Journal of Computer Assisted Tomography最新文献

Objective: This study aims to assess the diagnostic value of the coronary artery calcium score (CACS) to predict significant coronary artery stenosis (SCAS) in presolid organ transplant patients with a moderate and high risk of coronary artery disease.

Methods: In this retrospective HIPAA-compliant study, all pre-liver/kidney transplant patients with intermediate or high risk of coronary artery disease who underwent cardiac CT angiogram (CCTA) and CACS between January 1, 2018 and December 31, 2022 were reviewed. CACS was assessed according to the Agatston score. SCAS was defined as ≥50% diameter stenosis on CCTA. The potential to predict SCAS was assessed by computing the area under the receiver curve (AUC), and the sensitivity and specificity of CACS in diagnosing SCAS were calculated at various CACS thresholds.

Results: A total of 291 patients (81; 28% female) with a mean age of 57.7±9.9 years, were included. The median CACS was 772 (IQR: 320 to 1892) in patients with SCAS versus 23 (IQR: 0 to 187) in those without SCAS (P<0.01). CACS demonstrated efficacy in predicting SCAS, with an AUC of 0.88. In the subgroup analysis, mean CACS differed significantly between pre-liver and pre-kidney solid organ transplant patients, but the difference between AUC curves was not significant. With the use of traditional CACS thresholds, the sensitivity dropped below 95%, but with optimized thresholds of CACS ≤62 or ≥869 for 95% sensitivity and specificity, 63% of pretransplant patients could be attributed either to a low-risk or high-risk for SCAS, respectively.

Conclusions: Our study shows that CACS can accurately predict SCAS in a large proportion of pre-kidney and liver transplant patients with intermediate or high risk of coronary artery disease. CACS can be considered as a screening tool to identify patients with low likelihood of SCAS, who might not require CCTA, as well as those with a high likelihood in whom a proactive approach should be considered.

Background: Magnetic resonance cholangiopancreatography (MRCP) is used in the diagnosis and management of primary sclerosing cholangitis (PSC). However, MRCP is subjective, and guidelines state that there is insufficient evidence to recommend MRCP as a prognostic tool. EASL-PSC guidelines have identified quantitative MRCP (MRCP+) as having promising utility for risk assessment and prediction of clinical outcomes. We conducted a systematic review to determine the clinical utility of MRCP+ metrics for the management of patients with PSC.

Methods: We systematically searched PubMed and MEDLINE for cohort studies reporting on MRCP+ metrics associated with risk prediction, clinical outcomes, and disease progression published between January 2019 and May 2024. Studies reporting on adults with diagnosed PSC with paired MRCP were selected. There were no limitations on the type of study (retrospective/prospective). Studies reporting on only qualitative assessment of MRCP were excluded.

Results: Six manuscripts with 512 subjects met the study criteria. For risk prediction and disease progression, 4 articles reported 21 unique MRCP+ metrics, which were significantly associated with the Amsterdam-Oxford model and the MAYO risk score. MRCP+ metrics had AUC ranging 0.65 to 0.87 and hazard ratios ranging 0.96 to 17.79 for the prediction of adverse outcomes, including liver transplantation, death, hepatic decompensation, biliary complications, and cholangiocarcinoma. Associations between biochemical markers of liver function (alkaline phosphatase, bilirubin, aspartate aminotransferase, gamma glutamyl transferase, and albumin) ranged -0.42≤R≤0.48.

Conclusion: MRCP+ metrics have clinical utility to support patient management alongside addressing key gaps, including standardising MRCP assessment, early detection of disease, and quantification of risk.

Objective: To assess photon counting CT iodine density as a marker of histopathologic treatment response after neoadjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma.

Materials and methods: A retrospective PACS search identified 21 pancreatic ductal adenocarcinoma patients [14 men; mean (SD) age: 64 (10) y] who underwent neoadjuvant chemotherapy and pancreatic photon counting CT 2 months before resection from April 11, 2022 to February 2, 2024. The histopathologic treatment response grade was the reference standard. Freehand regions-of-interest measurements were drawn independently by 2 radiologists as large as possible within the mass on pancreatic parenchymal phase images. Attenuation, iodine density, and iodine density normalized to the aorta were recorded. Mann-Whitney U test was used to compare attenuation, iodine density, and normalized iodine density for responders (pathologic grade 1, 2) versus nonresponders (grade 3). Receiver operating characteristic curves were created, and optimal thresholds were determined with Youden's index. A P <0.05 indicated statistical significance.

Results: Thirteen of 21 (61.9%) patients showed pathologic treatment response. Iodine density for nonresponders and responders was mean (SD) 0.47 (0.23) mg/mL and 1.20 (0.75) mg/mL, respectively ( P= 0.005). Normalized iodine density for nonresponders and responders was 7.6 (5.5)% and 22.5 (16.0)%, ( P= 0.006). Attenuation for nonresponders and responders was 56.5 (10.9) HU and 70.6 (17.7) HU, ( P =0.04). Upon receiver operating characteristic analysis, an iodine density threshold of 0.65 mg/mL had 77% sensitivity and 88% specificity (AUC=0.86), and a normalized iodine density threshold of 10.1% had 77% sensitivity and 88% specificity (AUC=0.86) for treatment response. A 61.8 HU threshold had 77% sensitivity and 75% specificity (AUC=0.78).

Conclusions: Elevated iodine density correlates with pancreatic ductal adenocarcinoma histopathologic treatment response with high specificity. Photon counting CT iodine density may be used as a marker of histopathologic treatment response.

Objective: To evaluate an edge-on-irradiated silicon-based photon-counting detector CT (Deep Si-PCD-CT) prototype for quantification of iodine concentration and stability of HU values, as well as detectability of subtle features in simulated kidney parenchyma.

Materials and methods: A phantom, simulating moderately and strongly enhancing kidney parenchyma (at 180 and 240 HU) inside a small, medium, and large patient (23, 30, 37 cm diameter, respectively), was scanned on a Deep Si-PCD-CT. Centered in the kidney parenchyma was a water-equivalent rod at 0 HU and a rod of 0.8 mg/mL iodine concentration to simulate a benign, mildly enhancing cystic renal lesion, as well as a rod with a 2 mm septum and 5 mm mural nodule. Accuracy and stability of HU values were evaluated with repeated ROI measurements across consecutive slices, while the septum and nodule were identified on standard polychromatic clinical images and iodine maps. Images were reconstructed with a soft tissue kernel at 0.417- and 0.625-mm slice-thickness without additional denoising.

Results: Deep Si-PCD-CT produced accurate HU value measurements for water, intralesional iodine content, and renal parenchymal enhancement. The HU values were similarly variable from the ground truth values as compared with measurements from a commercial energy-integrating detector CT. The nodule and septum inside the phantom were successfully identified using the new Deep Si-PCD-CT prototype, while they were difficult to identify using the standard EID-CT at clinical window-level settings. The iodine maps created from the photon-counting detector CT displayed both the nodule and the septum well, facilitating quick identification.

Conclusions: Deep Si-PCD-CT is a promising tool for the accurate measurement of HU values, as well as the detection of subtle features of complexity in cystic renal lesions. It has the potential to improve the diagnosis and management of cystic renal lesions.

Objective: To compare the predictive value of minimal ablative margin (MAM) quantification using tumor segmentation on intraprocedural contrast-enhanced hepatic arterial (HAP) versus portal venous phase (PVP) CT on local outcomes following percutaneous thermal ablation of colorectal liver metastases (CRLM).

Methods: This dual-center retrospective study included patients undergoing thermal ablation of CRLM with intraprocedural preablation and postablation contrast-enhanced CT imaging between 2009 and 2021. Tumors were segmented in both HAP and PVP CT phases using an artificial intelligence-based auto-segmentation model and reviewed by a trained radiologist. The MAM was quantified using a biomechanical deformable image registration process. The area under the receiver operating characteristic curve (AUROC) was used to compare the prognostic value for predicting local tumor progression (LTP).

Results: Among 81 patients (60 y±13, 53 men), 151 CRLMs were included. During 29.4 months of median follow-up, LTP was noted in 24/151 (15.9%). Median tumor volumes on HAP and PVP CT were 1.7 mL and 1.2 mL, respectively, with respective median MAMs of 2.3 and 4.0 mm (both P < 0.001). The AUROC for 1-year LTP prediction was 0.78 (95% CI: 0.70-0.85) on HAP and 0.84 (95% CI: 0.78-0.91) on PVP ( P = 0.002).

Conclusions: During CT-guided percutaneous thermal ablation, MAM measured based on tumors segmented on PVP images conferred a higher predictive accuracy of ablation outcomes among CRLM patients than those segmented on HAP images, supporting the use of PVP rather than HAP images for segmentation during ablation of CRLMs.

CT imaging has advanced significantly, with dual-energy CT (DECT) marking a milestone by using 2 energy spectra for enhanced tissue characterization. The latest innovation is photon-counting detectors (PCD), which offer superior spatial resolution, contrast-to-noise ratio (CNR), and potential for reduced radiation dose compared with traditional energy-integrating detectors (EID). Photon-counting CT (PCD-CT), which directly counts individual photons using semiconductors, has important implications for chest imaging, especially for complex disease processes that benefit from imaging at higher spatial resolution. PCD-CT achieves improved spatial resolution by eliminating the blurring effects associated with EID scintillators. Enhanced CNR is achieved through energy discrimination and selective use of photon energies, which also helps to minimize electronic noise. PCD-CT facilitates significant radiation dose reduction, particularly valuable for patients who receive regular follow-ups, like in lung cancer screening. In addition, PCD-CT provides spectral capabilities in every scan, unlike DECT, which requires preselecting a specific spectral scan mode. In chest imaging, PCD-CT shows promise in detecting and definitively characterizing infectious diseases, interstitial lung disease, malignancies, and vascular conditions at low radiation doses, offering higher diagnostic accuracy and patient safety. Despite these advancements, challenges remain in optimizing spectral imaging and integrating PCD-CT into routine clinical workflows, necessitating ongoing research and development.

Objective: In recent years, experience has been accumulated in microwave ablation (MWA) of ground-glass nodules (GGNs). The goal of this retrospective study was to explore the feasibility, safety, and efficacy of synchronized computed tomography (CT)-guided MWA combined with intraoperative percutaneous biopsy (PB) for the treatment of highly suspected malignant GGNs.

Methods: From January 2021 to February 2025, 93 patients with highly suspected malignant GGNs underwent MWA and PB. Forty-one patients in group A were treated with sequential low power MWA-PB-radical MWA in one session. Fifty-two patients in group B were treated with staged procedures. The pathologic diagnostic results and pathology positive diagnosis rate were evaluated. The technical success, complete ablation rate, and complications were analyzed. The total operative time, irradiation dose, hospitalization time, and hospitalization expenses were compared between the 2 groups.

Results: The technical success rate of both groups was 100%. The complete ablation rates of group A and group B were 100% and 98.1%, respectively ( P >0.05). The positive pathologic diagnosis rate of group A was 90.2% (37/41). The incidence of pneumothorax and intrapulmonary hemorrhage was lower in group A than in group B (29.3% vs. 50.0%, P =0.04; 17.1% vs. 61.5%, P <0.001). The total operative time, irradiation dose, hospitalization time, and hospitalization expenses were lower in group A than in group B (all P <0.001).

Conclusion: Synchronized MWA and intraoperative PB is a safe and effective strategy with satisfactory technical success, complete ablation rates, and acceptable rates of positive pathologic diagnosis, which is an alternative treatment for GGNs with high suspicion of malignancy.

Objective: Adoption of abdominal photon counting detector CT (PCD-CT) into clinical pediatric CT practice requires evidence that it provides diagnostic images at acceptable radiation doses. Thus, this study aimed to compare radiation dose and image quality of PCD-CT and conventional energy-integrating detector CT (EID-CT) in pediatric abdominopelvic CT.

Materials and methods: This institutional review board-approved retrospective study included 147 children (median age 8.5 y; 80 boys, 67 girls) who underwent clinically indicated contrast-enhanced abdominopelvic PCD-CT between October 1, 2022 and April 30, 2023 and 147 children (median age 8.5 y; 74 boys, 73 girls) who underwent EID-CT between July 1, 2021 and January 1, 2022. Patients in the 2 groups were matched by age and effective diameter. Radiation dose parameters (CT dose index volume, CTDI vol ; dose length product, DLP; size-specific dose estimate, SSDE) were recorded. In a subset of 25 matched pairs, subjective image quality was assessed on a scale of 1 to 4 (1=highest quality), and liver attenuation, dose-normalized noise, and contrast-to-noise ratio (CNR) were measured. Groups were compared using parametric and/or nonparametric testing.

Results: Among the 147 matched pairs, there were no significant differences in sex ( P =0.576), age ( P =0.084), or diameter ( P =0.668). PCD-CT showed significantly lower median CTDI vol , DLP, and SSDE (1.6 mGy, 63.8 mGy-cm, 3.1 mGy) compared with EID-CT (3.7 mGy, 155.3 mGy-cm, 6.0 mGy) ( P< 0.001). In the subset of 25 patients, PCD-CT and EID-CT showed no significant difference in overall image quality for reader 1 (1.0 vs. 1.0, P =0.781) or reader 2 (1.0 vs. 1.0, P =0.817), or artifacts for reader 1 (1.0 vs. 1.0, P =0.688) or reader 2 (1.0 vs. 1.0, P =0.219). After normalizing for radiation dose, image noise was significantly lower with PCD-CT ( P <0.001), while CNR in the liver ( P =0.244) and portal vein ( P =0.079) were comparable to EID-CT.

Conclusion: Abdominopelvic PCD-CT in children significantly reduces radiation dose while maintaining subjective image quality, and accounting for dose levels, has the potential to lower image noise and achieve comparable CNR to EID-CT. These data expand understanding of the capabilities of PCD-CT and support its routine use in children.

Objective: To analyze symptoms, imaging features, management, and outcomes of musculoskeletal myeloid sarcoma in adult leukemic patients.

Materials and methods: This is a retrospective analysis of clinical symptoms, imaging features, management, and outcomes in 41 adult leukemic patients with biopsy-proven myeloid sarcomas of bones and muscles.

Results: Nineteen patients had acute, and 15 had chronic myeloid leukemia. Additional 5 previously treated leukemia patients included 1 with chronic myeloid leukemia, 3 with myelofibrosis, and 1 with myelodysplastic syndrome. The remaining 2 patients had isolated myeloid sarcoma with normal marrow without a history of hematologic disorder. Twenty-nine patients had bone tumors only, 3 muscle tumors only, 8 both bone and soft tissue tumors, and 1 intraarticular synovial tumor of an ankle. Of the 71 focal bone tumors, 68 were lytic and 3 were sclerotic. In addition, diffuse sclerotic bone lesions were present in 1 patient, and diffuse mixed lytic/sclerotic bone lesions in 2 patients. Most tumors were asymptomatic and were discovered incidentally on imaging. Local pain, mass, and pathologic fractures were the most common complaints when present. Vertebral bone and paravertebral soft tissue tumors caused neurological symptoms. Muscle tumors became symptomatic when they involved adjoining bone, nerve, or spinal cord. Only 3 among 13 muscle tumors presented as palpable masses. The imaging features of these musculoskeletal tumors were nonspecific. On MRI, both muscle and lytic bone MSs were hypo-to-iso-intense on T1WI, hyperintense on fat-suppressed T2WI, and enhanced on post-contrast fat-suppressed T1WI. A synovial myeloid sarcoma of the ankle showed diffusely thickened synovium on MRI. F-18 FDG PET-CT was helpful in the detection, monitoring of treatment response, and post-treatment surveillance in 5 patients. All patients were treated with cytarabine-based systemic anti-leukemic treatment and optional radiation, surgical resection, bone marrow transplant, and/or a combination of these. The known mean survival time of 35 dead patients after the appearance of musculoskeletal MS was 12.1 months.

Conclusions: Musculoskeletal myeloid sarcoma, which can occasionally precede it, is a rare complication of AML. Most tumors are asymptomatic. Imaging, particularly MRI and 18-F FDG PET-CT, plays a crucial role in detecting and monitoring treatment response, as well as post-treatment surveillance. The disease has poor clinical outcomes and short-term survival.