181541 DOI: 10.1016/j.ajem.2023.12.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting. Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. METHODS We performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018-2020. RESULTS 1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. CONCLUSIONS Our study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.
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Affiliation(s)
- Blake Gruenberg
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Gabriella Crane
- Vanderbilt University Medical Center, Department of Radiology, Division of Pediatric Radiology, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Donald H Arnold
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Noah J Harrison
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN, 37232, USA
| | - Marla Levine
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
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Ahmad M, Liu X, Morani AC, Ganeshan D, Anderson MR, Samei E, Jensen CT. Oncology-specific radiation dose and image noise reference levels in adult abdominal-pelvic CT. Clin Imaging 2023; 93:52-59. [PMID: 36375364 PMCID: PMC9712239 DOI: 10.1016/j.clinimag.2022.10.016] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To provide our oncology-specific adult abdominal-pelvic CT reference levels for image noise and radiation dose from a high-volume, oncologic, tertiary referral center. METHODS The portal venous phase abdomen-pelvis acquisition was assessed for image noise and radiation dose in 13,320 contrast-enhanced CT examinations. Patient size (effective diameter) and radiation dose (CTDIvol) were recorded using a commercial software system, and image noise (Global Noise metric) was quantified using a custom processing system. The reference level and range for dose and noise were calculated for the full dataset, and for examinations grouped by CT scanner model. Dose and noise reference levels were also calculated for exams grouped by five different patient size categories. RESULTS The noise reference level was 11.25 HU with a reference range of 10.25-12.25 HU. The dose reference level at a median effective diameter of 30.7 cm was 26.7 mGy with a reference range of 19.6-37.0 mGy. Dose increased with patient size; however, image noise remained approximately constant within the noise reference range. The doses were 2.1-2.5 times than the doses in the ACR DIR registry for corresponding patient sizes. The image noise was 0.63-0.75 times the previously published reference level in abdominal-pelvic CT examinations. CONCLUSIONS Our oncology-specific abdominal-pelvic CT dose reference levels are higher than in the ACR dose index registry and our oncology-specific image noise reference levels are lower than previously proposed image noise reference levels. ADVANCES IN KNOWLEDGE This study reports reference image noise and radiation dose levels appropriate for the indication of abdomen-pelvis CT examination for cancer diagnosis and staging. The difference in these reference levels from non-oncology-specific CT examinations highlight a need for indication-specific, dose index and image quality reference registries.
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Affiliation(s)
- Moiz Ahmad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Xinming Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Marcus R Anderson
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Clinical Imaging Physics Group, Medical Physics Graduate Program, Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Duke University Medical Center, Durham, NC, United States of America.
| | - Corey T Jensen
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
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Lee CY, Chen JD. Diagnostic values of supine and erect abdominal radiographs for patients with acute abdomen: which is better for decision making? J Chin Med Assoc 2022; 85:709-716. [PMID: 35316248 DOI: 10.1097/jcma.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Plain abdominal radiography including supine and erect abdominal radiographs (SAR and EAR) is a frequently used image modality for preliminary evaluation of acute abdomen. We aimed to explore which one of the SAR or EAR has a higher diagnostic value in overall diagnosis of acute abdomen, including their respective advantages over each other for the various underlying diseases. METHODS We retrospectively analyzed the imaging findings of plain abdominal radiography of patients with acute abdomen who received abdominal computed tomography (CT) within 24 hours at the emergency department of a medical center in northern Taiwan between October 2019 and February 2020. Final diagnosis was made by CT reports and clinical data. The relevance between the imaging findings and clinical diagnosis in the groups of SAR and EAR were compared. RESULTS A total of 1009 cases with acute abdomen were included, of which 341 (33.8%) underwent EAR and 668 (66.2%) underwent SAR. Among them, 820 cases had final diagnosis confirmed by CT and clinical data. In comparison of the diagnostic relevance of SAR and EAR, there were no significant difference in the overall acute abdomen, but EAR showed a better diagnostic relevance in cases with bowel obstruction than SAR did (100% vs 87.2%, p < 0.05). No statistical difference in other abdominal diseases. CONCLUSION There is no significant difference between SAR and EAR in evaluation of overall acute abdomen. However, EARs has a diagnostic advantage over SAR for evaluation of suspected bowel obstruction.
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Affiliation(s)
- Chia-Ying Lee
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Jen-Dar Chen
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Abstract
Organ segmentation, chest radiograph classification, and lung and liver nodule detections are some of the popular artificial intelligence (AI) tasks in chest and abdominal radiology due to the wide availability of public datasets. AI algorithms have achieved performance comparable to humans in less time for several organ segmentation tasks, and some lesion detection and classification tasks. This article introduces the current published articles of AI applied to chest and abdominal radiology, including organ segmentation, lesion detection, classification, and predicting prognosis.
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Affiliation(s)
- Sungwon Lee
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Building 10, Room 1C224D, 10 Center Drive, Bethesda, MD 20892-1182, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Building 10, Room 1C224D, 10 Center Drive, Bethesda, MD 20892-1182, USA.
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Chen KM, Lee BC, Chen PT, Liu KL, Lin KH, Chang CC, Wu TH, Hong JS, Lin YH. Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism. Front Endocrinol (Lausanne) 2021; 12:647184. [PMID: 34335463 PMCID: PMC8323492 DOI: 10.3389/fendo.2021.647184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to analyze the differences in the distribution of abdominal adipose tissue between the two subtypes of primary aldosteronism (PA) using abdominal computed tomography. We retrospectively analyzed patients diagnosed as having essential hypertension (EH) or PA from the prospectively collected Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Patients with PA were divided into the subgroups of idiopathic hyperaldosteronism (IHA) and unilateral aldosterone-producing adenoma (APA). Patients' basic clinicodemographic data were collected, and a self-developed CT-based software program was used to quantify the abdominal adiposity indexes, including visceral adipose tissue (VAT) area, VAT ratio, waist circumference (WC), subcutaneous adipose tissue (SAT) area, and SAT ratio. We included 190 patients with EH and 436 patients with PA (238 with IHA and 198 with APA). The APA group had significantly lower abdominal adiposity indexes than the other groups. We also found negative correlations of aldosterone-to-renin ratio (ARR) with VAT area, VAT ratio, WC, and body mass index (BMI) in the APA group. After propensity score matching (which left 184 patients each in the IHA and APA groups), patients in the APA group still had significantly lower WC, SAT area, SAT ratio, and VAT ratio than those in the IHA group. Furthermore, logistic regression analysis indicated that lower probability of abdominal obesity was significantly related to patients with APA. Our data revealed that the distribution of abdominal adipose tissue was similar in patients with IHA and those with EH, but the abdominal adiposity indexes were significantly lower in patients with APA than in those with IHA and EH.
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Affiliation(s)
- Kuan-Ming Chen
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Industrial Ph.D. Program of Biomedical Science and Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
- Industrial Ph.D. Program of Biomedical Science and Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ting Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Industrial Ph.D. Program of Biomedical Science and Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
- Industrial Ph.D. Program of Biomedical Science and Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Chin-Chen Chang, ; Tung-Hsin Wu,
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Chin-Chen Chang, ; Tung-Hsin Wu,
| | - Jia-Sheng Hong
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Goldberg-Stein S, Fink A, Paroder V, Kobi M, Yee J, Chernyak V. Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19). Abdom Radiol (NY) 2020; 45:2613-2623. [PMID: 32761402 PMCID: PMC7406871 DOI: 10.1007/s00261-020-02669-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage. MATERIALS AND METHODS This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed. RESULTS Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively (p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively (p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index. CONCLUSION Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.
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Affiliation(s)
| | - Adam Fink
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, NYC, New York, NY, USA
| | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Judy Yee
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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Pandey M, Xu Z, Sholle E, Maliakal G, Singh G, Fatima Z, Larine D, Lee BC, Wang J, van Rosendael AR, Baskaran L, Shaw LJ, Min JK, Al’Aref SJ. Extraction of radiographic findings from unstructured thoracoabdominal computed tomography reports using convolutional neural network based natural language processing. PLoS One 2020; 15:e0236827. [PMID: 32730362 PMCID: PMC7392233 DOI: 10.1371/journal.pone.0236827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Heart failure (HF) is a major cause of morbidity and mortality. However, much of the clinical data is unstructured in the form of radiology reports, while the process of data collection and curation is arduous and time-consuming. Purpose We utilized a machine learning (ML)-based natural language processing (NLP) approach to extract clinical terms from unstructured radiology reports. Additionally, we investigate the prognostic value of the extracted data in predicting all-cause mortality (ACM) in HF patients. Materials and methods This observational cohort study utilized 122,025 thoracoabdominal computed tomography (CT) reports from 11,808 HF patients obtained between 2008 and 2018. 1,560 CT reports were manually annotated for the presence or absence of 14 radiographic findings, in addition to age and gender. Thereafter, a Convolutional Neural Network (CNN) was trained, validated and tested to determine the presence or absence of these features. Further, the ability of CNN to predict ACM was evaluated using Cox regression analysis on the extracted features. Results 11,808 CT reports were analyzed from 11,808 patients (mean age 72.8 ± 14.8 years; 52.7% (6,217/11,808) male) from whom 3,107 died during the 10.6-year follow-up. The CNN demonstrated excellent accuracy for retrieval of the 14 radiographic findings with area-under-the-curve (AUC) ranging between 0.83–1.00 (F1 score 0.84–0.97). Cox model showed the time-dependent AUC for predicting ACM was 0.747 (95% confidence interval [CI] of 0.704–0.790) at 30 days. Conclusion An ML-based NLP approach to unstructured CT reports demonstrates excellent accuracy for the extraction of predetermined radiographic findings, and provides prognostic value in HF patients.
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Affiliation(s)
- Mohit Pandey
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Zhuoran Xu
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Evan Sholle
- Information Technologies and Services, Weill Cornell Medicine, New York, New York, United States of America
| | - Gabriel Maliakal
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Gurpreet Singh
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Zahra Fatima
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Daria Larine
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benjamin C. Lee
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Jing Wang
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | | | - Lohendran Baskaran
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Leslee J. Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - James K. Min
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- * E-mail:
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Affiliation(s)
- Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
| | - Michael Connerney
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
| | - Hiba Rauf
- Department of Internal Medicine, American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Mannat Saini
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Hospital, Abington, Pennsylvania, USA
| | - Sahil Mamtani
- Department of Internal Medicine, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Umer Syed
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
| | - Stephen Luddington
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
| | - Aaron Walfish
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, Queens, New York, New York, USA
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Khan Z, Darr U, Saud Khan M, Nawras M, Rafiq E, Nawras A. First case of paralytic ileus after endoscopic mucosal resection of caecal polyp. Arab J Gastroenterol 2020; 21:117-121. [PMID: 32423855 DOI: 10.1016/j.ajg.2020.04.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/08/2018] [Accepted: 04/08/2020] [Indexed: 11/18/2022]
Abstract
Endoscopic mucosal resection (EMR) is a technique developed for the removal of sessile or flat neoplastic lesions confined to the superficial layers (mucosa and submucosa) of the gastrointestinal tract. Bleeding and perforation are well-known complications of EMR. Here we report the first case of paralytic ileus after EMR of a caecal polyp. A 66-year-old man was scheduled for elective EMR of a 3.5-cm caecal polyp under general anaesthesia after a screening colonoscopy. The procedure was performed by an expert endoscopist, and air was insufflated during the procedure because of the unavailability of CO2. The polyp was successfully removed; the procedure duration was 81 min. After the procedure, the patient complained of abdominal pain and dyspnoea. He developed tachypnoea and tachycardia as well as oxygen desaturation with SpO2 84%. He was administered oxygen therapy via a non-rebreather mask, following which his oxygenation improved. His abdominal X-ray findings were consistent with ileus. Therefore, a nasogastric tube was placed, and the patient was admitted to our hospital. He was managed conservatively and underwent serial abdominal X-rays that showed improvement of the ileus. On the fourth day of admission, he was started on an oral diet; on the sixth day of admission, he was discharged with resolving ileus. Computed tomography enterography performed 1 week after discharge showed complete resolution of the ileus. Factors that may have contributed to the occurrence of ileus in our patient include the use of air during the procedure, location of the polyp (caecal), duration of the procedure, effect of electrocautery, use of general anaesthesia and possibility of aspiration pneumonitis. This case report will make endoscopists aware of the abovementioned factors while performing EMR as this procedure can lead to the complication of paralytic ileus with significant patient morbidity. Conservative treatment should be attempted first before any other intervention.
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Affiliation(s)
- Zubair Khan
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States.
| | - Umar Darr
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States
| | - Mohammad Saud Khan
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States
| | - Mohamad Nawras
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States
| | - Ehsan Rafiq
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States
| | - Ali Nawras
- University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States
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Lee CH, Jeon SY, Yhim HY, Jang KY, Kwak JY. Occurrence of lymphoplasmacytic lymphoma in a chronic myeloid leukemia patient following long-term treatment with tyrosine kinase inhibitors: A case report. Medicine (Baltimore) 2020; 99:e19962. [PMID: 32384445 PMCID: PMC7220158 DOI: 10.1097/md.0000000000019962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION After tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 were introduced for the treatment of chronic myeloid leukemia, clinical outcomes have improved dramatically. However, together with the increase in the survival rate, a more frequent occurrence of secondary malignancies has been observed as well. TKIs have been demonstrated to be a risk factor of malignancies such as non-Hodgkin lymphoma, prostate cancer, and skin cancer. However, lymphoplasmacytic lymphoma (LPL) has never been reported as a secondary malignancy after TKI treatment in chronic myeloid leukemia (CML). PATIENT CONCERNS An 81-year-old male patient diagnosed with CML and treated with TKIs for a long period (15 years) was admitted due to a chief complaint of abdominal pain. A large abdominal mass was detected by imaging that included computed tomography. DIAGNOSIS LPL was confirmed from biopsies after ultrasonography and sigmoidoscopy. Serum IgM level was increased and M protein and monoclonal gammopathy, IgM_kappa light chain type were detected. INTERVENTIONS The patient received six cycles of R-CHOP chemotherapy. OUTCOMES After chemotherapy, he showed response. The sizes of the abdominal mass and lymph nodes decreased; moreover, serum M protein and IgM levels decreased, as well. CONCLUSION Herein, for the first time, we describe a patient who developed LPL as a secondary malignancy after administration of TKIs for the treatment of CML. Our observations indicate the importance of awareness of this secondary malignancy that can develop in CML patients treated with TKIs.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Biopsy/methods
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Immunoglobulin M/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Male
- Neoplasms, Second Primary/blood
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Prednisone/administration & dosage
- Radiography, Abdominal/methods
- Rituximab/administration & dosage
- Tomography, X-Ray Computed/methods
- Treatment Outcome
- Vincristine/administration & dosage
- Waldenstrom Macroglobulinemia/blood
- Waldenstrom Macroglobulinemia/drug therapy
- Waldenstrom Macroglobulinemia/etiology
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
| | | | | | - Kyu Yun Jang
- Department of Pathology, Chonbuk National University Medical School, Jeonju, Republic of Korea
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11
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Guragai M, Bhusai S, Bhatta A. Intestinal Obstruction of Congenital Origin: A Case Report. JNMA J Nepal Med Assoc 2020. [PMID: 32335643 PMCID: PMC7580479 DOI: 10.31729/jnma.4708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Congenital bands are rare causes of intestinal obstruction and often leads to diagnostic challenges. Diagnostic delays in cases of mechanical obstruction might lead to irreversible bowel ischemia and perforation. Presently described is a case of an 18 month young child with severe vomiting developed for one day. The child was initially thought to have acute viral enteritis and treated accordingly. Due to the severity, an X-Ray and computed tomography scan were sent which pointed towards the possibility of having congenital bands. He was treated operatively. The child was kept under observation for eleven days and was discharged. Although rare, intestinal obstruction due to congenital bands must be considered when treating a child with severe vomiting.
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Affiliation(s)
- Mandeep Guragai
- Kathmandu Medical College and Teaching Hospital, Sinamangai, Kathmandu, Nepal
- Correspondence: Mr. Mandeep Guragai, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9860086566
| | - Suzit Bhusai
- Kathmandu Medical College and Teaching Hospital, Sinamangai, Kathmandu, Nepal
| | - Anwesh Bhatta
- Department of Paediatrics, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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12
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Al Naomi H, Aly A, Kharita MH, Hilli SA, Al Obadli A, Singh R, Rehani MM, Kalra MK. Multiphase abdomen-pelvis CT in women of childbearing potential (WOCBP): Justification and radiation dose. Medicine (Baltimore) 2020; 99:e18485. [PMID: 31977845 PMCID: PMC7004794 DOI: 10.1097/md.0000000000018485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess justification and radiation doses of abdomen-pelvis CT in women of childbearing potential (WOCBP) scanned in 2 tertiary hospitals in Qatar.The local ethical committee approved retrospective study of 451 WOCBP (14-55 years) who underwent abdomen-pelvis CT examinations. Patients' age, clinical indications for ordered CT, scanner types and vendors, number and type of scan phases (non-contrast, arterial, portal venous, and/or delayed phases), and radiation dose descriptors (CT dose index volume - CTDIvol and dose length product- DLP) were recorded. Patients undergoing simultaneous chest-abdomen-pelvis CT were excluded. We classified the clinical indications for all 451 CT into indicated and unindicated based on the ACR Appropriateness Criteria. Information regarding the date of last menstrual period, likelihood of pregnancy, and if available, results of the pregnancy test were recorded. Data were analyzed with descriptive statistics (median and inter-quartile range) and analysis of variance (ANOVA).None of the patients were pregnant at the time of their scanning. Amongst the 673 phases acquired for multiphase abdomen-pelvis CT in 451 patients, the 47% unindicated phases (315/673) included non-contrast (122/673, 18%), arterial (33/673, 5%), portal venous (125/673, 19%) and delayed (35/673, 5%) phases. The respective median DLP for indicated and unindicated phases were 266 and 758 mGy.cm (P < .0001).Multiphase abdomen-pelvis CT exams are frequent but seldom justified in WOCBP. They lead to a substantial increase in unindicated radiation dose compared to a single-phase CT.
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Affiliation(s)
| | - Antar Aly
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Ramandeep Singh
- Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Madan M. Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston MA
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13
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Ghonge NP, Sahu A. 'Hepato-diaphragmatic fat interposition' and 'increased right hemi-diaphragmatic thickness': new imaging signs for early diagnosis of hepatic cirrhosis on routine CT abdomen. Abdom Radiol (NY) 2020; 45:153-160. [PMID: 31542819 DOI: 10.1007/s00261-019-02230-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cirrhosis of liver is often a silent disease and need early diagnosis for effective treatment strategy. OBJECTIVES The present article aims to describe new imaging signs for early diagnosis of cirrhosis on routine CT. These are 'hepato-diaphragmatic fat interposition' (HDFI) and 'increased right hemi-diaphragmatic thickness' (increased r-DT sign). MATERIALS AND METHODS This was a retrospective study based on the presence or absence of cirrhosis of liver (n = 100). 'HDFI sign' was labeled as positive if F is more than 50% of D; where F is the medio-lateral extent of the intra-abdominal fat along the postero-medial margin of liver and D is the distance from the lateral vertebral margin to the medial margin of the outer-most rib in the same axial image. Increased 'r-DT sign' is labeled when the dimension on right side exceeds left side by at least 0.2 cm. Pearson χ2 was performed to calculate the p value. A p value of < 0.05 was considered to indicate a significant difference. RESULTS There was a significant difference between cirrhotic and normal group, The sensitivity, specificity, positive predictive value and the negative predictive value of HDFI sign was found to be 94%, 62%, 71.21% and 91.17%, while that of increased r-DT sign was found to be 96%,52%, 66.66% and 92.85%. The area under the ROC curve for the HDFI sign was found to be 0.78 as compared to 0.74 for the increased r-DT sign. CONCLUSION Both these new signs should be used as additional imaging signs for early diagnosis of cirrhosis.
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Affiliation(s)
| | - Amit Sahu
- Max Superspeciality Hospital, Saket, New Delhi, India
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14
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Mohammadbeigi A, Khoshgard K, Haghparast A, Eivazi MT. LOCAL DRLS FOR PAEDIATRIC CT EXAMINATIONS BASED ON SIZE-SPECIFIC DOSE ESTIMATES IN KERMANSHAH, IRAN. Radiat Prot Dosimetry 2019; 186:496-506. [PMID: 31330009 DOI: 10.1093/rpd/ncz056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 06/10/2023]
Abstract
Due to the radiosensitivity of paediatric patients to X-ray, it is necessary to survey the paediatric DRLs using size-specific dose estimates (SSDE). In the present study, we determined the local diagnostic reference levels (DRLs) for paediatric chest, head and abdomen-pelvis CT examinations and their Surview scans in Kermanshah city, Iran. For ≤1 year, 1-5 years, 5-10 years and 10-15 years the DRLs (mGy) based on SSDE were determined N/A, 6.00, 6.25, 8.27 for abdomen-pelvis, and 8.74, 7.45, 11.15, 10.45 for chest and 19.05, 18.33, 18.22, 20.14 for head examinations, respectively. The differences between body size and default phantom defined in CT scanners are significant and should be considered when determining the DRLs. Based on our findings, use of CTDIv and SSDE parameters for determining DRLs leads to significant different results in children; thus SSDE is suggested as a more accurate index than CTDIV for establishing DRLs in paediatric CT examinations.
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Affiliation(s)
- Ahmad Mohammadbeigi
- M.Sc in Medical Physics, Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Haghparast
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Taghi Eivazi
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Mehdipour A, Parsi M, Khorram FS. PATIENT DOSE SURVEY BASED ON SIZE-SPECIFIC DOSE ESTIMATE AND ACCEPTABLE QUALITY DOSE IN CHEST AND ABDOMEN/PELVIS CT EXAMINATIONS. Radiat Prot Dosimetry 2019; 185:176-182. [PMID: 30824932 DOI: 10.1093/rpd/ncy288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 12/01/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
The practical aspects of two recently developed patient dose optimization methods in computed tomography (CT) examinations, size-specific dose estimate (SSDE) and acceptable quality dose (AQD), were verified for the chest and abdomen/pelvis examinations. A dose survey was performed in a CT institute by considering patients lateral diameter, weight and body mass index (BMI). The AQD tables for weight and BMI groups and SSDE threshold curves were obtained. The mean of volume CT dose index and dose length product for standard-size patients were compared with the national diagnostic reference levels (NDRLs) of Iran. The results show that patient doses are below the NDRLs. It is more reliable to report the AQDs based on SSDE and for BMI groups which can well take into account patient size in the dose optimization process. The SSDE threshold curves can be determined with more precision by including dose data of all possible sizes in the curves.
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Affiliation(s)
- Ali Mehdipour
- Department of Radiology, Faculty of Paramedical, Rafsanjan University of Medical Sciences, PO BOX, Rafsanjan, Iran
| | - Masoumeh Parsi
- Immunology of Infectious Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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16
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Eguchi T, Inoue K, Horino T, Matsumoto T, Kamioka S, Nishida Y, Morimoto M, Morimoto N, Ichii O, Terada Y. Intestinal Spirochetosis Caused by Brachyspira pilosicoli in a Systemic Lupus Erythematosus Patient. J Clin Rheumatol 2019; 25:e142-e145. [PMID: 31764507 DOI: 10.1097/rhu.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tomohiro Eguchi
- Department of Endocrinology Metabolism, and Nephrology Kochi Medical School Kochi University Kochi, Japan Department of Endocrinology Metabolism, and Nephrology Kochi Medical School Kochi University Kochi, Japan Department of Endocrinology Metabolism, and Nephrology Kochi Medical School Kochi University Kochi, Japan Department of Clinical Laboratory Kochi Medical School Kochi University Kochi, Japan Laboratory of Anatomy Department of Biomedical Sciences Graduate School of Veterinary Medicine Hokkaido University Sapporo, Japan Department of Endocrinology Metabolism, and Nephrology Kochi Medical School Kochi University Kochi, Japan
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17
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Choi Y, Jeon SY, Yoo WH. Hepatosplenic T-Cell Lymphoma Arising in a Patient Treated With Tumor Necrosis Factor-α Inhibitors for Ankylosing Spondylitis. J Clin Rheumatol 2019; 25:e134-e135. [PMID: 31764502 DOI: 10.1097/rhu.0000000000000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - So-Yeon Jeon
- Division of Hematology/Oncology, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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18
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Qurashi AA, Rainford LA, Alshamrani KM, Foley SJ. THE IMPACT OF OBESITY ON ABDOMINAL CT RADIATION DOSE AND IMAGE QUALITY. Radiat Prot Dosimetry 2019; 185:17-26. [PMID: 30508172 DOI: 10.1093/rpd/ncy212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
The aim of this study was to evaluate how iterative reconstruction can compensate for the noise increase in low radiation dose abdominal computed tomography (CT) technique for large size patients and the general impact of obesity on abdominal organ doses and image quality in CT. An anthropomorphic phantom layered with either none or a single layer of 3-cm- thick circumferential animal fat packs to simulate obese patients was imaged using a 128MDCT scanner. Abdominal protocols (n = 12) were applied using automatic tube current modulation (ATCM) with various quality reference mAs (150, 200, 250 and 300). kVs of 100, 120 and 140 were used for each mAs selection. Metal oxide semiconductor field effect transistor dosimeters (MOSFET) measured internal organ dose. All images produced were reconstructed with filtered back projection (FBP) and sinogram affirmed iterative reconstruction (SAFIRE) (3, 4 and 5) and objective noise was measured within three regions of interest at the level of L4-L5. Organ doses varied from 0.12 to 41.9 mGy, the spleen received the highest doses for both phantom sizes. Compared to the phantom simulating average size, the obese phantom was associated with up to twofold increase in delivered mAs, dose length product (DLP) and computed tomography dose index (CTDIvol) for the matched mAs selection (p < 0.05). However, organ dose increased by 50% only. The use of 100 kV resulted in a 40% lower dose (p < 0.05) compared to 120 kV and the associated noise increase was improved by SAFIRE (5) use, which resulted in 60% noise reduction compared to FBP (p < 0.05). When combined with iterative reconstruction, low kV is feasible for obese patients to optimise radiation dose and maintain objective image quality.
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Affiliation(s)
- Abdulaziz A Qurashi
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Louise A Rainford
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Khalid M Alshamrani
- Radiological Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Shane J Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
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19
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Ferstenfeld I, Shemer A, Razon Y, Yeshayahu Y. An Uncommon Complication of a Common Disease: Pneumatosis Intestinalis in an Infant with Kawasaki Disease. Isr Med Assoc J 2019; 21:763-765. [PMID: 31713369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ido Ferstenfeld
- Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Asaf Shemer
- Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Razon
- Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yonatan Yeshayahu
- Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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20
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Moloney F, Twomey M, James K, Kavanagh RG, Fama D, O'Neill S, Grey TM, Moore N, Murphy MJ, O'Connor OJ, Maher MM. A phantom study of the performance of model-based iterative reconstruction in low-dose chest and abdominal CT: When are benefits maximized? Radiography (Lond) 2019; 24:345-351. [PMID: 30292504 DOI: 10.1016/j.radi.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this study was to assess and compare the effects of CT image reconstruction techniques on low-dose CT image quality using phantoms. METHODS Anthropomorphic torso and spatial/contrast-resolution phantoms were scanned at decreasing tube currents between 400 and 10 mA. CT thorax and abdomen/pelvis series were reconstructed with filtered back projection (FBP) alone, combined 40% adaptive statistical iterative reconstruction & FBP (ASIR40), and model-based iterative reconstruction (MBIR) [(resolution-preference 05 (RP05) and RP20 in the thorax and RP05 and noise-reduction 05 (NR05) in the abdomen)]. Two readers rated image quality quantitatively and qualitatively. RESULTS In thoracic CT, objective image noise on MBIR RP05 data sets outperformed FBP at 200, 100, 50 and 10 mA and outperformed ASIR40 at 50 and 10 mA (p < 0.001). MBIR RP20 outperformed FBP at 50 and 10 mA and outperformed ASIR40 at 10 mA (p < 0.001). Compared with both FBP and ASIR40, MBIR RP05 demonstrated significantly better signal-to-noise ratio (SNR) at 10 mA. In abdomino-pelvic CT, MBIR RP05 and NR05 outperformed FBP and ASIR at all tube current levels for objective image noise. NR05 demonstrated greater SNR at 200, 100, 50 and 10 mA and RP05 demonstrated greater SNR at 50 and 10 mA compared with both FBP and ASIR. MBIR images demonstrated better subjective image quality scores. Spatial resolution, low-contrast detectability and contrast-to-noise ratio (CNR) were comparable between image reconstruction techniques. CONCLUSION CTs reconstructed with MBIR have lower image noise and improved image quality compared with FBP and ASIR. These effects increase with reduced radiation exposure confirming optimal use for low-dose CT imaging.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - K James
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - R G Kavanagh
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland.
| | - D Fama
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - S O'Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - T M Grey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - N Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M J Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
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21
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Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. AREAS COVERED We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. EXPERT COMMENTARY For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease.
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Affiliation(s)
- M Brighi
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy.
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - N Pagano
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
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22
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Pickhardt PJ, Nelson L. Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients. Abdom Radiol (NY) 2019; 44:2963-2970. [PMID: 31104074 DOI: 10.1007/s00261-019-02064-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the relative diagnostic yield of contrast-enhanced CT in adults presenting with symptoms referable to a specific abdominal quadrant. METHODS Electronic health records review systematically identified patients meeting the following inclusion criteria: adults (≥ 18 years) undergoing IV contrast-enhanced abdominopelvic CT for acute non-traumatic symptoms referable to a specific abdominal quadrant (RLQ/LLQ/LUQ/RUQ). The CT-based diagnosis and any clinical diagnosis in the absence of CT diagnosis were recorded. The final cohort of 1000 subjects (mean age, 48.1 years; 647F/353M) consisted of consecutive sub-cohorts of 250 patients for each abdominal quadrant. Positive oral contrast was utilized in 91.6% (916/1000) of cases. RESULTS A positive CT diagnosis was provided in 47.3% (473/1000) of all patients, and was highest for LLQ (58.8%) and RLQ (58.0%) symptoms, including diverticulitis and appendicitis in 23.6% and 24.8% cases, respectively. CT positivity was lower for the LUQ (34.4%) and RUQ (38.0%) (p < 0.0001), with no single diagnosis representing > 5% of cases. However, all quadrants provided valuable triage of 218 hospital admissions (21.8%), 83.0% were CT positive, whereas 62.7% of 782 discharged patients were CT negative. Only 7.0% of CT-negative patients were admitted. A clinical-only diagnosis was provided in 9.3% of the total cohort (93/1000), representing 17.6% of the CT-negative cohort (93/527). CONCLUSION The rate of positive CT diagnosis is considerably higher for the lower abdominal quadrants, predominately due to appendicitis and diverticulitis. However, CT results (positive vs. negative) for all four quadrants strongly correlated with hospital admission versus discharge. Clinical-only diagnosis represented < 10% of all cases.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
| | - Leslie Nelson
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
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23
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Maxwell S, Fox R, McRobbie D, Bulsara M, Doust J, O’Leary P, Slavotinek J, Stubbs J, Moorin R. How have advances in CT dosimetry software impacted estimates of CT radiation dose and cancer incidence? A comparison of CT dosimetry software: Implications for past and future research. PLoS One 2019; 14:e0217816. [PMID: 31412037 PMCID: PMC6693687 DOI: 10.1371/journal.pone.0217816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/21/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Organ radiation dose from a CT scan, calculated by CT dosimetry software, can be combined with cancer risk data to estimate cancer incidence resulting from CT exposure. We aim to determine to what extent the use of improved anatomical representation of the adult human body “phantom” in CT dosimetry software impacts estimates of radiation dose and cancer incidence, to inform comparison of past and future research. Methods We collected 20 adult cases for each of three CT protocols (abdomen/pelvis, chest and head) from each of five public hospitals (random sample) (January-April inclusive 2010) and three private clinics (self-report). Organ equivalent and effective dose were calculated using both ImPACT (mathematical phantom) and NCICT (voxelised phantom) software. Bland-Altman plots demonstrate agreement and Passing-Bablok regression reports systematic, proportional or random differences between results. We modelled the estimated lifetime attributable risk of cancer from a single exposure for each protocol, using age-sex specific risk-coefficients from the Biologic Effects of Ionizing Radiation VII report. Results For the majority of organs used in epidemiological studies of cancer incidence, the NCICT software (voxelised) provided higher dose estimates. Across the lifespan NCICT resulted in cancer estimates 2.9%-6.6% and 14.8%-16.3% higher in males and females (abdomen/pelvis) and 7.6%-19.7% and 12.9%-26.5% higher in males and females respectively (chest protocol). For the head protocol overall cancer estimates were lower for NCICT, but with greatest disparity, >30% at times. Conclusion When the results of previous studies estimating CT dose and cancer incidence are compared to more recent, or future, studies the dosimetry software must be considered. Any change in radiation dose or cancer risk may be attributable to the software and phantom used, rather than—or in addition to—changes in scanning practice. Studies using dosimetry software to estimate radiation dose should describe software comprehensively to facilitate comparison with past and future research.
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Affiliation(s)
- Susannah Maxwell
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Richard Fox
- School of Physics, University of Western Australia, Perth, Western Australia, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Max Bulsara
- Institute for Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Centre for Health Services Research, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice Faculty of Health Sciences and Medicine Bond University, Gold Coast, Queensland, Australia
| | - Peter O’Leary
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - John Stubbs
- CanSpeak Australia, Spring Hill, Queensland, Australia
| | - Rachael Moorin
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Metaxas VI, Messaris GA, Lekatou AN, Petsas TG, Panayiotakis GS. PATIENT DOSE IN DIGITAL RADIOGRAPHY UTILISING BMI CLASSIFICATION. Radiat Prot Dosimetry 2019; 184:155-167. [PMID: 30452729 DOI: 10.1093/rpd/ncy194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 06/09/2023]
Abstract
Dose audit is important towards optimisation of patients' radiation protection in diagnostic radiography. In this study, the effect of the body mass index (BMI) on radiation dose received by 1869 adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis radiography in an X-ray room with a digital radiography system was investigated. Patients were categorised into three groups (normal, overweight and obese) based on the BMI values. The patients' entrance surface air kerma (ESAK) and the effective dose (ED) were calculated based on the X-ray tube output, exposure parameters and technical data, as well as utilising appropriate conversion coefficients of the recorded kerma area product (KAP) values. The local diagnostic reference levels (LDRLs) were established at the 75th percentile of the distribution of ESAK and KAP values. Statistically, a significant increase was found in ESAK, KAP and ED values, for all examinations, both for overweight and obese patients compared to normal patients (Mann-Whitney test, p < 0.0001). Regarding the gender of the patients, a statistically significant increase was found in the dose values for male patients compared to female patients, except for the chest LAT examinations (Mann-Whitney test, p = 0.06). The percentage increase for chest PA, chest LAT, abdomen AP, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP in overweight patients was 75%, 100%, 136%, 130%, 70%, 66% and 174% for median ESAK, 67%, 81%, 135%, 134%, 85%, 63% and 172% for median KAP, as well as 89%, 54%, 146%, 138%, 82%, 57% and 183% for median ED values, respectively. For obese patients, the corresponding increases were 200%, 186%, 459%, 345%, 203%, 150% and 785% for median ESAK, 200%, 185%, 423%, 357%, 227%, 142% and 597% for median KAP, as well as 222%, 156%, 446%, 363%, 218%, 136% and 625% for median ED. The corresponding LDRLs for overweight patients were 0.17 mGy, 1.21 mGy, 3.74 mGy, 7.70 mGy, 7.99 mGy, 4.07mGy, 5.03 mGy and 0.13 Gy cm2, 0.69 Gy cm2, 2.35 Gy cm2, 2.10 Gy cm2, 2.59 Gy cm2, 2.13 Gy cm2, 2.49 Gy cm2 in terms of ESAK and KAP values, respectively, while in the case of obese patients were 0.28 mGy, 1.82 mGy, 7.26 mGy, 15.10 mGy, 13.86 mGy, 6.89 mGy, 13.40 mGy and 0.21 Gy cm2, 1.10 Gy cm2, 4.68 Gy cm2, 4.01 Gy cm2, 4.80 Gy cm2, 3.27 Gy cm2, 6.02 Gy cm2, respectively. It can be concluded that overweight and obese patients received a significantly increased radiation dose. Careful adjustment of imaging protocols is needed for these patients to reduce patient dose, while keeping the image quality at an acceptable level. Additional studies need to be conducted for these patient groups, that could further contribute to the development of radiation protection culture in diagnostic radiography.
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Affiliation(s)
- Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Gerasimos A Messaris
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Aristea N Lekatou
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Theodore G Petsas
- Department of Radiology, School of Medicine, University of Patras, Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
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Choudhary N, Rana BS, Shukla A, Oinam AS, Singh NP, Kumar S. PATIENTS DOSE ESTIMATION IN CT EXAMINATIONS USING SIZE SPECIFIC DOSE ESTIMATES. Radiat Prot Dosimetry 2019; 184:256-262. [PMID: 30496523 DOI: 10.1093/rpd/ncy207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
The present work reports data of radiation exposure to the patients during head, chest, pelvis and abdomen CT examinations performed on a third-generation 16-slice CT machine. Radiation exposure was estimated using size specific dose estimates (SSDE) method, which takes into account patient's physical dimensions in phantom measured computed tomography dose index (CTDI) value. The reported median CT dose volume index CTDIvol values in head, chest, pelvis and abdomen examinations were 26.76, 16.27, 29.81 and 14.74 mGy, respectively. The median doses evaluated using SSDE methodology for the above mentioned procedure were 54.1, 23.1, 42.8 and 20.1 mGy, respectively. Our results showed variation in dose values estimated using CTDI and SSDE methods in all examinations. The evaluated SSDE values were also compared to the values derived from data reported by the American Association of Physicist in Medicine (AAPM). SSDE values in present measurements are 4-8% lower than AAPM values. The present results show that CTDI parameters recorded on CT console should not be used to specify patient dose during CT procedures.
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Affiliation(s)
- Neha Choudhary
- Department of Radiotherapy, Shanti Mukand Hospita, New Delhi, India
| | | | - Arvind Shukla
- Department of Radiotherapy, R. N. T Medical College, Udaipur, India
| | | | | | - Sanjeev Kumar
- Department of Physics, G. G. D. S. D. College, Chandigarh, India
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Bashier EH, Suliman II. RADIATION DOSE DETERMINATION IN ABDOMINAL CT EXAMINATIONS OF CHILDREN AT SUDANESE HOSPITALS USING SIZE-SPECIFIC DOSE ESTIMATES. Radiat Prot Dosimetry 2019; 183:443-448. [PMID: 30215799 DOI: 10.1093/rpd/ncy164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/07/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
In this study, we thought to estimate the radiation exposure of children undergoing multi-detector CT examinations using size-specific dose estimates (SSDE). Console-displayed volume computed tomography dose index (CTDIvol) were recorded for a total of 78 paediatric abdominal CT examinations performed in six hospitals. Measurements of the patient diameters were taken from the mid-slice location on the transverse and scout CT images. Size-specific conversion coefficients were used to translate CTDIvol to the SSDE, according AAPM Report 204. For children aged 0-1 y, CTDIvol, SSDEtrans (from transverse images) and SSDEsco (from scout images) were: 12.80 ± 16.10, 14.43 ± 13.22; and 14.37 ± 13.03 mGy; respectively. For children aged 1-5 y, CTDIvol, SSDEtrans and SSDEsco were: 12.11 ± 14.47, 18.8 ± 18.61 and 16.51 ± 13.55 mGy; respectively. The obtained doses are higher than the corresponding diagnostic reference levels. SSDE increase with patient size as results of tube current modulation and is therefore a valuable tool for dose optimisation.
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Affiliation(s)
- Einas H Bashier
- Sudan Atomic Energy Commission, Radiation Safety Institute, Khartoum, Sudan
| | - I I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, Khartoum, Sudan
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
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Baliyan V, Kordbacheh H, Davarpanah AH, Mozafarry A, Sahani DV, Kambadakone A. Orthopedic metallic hardware in routine abdomino-pelvic CT scans: occurrence and clinical significance. Abdom Radiol (NY) 2019; 44:1567-1574. [PMID: 30386880 DOI: 10.1007/s00261-018-1818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the occurrence of orthopedic metallic hardware in routine abdomen/pelvic computed tomography (CT) scans and their impact on image quality (IQ) and diagnostic evaluation. MATERIAL AND METHODS In this retrospective single institution study, we analyzed 3500 consecutive abdomen/pelvis CT scans for occurrence of orthopedic metallic hardware. In the cohort of patients with metallic hardware detected on CT scans, subjective and objective IQ analysis was performed to estimate diagnostic acceptability (DA, 4-point scale), subjective noise (SN, 3-point scale), presence of artifacts (PA, 4-point scale) and objective noise. The clinical significance of metallic hardware was determined by evaluating the impact of artifacts on radiological diagnosis according to the clinical indication and disease type. RESULTS Orthopedic metallic hardware was encountered in 4.97% of abdomino-pelvic CT scans (n = 174/3500), and artifacts related to the hardware in the region of clinical interest were identified in 82% (n = 144/174) of scans. The overall mean DA was 2.66 (n = 174), and it was severely limited (score < 2) in 32% of cases particularly affecting patients with bilateral hip implants (92.6%, n = 25/27). The artifacts due to hardware significantly limited diagnostic evaluation in 58.6% of cases (PA score ≥ 3), and the image noise was unacceptable in 71% of cases (SN score > 2) in the region of clinical interest. CONCLUSION Orthopedic metallic hardware is encountered in nearly 5% of abdomino-pelvic CT scans and causes significant image degradation limiting diagnostic evaluation in the region of clinical interest.
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Affiliation(s)
- Vinit Baliyan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Hamed Kordbacheh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Amirhossein Mozafarry
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University - Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Affiliation(s)
- Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianhui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuli Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanjun Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Du
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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Schlemper J, Oktay O, Schaap M, Heinrich M, Kainz B, Glocker B, Rueckert D. Attention gated networks: Learning to leverage salient regions in medical images. Med Image Anal 2019; 53:197-207. [PMID: 30802813 PMCID: PMC7610718 DOI: 10.1016/j.media.2019.01.012] [Citation(s) in RCA: 515] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
We propose a novel attention gate (AG) model for medical image analysis that automatically learns to focus on target structures of varying shapes and sizes. Models trained with AGs implicitly learn to suppress irrelevant regions in an input image while highlighting salient features useful for a specific task. This enables us to eliminate the necessity of using explicit external tissue/organ localisation modules when using convolutional neural networks (CNNs). AGs can be easily integrated into standard CNN models such as VGG or U-Net architectures with minimal computational overhead while increasing the model sensitivity and prediction accuracy. The proposed AG models are evaluated on a variety of tasks, including medical image classification and segmentation. For classification, we demonstrate the use case of AGs in scan plane detection for fetal ultrasound screening. We show that the proposed attention mechanism can provide efficient object localisation while improving the overall prediction performance by reducing false positives. For segmentation, the proposed architecture is evaluated on two large 3D CT abdominal datasets with manual annotations for multiple organs. Experimental results show that AG models consistently improve the prediction performance of the base architectures across different datasets and training sizes while preserving computational efficiency. Moreover, AGs guide the model activations to be focused around salient regions, which provides better insights into how model predictions are made. The source code for the proposed AG models is publicly available.
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Affiliation(s)
- Jo Schlemper
- BioMedIA, Imperial College London, London, SW7 2AZ, UK.
| | - Ozan Oktay
- BioMedIA, Imperial College London, London, SW7 2AZ, UK; HeartFlow, Redwood City, CA 94063, USA.
| | | | | | | | - Ben Glocker
- BioMedIA, Imperial College London, London, SW7 2AZ, UK
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Affiliation(s)
- Maryam Vahabzadeh
- Medical Toxicology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Banagozar Mohammadi
- Internal Medicine Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Niu DG, Yang F, Tian WL, Zhao YZ, Li C, Ding LA, Fang HC, Huang Q. A technique to establish fistuloclysis for high-output jejunocutaneous fistula through percutaneous enterostomy: A case report. Medicine (Baltimore) 2019; 98:e14653. [PMID: 30855454 PMCID: PMC6417508 DOI: 10.1097/md.0000000000014653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Currently, fistucolysis helps to establish intestinal nutrition and succus entericus reinfusion in the case of controllable mature high-output enterocutaneous fistula. However, if the tube cannot reach the distal limb of a fistula, fistuloclysis is not achieved. We proposed a strategy to establish succus entericus reinfusion for intractable intestinal fistula through percutaneous enterostomy. PATIENT CONCERNS A 43-year-old man was transferred to our facility for postoperative enterocutaneous fistulae, sepsis, malnutrition, and electrolyte and fluid imbalance. The contrast X-ray demonstrated the breakdown of the primary anastomosis, with fistula output ranging from 1500 to 2000 mL/d, despite the administration of medications to reduce gastrointestinal secretions. DIAGNOSES The patient was diagnosed with high-output anastomosis fistula by gastrointestinal radiography. INTERVENTIONS We used percutaneous enterostomy to establish fistuloclysis. OUTCOMES Fistuloclysis was established by percutaneous enterostomy successfully. No complications were found during the past 4-month follow-up after percutaneous enterostomy. He is waiting for reconstruction surgery after 6 months' enteral nutrition (EN). LESSONS Fistuloclysis-assisted EN, if used appropriately, avoids the complications of long-term parenteral nutrition (PN) and may promote faster fistula healing.
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Affiliation(s)
- Dong-Guang Niu
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Fan Yang
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei-Liang Tian
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun-Zhao Zhao
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chen Li
- Oncology Department, Xintai People's Hospital, Tai’an, Shandong, China
| | - Lian-An Ding
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Hong-Chun Fang
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Qian Huang
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
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Abstract
We studied the reliability of radiomic features on abdominal computed tomography (CT) images reconstructed with multiple CT image acquisition settings using the ACR (American College of Radiology) CT Phantom. Twenty-four sets of CT images of the ACR CT phantom were attained from a GE Discovery 750HD scanner using 24 different image acquisition settings, combinations of 4 tube currents (25, 50, 100, 200 Effective mAs), 3 slice thicknesses (1.25, 2.5, 5 mm), and 2 convolution kernels (STANDARD and SOFT). Polyethylene (-95 HU) and acrylic (120 HU) of the phantom model were selected for calculating real feature value; a noise-free, computer-generated phantom image series that reproduced the 2 objects and the background was used for calculating reference feature value. Feature reliability was defined as the degree of predicting reference feature value from real feature value. Radiomic features mean, std, skewness, kurtosis, gray-level co-occurrence matrix (GLCM)-energy, GLCM-contrast, GLCM-correlation, GLCM-homogeneity were investigated. The value of R2 ≥ 0.85 was considered to be of high reliability. The reliability of mean and std were high across all image acquisition settings. At 200 Effective mAs, all features except GLCM-homogeneity showed high reliability, whereas at 25 Effective mAs, most features (except mean and std) showed low reliability. From high to low, reliability was ranked in the following order: mean, std, skewness, kurtosis, GLCM-energy, correlation, contrast and homogeneity. CT image acquisition settings affected the reliability of radiomic features. High reliable features were attained from images reconstructed at high tube current and thick slice thickness.
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Affiliation(s)
- Lin Lu
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Yongguang Liang
- Department of Radiology, Columbia University Medical Center, New York, NY
| | | | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, NY
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Abstract
BACKGROUND VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT. IMPLICATIONS FOR PRACTICE Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.
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MESH Headings
- Aftercare/methods
- Anal Canal/abnormalities
- Anal Canal/physiopathology
- Diagnosis, Differential
- Esophagus/abnormalities
- Esophagus/physiopathology
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Humans
- Infant, Newborn
- Kidney/abnormalities
- Kidney/physiopathology
- Limb Deformities, Congenital/complications
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/physiopathology
- Limb Deformities, Congenital/therapy
- Neonatal Screening/methods
- Patient Care Management/methods
- Physical Examination/methods
- Radiography, Abdominal/methods
- Radiography, Thoracic/methods
- Respiratory Distress Syndrome, Newborn/diagnosis
- Situs Inversus/complications
- Situs Inversus/diagnosis
- Situs Inversus/physiopathology
- Situs Inversus/therapy
- Spine/abnormalities
- Spine/physiopathology
- Trachea/abnormalities
- Trachea/physiopathology
- Vestibulocochlear Nerve Diseases/congenital
- Vestibulocochlear Nerve Diseases/diagnosis
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Darras KE, Clark SJ, Kang H, Mohammed MF, Barrett S, Chang SD, Harris AC, Nicolaou S, McLaughlin PD. Virtual monoenergetic reconstruction of contrast-enhanced CT scans of the abdomen and pelvis at 40 keV improves the detection of peritoneal metastatic deposits. Abdom Radiol (NY) 2019; 44:422-428. [PMID: 30120515 DOI: 10.1007/s00261-018-1733-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the role of virtual monoenergetic imaging (VMI) in the detection of peritoneal metastatic disease in contrast-enhanced computed tomography (CT) of the abdomen and pelvis and to compare this technique to the conventional 120 kV mixed dataset. MATERIALS AND METHODS Institutional review board approval was obtained with no informed consent required for this retrospective analysis. 43 consecutive patients with histopathologically confirmed peritoneal disease were scanned using a standard protocol on a 128-section dual-source, dual-energy CT system (100/140 keV). Scans were retrospectively reconstructed at VMI energy levels from 40-110 keV in 10 keV increments and were analyzed both quantitatively and qualitatively. CNR values for peritoneal metastatic deposits were recorded using region of interest (ROI) analysis at each energy level for all VMI datasets. Subjective analysis was performed by two independent fellowship-trained readers with combined experience of greater than 15 years. Qualitative parameters included diagnostic acceptability, subjective noise, and contrast resolution and confidence. RESULTS The contrast-to-noise ratios (CNRs) for peritoneal metastatic deposits at the different VMI energy levels were compared using a one-way ANOVA with Tukey Post Test, and the optimal CNR was observed at 40 keV (p < 0.0001). Qualitative parameters were compared using a Paired T Test. Subjective noise, diagnostic acceptability, and contrast resolution was significantly better on the conventional images, but readers reported increased confidence on VMI at 40 keV (p < 0.001). CONCLUSION VMI reconstruction of contrast-enhanced dual-energy CT scans of the abdomen and pelvis at 40 keV maximizes the conspicuity of metastatic peritoneal deposits and improves radiologists' diagnostic confidence compared with conventional CT images. We recommend using virtual monoenergetic datasets at 40 keV as a tool for improving the detection of these lesions in routine clinical practice.
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Affiliation(s)
- Kathryn E Darras
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Sheldon J Clark
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Heejun Kang
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Mohammed F Mohammed
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Sarah Barrett
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Alison C Harris
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Patrick D McLaughlin
- Department of Radiology, Vancouver General Hospital, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, 3350-950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Atwi NE, Smith DL, Flores CD, Dharaiya E, Danrad R, Kambadakone A, Toshav AM. Dual-energy CT in the obese: a preliminary retrospective review to evaluate quality and feasibility of the single-source dual-detector implementation. Abdom Radiol (NY) 2019; 44:783-789. [PMID: 30229423 DOI: 10.1007/s00261-018-1774-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the feasibility of performing dual-energy CT with a single-source spectral detector system in obese patients. MATERIALS AND METHODS Retrospective, IRB-approved review of 28 patients weighing ≥ 270 lbs (122 kg) who underwent CT of the abdomen on a single-source spectral detector system was performed. Two blinded, independent radiologists rated relative preference between conventional CT images taken at 120 kVp (CCT120) and monoenergetic 70 keV equivalent (MonoE70) as well as iodine map image quality in the spleen, pancreas, kidneys, and liver. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between conventional CT and MonoE70 images and correlated with body habitus markers of weight, height, and abdominal diameter. RESULTS MonoE70 images were preferred by radiologists 100% of the time (1-sample t test, p < 0.0001) over conventional CCT120 images. Noise was significantly lower; SNR and CNR were significantly higher in MonoE70 images than in CCT120 images (paired t tests, p < 0.0001). Mean iodine map rating (scale 1-5) was 4.54 ± 0.58, denoting near homogenous and complete iodine mapping through the spleen, pancreas, kidneys, and liver for the majority of patients. Body habitus markers were not significantly correlated with image preference score; noise; MonoE70 SNR; MonoE70 CNR; change in noise, SNR, or CNR from CCT120 to MonoE70, or iodine map quality; ordinal and linear regression, p = 0.2547, p = 0.6837, p = 0.1888, p = 0.5489, p = 0.9830, p = 0.8849, p = 0.8741, p = 0.1522, respectively. CONCLUSION The single-source spectral detector implementation of dual-energy CT provides viable, high-quality imaging for obese patients.
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Affiliation(s)
- Noah E Atwi
- Department of Radiology, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - David L Smith
- Department of Radiology, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Carson D Flores
- School of Medicine, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Ekta Dharaiya
- Philips Healthcare, 595 Miner Road, Highland Heights, OH, 44143, USA
| | - Raman Danrad
- Department of Radiology, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Avinash Kambadakone
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Aran M Toshav
- Department of Radiology, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA.
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Butt UI, Bhatti S, Warraich MU, Wadood A, Abbas MA, Chughtai A. Type 1 gallbladder perforation: A rare cause of acute abdomen. J PAK MED ASSOC 2019; 69:271-273. [PMID: 30804600] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gallbladder perforation is rare. Diagnosis is usually made during operative intervention. Delay in recognition is associated with high morbidity and mortality. We report a case of type 1 gall bladder perforation in a male patient with no previous complaints related to gallstones.
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37
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Abstract
This case report depicts the radiologic findings of a 51-year-old male presenting with Decompression Sickness. Decompression Sickness is diagnosed clinically, therefore radiologic imaging of this disease entity is limited. Our patient's history includes a scuba dive to depth of 110 feet with a descending time of 24 minutes and an ascending time of 8 minutes. The patient subsequently presented to the Emergency Room with symptoms of shortness of breath and abdominal pain. The abdominal pain prompted physicians to explore further, and hence computed tomography (CT) imaging of the abdomen and pelvis was performed. This case report demonstrates a striking and unique gas pattern in both the systemic and portal venous system of our patient and provides an excellent example of the imaging findings of Decompression Sickness in the literature.
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Affiliation(s)
- Taylor Schwartz
- Nova Southeastern University College of Medicine, Davie, FL, USA
| | | | - Roberta Santini
- Department of Radiology, Plantation General Hospital, Plantation, FL, USA
| | - David Kopylov
- Department of Radiology, Hahnemann University Hospital, Philadelphia, PA, USA
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Abstract
A diagnosis of hereditary angioedema is usually made with recurrent episodes of swelling of the subcutaneous tissue with a family history. We herein report a case in which recurrent acute abdomen was the main manifestation of hereditary angioedema. A 45-year-old womon presented with a 10-year history of recurrent severe abdominal pain. Abdominal computed tomography revealed remarkable submucosal edema of the ileum. A blood examination revealed grossly reduced complement C4 and CH50 with deficiency of C1-inhibitor. Genetic testing revealed a heterozygous nonsense mutation of the SERPING1 gene, and a diagnosis of hereditary angioedema was made. Hereditary angioedema should be listed as a differential diagnosis of recurrent acute abdomen.
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Affiliation(s)
- Keiichi Iwanami
- Department of Rheumatology, Tokyo Bay Urayasu/Ichikawa Medical Center, Japan
| | - Tsubasa Okano
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Japan
| | - Osamu Ohara
- Department of Genome Research and Development, Kazusa DNA Research Institute, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Japan
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Rollins KE, Awwad A, Macdonald IA, Lobo DN. A comparison of two different software packages for analysis of body composition using computed tomography images. Nutrition 2019; 57:92-96. [PMID: 30153585 PMCID: PMC6269124 DOI: 10.1016/j.nut.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 05/16/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The analysis of body composition from computed tomography (CT) imaging has become widespread. However, the methodology used is far from established. Two main software packages are commonly used for body composition analysis, with results used interchangeably. However, the equivalence of these has not been well established. The aim of this study was to compare the results of body composition analysis performed using the two software packages to assess their equivalence. METHODS Triphasic abdominal CT scans from 50 patients were analyzed for a range of body composition measures at the third lumbar vertebral level using OsiriX (v7.5.1, Pixmeo, Switzerland) and SliceOmatic (v5.0, TomoVision, Montreal, Canada) software packages. Measures analyzed were skeletal muscle index (SMI), fat mass (FM), fat-free mass (FFM), and mean skeletal muscle Hounsfield Units (SMHU). RESULTS The overall mean SMI calculated using the two software packages was significantly different (SliceOmatic 51.33 versus OsiriX 53.77, P < 0.0001), and this difference remained significant for non-contrast and arterial scans. When FM and FFM were considered, again the results were significantly different (SliceOmatic 33.7 versus OsiriX 33.1 kg, P < 0.0001; SliceOmatic 52.1 versus OsiriX 54.2 kg, P < 0.0001, respectively), and this difference remained for all phases of CT. Finally, when analyzed, mean SMHU was also significantly different (SliceOmatic 32.7 versus OsiriX 33.1 HU, P = 0.046). CONCLUSIONS All four body composition measures were statistically significantly different by the software package used for analysis; however, the clinical significance of these differences is doubtful. Nevertheless, the same software package should be used if serial measurements are being performed.
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Affiliation(s)
- Katie E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health (NIHR) Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham United Kingdom
| | - Amir Awwad
- Sir Peter Mansfield Imaging Centre (SPMIC), University of Nottingham, University Park, Nottingham, United Kingdom
| | - Ian A Macdonald
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom; MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham United Kingdom
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health (NIHR) Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham United Kingdom; MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham United Kingdom.
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Abstract
PURPOSE Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. METHODS We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. RESULTS Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. CONCLUSION ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
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Affiliation(s)
- Sneha Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
| | - Anagha Rajeev Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Saurabh Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Soyaf A Phajlani
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
- Department of Radiology, Government Medical College, Nagpur, 440009, India
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Choy S, Parhar D, Lian K, Schmiedeskamp H, Louis L, O'Connell T, McLaughlin P, Nicolaou S. Comparison of image noise and image quality between full-dose abdominal computed tomography scans reconstructed with weighted filtered back projection and half-dose scans reconstructed with improved sinogram-affirmed iterative reconstruction (SAFIRE*). Abdom Radiol (NY) 2019; 44:355-361. [PMID: 29980828 DOI: 10.1007/s00261-018-1687-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively compare the image noise, signal-to-noise ratio (SNR), and subjective image quality between CT images acquired with a dual-source, split-dose imaging protocol reconstructed at full and half doses with weighted filtered back projection (wFBP) and an improved sinogram-affirmed iterative reconstruction algorithm (SAFIRE*). METHODS Fifty-three consecutive patients underwent contrast-enhanced CT of the abdomen using a standardized dual-source, single energy CT protocol. Half-dose images were retrospectively generated using data from one detector only. Full-dose datasets were reconstructed with wFBP, while half-dose datasets were reconstructed with wFBP and SAFIRE* strengths 1-5. Region of interest analysis was performed to assess SNR and noise. Diagnostic acceptability, subjective noise, and spatial resolution were graded on a 10-point scale by two readers. Statistical analysis was carried out with repeated measures analysis of variance, Wilcoxon signed rank test, and Cohen's κ test. RESULTS With the increasing strengths of SAFIRE*, a progressive reduction in noise and increase in SNR (p < 0.01) was observed. There was a statistically significant decrease in objective noise and increase in SNR in half-dose SAFIRE* strength 4 and 5 reconstructions compared to full-dose reconstructions using wFBP (p < 0.01). Qualitative analysis revealed a progressive increase in diagnostic acceptability, decrease in subjective noise and increase in spatial resolution for half-dose images reconstructed with the increasing strengths of SAFIRE* (p < 0.01). CONCLUSIONS Half-dose CT images reconstructed with SAFIRE* at strength 4 and 5 have superior image quality compared to full-dose images reconstructed with wFBP. SAFIRE* potentially allows dose reductions in the order of 50% over wFBP.
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Affiliation(s)
- Stephen Choy
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Dennis Parhar
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Kevin Lian
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | | | - Luck Louis
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Timothy O'Connell
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Patrick McLaughlin
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Nam CM, Lee KJ, Ko Y, Kim KJ, Kim B, Lee KH. Development of an algorithm to automatically compress a CT image to visually lossless threshold. BMC Med Imaging 2018; 18:53. [PMID: 30558555 PMCID: PMC6297995 DOI: 10.1186/s12880-017-0244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To develop an algorithm to predict the visually lossless thresholds (VLTs) of CT images solely using the original images by exploiting the image features and DICOM header information for JPEG2000 compression and to evaluate the algorithm in comparison with pre-existing image fidelity metrics. METHODS Five radiologists independently determined the VLT for 206 body CT images for JPEG2000 compression using QUEST procedure. The images were divided into training (n = 103) and testing (n = 103) sets. Using the training set, a multiple linear regression (MLR) model was constructed regarding the image features and DICOM header information as independent variables and regarding the VLTs determined with median value of the radiologists' responses (VLTrad) as dependent variable, after determining an optimal subset of independent variables by backward stepwise selection in a cross-validation scheme. The performance was evaluated on the testing set by measuring absolute differences and intra-class correlation (ICC) coefficient between the VLTrad and the VLTs predicted by the model (VLTmodel). The performance of the model was also compared two metrics, peak signal-to-noise ratio (PSNR) and high-dynamic range visual difference predictor (HDRVDP). The time for computing VLTs between MLR model, PSNR, and HDRVDP were compared using the repeated ANOVA with a post-hoc analysis. P < 0.05 was considered to indicate a statistically significant difference. RESULTS The means of absolute differences with the VLTrad were 0.58 (95% CI, 0.48, 0.67), 0.73 (0.61, 0.85), and 0.68 (0.58, 0.79), for the MLR model, PSNR, and HDRVDP, respectively, showing significant difference between them (p < 0.01). The ICC coefficients of MLR model, PSNR, and HDRVDP were 0.88 (95% CI, 0.81, 0.95), 0.85 (0.79, 0.91), and 0.84 (0.77, 0.91). The computing times for calculating VLT per image were 1.5 ± 0.1 s, 3.9 ± 0.3 s, and 68.2 ± 1.4 s, for MLR metric, PSNR, and HDRVDP, respectively. CONCLUSIONS The proposed MLR model directly predicting the VLT of a given CT image showed competitive performance to those of image fidelity metrics with less computational expenses. The model would be promising to be used for adaptive compression of CT images.
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Affiliation(s)
- Chang-Mo Nam
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Yousun Ko
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kil Joong Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Oedae-ro 81, Mohyeon-myeon, Cheoin-gu, Yongin-si, Gyeonggi-do, 17035, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
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Raudabaugh J, Nguyen G, Lowry C, Januzis N, Colsher J, Nelson R, Yoshizumi TT. EFFECTIVE DOSE ESTIMATION FROM ORGAN DOSE MEASUREMENTS IN FAST-kV SWITCH DUAL ENERGY COMPUTED TOMOGRAPHY. Radiat Prot Dosimetry 2018; 182:352-358. [PMID: 30590847 DOI: 10.1093/rpd/ncy072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 04/16/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to validate a novel approach to estimating effective dose (E) in 'fast-kV switch dual energy computed tomography' using MOSFET detectors. The effective energy of the combined dual energy environment was characterized with the dual energy CT scanner and then MOSFETs were calibrated matching to the effective energy of the dual energy CT beam with a conventional CT beam. The calibration method was then experimentally validated by comparing the dose between MOSFET and an ion chamber (IC) using a standard CTDI body phantom. The measured doses of the MOSFET and IC were 17.1 mGy ± 3.8% and 17.1 mGy ± 0.4%, respectively. To measure organ doses, an adult anthropomorphic phantom loaded with 18 MOSFET detectors was scanned using a standard fast-kV switch dual energy abdomen/pelvis CT protocol. E was calculated by applying ICRP 103 tissue weighting factors as well as partial volume correction factors for organs that were not completely covered by the protocol field-of-view. E from the dual energy abdomen/pelvis CT was calculated to be 17.8 mSv ± 11.6%. This calculation was then compared to E from dose length product method, which yielded 14.62 mSv.
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Affiliation(s)
- Justin Raudabaugh
- Medical Physics Graduate Program, Duke University, Durham, NC, USA
- Duke Radiation Dosimetry Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Giao Nguyen
- Duke Radiation Dosimetry Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Carolyn Lowry
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Natalie Januzis
- Environmental Health & Radiation Safety, University of Pennsylvania, Philadelphia, PA, USA
| | - James Colsher
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Rendon Nelson
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Terry T Yoshizumi
- Duke Radiation Dosimetry Laboratory, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Kechichian R, Valette S, Desvignes M. Automatic Multiorgan Segmentation via Multiscale Registration and Graph Cut. IEEE Trans Med Imaging 2018; 37:2739-2749. [PMID: 29994393 DOI: 10.1109/tmi.2018.2851780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We propose an automatic multiorgan segmentation method for 3-D radiological images of different anatomical contents and modalities. The approach is based on a simultaneous multilabel graph cut optimization of location, appearance, and spatial configuration criteria of target structures. Organ location is defined by target-specific probabilistic atlases (PA) constructed from a training dataset using a fast (2+1)D SURF-based multiscale registration method involving a simple four-parameter transformation. PAs are also used to derive target-specific organ appearance models represented as intensity histograms. The spatial configuration prior is derived from shortest-path constraints defined on the adjacency graph of structures. Thorough evaluations on Visceral project benchmarks and training dataset, as well as comparisons with the state-of-the-art confirm that our approach is comparable to and often outperforms similar approaches in multiorgan segmentation, thus proving that the combination of multiple suboptimal but complementary information sources can yield very good performance.
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Abstract
RATIONALE Schwannomas are usually benign tumors arising from well-differentiated schwann cells, which rarely occur in the retroperitoneal space. The lack of specific signs and radiologic imaging characteristics makes preoperative diagnosis rather difficult. Most retroperitoneal schwannomas are benign and the primary treatment choice for retroperitoneal schwannomas is surgical excision, however, the involvement of the urinary system is scarcely reported. PATIENT CONCERNS A 34-year-old woman presented with progressive left abdominal pain and rebound abdominal mass at the left lower quadrant for 1 month. Radiological imaging suggested capsulated solid mass with cystic and necrotic areas in the retroperitoneum accompanied by severe left kidney hydronephrosis and preoperative biopsy result was inconclusive. DIAGNOSES We believe this is a rare case of retroperitoneal schwannoma complicated with severe hydronephrosis. INTERVENTIONS After preparation, the patient underwent laparoscopy exploration and converted to open surgical exploration. The patient accepted complete surgical excision of the retroperitoneal tumor and left kidney. Postoperative pathology diagnosis of the mass was proven to be benign retroperitoneal schwannoma. OUTCOMES Postoperative course of the patient was uneventful and the left abdominal pain was greatly improved. After 12-month follow up, no evidence of recurrence or any other complication including renal failure was observed. LESSONS Preoperative imaging and preoperative ultrasound-guided biopsy are helpful to make accurate diagnosis. The final diagnosis is based on postoperative histological and immunohistochemical findings. The primary treatment option is complete surgical resection of the retroperitoneal schwannoma and the involved upper urinary system when severe hydronephrosis occured. Local recurrence and overall survival are closely correlated with negative resection margins and pathology types.
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Affiliation(s)
- Liandong Zhang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Ming Gao
- Department of Nephrology, Xi’an No. 4 Hospital, Xi’an, Shaanxi, PR China
| | - Tongdian Zhang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Ziming Wang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Wenpin Liu
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Hecheng Li
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
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Shah R, Khoram R, Lambert JW, Sun Y, Wang ZJ, Webb EM, Yeh BM. Effect of gantry rotation speed and scan mode on peristalsis motion artifact frequency and severity at abdominal CT. Abdom Radiol (NY) 2018; 43:2239-2245. [PMID: 29450609 DOI: 10.1007/s00261-018-1497-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to understand the effect of CT gantry speed and axial vs. helical scan mode on the frequency and severity of bowel peristalsis artifacts. METHOD We retrospectively identified 150 oncologic abdominopelvic CT scans obtained on a 256 slice CT scanner: 50 scans obtained with Axial mode and 0.5-s gantry rotation time (Slow-Axial); 50 with Axial mode and 0.28-s gantry rotation time (Fast-Axial); and 50 scans with Helical mode and 0.28-s gantry rotation time (Fast-Helical). The patients included 74 women and 76 men with a mean age of 61 years (range 22-85 years). Two readers viewed all CT scans to record the presence and severity of bowel peristalsis artifact, location of artifact (stomach, duodenum/jejunum, ileum, and colon) and artifact location relative to bowel interface (gas-bowel, fluid-bowel, and gas-fluid). The severity of artifacts was recorded subjectively on a 3-point scale, and objectively based on maximum length of the artifact. RESULTS Peristalsis artifact was more commonly seen with Slow-Axial scan acquisition (37 of 50 patient scans, or 74%) than Fast-Axial (15 in 50 patient scans, or 30%, p < 0.001) and Fast-Helical (22 of 50 patient scans, or 44%, p < 0.005). The bowel segment distribution and severity of peristalsis artifacts were not significantly different between scan techniques. CONCLUSION Peristalsis artifacts are common at abdominopelvic CT scans. Fast gantry rotation speed significantly reduces the frequency of bowel peristalsis artifacts and should be a consideration when imaging of bowel and structures near bowel is critical.
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Affiliation(s)
- Rutwik Shah
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA.
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, M-372, San Francisco, CA, 94143-0628, USA.
| | - Rhanna Khoram
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Jack W Lambert
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Yuxin Sun
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Zhen J Wang
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Emily M Webb
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Benjamin M Yeh
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
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Gibson E, Giganti F, Hu Y, Bonmati E, Bandula S, Gurusamy K, Davidson B, Pereira SP, Clarkson MJ, Barratt DC. Automatic Multi-Organ Segmentation on Abdominal CT With Dense V-Networks. IEEE Trans Med Imaging 2018; 37:1822-1834. [PMID: 29994628 PMCID: PMC6076994 DOI: 10.1109/tmi.2018.2806309] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Automatic segmentation of abdominal anatomy on computed tomography (CT) images can support diagnosis, treatment planning, and treatment delivery workflows. Segmentation methods using statistical models and multi-atlas label fusion (MALF) require inter-subject image registrations, which are challenging for abdominal images, but alternative methods without registration have not yet achieved higher accuracy for most abdominal organs. We present a registration-free deep-learning-based segmentation algorithm for eight organs that are relevant for navigation in endoscopic pancreatic and biliary procedures, including the pancreas, the gastrointestinal tract (esophagus, stomach, and duodenum) and surrounding organs (liver, spleen, left kidney, and gallbladder). We directly compared the segmentation accuracy of the proposed method to the existing deep learning and MALF methods in a cross-validation on a multi-centre data set with 90 subjects. The proposed method yielded significantly higher Dice scores for all organs and lower mean absolute distances for most organs, including Dice scores of 0.78 versus 0.71, 0.74, and 0.74 for the pancreas, 0.90 versus 0.85, 0.87, and 0.83 for the stomach, and 0.76 versus 0.68, 0.69, and 0.66 for the esophagus. We conclude that the deep-learning-based segmentation represents a registration-free method for multi-organ abdominal CT segmentation whose accuracy can surpass current methods, potentially supporting image-guided navigation in gastrointestinal endoscopy procedures.
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Elbanna KY, Mohammed MF, Huang SC, Mak D, Dawe JP, Joos E, Wong H, Khosa F, Nicolaou S. Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients. Abdom Radiol (NY) 2018; 43:1642-1655. [PMID: 29051983 DOI: 10.1007/s00261-017-1364-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Our study aims to investigate the frequency and patterns of delayed manifestations of abdominal and pelvic injuries which may not be identified or which fail to manifest on the initial abdominopelvic CT in posttraumatic patients. METHODS For our institutional review board (IRB)-approved retrospective study, our hospital trauma registry was queried for patients with blunt multitrauma and Injury Severity Score (ISS) ≥ 16 between January 2010 and August 2016, yielding 3735 patients. A total of 203 patients received a follow-up abdominopelvic CT within six months from the initial scan and those with new findings on follow-up CT were identified. A retrospective blinded review of the initial CT examinations was performed by two experienced radiologists. The retrospective readings and original reports were compared to categorize the new abnormalities detected on follow-up CT scans. The categories included missed injuries, late presentations and sequelae of trauma, and complications of surgery, hospital admission, and invasive procedures. The patients' notes were reviewed for the clinical indications, time interval for repeat CT examination, and subsequent clinical management. The software used for statistical analysis of the extracted data was Microsoft Excel for Mac (version 15.33). RESULTS Out of 3735 patients, 203 patients received 232 follow-up abdominopelvic CTs. The average elapsed time between the initial CT and the follow-up CT was 15 ± 27 days. Evaluation for an abdominal fluid collection was the most common clinical indication, accounting for 40% of the total number (n = 243) of indications. Delayed manifestations and complications of trauma were present in 41 patients due to 47 abnormalities, most commonly related to solid organ injury, followed by abdominal collections and hematoma. Twenty-nine CT findings (62%) were only detectable on follow-up CT, while nine injuries (19%) were missed on initial CT. The findings on repeated CT warranted eight surgical and 15 interventional procedures. CONCLUSION A small percentage of traumatic injuries may be unidentified or fail to manifest on the initial CT, resulting in delayed manifestations of abdominopelvic trauma, which may lead to subsequent readmission, delayed management, and more severe medical complications.
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Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
- , Toronto, ON, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Shih-Chieh Huang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mak
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Heather Wong
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Faisal Khosa
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
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Kataria B, Althén JN, Smedby Ö, Persson A, Sökjer H, Sandborg M. Assessment of image quality in abdominal CT: potential dose reduction with model-based iterative reconstruction. Eur Radiol 2018; 28:2464-2473. [PMID: 29368163 PMCID: PMC5938296 DOI: 10.1007/s00330-017-5113-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/23/2017] [Accepted: 09/29/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To estimate potential dose reduction in abdominal CT by visually comparing images reconstructed with filtered back projection (FBP) and strengths of 3 and 5 of a specific MBIR. MATERIAL AND METHODS A dual-source scanner was used to obtain three data sets each for 50 recruited patients with 30, 70 and 100% tube loads (mean CTDIvol 1.9, 3.4 and 6.2 mGy). Six image criteria were assessed independently by five radiologists. Potential dose reduction was estimated with Visual Grading Regression (VGR). RESULTS Comparing 30 and 70% tube load, improved image quality was observed as a significant strong effect of log tube load and reconstruction method with potential dose reduction relative to FBP of 22-47% for MBIR strength 3 (p < 0.001). For MBIR strength 5 no dose reduction was possible for image criteria 1 (liver parenchyma), but dose reduction between 34 and 74% was achieved for other criteria. Interobserver reliability showed agreement of 71-76% (κw 0.201-0.286) and intra-observer reliability of 82-96% (κw 0.525-0.783). CONCLUSION MBIR showed improved image quality compared to FBP with positive correlation between MBIR strength and increasing potential dose reduction for all but one image criterion. KEY POINTS • MBIR's main advantage is its de-noising properties, which facilitates dose reduction. • MBIR allows for potential dose reduction in relation to FBP. • Visual Grading Regression (VGR) produces direct numerical estimates of potential dose reduction. • MBIR strengths 3 and 5 dose reductions were 22-34 and 34-74%. • MBIR strength 5 demonstrates inferior performance for liver parenchyma.
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Affiliation(s)
- Bharti Kataria
- Department of Radiology, Department of Medical and Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85, Linköping, Sweden.
| | - Jonas Nilsson Althén
- Department of Medical Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Örjan Smedby
- School of Technology and Health (STH), KTH Royal Institute, Stockholm, Sweden
| | - Anders Persson
- Department of Radiology, Department of Medical and Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85, Linköping, Sweden
| | - Hannibal Sökjer
- Department of Medical and Health Sciences, Linköping University, S-581 83, Linköping, Sweden
| | - Michael Sandborg
- Department of Medical Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Abstract
Cystic hepatic metastases arising from lung cancer are rare. We herein describe a case of a 71-year-old women admitted to our hospital for abdominal pain 6 months after the resection of a lung adenocarcinoma. Two cystic lesions of the liver were discovered at abdominal ultrasonography and computerized tomography scan. An ERCP excluded a biliary adenoma or adenocarcinoma, and an ultrasound-guided liver biopsy was negative for malignant cells. For persistence of symptoms and lack of a diagnosis, the patient underwent an exploratory laparotomy, a surgical biopsy with a diagnosis of adenocarcinoma, and a consequent right hepatectomy. After 2 years of follow-up, the patient is well and disease free. Although cystic liver metastasis are rare and a differential diagnosis difficult, the malignant nature should always be considered in the differential diagnosis of hepatic cysts to offer the patient the best treatment.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, Monza, II University of Milan Bicocca, Milan, Italy.
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