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Magnetic resonance arthrography with positional manoeuvre for the diagnosis of synovial fold of posterior shoulder joint capsule. 磁共振关节造影结合体位操作诊断肩关节后关节囊滑膜皱褶。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-07-26 DOI: 10.1007/s00330-024-10982-3
Papatya Keles, Hayri Ogul, Kutsi Tuncer, Zakir Sakci, Mutlu Ay, Mecit Kantarci

Objectives: The objective of this study is to prospectively assess the effectiveness of shoulder magnetic resonance (MR) arthrograms with positional manoeuvres in detecting posterior synovial folds.

Methods: Two radiologists independently assessed all axial MR arthrograms in internal rotation, neutral position, and external rotation for the presence of a posterior synovial fold. The diagnostic performances of the MR arthrograms were then compared, with results validated through arthroscopy.

Results: Arthroscopy was performed on 81 of the 150 patients included in the study. A posterior synovial fold was identified arthroscopically in eleven of these patients. Measurements of the posterior synovial fold obtained in external rotation and the neutral position of the arm showed a significant correlation with arthroscopic results (p < 0.05). For detecting the posterior synovial fold with arthroscopic correlation, the sensitivity and specificity values for observer 1 and observer 2 were 100-81.4% and 100-88.6%, respectively, for MR arthrograms in the neutral position; 100-52.9% and 100-62.9% for MR arthrograms in external rotation; and 100-95.7% and 81.8-98.6% for MR arthrograms in internal rotation. There was a fair agreement for MR arthrography in external rotation for detecting posterior synovial folds, while MR arthrograms in internal rotation and neutral position showed near-perfect and significant interobserver agreement.

Conclusion: The rotational positions of the humeral neck during MR arthrographic examination can influence the diagnostic specificity and sensitivity of axial MR arthrograms in detecting the posterior synovial fold.

Clinical relevance statement: The posterior synovial fold can mimic a posterior labral detachment. Therefore, its correct identification is crucial in order to avoid unnecessary surgical procedures.

Key points: Movement of the shoulder may introduce variability in MR arthrography appearance. Rotation of the humeral neck during MR arthrography can affect diagnoses in posterior synovial fold detection. Given that posterior synovial folds can imitate posterior labral detachment, their correct identification is crucial to avoid unnecessary surgical procedures.

研究目的本研究旨在前瞻性地评估肩部磁共振(MR)关节造影在检测后滑膜皱褶方面的有效性:两名放射科医生分别独立评估内旋位、中立位和外旋位的所有轴向磁共振关节造影,以确定是否存在滑膜后皱褶。然后比较 MR 关节镜的诊断性能,并通过关节镜检查验证结果:结果:150 名患者中有 81 名接受了关节镜检查。其中有 11 名患者的关节镜检查发现了滑膜后褶。在外旋位和手臂中立位时对后滑膜褶的测量结果与关节镜结果有显著相关性(p 结论:肱骨外旋位和中立位时对后滑膜褶的测量结果与关节镜结果有显著相关性:MR关节造影检查时肱骨颈的旋转位置会影响轴向MR关节造影在检测滑膜后皱襞方面的诊断特异性和敏感性:滑膜后皱襞可模拟唇后脱离。因此,正确识别滑膜后皱襞对于避免不必要的外科手术至关重要:要点:肩部的运动可能会导致核磁共振关节造影外观的变化。在 MR 关节镜检查过程中,肱骨颈的旋转会影响滑膜后皱襞的诊断。鉴于后滑膜皱襞可模仿后唇瓣脱落,因此正确识别后滑膜皱襞对于避免不必要的外科手术至关重要。
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引用次数: 0
Asymmetric background parenchymal enhancement on contrast-enhanced mammography: associated factors, diagnostic workup, and clinical outcome. 造影剂增强乳腺 X 光片上的非对称背景实质增强:相关因素、诊断工作和临床结果。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-07-30 DOI: 10.1007/s00330-024-10856-8
Noam Nissan, Jill Gluskin, Rosa Elena Ochoa-Albiztegui, Janice S Sung, Maxine S Jochelson

Objectives: To summarize our institutional experience with contrast-enhanced mammography (CEM) exams reporting asymmetric background parenchymal enhancement (BPE).

Materials and methods: Consecutive CEMs performed between December 2012 and July 2023 were retrospectively reviewed to identify exams reporting asymmetric BPE. Associated factors, the level of reporting certainty, BI-RADS score, diagnostic workup, and clinical outcome were summarized. BPE grades and BI-RADS were compared between initial CEM vs. immediate MRI and 6-month follow-up CEM, when indicated, using the Sign test.

Results: Overall, 175/12,856 (1.4%) CEMs (140 female patients, mean age, 46 ± 8.0 years) reported asymmetric BPE. Reporting certainty was mostly high (n = 86), then moderate (n = 59) and low (n = 30). Associated factors included contralateral irradiation (n = 94), recent ipsilateral breast treatment (n = 14), and unilateral breastfeeding (n = 4). BI-RADS scores were 0 (n = 21), 1/2 (n = 75), 3 (n = 67), 4 (n = 3), and 6 (n = 1), or given for a finding other than asymmetric BPE (n = 8). Initial diagnostic-workup often included targeted-US (n = 107). Immediate MRI (n = 65) and/or 6-month CEM follow-up (n = 69) downgraded most cases, with a significant decrease in BPE grade compared to the initial CEM (p < 0.01 for both). On follow-up, two underlying cancers were diagnosed in the area of questionable asymmetric BPE.

Conclusion: Apparent asymmetric BPE is most often a benign finding with an identifiable etiology. However, rarely, it may mask an underlying malignancy presenting as non-mass enhancement, thus requiring additional scrutiny.

Clinical relevance statement: The variability in the diagnostic-workup of apparent asymmetric background parenchymal enhancement stresses the clinical challenge of this radiological finding. Further studies are required to verify these initial observations and to establish standardized management guidelines.

Key points: Apparent asymmetric background parenchymal enhancement usually represents a benign clinical correlate, though rarely it may represent malignancy. Evaluation of asymmetric background parenchymal enhancement varied considerably in the metrics that were examined. Targeted US and MRI can be useful in evaluating unexplained asymmetric background parenchymal enhancement.

摘要总结我院造影剂增强乳腺摄影(CEM)检查报告非对称背景实质增强(BPE)的经验:对 2012 年 12 月至 2023 年 7 月期间进行的连续 CEM 进行回顾性审查,以确定报告非对称 BPE 的检查。总结了相关因素、报告确定性水平、BI-RADS 评分、诊断工作和临床结果。使用Sign检验比较了初始CEM与即刻MRI和6个月随访CEM之间的BPE等级和BI-RADS:总体而言,175/12,856(1.4%)名 CEM(140 名女性患者,平均年龄为 46 ± 8.0 岁)报告了不对称 BPE。报告的确定性大多为高(86 例),然后是中(59 例)和低(30 例)。相关因素包括对侧照射(n = 94)、近期同侧乳房治疗(n = 14)和单侧哺乳(n = 4)。BI-RADS 评分分别为 0 分(21 人)、1/2 分(75 人)、3 分(67 人)、4 分(3 人)和 6 分(1 人),或因发现非对称 BPE 而评分(8 人)。最初的诊断工作通常包括靶向 US(107 例)。立即进行核磁共振成像(n = 65)和/或 6 个月的 CEM 随访(n = 69)可降低大多数病例的等级,与最初的 CEM 相比,BPE 等级显著下降(p 结论:BPE 是一种常见的非对称性病变:明显的不对称 BPE 通常是一种良性病变,病因可以确定。然而,在极少数情况下,它可能会掩盖潜在的恶性肿瘤,表现为非肿块增强,因此需要进行额外检查:临床相关性声明:明显的非对称背景实质增强在诊断工作中的变异性强调了这一放射发现的临床挑战性。需要进一步研究来验证这些初步观察结果,并制定标准化的管理指南:要点:明显的非对称背景实质强化通常代表良性临床相关性,但在极少数情况下可能代表恶性肿瘤。对非对称背景实质增强的评估在所研究的指标中差异很大。靶向 US 和 MRI 可用于评估原因不明的非对称性背景实质强化。
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引用次数: 0
Are there features that can predict the unresectability of pleural mesothelioma? 是否有一些特征可以预测胸膜间皮瘤的不可切除性?
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-08-15 DOI: 10.1007/s00330-024-10963-6
Maria Mayoral, Jose Arimateia Batista Araujo-Filho, Kay See Tan, Eduardo Ortiz, Prasad S Adusumilli, Valerie Rusch, Marjorie Zauderer, Michelle S Ginsberg

Introduction: The current clinical staging of pleural mesothelioma (PM) is often discordant with the pathologic staging. This study aimed to identify clinical and radiological features that could help predict unresectability in PM.

Methods: Twenty-two descriptive radiologic features were retrospectively evaluated on preoperative computed tomography (CT) and/or positron emission tomography/CT (PET/CT) performed in patients with presumably resectable PM who underwent surgery. Measurements of maximum and sum pleural thickness at three levels of the thorax (upper, middle, and lower) were taken and stratified based on the cutpoints provided by the International Association for the Study of Lung Cancer (IASLC). Clinical and radiological features, including clinical-stage, were compared between resectable and unresectable tumors by univariate analysis and logistic regression modeling.

Results: Of 133 patients, 69/133 (52%) had resectable and 64/133 (48%) had unresectable PM. Asbestos exposure (p = 0.005), neoadjuvant treatment (p = 0.001), clinical T-stage (p < 0.0001), all pleural thickness measurements (p < 0.05), pleural thickness pattern (p < 0.0001) and degree (p = 0.033), lung invasion (p = 0.004), extrapleural space obliteration (p < 0.0001), extension to subphrenic space (p = 0.0004), and two combination variables representing extensive diaphragmatic contact and/or chest wall involvement (p = 0.002) and mediastinal invasion (p < 0.0001) were significant predictors at univariate analysis. At multivariable analysis, all models achieved a strong diagnostic performance (area under the curve (AUC) > 0.8). The two best-performing models were one that included the upper-level maximum pleural thickness, extrapleural space obliteration, and mediastinal infiltration (AUC = 0.876), and another that integrated clinical variables and radiological assessment through the clinical T-stage (AUC = 0.879).

Conclusion: Selected clinical and radiologic features, including pleural thickness measurements, appear to be strong predictors of unresectability in PM.

Clinical relevance statement: A more accurate prediction of unresectability in the preoperative assessment of patients with pleural mesothelioma may avoid unnecessary surgery and prompt initiation of nonsurgical treatments.

Key points: About half of pleural mesothelioma patients are reported to receive an incorrect disease stage preoperatively. Eleven features identified as predictors of unresectability were included in strongly performing predictive models. More accurate preoperative staging will help clinicians and patients choose the most appropriate treatments.

导言:目前胸膜间皮瘤(PM)的临床分期往往与病理分期不一致。本研究旨在确定有助于预测胸膜间皮瘤不可切除性的临床和放射学特征:方法:对接受手术的推测可切除间皮瘤患者的术前计算机断层扫描(CT)和/或正电子发射断层扫描/CT(PET/CT)进行了回顾性评估。根据国际肺癌研究协会(IASLC)提供的切点,对胸廓三个层面(上、中、下)的最大胸膜厚度和总胸膜厚度进行了测量和分层。通过单变量分析和逻辑回归模型比较了可切除肿瘤和不可切除肿瘤的临床和放射学特征,包括临床分期:在133名患者中,69/133(52%)人的肿瘤可切除,64/133(48%)人的肿瘤不可切除。结果显示:133 例患者中,69/133(52%)例为可切除型 PM,64/133(48%)例为不可切除型 PM,石棉暴露(P = 0.005)、新辅助治疗(P = 0.001)、临床 T 分期(P 0.8)。表现最好的两个模型是一个包括胸膜上层最大厚度、胸膜外间隙阻塞和纵隔浸润(AUC = 0.876),另一个通过临床T分期整合了临床变量和放射学评估(AUC = 0.879):结论:选定的临床和放射学特征,包括胸膜厚度测量,似乎是预测 PM 不可切除性的有力指标:临床相关性声明:在对胸膜间皮瘤患者进行术前评估时,更准确地预测不可切除性可避免不必要的手术,并及时启动非手术治疗:要点:据报道,约有一半的胸膜间皮瘤患者术前得到的疾病分期不正确。有11项特征被确定为不可切除性的预测因素,这些特征被纳入到性能较强的预测模型中。更准确的术前分期将有助于临床医生和患者选择最合适的治疗方法。
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引用次数: 0
Automated evaluation of ablative margins in thermal ablation: more evidence for the clinical impact of computer science, onward to enhanced needle placement. 热消融术中消融边缘的自动评估:计算机科学对临床影响的更多证据,进而加强针的放置。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-09-26 DOI: 10.1007/s00330-024-11090-y
Tom Boeken
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引用次数: 0
RECIST 1.1, mRECIST, and Choi criteria for evaluating treatment response and survival outcomes in hepatocellular carcinoma patients treated with atezolizumab plus bevacizumab. RECIST 1.1、mRECIST 和 Choi 标准,用于评估接受阿特珠单抗联合贝伐单抗治疗的肝细胞癌患者的治疗反应和生存结果。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-07-30 DOI: 10.1007/s00330-024-10986-z
Dong Hwan Kim, Eun Jeong Min, Bohyun Kim, Jong Young Choi, Jeong Won Jang, Pil Soo Sung, Ji Won Han, Hokun Kim, Joon-Il Choi

Objectives: We aimed to compare the early responder rates, defined as complete or partial responders, using response evaluation criteria in solid tumors (RECIST) 1.1, modified RECIST (mRECIST), and Choi criteria in advanced HCC patients treated with atezolizumab-bevacizumab (atezo-bev), and to correlate them with progression-free survival (PFS) and overall survival (OS).

Methods: This retrospective study included advanced HCC patients treated with ≥ 3 cycles of atezo-bev. Two reviewers assessed responses using RECIST 1.1, mRECIST, and Choi criteria at 1st follow-up imaging. Kaplan-Meier curves with log-rank tests evaluated and compared PFS and OS. Cox proportional hazard models identified survival outcome predictors. Kappa statistics assessed inter-reader agreement.

Results: We evaluated 77 patients (65 men; mean age, 62.8 ± 12.3 years). Choi's criteria revealed the highest early responders rate (53.2%), exceeding mRECIST (32.5-33.8%) and RECIST 1.1 (24.7-26.0%), with an excellent agreement in all criteria (κ, 0.85-0.95). Across criteria, a consistent number of patients progressed (23-26) and was associated with significantly poor OS (ps ≤ 0.049). Responders by any criteria showed longer PFS (ps ≤ 0.009), and 1-year OS (ps ≤ 0.01). Choi criteria linked to significantly better OS without landmark (p = 0.003), with 1-year OS rates at 76.9% for responders vs 38.1% for non-responders. Cox analysis identified responders by Choi criteria as a significant OS predictor.

Conclusion: Choi criteria identified more early responders than RECIST 1.1 and mRECIST, significantly correlating with improved OS. Choi criteria could be considered as a formal response assessment criterion for the emerging atezo-bev systemic treatment.

Clinical relevance statement: For atezo-bev treatment of advanced HCC, more comprehensive response criteria, such as Choi criteria, could be effective in identifying early responders and predicting survival outcomes along with RECIST 1.1 and mRECIST.

Key points: Choi criteria identified a higher rate of early responders compared to mRECIST and RECIST1.1 following atezo-bev treatment. Responders by all criteria had longer PFS and 1-year OS, and only those by Choi criteria experienced longer OS without landmark time. Choi criteria, with RECIST 1.1 and mRECIST, is an effective response assessment tool for atezo-bev treatment.

研究目的我们旨在比较使用阿特珠单抗-贝伐单抗(atezo-bev)治疗的晚期HCC患者中,使用实体瘤反应评价标准(RECIST)1.1、改良RECIST(mRECIST)和Choi标准的早期反应者(定义为完全或部分反应者)率,并将其与无进展生存期(PFS)和总生存期(OS)相关联:这项回顾性研究纳入了接受atezo-bev治疗≥3个周期的晚期HCC患者。两名审查员在第一次随访成像时使用 RECIST 1.1、mRECIST 和 Choi 标准评估反应。卡普兰-梅耶曲线和对数秩检验评估并比较了PFS和OS。Cox 比例危险模型确定了生存结果预测因子。Kappa统计评估了读片者之间的一致性:我们评估了 77 名患者(65 名男性;平均年龄为 62.8 ± 12.3 岁)。崔氏标准显示的早期反应率最高(53.2%),超过了 mRECIST(32.5%-33.8%)和 RECIST 1.1(24.7%-26.0%),所有标准的一致性都非常好(κ,0.85-0.95)。在所有标准中,进展的患者人数一致(23-26 人),且与明显较差的 OS 相关(ps ≤ 0.049)。任何标准的应答者都显示较长的 PFS(ps ≤ 0.009)和 1 年 OS(ps ≤ 0.01)。Choi标准与明显更好的无地标OS相关(P = 0.003),应答者的1年OS率为76.9%,非应答者为38.1%。Cox分析发现,Choi标准的应答者是预测OS的重要指标:结论:与 RECIST 1.1 和 mRECIST 相比,Choi 标准能识别出更多的早期应答者,与改善的 OS 显著相关。结论:Choi标准比RECIST 1.1和mRECIST识别出更多的早期反应者,这与OS的改善有明显相关性。Choi标准可被视为新兴的阿特佐-贝夫系统治疗的正式反应评估标准:对于阿特佐-贝伐治疗晚期 HCC,更全面的反应标准(如 Choi 标准)可有效识别早期反应者,并与 RECIST 1.1 和 mRECIST 一起预测生存结果:要点:与mRECIST和RECIST1.1相比,Choi标准能在阿特佐-贝夫治疗后识别出更高比例的早期反应者。所有标准的应答者都有较长的 PFS 和 1 年 OS,只有 Choi 标准的应答者有较长的 OS,且没有地标时间。Choi标准以及RECIST1.1和mRECIST是阿特佐-贝夫治疗的有效反应评估工具。
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引用次数: 0
Fat-suppression T2 relaxation time and water fraction predict response to intravenous glucocorticoid therapy for thyroid-associated ophthalmopathy. 脂肪抑制 T2 弛豫时间和水分数可预测甲状腺相关眼病患者对静脉注射糖皮质激素治疗的反应。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-08-02 DOI: 10.1007/s00330-024-10868-4
Linhan Zhai, Feng Li, Ban Luo, Qiuxia Wang, Hongyu Wu, Yali Zhao, Gang Yuan, Jing Zhang

Objective: To investigate the value of fat-suppression (FS) T2 relaxation time (T2RT) derived from FS T2 mapping and water fraction (WF) derived from T2 IDEAL to predict the treatment response to intravenous glucocorticoids (IVGC) in patients with thyroid-associated ophthalmopathy (TAO) based on texture analysis.

Materials and methods: In this study, 89 patients clinically diagnosed with active and moderate-to-severe TAO were enroled (responsive group, 48 patients; unresponsive group, 41 patients). The baseline clinical characteristics and texture features were compared between the two groups. Multivariate analysis was performed to identify the independent predictors of treatment response to IVGC. ROC analysis and the DeLong test were used to assess and compare the predictive performance of different models.

Results: The responsive group exhibited significantly shorter disease duration and higher 90th percentile of FS T2RT and kurtosis of WF in the extraocular muscle (EOM) and 95th percentile of WF in the orbital fat (OF) than the unresponsive group. Model 2 (disease duration + WF; AUC, 0.816) and model 3 (disease duration + FS T2RT + WF; AUC, 0.823) demonstrated superior predictive efficacy compared to model 1 (disease duration + FS T2RT; AUC, 0.756), while there was no significant difference between models 2 and 3.

Conclusions: The orbital tissues of responders exhibited more oedema and heterogeneity. Furthermore, OF is as valuable as EOM for assessing the therapeutic efficacy of IVGC. Finally, WF derived from T2 IDEAL processed by texture analysis can provide valuable information for predicting the treatment response to IVGC in patients with active and moderate-to-severe TAO.

Clinical relevance statement: The texture features of FS T2RT and WF are different between responders and non-responders, which can be the predictive tool for treatment response to IVGC.

Key points: Texture analysis can be used for predicting response to IVGC in TAO patients. TAO patients responsive to IVGC show more oedema and heterogeneity in the orbital tissues. WF from T2 IDEAL is a tool to predict the therapeutic response of TAO.

目的研究基于纹理分析的脂肪抑制(FS)T2弛豫时间(T2RT)和T2 IDEAL得出的水分数(WF)预测甲状腺相关性眼病(TAO)患者对静脉注射糖皮质激素(IVGC)治疗反应的价值:本研究共纳入89例临床诊断为活动性中重度TAO患者(有反应组48例,无反应组41例)。比较了两组患者的基线临床特征和纹理特征。为确定 IVGC 治疗反应的独立预测因素,进行了多变量分析。采用 ROC 分析和 DeLong 检验来评估和比较不同模型的预测性能:结果:与无反应组相比,有反应组的病程明显更短、眼外肌(EOM)FS T2RT第90百分位数和WF峰度更高、眼眶脂肪(OF)WF第95百分位数更高。与模型 1(病程 + FS T2RT;AUC,0.756)相比,模型 2(病程 + WF;AUC,0.816)和模型 3(病程 + FS T2RT + WF;AUC,0.823)显示出更优越的预测效果,而模型 2 和模型 3 之间没有显著差异:有反应者的眼眶组织表现出更多的水肿和异质性。此外,在评估 IVGC 的疗效方面,OF 与 EOM 具有同等价值。最后,通过纹理分析处理 T2 IDEAL 得出的 WF 可以为预测活动性中重度 TAO 患者对 IVGC 的治疗反应提供有价值的信息:FS T2RT和WF的纹理特征在有反应者和无反应者之间存在差异,可作为预测IVGC治疗反应的工具:纹理分析可用于预测TAO患者对IVGC的反应。要点:纹理分析可用于预测TAO患者对IVGC的反应,对IVGC有反应的TAO患者眼眶组织水肿和异质性更明显。T2 IDEAL的WF是预测TAO治疗反应的工具。
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引用次数: 0
A machine learning-based pipeline for multi-organ/tissue patient-specific radiation dosimetry in CT. 基于机器学习的 CT 多器官/组织患者特异性辐射剂量测量管道。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-08-13 DOI: 10.1007/s00330-024-11002-0
Eleftherios Tzanis, John Damilakis

Objectives: To develop a machine learning-based pipeline for multi-organ/tissue personalized radiation dosimetry in CT.

Materials and methods: For the study, 95 chest CT scans and 85 abdominal CT scans were collected retrospectively. For each CT scan, a personalized Monte Carlo (MC) simulation was carried out. The produced 3D dose distributions and the respective CT examinations were utilized for the development of organ/tissue-specific dose prediction deep neural networks (DNNs). A pipeline that integrates a robust open-source organ segmentation tool with the dose prediction DNNs was developed for the automatic estimation of radiation doses for 30 organs/tissues including sub-volumes of the heart and lungs. The accuracy and time efficiency of the presented methodology was assessed. Statistical analysis (t-tests) was conducted to determine if the differences between the ground truth organ/tissue radiation dose estimates and the respective dose predictions were significant.

Results: The lowest median percentage differences between MC-derived organ/tissue doses and DNN dose predictions were observed for the lung vessels (4.3%), small bowel (4.7%), pulmonary artery (4.7%), and colon (5.2%), while the highest differences were observed for the right lung's upper lobe (13.3%), spleen (13.1%), pancreas (12.1%), and stomach (11.6%). Statistical analysis showed that the differences were not significant (p-value > 0.18). Furthermore, the mean inference time, regarding the validation cohort, of the developed methodology was 77.0 ± 11.0 s.

Conclusion: The proposed workflow enables fast and accurate organ/tissue radiation dose estimations. The developed algorithms and dose prediction DNNs are publicly available ( https://github.com/eltzanis/multi-structure-CT-dosimetry ).

Clinical relevance statement: The accuracy and time efficiency of the developed pipeline compose a useful tool for personalized dosimetry in CT. By adopting the proposed workflow, institutions can utilize an automated pipeline for patient-specific dosimetry in CT.

Key points: Personalized dosimetry is ideal, but is time-consuming. The proposed pipeline composes a tool for facilitating patient-specific CT dosimetry in routine clinical practice. The developed workflow integrates a robust open-source segmentation tool with organ/tissue-specific dose prediction neural networks.

目的开发一种基于机器学习的管道,用于 CT 中多器官/组织个性化辐射剂量测定:研究回顾性收集了 95 例胸部 CT 扫描和 85 例腹部 CT 扫描。对每个 CT 扫描进行了个性化蒙特卡罗(MC)模拟。生成的三维剂量分布和相应的 CT 检查结果被用于开发器官/组织特异性剂量预测深度神经网络(DNN)。开发的管道集成了强大的开源器官分割工具和剂量预测 DNN,用于自动估算包括心脏和肺部子体积在内的 30 个器官/组织的辐射剂量。对该方法的准确性和时间效率进行了评估。进行了统计分析(t 检验),以确定真实器官/组织辐射剂量估计值与相应剂量预测值之间的差异是否显著:肺血管(4.3%)、小肠(4.7%)、肺动脉(4.7%)和结肠(5.2%)的 MC 导出器官/组织剂量与 DNN 预测剂量之间的中位百分比差异最小,而右肺上叶(13.3%)、脾脏(13.1%)、胰腺(12.1%)和胃(11.6%)的差异最大。统计分析显示,差异不显著(P 值 > 0.18)。此外,就验证队列而言,所开发方法的平均推断时间为 77.0 ± 11.0 秒:结论:所提出的工作流程能够快速、准确地估算器官/组织的辐射剂量。开发的算法和剂量预测 DNN 可公开获取 ( https://github.com/eltzanis/multi-structure-CT-dosimetry )。临床相关性声明:所开发管道的准确性和时间效率为 CT 中的个性化剂量测定提供了有用的工具。通过采用建议的工作流程,医疗机构可以利用自动化管道进行 CT 患者特异性剂量测定:个性化剂量测定是理想的,但耗时较长。建议的流程是在常规临床实践中促进患者特异性 CT 剂量测定的工具。所开发的工作流程集成了强大的开源分割工具和器官/组织特异性剂量预测神经网络。
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引用次数: 0
Coronary computed tomography angiography improves assessment of patients with acute chest pain and inconclusively elevated high-sensitivity troponins. 冠状动脉计算机断层扫描血管造影术可改善对急性胸痛和高敏肌钙蛋白升高不确定患者的评估。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-08-16 DOI: 10.1007/s00330-024-10930-1
Murat Arslan, Jeroen Schaap, Bart van Gorsel, Anton Aubanell, Ricardo P J Budde, Alexander Hirsch, Martijn W Smulders, Casper Mihl, Peter Damman, Olga Sliwicka, Jesse Habets, Eric A Dubois, Admir Dedic

Objectives: To determine whether coronary computed tomography angiography (CCTA) can improve the diagnostic work-up of patients with acute chest pain and inconclusively high-sensitivity troponins (hs-troponin).

Methods: We conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of ≥ 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Results: A total of 106 patients (mean age 65 ± 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of ≥ 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter ≥ 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.

Conclusion: The absence of ≥ 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins.

Clinical relevance statement: Coronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.

Trial registration: Clinicaltrials.gov (NCT03129659). Registered on 26 April 2017 KEY POINTS: Acute chest discomfort is a common presenting complaint in the emergency department. CCTA achieved very high negative predictive values for type 1 NSTE-ACS in this population. CCTA can serve as an adjunct for evaluating equivocal ACS and evaluates for other pathology.

目的确定冠状动脉计算机断层扫描血管造影术(CCTA)能否改善急性胸痛和高敏肌钙蛋白(hs-troponin)不确定患者的诊断工作:我们进行了一项前瞻性、盲法、观察性多中心研究。研究纳入了因急性胸痛和高敏肌钙蛋白(hs-troponin)不确定升高而到急诊科就诊的 30-80 岁患者,并对他们进行了 CCTA 检查。主要结果是CCTA对1型非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者的诊断准确性,即血管狭窄≥50%:共纳入 106 名患者(平均年龄 65 ± 10 岁,29% 为女性),其中 20 名患者(19%)被确诊为 1 型非 STE-ACS 患者。45名患者的CCTA显示为非阻塞性冠状动脉疾病(CAD)或无CAD。CCTA 鉴定 1 型 NSTE-ACS 患者的敏感性、特异性、阴性预测值 (NPV)、阳性预测值和≥50% 狭窄的曲线下面积 (AUC) 分别为 95%(95% 置信区间:74-100)、56%(45-68)、98%(87-100)、35%(29-41)和 0.83(0.73-0.94)。当仅考虑直径≥2毫米的冠状动脉节段来判定1型NSTE-ACS时,敏感性和NPV均增加到100%。在 8 例患者中,CCTA 能够发现临床相关的非冠状动脉发现:结论:对于 hs-troponins 无法确定是否升高的急性胸痛患者,CCTA 可用于排除 1 型 NSTE-ACS。此外,CCTA 还能发现导致急性胸痛和 hs-troponins 无法确定是否升高的其他相关疾病,从而有助于改进诊断工作:冠状动脉CTA(CCTA)可以安全地排除因急性胸痛和hs-肌钙蛋白不确定升高而就诊于急诊室的1型非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者,同时还能发现其他相关的非冠状动脉疾病:Clinicaltrials.gov (NCT03129659)。注册日期:2017 年 4 月 26 日 要点:急性胸部不适是一种常见的主诉症状:急性胸部不适是急诊科的常见主诉。在该人群中,CCTA 对 1 型 NSTE-ACS 的阴性预测值非常高。CCTA 可作为评估等位 ACS 的辅助手段,并可评估其他病变。
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引用次数: 0
Misinterpretations about CT numbers, material decomposition, and elemental quantification. 对 CT 数字、材料分解和元素定量的误读。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-07-21 DOI: 10.1007/s00330-024-10934-x
Aria M Salyapongse, Timothy P Szczykutowicz

Background: Quantitative CT imaging, particularly iodine and calcium quantification, is an important CT-based biomarker.

Purpose: This study quantifies sources of errors in quantitative CT imaging in both single-energy and spectral CT.

Materials and methods: This work examines the theoretical relationship between CT numbers, linear attenuation coefficient, and material quantification. We derive four understandings: (1) CT numbers are not proportional with element mass in vivo, (2) CT numbers are proportional with element mass only when contained in a voxel of pure water, (3) iodine-water material decomposition is never accurate in vivo, and (4) for error-free material decomposition a voxel must only consist of the basis decomposition vectors. Misinterpretation-based errors are calculated using the National Institute of Standards and Technology (NIST) XCOM database for: tissue chemical compositions, clinical concentrations of hydroxyapatite (HAP), and iodine. Quantification errors are also demonstrated experimentally using phantoms.

Results: In single-energy CT, misinterpretation-induced errors for HAP density in adipose, muscle, lung, soft tissue, and blood ranged from 0-132%, i.e., a mass error of 0-749 mg/cm3. In spectral CT, errors with iodine in the same tissues resulted in a range of < 0.1-33% error, resulting in a mass error of < 0.1-1.2 mg/mL.

Conclusion: Our work demonstrates material quantification is fundamentally limited when measured in vivo due to measurement conditions differing from assumed and the errors are at or above detection limits for bone mineral density (BMD) and spectral iodine quantification. To define CT-derived biomarkers, the errors we demonstrate should either be avoided or built into uncertainty bounds.

Clinical relevance statement: Improving error bounds in quantitative CT biomarkers, specifically in iodine and BMD quantification, could lead to improvements in clinical care aspects based on quantitative CT.

Key points: CT numbers are only proportional with element mass only when contained in a voxel of pure water, therefore iodine-water material decomposition is never accurate in vivo. Misinterpretation-induced errors ranged from 0-132% for HAP density and < 0.1-33% in spectral CT with iodine. For error-free material decomposition, a voxel must only consist of the basis decomposition vectors.

背景:定量 CT 成像,尤其是碘和钙定量,是一种重要的基于 CT 的生物标志物。目的:本研究量化了单能 CT 和光谱 CT 定量 CT 成像的误差来源:本研究探讨了 CT 数字、线性衰减系数和材料定量之间的理论关系。我们得出四点认识:(1) CT 数字在体内与元素质量不成正比;(2) CT 数字只有在包含在纯水体素中时才与元素质量成正比;(3) 碘水材料分解在体内永远不会准确;(4) 要实现无差错材料分解,体素必须仅由基础分解矢量组成。利用美国国家标准与技术研究院(NIST)的 XCOM 数据库计算了基于误读的误差:组织化学成分、羟基磷灰石(HAP)和碘的临床浓度。此外,还使用模型进行了定量误差实验:结果:在单能 CT 中,脂肪、肌肉、肺、软组织和血液中 HAP 密度的误读误差范围为 0-132%,即质量误差为 0-749 mg/cm3。在光谱 CT 中,相同组织中碘的误差范围为结论:我们的工作表明,由于测量条件与假定条件不同,在体内测量时,材料定量会受到根本限制,而且误差达到或超过骨矿物质密度 (BMD) 和光谱碘定量的检测限。为了定义 CT 衍生生物标记物,我们所展示的误差应予以避免或纳入不确定性范围:临床相关性声明:改进定量 CT 生物标志物的误差范围,特别是碘和 BMD 定量,可以改善基于定量 CT 的临床护理方面:CT数字只有在包含在纯水体素中时才与元素质量成正比,因此碘-水物质分解在体内永远不会准确。误读导致的误差范围为 0-132% 的 HAP 密度和
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引用次数: 0
Multi-reader multiparametric DECT study evaluating different strengths of iterative and deep learning-based image reconstruction techniques. 多阅读器多参数 DECT 研究,评估基于迭代和深度学习的图像重建技术的不同优势。
IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-02-01 Epub Date: 2024-07-24 DOI: 10.1007/s00330-024-10974-3
Jinjin Cao, Nayla Mroueh, Simon Lennartz, Nathaniel D Mercaldo, Nisanard Pisuchpen, Sasiprang Kongboonvijit, Shravya Srinivas Rao, Kampon Yuenyongsinchai, Theodore T Pierce, Madeleine Sertic, Ryan Chung, Avinash R Kambadakone

Objectives: To perform a multi-reader comparison of multiparametric dual-energy computed tomography (DECT) images reconstructed with deep-learning image reconstruction (DLIR) and standard-of-care adaptive statistical iterative reconstruction-V (ASIR-V).

Methods: This retrospective study included 100 patients undergoing portal venous phase abdominal CT on a rapid kVp switching DECT scanner. Six reconstructed DECT sets (ASIR-V and DLIR, each at three strengths) were generated. Each DECT set included 65 keV monoenergetic, iodine, and virtual unenhanced (VUE) images. Using a Likert scale, three radiologists performed qualitative assessments for image noise, contrast, small structure visibility, sharpness, artifact, and image preference. Quantitative assessment was performed by measuring attenuation, image noise, and contrast-to-noise ratios (CNR). For the qualitative analysis, Gwet's AC2 estimates were used to assess agreement.

Results: DECT images reconstructed with DLIR yielded better qualitative scores than ASIR-V images except for artifacts, where both groups were comparable. DLIR-H images were rated higher than other reconstructions on all parameters (p-value < 0.05). On quantitative analysis, there was no significant difference in the attenuation values between ASIR-V and DLIR groups. DLIR images had higher CNR values for the liver and portal vein, and lower image noise, compared to ASIR-V images (p-value < 0.05). The subgroup analysis of patients with large body habitus (weight ≥ 90 kg) showed similar results to the study population. Inter-reader agreement was good-to-very good overall.

Conclusion: Multiparametric post-processed DECT datasets reconstructed with DLIR were preferred over ASIR-V images with DLIR-H yielding the highest image quality scores.

Clinical relevance statement: Deep-learning image reconstruction in dual-energy CT demonstrated significant benefits in qualitative and quantitative image metrics compared to adaptive statistical iterative reconstruction-V.

Key points: Dual-energy CT (DECT) images reconstructed using deep-learning image reconstruction (DLIR) showed superior qualitative scores compared to adaptive statistical iterative reconstruction-V (ASIR-V) reconstructed images, except for artifacts where both reconstructions were rated comparable. While there was no significant difference in attenuation values between ASIR-V and DLIR groups, DLIR images showed higher contrast-to-noise ratios (CNR) for liver and portal vein, and lower image noise (p value < 0.05). Subgroup analysis of patients with large body habitus (weight ≥ 90 kg) yielded similar findings to the overall study population.

目的对使用深度学习图像重建(DLIR)和标准自适应统计迭代重建-V(ASIR-V)重建的多参数双能计算机断层扫描(DECT)图像进行多读取器比较:这项回顾性研究包括 100 名在快速 kVp 切换 DECT 扫描仪上接受门静脉期腹部 CT 检查的患者。共生成了六套重建 DECT(ASIR-V 和 DLIR,每套有三种强度)。每个 DECT 集包括 65 keV 单能、碘和虚拟未增强 (VUE) 图像。三名放射科医生使用李克特量表对图像噪声、对比度、小结构可见度、清晰度、伪影和图像偏好进行定性评估。定量评估是通过测量衰减、图像噪声和对比噪声比(CNR)来进行的。在定性分析中,使用 Gwet 的 AC2 估计值来评估一致性:结果:使用 DLIR 重建的 DECT 图像的定性评分优于 ASIR-V 图像,但伪影除外,两组图像的伪影不相上下。在所有参数上,DLIR-H 图像的评分均高于其他重建图像(P 值 结论:DLIR-H 图像在所有参数上的评分均高于其他重建图像:使用 DLIR 重建的多参数后处理 DECT 数据集比 ASIR-V 图像更受欢迎,其中 DLIR-H 图像质量得分最高:双能 CT 中的深度学习图像重建与自适应统计迭代重建-V 相比,在定性和定量图像指标方面都有显著优势:使用深度学习图像重建(DLIR)重建的双能 CT(DECT)图像与自适应统计迭代重建-V(ASIR-V)重建的图像相比,在定性评分方面更胜一筹,但在伪影方面,两种重建的评分不相上下。虽然ASIR-V组和DLIR组的衰减值没有明显差异,但DLIR图像显示肝脏和门静脉的对比噪声比(CNR)更高,图像噪声更低(P值<0.05)。对体型偏胖(体重≥ 90 千克)的患者进行分组分析,结果与总体研究结果相似。
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引用次数: 0
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