Stage III Chorioamnionitis is Associated with Reduced Risk of Severe Retinopathy of Prematurity.

OBJECTIVE: To identify whether histologically confirmed chorioamnionitis (hCAM) is associated with development of retinopathy of prematurity (ROP). STUDY DESIGN: We retrospectively analyzed 2 different cohorts. Cohort 1 was the national database of newborns in Japan born at ≤1500g or <32 weeks' gestation (January 2003 through April 2021, n = 38 013). Cohort 2 was babies born at <1500g from a single institution in Tsuchiura, Japan, (April 2015 through March 2018, n = 118). RESULTS: For Cohort1, after adjusting for potential confounders, stage III CAM (n = 5554) was associated with lower odds of severe ROP (stage ≥3 or required peripheral retinal ablation) by 14% (OR: 0.86; 95% CI: 0.78-0.94]. CAM of stage I (n = 3277) and II (n = 4319) was not associated with the risk of ROP. For Cohort 2, the odds of severe ROP were significantly reduced in moderate to severe hCAM groups (stage II, OR: 0.06, 95% CI: 0.05-0.82; stage III, OR: 0.10, 95% CI: 0.01-0.84). Neonates with funisitis, comorbidity of hCAM, and a finding of fetal inflammatory response had lower odds of severe ROP (OR: 0.11; 95% CI: 0.01-0.93). CONCLUSIONS: After adjusting for confounders, severe hCAM with fetal inflammatory response was associated with reduced risk of ROP.

The Feasibility of Deep Learning-Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation.

OBJECTIVE: The purpose of this study is to evaluate the efficacy of deep learning reconstruction (DLR) on low-tube-voltage computed tomographic angiography (CTA) for transcatheter aortic valve implantation (TAVI). METHODS: We enrolled 30 patients who underwent TAVI-CT on a 320-row CT scanner. Electrocardiogram-gated coronary CTA (CCTA) was performed at 100 kV, followed by nongated aortoiliac CTA at 80 kV using a single bolus of contrast material. We used hybrid-iterative reconstruction (HIR), model-based IR (MBIR), and DLR to reconstruct these images. The contrast-to-noise ratios (CNRs) were calculated. Five-point scales were used for the overall image quality analysis. The diameter of the aortic annulus was measured in each reconstructed image, and we compared the interobserver and intraobserver agreements. RESULTS: In the CCTA, the CNR and image quality score for DLR were significantly higher than those for HIR and MBIR ( P < 0.01). In the aortoiliac CTA, the CNR for DLR was significantly higher than that for HIR ( P < 0.01) and significantly lower than that for MBIR ( P ≤ 0.02). The image quality score for DLR was significantly higher than that for HIR ( P < 0.01). No significant differences were observed between the image quality scores for DLR and MBIR. The measured aortic annulus diameter had high interobserver and intraobserver agreement regardless of the reconstruction method (all intraclass correlation coefficients, >0.89). CONCLUSIONS: In low tube voltage TAVI-CT, DLR provides higher image quality than HIR, and DLR provides higher image quality than MBIR in CCTA and is visually comparable to MBIR in aortoiliac CTA.

Genome Analysis in Sick Neonates and Infants: High-yield Phenotypes and Contribution of Small Copy Number Variations.

OBJECTIVE: To delineate the diagnostic efficacy of medical exome, whole exome, and whole genome sequencing according to primary symptoms, the contribution of small copy number variations, and the impact of molecular diagnosis on clinical management. STUDY DESIGN: This was a prospective study of 17 tertiary care centers in Japan, conducted between April 2019 and March 2021. Critically ill neonates and infants less than 6 months of age were recruited in neonatal intensive care units and in outpatient clinics. The patients underwent medical exome, whole exome, or whole genome sequencing as the first tier of testing. Patients with negative results after medical exome or whole exome sequencing subsequently underwent whole genome sequencing. The impact of molecular diagnosis on clinical management was evaluated through contacting primary care physicians. RESULTS: Of the 85 patients, 41 (48%) had positive results. Based on the primary symptoms, patients with metabolic phenotypes had the highest diagnostic yield (67%, 4/6 patients), followed by renal (60%, 3/5 patients), and neurologic phenotypes (58%, 14/24 patients). Among them, 4 patients had pathogenic small copy number variations identified using whole genome sequencing. In the 41 patients with a molecular diagnosis, 20 (49%) had changes in clinical management. CONCLUSIONS: Genome analysis for critically ill neonates and infants had a high diagnostic yield for metabolic, renal, and neurologic phenotypes. Small copy number variations detected using whole genome sequencing contributed to the overall molecular diagnosis in 5% of all the patients. The resulting molecular diagnoses had a significant impact on clinical management.

Furosemide clearance in very preterm neonates early in life: A pilot study using scavenged samples.

BACKGROUND: Furosemide is an off-label drug, frequently used as a diuretic in neonates with oliguria and/or edema. Its clearance in preterm neonates is lower than in term neonates or children. We aimed, herein, to clarify furosemide clearance (CL) in very preterm (VP) neonates (<28 weeks' gestation) within the first 2 weeks of life and identify the factors predictive of the pharmacokinetics (PK) parameters, such as CL. METHODS: Furosemide was administered at 0.5 or 1 mg/kg in a 0.5-h infusion via a syringe pump; blood samples were drawn from an artery or vein after the intravenous injection. The serum furosemide concentration was measured using high-performance liquid chromatography. The PK parameters were then analyzed using Bayesian estimation. RESULTS: Thirteen blood samples were obtained from 10 VP neonates after intravenous injection. The mean postconceptional age and mean postnatal days at exposure to furosemide were 26.9 weeks and 7.1 days, respectively. The estimated mean CL was 16.5 mL/kg/h. The mean distribution volume (Vd) and elimination half-life (t1/2) were 0.37 L/kg and 15.3 h, respectively. Furosemide CL was negatively associated with serum creatinine (SCr) [CL = 84.2 - 67.1 × SCr (mg/dL)]. CONCLUSIONS: Very preterm neonates within the first 2 weeks of life had a higher CL than subjects in other preterm neonatal studies. The SCr level was the sole parameter influencing furosemide CL and might serve as a good index for furosemide dosing in VP neonates.

Image quality improvement with deep learning-based reconstruction on abdominal ultrahigh-resolution CT: A phantom study.

PURPOSE: In an ultrahigh-resolution CT (U-HRCT), deep learning-based reconstruction (DLR) is expected to drastically reduce image noise without degrading spatial resolution. We assessed a new algorithm's effect on image quality at different radiation doses assuming an abdominal CT protocol. METHODS: For the normal-sized abdominal models, a Catphan 600 was scanned by U-HRCT with 100%, 50%, and 25% radiation doses. In all acquisitions, DLR was compared to model-based iterative reconstruction (MBIR), filtered back projection (FBP), and hybrid iterative reconstruction (HIR). For the quantitative assessment, we compared image noise, which was defined as the standard deviation of the CT number, and spatial resolution among all reconstruction algorithms. RESULTS: Deep learning-based reconstruction yielded lower image noise than FBP and HIR at each radiation dose. DLR yielded higher image noise than MBIR at the 100% and 50% radiation doses (100%, 50%, DLR: 15.4, 16.9 vs MBIR: 10.2, 15.6 Hounsfield units: HU). However, at the 25% radiation dose, the image noise in DLR was lower than that in MBIR (16.7 vs. 26.6 HU). The spatial frequency at 10% of the modulation transfer function (MTF) in DLR was 1.0 cycles/mm, slightly lower than that in MBIR (1.05 cycles/mm) at the 100% radiation dose. Even when the radiation dose decreased, the spatial frequency at 10% of the MTF of DLR did not change significantly (50% and 25% doses, 0.98 and 0.99 cycles/mm, respectively). CONCLUSION: Deep learning-based reconstruction performs more consistently at decreasing dose in abdominal ultrahigh-resolution CT compared to all other commercially available reconstruction algorithms evaluated.

Improved visualization of a fine intrahepatic biliary duct on drip infusion cholangiography-computed tomography: Impact of knowledge-based iterative model reconstruction.

AIM: The purpose of this study was to investigate the visualization of fine biliary ducts with knowledge-based iterative model reconstruction (IMR) in low-dose drip infusion computed tomography (CT) cholangiography (DIC-CT) as compared with filtered back projection (FBP) and hybrid iterative reconstruction (iDose4 ). METHODS: A total of 38 patients underwent DIC-CT for living donor liver transplantation. CT was performed approximately 20 min after the end of the infusion of meglumine iotroxate (100 mL). Images were reconstructed using FBP, iDose4 , and IMR, and 1-mm slice images at fixed window level and width were prepared for assessment. Two reviewers independently evaluated the quality of visualization of the fine biliary ducts of the caudate lobe (B1) using a 5-point scale. The visualization scores of three reconstructed images were compared using the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: For reviewer 1, the visualization score of IMR was significantly higher than that of FBP (P = 0.012), and tended to be higher than that of iDose4 (P = 0.078). For reviewer 2, the visualization score of IMR was significantly higher than those of both FBP and iDose4 (P < 0.01). CONCLUSIONS: IMR showed better visualization of B1 on DIC-CT than FBP or iDose4 . DIC-CT reconstructed with IMR may be useful to the anatomical grasp of biliary tracts in cases of hepatectomy.

Low Radiation Dose and High Image Quality of 320-Row Coronary Computed Tomography Angiography Using a Small Dose of Contrast Medium and Refined Scan Timing Prediction.

OBJECTIVE: The aim of the study was to investigate the feasibility of coronary computed tomography (CT) angiography with a low kilovoltage peak scan and a refined scan timing prediction using a small contrast medium (CM) dose. METHODS: In protocol A, 120-kVp scanning and a standard CM dose were used. The scan timing was fixed. In protocol B, 80 kVp and a 60% CM dose were used. The scan timing was determined according to the interval from the CM arrival to the peak time in the ascending aorta. We measured the CT number and recorded the radiation dose. RESULTS: Higher CT numbers were observed in the left circumflex (proximal, P = 0.0235; middle, P = 0.0007; distal, P < 0.0001) in protocol B compared with protocol A. The radiation dose in protocol B was significantly lower than in protocol A (2.2 ± 0.9 vs 4.3 ± 1.7 mSv). CONCLUSIONS: Low-contrast, low-radiation dose, high-image quality coronary CT angiography can be performed with low kilovoltage peak scanning and a refined scan timing prediction.

A Pilot Study of Soluble Form of LOX-1 as a Novel Biomarker for Neonatal Hypoxic-Ischemic Encephalopathy.

OBJECTIVE: To evaluate the soluble form of lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) as a biomarker of severity staging and prognosis in neonatal hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: We performed an observational study enrolling 27 infants with HIE and 45 control infants of gestational age ≥36 weeks and birth weight ≥1800 g. The HIE criteria were pH ≤7.0 or a base deficit ≥16 mmol/L within 60 minutes after birth, and a 10-minute Apgar score ≤5 or resuscitation time ≥10 minutes. HIE severity was evaluated using modified Sarnat staging. We measured plasma sLOX-1 level and assessed general and neurologic signs at discharge, and classified infants with no neurosensory impairments as intact survival. RESULTS: sLOX-1 level within 6 hours after birth was correlated with the severity of HIE. sLOX-1 differentiated moderate-severe HIE (median, 1017 pg/mL; IQR, 553-1890 pg/mL) from mild HIE (median, 339 pg/mL; IQR, 288-595 pg/mL; P = .007). The sensitivity and specificity of the differentiation with a cutoff value of ≥550 pg/mL were 80.0% and 83.3%, respectively. In 19 infants with therapeutic hypothermia, a sLOX-1 cutoff value of <1000 pg/mL differentiated intact survival (median, 761 pg/mL; IQR, 533-1610 pg/mL) from death or neurosensory impairment (median, 1947 pg/mL; IQR, 1325-2506 pg/mL; P = .019) with 100% specificity and a positive predictive value. CONCLUSION: sLOX-1 may be a useful biomarker of neonatal HIE for severity staging and outcome prediction. Further investigations will facilitate its clinical use.

Dynamic flow imaging using 320-detector row CT and motion coherence analysis in coronary aneurysms associated with Kawasaki disease.

Introduction We propose a new dynamic flow imaging using 320-detector row CT, and investigate the assessment of coronary flow in aneurysms of Kawasaki disease in adulthood. METHODS: Six patients with Kawasaki disease and coronary aneurysms associated (26.7 years old) and six controls were enrolled. Dynamic coronary CT angiography with 320-row CT was continuously performed at mid-diastole throughout 15-25 cardiac cycles with prospective Electrocardiogram gating after injection of contrast media. Dynamic data sets of 15-25 cycles were computed into 90-100 data sets by motion coherence image processing. Next, time-density curves for coronary arteries were calculated for all the phases. On the basis of the maximum slope method, coronary flow index was defined as the ratio of the maximum upslope of the attenuation of coronary arteries to the upslope of the attenuation of ascending aorta on the time-density curves. Coronary flow indexes for the proximal and distal sites of coronary arteries and intra-aneurysm were measured.

Apparent diffusion coefficient histogram analysis for prediction of prognosis in glioblastoma.

BACKGROUND: To investigate the potential to predict prognosis of glioblastoma (GBM) patients by analysis of the broader and lower values in the lower distribution of apparent diffusion coefficient (ADCL) (B&L-ADCL) values in the ADC histogram. BACKGROUND: Presurgical publicly available diffusion-weighted images (DWI) and contrast-enhanced T1-weighted images from 76 GBM patients were analyzed. With applied 2-mixture normal distribution in the ADC histogram of enhanced lesions on T1-weighted images, the mean and width of ADCL were analyzed. We dichotomized the lower mean of ADCL (L-ADCL) and the broader width of ADCL (B-ADCL) at their own average. B&L-ADCL was defined as B-ADCL with L-ADCL. Progression-free survival (PFS) and overall survival (OS) were determined by using Cox proportional hazards analysis and the Kaplan-Meier method with the log-rank test. The difference between PFS and OS was calculated. RESULTS: Six (7.89%) patients had B&L-ADCL values. B&L-ADCL was strongly associated with poor PFS (hazard risk: 5.747; P=0.002) and OS (hazard risk: 3.331; P=0.018). There were significant differences in PFS (median, 77 vs. 302 days; P<0.001) and OS (median, 199 vs. 472 days; P=0.004) between the patents with and without B&L-ADCL. There was no significant difference in the OS-PFS duration difference between the patients with (median, 79 days) and without B&L-ADCL (median, 132 days) (P=0.348). CONCLUSION: In this study, B&L-ADCL from pretreatment ADC analysis predicted poor PFS. B&L-ADCL may indicate higher cellularity and heterogeneity in GBM tumor tissue.

[Improvement of Image Quality in the Axial Section Using High-resolution Scan Mode and Hybrid Iterative Reconstruction in Ultra-high-resolution Computed Tomography].

The purpose of this study is to compare the physical characteristics and visibility of high-resolution and conventional images acquired with the same X-ray dose, and to investigate the superiority of super high-resolution imaging. A Catphan phantom was scanned in the normal resolution (NR), high-resolution (HR), and super high-resolution (SHR) modes of ultra-high-resolution computed tomography at 120 kV and 75 mAs. All images were reconstructed into a 5-mm thick image slices with filtered back-projection (FBP) and hybrid image reconstruction (HIR), which included normal and enhanced adaptive iterative dose reduction 3D (AIDR and eAIDR, respectively). The modulation transfer function (MTF) and noise power spectrum (NPS) were measured using the circular edge method and radial frequency method, respectively. The signal-to-noise ratio (SNR) was then calculated. High-contrast resolution and low-contrast detectability were evaluated visually by five radiological technologists. The MTFs of HReAIDR and HRFBP images were higher than those of NRFBP images. However, the NPSs of HReAIDR and HRFBP images were larger than those of NRFBP images. The SNR of HReAIDR images was higher than that of NRFBP and HRFBP images. The scores of high-contrast resolution of HReAIDR, NRFBP, and HRFBP images were 13, 8, and 13 cycles/cm, respectively, and the scores of low-contrast detectability were 5, 5, and 6 mm, respectively. Hence, an improvement in high-contrast resolution of signal more than 400 HU in the axial section can be achieved without increasing the radiation dose and decreasing low-contrast detectability with 10 HU using the HR mode and eAIDR.

Group B streptococcal disease in infants in the first year of life: a nationwide surveillance study in Japan, 2011-2015.

PURPOSE: This study aimed to describe the epidemiology of childhood group B streptococcus (GBS) disease including late late-onset disease (LLOD) and to clinically characterize recurrent cases and twin-sibling cases in Japan. METHODS: We collected information on infants (<1 year of age) with invasive GBS disease and institutional information about births and transfers through a nationwide questionnaire between 2011 and 2015. RESULTS: We identified 133 infants with early-onset disease (EOD), 274 late-onset disease (LOD), and 38 LLOD from 149 institutes. The case fatality rate (CFR) of EOD, LOD, and LLOD was 4.5, 4.4, and 0%, respectively. CFR in EOD was significantly (P < 0.001) associated with preterm birth, but not that in LOD and LLOD. Twenty-nine percent of infants with meningitis (49/169) had neurologic sequelae. We showed clinical details of 12 recurrent cases that accounted for 2.8% of the total patients, and 4 sets of both twins affected; 4 of 12 recurrent cases and 3 of 4 twin-sibling sets were also associated with preterm birth. Based on the livebirth number of 581,488, the instituted-based incidence of EOD, LOD, and LLOD was estimated as 0.09 (95% CI 0.06-0.11), 0.12 (95% CI 0.11-0.14), and 0.01 (95% CI 0.01-0.02) per 1000 livebirths, respectively. CONCLUSIONS: CFR of EOD and LOD in Japan is comparable with that in high-income European countries or the United States, and their incidence is much lower. Our findings also describe the clinical details of LLOD, recurrent infections, and infections in twin siblings. This study is the largest among Asian childhood GBS studies ever reported.

Geometrical characteristics of aortic root and left ventricular dysfunction in aortic stenosis: quantification of 256-slice coronary CT angiography.

The purpose of this study is to analyze the geometrical characteristics of aortic root and left ventricular (LV) function in aortic stenosis (AS) using 256-slice coronary-computed tomography angiography (CCTA). Retrospective ECG-gated 256-slice CCTA data from 32 patients with tricuspid AS scheduled for aortic valve replacement, and 11 controls were analyzed. Aortic root geometry was measured using multiplanar reconstruction CT images. CCTA data set was transformed into 100 phases/cycle using motion coherence image processing. Systolic shortening (SS, mm/ms) and diastolic relaxation (DR, mm/ms2) in the circumferential and longitudinal directions on time curves of myocardial length were calculated, and were used as estimates of geometric LV function. Comparison of parameters was analyzed by Mann-Whitney U test. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff of parameters for differentiating AS patients. Height of the right coronary cusp was significantly lower for AS patients than controls (11.4 ± 2.4 vs. 13.9 ± 2.0 mm/m2, p < 0.005). Vertical-longitudinal SS was significantly lower for AS patients than for controls (1.7 ± 0.8 vs. 2.7 ± 0.7 mm/ms/m2, p < 0.001). ROC analysis revealed optimal height of the right coronary cusp of 12.4 mm/m2 and vertical-longitudinal SS of 2.4 mm/ms/m2 for differentiating AS patients from controls, with C statistics of 0.82 and 0.85. In AS patients, ROC analysis revealed optimal vertical-longitudinal DR of 0.05 mm/ms2/m2 for predicting patients with stroke volume index <35 ml with C statistics of 0.93. Quantification of CCTA demonstrates that AS is characterized by small coronary cusps as aortic root remodeling and vertical-longitudinal LV dysfunction related to restrictive physiology.

Additive value of "otosclerosis-weighted" images for the CT diagnosis of fenestral otosclerosis.

Background Otosclerotic foci are usually seen as minute low-density lesions and this may be attributed to relatively low sensitivity on visual assessment using computed tomography (CT). Otosclerotic foci can be detected by using the accurate region of interest (ROI) setting, while small ROI settings by less-experienced radiologists may result in false negative findings. Purpose To evaluate the diagnostic ability of our proposed method ("otosclerosis-weighted" imaging [OWI]), which is based on reversing the density, compared with conventional CT (CCT) imaging alone. Material and Methods Temporal bone CTs of consecutive patients with otosclerosis were analyzed. Gender- and age-matched control participants were also included. All CT images were obtained using a 64-detector row scanner. OWI was obtained by extracting the temporal bone region using the threshold technique and reversing the density (black to white). Four independent radiologists took part in two reading sessions. In the first session, the observers read only CCT imaging. In the second session, they read OWI along with the CCT imaging. Sensitivity was assessed for the four readers. Results Thirty temporal bones of 25 patients with otosclerosis (3 men, 22 women; mean age, 53.9 ± 9.0 years) and 30 temporal bones of 30 control participants (4 men, 26 women; mean age, 44.0 ± 16.2 years) were included. For all observers, reading with a combination of the two methods was associated with a higher sensitivity (63.3-80.0%) than with conventional CT images alone (30.0-60.0%; P < 0.05, each). Conclusion Application of our proposed method based on threshold value may help detect foci of fenestral otosclerosis.

Prognostic Utility of Computed Tomography Histogram Analysis in Patients With Post-Cardiac Arrest Syndrome: Evaluation Using an Automated Whole-Brain Extraction Algorithm.

OBJECTIVE: The aim of the study was to evaluate the prognostic utility of computed tomography (CT) histogram analysis with an automated whole-brain extraction algorithm in patients with post-cardiac arrest syndrome (PCAS). METHODS: Computed tomography data from consecutive patients between January 2009 and February 2012 were obtained and retrospectively analyzed. All CT images were obtained using a 64-detector-row CT scanner with a slice thickness of 4.0 mm. A brain region was extracted from the whole-brain CT images using our original automated algorithm and used for the subsequent histogram analysis. The obtained histogram statistics (mean brain tissue CT value, kurtosis, and skewness), as well as clinical parameters, were compared between the good and poor outcome groups using the Student t test. In addition, receiver operating characteristic curve analysis was performed for the discrimination between the 2 groups for each parameter. RESULTS: One hundred thirty-eight consecutive PCAS patients were enrolled. The patients were classified into good (n = 47) and poor (n = 91) outcome groups. The mean brain tissue CT value was significantly higher in the good outcome group than in the poor outcome group (P < 0.05). Kurtosis, skewness, and age were significantly lower in the good outcome group than in the poor outcome group (P < 0.0001, P < 0.05, and P < 0.05, respectively). The area-under-the-curve values for kurtosis, mean brain tissue CT value, skewness, and age were 0.751, 0.639, 0.623, and 0.626, respectively. A combination of the 4 parameters increased the diagnostic performance (area under the curve = 0.814). CONCLUSIONS: Histogram analysis of whole-brain CT images with our automated extraction algorithm is useful for assessing the outcome of PCAS patients.

Current incidence of clinical kernicterus in preterm infants in Japan.

Clinical kernicterus in preterm infants has recently been reported in Japan, diagnosed on the basis of clinical findings during the neonatal and infancy periods. We investigated the incidence of clinical kernicterus in preterm infants <30 weeks gestational age (GA) based on a nationwide survey conducted in 233 certified educational facilities for neonatologists. The numbers of infants admitted and infants who died within 14 days after birth during 2011, and the number of infants who subsequently developed clinical kernicterus, were recorded. A total of 2720 infants were analyzed, representing 59% (2720/4623) of all preterm live births <30 weeks GA in Japan in 2011. Of these, 159 (5.8%) died within 14 days after birth, similar to the national rate. Five infants developed clinical kernicterus in infancy (5/2720, 0.18%). The current incidence of clinical kernicterus in Japan is therefore estimated at 1.8 per 1000 live births <30 weeks GA.

Subcutaneous fat necrosis after selective head cooling in an infant.

Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Selective head cooling was provided for 72 h after birth. SCFN developed on the patient's cheeks and back at the age of 21 days. Thus, SCFN may be caused by selective head cooling, similarly to whole-body cooling.

Characteristics of the deep learning-based virtual monochromatic image with fast kilovolt-switching CT: a phantom study.

PURPOSE: We assessed the physical properties of virtual monochromatic images (VMIs) obtained with different energy levels in various contrast settings and radiation doses using deep learning-based spectral computed tomography (DL-Spectral CT) and compared the results with those from single-energy CT (SECT) imaging. MATERIALS AND METHODS: A Catphan® 600 phantom was scanned by DL-Spectral CT at various radiation doses. We reconstructed the VMIs obtained at 50, 70, and 100 keV. SECT (120 kVp) images were acquired at the same radiation doses. The standard deviations of the CT number and noise power spectrum (NPS) were calculated for noise characterization. We evaluated the spatial resolution by determining the 10% task-based transfer function (TTF) level, and we assessed the task-based detectability index (d'). RESULTS: Regardless of the radiation dose, the noise was the lowest at 70 keV VMI. The NPS showed that the noise amplitude at all spatial frequencies was the lowest among other VMI and 120 kVp images. The spatial resolution was higher for 70 keV VMI compared to the other VMIs, except for high-contrast objects. The d' of 70 keV VMI was the highest among the VMI and 120 kVp images at all radiation doses and contrast settings. The d' of the 70 keV VMIs at the minimum dose was higher than that at the maximum dose in any other image. CONCLUSION: The physical properties of the DL-Spectral CT VMIs varied with the energy level. The 70 keV VMI had the highest detectability by far among the VMI and 120-kVp images. DL-Spectral CT may be useful to reduce radiation doses.

Neonatal asphyxia as an inflammatory disease: Reactive oxygen species and cytokines.

Neonatologists resuscitate asphyxiated neonates by every available means, including positive ventilation, oxygen therapy, and drugs. Asphyxiated neonates sometimes present symptoms that mimic those of inflammation, such as fever and edema. The main pathophysiology of the asphyxia is inflammation caused by hypoxic-ischemic reperfusion. At birth or in the perinatal period, neonates may suffer several, hypoxic insults, which can activate inflammatory cells and inflammatory mediator production leading to the release of larger quantities of reactive oxygen species (ROS). This in turn triggers the production of oxygen stress-induced high mobility group box-1 (HMGB-1), an endogenous damage-associated molecular patterns (DAMPs) protein bound to toll-like receptor (TLR) -4, which activates nuclear factor-kappa B (NF-κB), resulting in the production of excess inflammatory mediators. ROS and inflammatory mediators are produced not only in activated inflammatory cells but also in non-immune cells, such as endothelial cells. Hypothermia inhibits pro-inflammatory mediators. A combination therapy of hypothermia and medications, such as erythropoietin and melatonin, is attracting attention now. These medications have both anti-oxidant and anti-inflammatory effects. As the inflammatory response and oxidative stress play a critical role in the pathophysiology of neonatal asphyxia, these drugs may contribute to improving patient outcomes.