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Talakić E, Kaufmann-Bühler AK, Igrec J, Adelsmayr G, Janisch M, Döller C, Geyer E, Lackner K, Fuchsjäger M, Schöllnast H. Perfusion Computed Tomography in Rectal Carcinoma: Influence of Optimization of the Patlak Range on Calculation of Equivalent Blood Volume and Flow Extraction. J Comput Assist Tomogr 2023; 47:850-855. [PMID: 37948358 DOI: 10.1097/rct.0000000000001506] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
PURPOSE The aim of the study is to assess the influence of manual adjustment of the Patlak range in computed tomography (CT) perfusion analysis of rectal carcinoma compared with default range of the perfusion software. METHODS This study was approved by the institutional review board and informed consent was obtained. Twenty-one patients (12 male, 9 female; mean age ± SD, 59 ± 11 years) with rectal cancer were included and underwent perfusion CT before preoperative chemoradiotherapy. Equivalent blood volume (BV) and flow-extraction (FE) were calculated using the Patlak plot model. Two perfusion sets were calculated per patient, a perfusion set using the default setting as provided by the software (dBV, dFE) and an optimized perfusion set after manual adaption of the Patlak range (aBV, aFE), which was limited to the intravascular space clearance of contrast to the extravascular space. Perfusion values calculated with both methods were compared for significance in differences using the Wilcoxon test. A P value of 0.05 or less was defined as statistically significant. RESULTS Adjustment of the Patlak range statistically significantly influenced BV and FE calculation. Median dBV was 23.2 mL/100 mL (interquartile range [IQR], 12.1 mL/100 mL), whereas median aBV was 20.3 mL/100 mL (IQR, 10.9 mL/100 mL). The difference in BV was statistically significant ( P = 0.021). Median dFE was 8.3 mL/min/100 mL (IQR, 4.7 mL/min/100 mL), whereas median aFE was 15.4 mL/min/100 mL (IQR, 5.8 mL/min/100 mL). The difference in FE was statistically significant ( P < 0.001). CONCLUSIONS Our findings indicate that in perfusion CT of rectal carcinoma, adjustment of the Patlak range may significantly influence BV and FE compared with default setting of the software. This may contribute to standardization in the use of this technique for functional imaging of rectal cancer.
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Affiliation(s)
- Emina Talakić
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | | | - Jasminka Igrec
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Gabriel Adelsmayr
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Michael Janisch
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Carmen Döller
- Department of Therapeutic Radiology and Oncology, Medical University of Graz
| | - Edith Geyer
- Department of Therapeutic Radiology and Oncology, Medical University of Graz
| | - Karoline Lackner
- Diagnostic and Research Institute of Pathology, Medical University of Graz
| | - Michael Fuchsjäger
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
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Talakić E, Schöllnast H, Kaufmann-Bühler AK, Hohenberg F, Mijović K, Nagy E, Fuchsjäger M, Tschauner S. The "cardiac neglect": a gentle reminder to radiologists interpreting contrast-enhanced abdominal MDCT. Front Cardiovasc Med 2023; 10:1147166. [PMID: 37180771 PMCID: PMC10167052 DOI: 10.3389/fcvm.2023.1147166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/24/2023] [Indexed: 05/16/2023] Open
Abstract
Myocardial infarction (MI) may be visible on contrast-enhanced multidetector computed tomography (MDCT) scans of the abdomen. In the previous literature, potentially missed MI in abdominal MDCTs was not perceived as an issue in radiology. This retrospective single-center study assessed the frequency of detectable myocardial hypoperfusion in contrast-enhanced abdominal MDCTs. We identified 107 patients between 2006 and 2022 who had abdominal MDCTs on the same day or the day before a catheter-proven or clinically evident diagnosis of MI. After reviewing the digital patient records and applying the exclusion criteria, we included 38 patients, with 19 showing areas of myocardial hypoperfusion. All MDCT studies were non ECG-gated. The delay between the MDCT examination and MI diagnosis was shorter in studies with myocardial hypoperfusion (7.4 ± 6.5 hours and 13.8 ± 12.5 hours) but not statistically significant p = 0.054 . Only 2 of 19 (11%) of these pathologies had been noted in the written radiology reports. The most common cardinal symptom was epigastric pain (50%), followed by polytrauma (21%). STEMI was significantly more common in cases of myocardial hypoperfusion p = 0.009 . Overall, 16 of 38 (42%) patients died because of acute MI. Based on extrapolations using local MDCT rates, we estimate several thousand radiologically missed MI cases worldwide per year.
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Affiliation(s)
- Emina Talakić
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Helmut Schöllnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Institute of Radiology, LKH Graz II, Graz, Austria
| | | | - Florian Hohenberg
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Ksenija Mijović
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Emergency Radiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Eszter Nagy
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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Adelsmayr G, Janisch M, Kaufmann-Bühler AK, Holter M, Talakic E, Janek E, Holzinger A, Fuchsjäger M, Schöllnast H. CT texture analysis reliability in pulmonary lesions: the influence of 3D vs. 2D lesion segmentation and volume definition by a Hounsfield-unit threshold. Eur Radiol 2023; 33:3064-3071. [PMID: 36947188 PMCID: PMC10121537 DOI: 10.1007/s00330-023-09500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/14/2022] [Accepted: 01/25/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Reproducibility problems are a known limitation of radiomics. The segmentation of the target lesion plays a critical role in texture analysis variability. This study's aim was to compare the interobserver reliability of manual 2D vs. 3D lung lesion segmentation with and without pre-definition of the volume using a threshold of - 50 HU. METHODS Seventy-five patients with histopathologically proven lung lesions (15 patients each with adenocarcinoma, squamous cell carcinoma, small cell lung cancer, carcinoid, and organizing pneumonia) who underwent an unenhanced CT scan of the chest were included. Three radiologists independently segmented each lesion manually in 3D and 2D with and without pre-segmentation volume definition by a HU threshold, and shape parameters and original, Laplacian of Gaussian-filtered, and wavelet-based texture features were derived. To assess interobserver reliability and identify the most robust texture features, intraclass correlation coefficients (ICCs) for different segmentation settings were calculated. RESULTS Shape parameters had high reliability (64-79% had excellent and good ICCs). Texture features had weak reliability levels, with the highest ICCs (38% excellent or good) found for original features in 3D segmentation without the use of a HU threshold. A small proportion (4.3-11.5%) of texture features had excellent or good ICC values at all segmentation settings. CONCLUSION Interobserver reliability of texture features from CT scans of a heterogeneous collection of manually segmented lung lesions was low with a small proportion of features demonstrating high reliability independent of the segmentation settings. These results indicate a limited applicability of texture analysis and the need to define robust texture features in patients with lung lesions. KEY POINTS • Our study showed a low reproducibility of texture features when 3 radiologists independently segmented lung lesions in CT images, which highlights a serious limitation of texture analysis. • Interobserver reliability of texture features was low regardless of whether the lesion was segmented in 2D and 3D with or without a HU threshold. • In contrast to texture features, shape parameters showed a high interobserver reliability when lesions were segmented in 2D vs. 3D with and without a HU threshold of - 50.
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Affiliation(s)
- Gabriel Adelsmayr
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Michael Janisch
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Ann-Katrin Kaufmann-Bühler
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2/9/V, 8036, Graz, Austria
| | - Emina Talakic
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Elmar Janek
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Andreas Holzinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2/9/V, 8036, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria.
| | - Helmut Schöllnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
- Institute of Radiology, LKH Graz II, Göstinger Strasse 22, 8020, Graz, Austria
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Steiner J, Kaufmann-Bühler AK, Fuchsjäger M, Schemmer P, Talakić E. Secondary sclerosing cholangitis in a young COVID-19 patient resulting in death: A case report. World J Gastrointest Surg 2022; 14:1411-1417. [PMID: 36632122 PMCID: PMC9827572 DOI: 10.4240/wjgs.v14.i12.1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 in Wuhan, China, liver injury in patients with coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection has been regularly reported in the literature. There are a growing number of publications describing the occurrence of secondary sclerosing cholangitis (SSC) after SARS-CoV-2 infection in various cases. We present a case of sudden onset SSC in a critically ill patient (SSC-CIP) following COVID-19 infection who was previously healthy.
CASE SUMMARY A 33-year old female patient was admitted to our University Hospital due to increasing shortness of breath. A prior rapid antigen test showed a positive result for SARS-CoV-2. The patient had no known preexisting conditions. With rapidly increasing severe hypoxemia she required endotracheal intubation and developed the need for veno-venous extracorporeal membrane oxygenation in a setting of acute respiratory distress syndrome. During the patient´s 154-d stay in the intensive care unit and other hospital wards she underwent hemodialysis and extended polypharmaceutical treatment. With increasing liver enzymes and the development of signs of cholangiopathy on magnetic resonance cholangiopancreatography (MRCP) as well as endoscopic retrograde cholangiopancreatography (ERCP), the clinical setting was suggestive of SSC. At an interdisciplinary meeting, the possibility of orthotopic liver transplantation and additional kidney transplantation was discussed due to the constant need for hemodialysis. Following a deterioration in her general health and impaired respiratory function with a reduced chance of successful surgery and rehabilitation, the plan for transplantation was discarded. The patient passed away due to multiorgan failure.
CONCLUSION SSC-CIP seems to be a rare but serious complication in patients with SARS-CoV-2 infection, of which treating physicians should be aware. Imaging with MRCP and/or ERCP seems to be indicated and a valid method for early diagnosis. Further studies on the effects of early and late SSC in (post-) COVID-19 patients needs to be performed.
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Affiliation(s)
- Jakob Steiner
- Department of General Radiology, Medical University of Graz, Graz 8036, Austria
| | | | - Michael Fuchsjäger
- Department of General Radiology, Medical University of Graz, Graz 8036, Austria
| | - Peter Schemmer
- Department of General Visceral and Transplant Surgery, Medical University of Graz, Graz 8036, Austria
| | - Emina Talakić
- Department of General Radiology, Medical University of Graz, Graz 8036, Austria
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Kaufmann-Bühler AK, Schöllnast H, Igrec J. [Melorheostosis - a benign entity mimicking malignant bone tumor in young adults]. ROFO-FORTSCHR RONTG 2021; 194:416-419. [PMID: 34933351 PMCID: PMC8959910 DOI: 10.1055/a-1656-9987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Jasminka Igrec
- Division of General Radiology, Medical University of Graz, Austria
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Janek E, Kaufmann-Bühler AK, Tschauner S, Fuchsjäger MH, Talakic E. Abernethy-Malformation – Fallbericht. ROFO-FORTSCHR RONTG 2021; 194:85-87. [PMID: 34384114 DOI: 10.1055/a-1495-6217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schmid J, Prattes J, Kaufmann-Bühler AK, Riedl JM. Sampling site matters when testing for COVID-19 after total laryngectomy: a case report. Wien Klin Wochenschr 2021; 133:416-417. [PMID: 33599848 PMCID: PMC7890779 DOI: 10.1007/s00508-021-01826-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes Schmid
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria.
| | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ann-Katrin Kaufmann-Bühler
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Jakob M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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