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Neurostimulation employing photoactive organic semiconductors offers an appealing alternative to conventional techniques, enabling targeted action and wireless control through light. In this study, organic electrolytic photocapacitors (OEPC) are employed to investigate the effects of light-controlled electric stimulation on neuronal networks in vitro and in vivo. The interactions between the devices and biological systems are characterized. Stimulation of primary rat cortical neurons results in an elevated expression of c-Fos within a mature neuronal network. OEPC implantation for three weeks and subsequent stimulation of the somatosensory cortex leads to an increase of c-Fos in neurons at the stimulation site and in connected brain regions (entorhinal cortex, hippocampus), both in the ipsi- and contralateral hemispheres. Reactivity of glial and immune cells after semi-chronic implantation of OEPC in the rat brain is comparable to that of surgical controls, indicating minimal foreign body response. Device functionality is further substantiated through retained charging dynamics following explantation. OEPC-based, light-controlled electric stimulation has a significant impact on neural responsiveness. The absence of detrimental effects on both the brain and device encourages further use of OEPC as cortical implants. These findings highlight its potential as a novel mode of neurostimulation and instigate further exploration into applications in fundamental neuroscience.
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OBJECTIVES: Robustness of radiomic features in physiological tissue is an important prerequisite for quantitative analysis of tumor biology and response assessment. In contrast to previous studies which focused on different tumors with mostly short scan-re-scan intervals, this study aimed to evaluate the robustness of radiomic features in cancer-free patients and over a clinically encountered inter-scan interval. MATERIALS AND METHODS: Patients without visible tumor burden who underwent at least two portal-venous phase dual energy CT examinations of the abdomen between May 2016 and January 2020 were included, while macroscopic tumor burden was excluded based upon follow-up imaging for all patients (≥3 months). Further, patients were excluded if no follow-up imaging was available, or if the CT protocol showed deviations between repeated examinations. Circular regions of interest were placed and proofread by two board-certified radiologists (4 years and 5 years experience) within the liver (segments 3 and 6), the psoas muscle (left and right), the pancreatic head, and the spleen to obtain radiomic features from normal-appearing organ parenchyma using PyRadiomics. Radiomic feature robustness was tested using the concordance correlation coefficient with a threshold of 0.75 considered indicative for deeming a feature robust. RESULTS: In total, 160 patients with 480 repeated abdominal CT examinations (range: 2-4 per patient) were retrospectively included in this single-center, IRB-approved study. Considering all organs and feature categories, only 4.58 % (25/546) of all features were robust with the highest rate being found in the first order feature category (20.37 %, 22/108). Other feature categories (grey level co-occurrence matrix, grey level dependence matrix, grey level run length matrix, grey level size zone matrix, and neighborhood gray-tone difference matrix) yielded an overall low percentage of robust features (range: 0.00 %-1.19 %). A subgroup analysis revealed the reconstructed field of view and the X-ray tube current as determinants of feature robustness (significant differences in subgroups for all organs, p < 0.001) as well as the size of the region of interest (no significant difference for the pancreatic head with p = 0.135, significant difference with p < 0.001 for all other organs). CONCLUSION: Radiomic feature robustness obtained from cancer-free subjects with repeated examinations using a consistent protocol and CT scanner was limited, with first order features yielding the highest proportion of robust features.
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Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Tomografia Computadorizada por Raios X/métodos , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Idoso , Adulto , Estudos Retrospectivos , Pâncreas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Radiografia Abdominal/métodos , Idoso de 80 Anos ou mais , Baço/diagnóstico por imagem , Tecido Parenquimatoso/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , RadiômicaRESUMO
PURPOSE: To investigate the potential of combining Compressed Sensing (CS) and a newly developed AI-based super resolution reconstruction prototype consisting of a series of convolutional neural networks (CNN) for a complete five-minute 2D knee MRI protocol. METHODS: In this prospective study, 20 volunteers were examined using a 3T-MRI-scanner (Ingenia Elitionâ¯X,â¯Philips). Similar to clinical practice, the protocol consists of a fat-saturated 2D-proton-density-sequence in coronal, sagittal and transversal orientation as well as a sagittal T1-weighted sequence. The sequences were acquired with two different resolutions (standard and low resolution) and the raw data reconstructed with two different reconstruction algorithms: a conventional Compressed SENSE (CS) and a new CNN-based algorithm for denoising and subsequently to interpolate and therewith increase the sharpness of the image (CS-SuperRes). Subjective image quality was evaluated by two blinded radiologists reviewing 8 criteria on a 5-point Likert scale and signal-to-noise ratio calculated as an objective parameter. RESULTS: The protocol reconstructed with CS-SuperRes received higher ratings than the time-equivalent CS reconstructions, statistically significant especially for low resolution acquisitions (e.g., overall image impression: 4.3⯱â¯0.4 vs. 3.4⯱â¯0.4, pâ¯<â¯0.05). CS-SuperRes reconstructions for the low resolution acquisition were comparable to traditional CS reconstructions with standard resolution for all parameters, achieving a scan time reduction from 11:01â¯min to 4:46â¯min (57â¯%) for the complete protocol (e.g. overall image impression: 4.3⯱â¯0.4 vs. 4.0⯱â¯0.5, pâ¯<â¯0.05). CONCLUSION: The newly-developed AI-based reconstruction algorithm CS-SuperRes allows to reduce scan time by 57% while maintaining unchanged image quality compared to the conventional CS reconstruction.
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Algoritmos , Voluntários Saudáveis , Articulação do Joelho , Imageamento por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Feminino , Estudos Prospectivos , Adulto , Articulação do Joelho/diagnóstico por imagem , Compressão de Dados/métodos , Redes Neurais de Computação , Pessoa de Meia-Idade , Razão Sinal-Ruído , Interpretação de Imagem Assistida por Computador/métodos , Adulto JovemRESUMO
BACKGROUND: While computed tomography pulmonary angiography (CTPA) is an integral part of the work-up in patients with suspected pulmonary hypertension (PH), there is no established CTPA-derived prognostic marker. We aimed to assess whether quantitative readouts of lung vessel morphology correlate with established prognostic indicators in PH. METHODS: We applied a fully-automatic in-house developed algorithm for segmentation of arteries and veins to determine lung vessel morphology in patients with precapillary PH who underwent right heart catheterization and CTPA between May 2016 and May 2019. Primary endpoint of this retrospective study was the calculation of receiver operating characteristics for identifying low and high mortality risk according to the 3-strata risk assessment model presented in the current guidelines. RESULTS: We analyzed 73 patients, median age 65 years (interquartile range (IQR): 54-76), female/male ratio 35/38, median mean pulmonary arterial pressure 37 mm Hg (IQR: 30-46), and found significant correlations with important prognostic factors in pulmonary arterial hypertension. N-terminal pro-brain natriuretic peptide, cardiac index, mixed venous oxygen saturation, and 6-minute walking distance were correlated with the ratio of the number of arteries over veins with vessel diameters of 6-10 mm (Spearman correlation coefficients ρ = 0.64, p < 0.001; ρ = -0.60, p < 0.001; ρ = -0.47, p = 0.005; ρ = -0.45, p = 0.001, respectively). This ratio predicted a low- and high-risk score with an area under the curve of 0.73 (95% confidence interval (CI): 0.56-0.90) and 0.86 (95% CI: 0.74-0.97), respectively. CONCLUSIONS: The ratio of the number of arteries over veins with diameters between 6 and 10 mm is significantly correlated with prognostic markers in pulmonary hypertension and predicts low and high mortality risk.
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Hipertensão Pulmonar , Humanos , Masculino , Feminino , Idoso , Hipertensão Pulmonar/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Artéria Pulmonar/diagnóstico por imagem , PulmãoRESUMO
This study aimed to compare the image quality and diagnostic accuracy of deep-learning-based image denoising reconstructions (DLIDs) to established iterative reconstructed algorithms in low-dose computed tomography (LDCT) of patients with suspected urolithiasis. LDCTs (CTDIvol, 2 mGy) of 76 patients (age: 40.3 ± 5.2 years, M/W: 51/25) with suspected urolithiasis were retrospectively included. Filtered-back projection (FBP), hybrid iterative and model-based iterative reconstruction (HIR/MBIR, respectively) were reconstructed. FBP images were processed using a Food and Drug Administration (FDA)-approved DLID. ROIs were placed in renal parenchyma, fat, muscle and urinary bladder. Signal- and contrast-to-noise ratios (SNR/CNR, respectively) were calculated. Two radiologists evaluated image quality on five-point Likert scales and urinary stones. The results showed a progressive decrease in image noise from FBP, HIR and DLID to MBIR with significant differences between each method (p < 0.05). SNR and CNR were comparable between MBIR and DLID, while it was significantly lower in HIR followed by FBP (e.g., SNR: 1.5 ± 0.3; 1.4 ± 0.4; 1.0 ± 0.3; 0.7 ± 0.2, p < 0.05). Subjective analysis confirmed best image quality in MBIR, followed by DLID and HIR, both being superior to FBP (p < 0.05). Diagnostic accuracy for urinary stone detection was best using MBIR (0.94), lowest using FBP (0.84) and comparable between DLID (0.90) and HIR (0.90). Stone size measurements were consistent between all reconstructions and showed excellent correlation (r2 = 0.958-0.975). In conclusion, MBIR yielded the highest image quality and diagnostic accuracy, with DLID producing better results than HIR and FBP in image quality and matching HIR in diagnostic precision.
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OBJECTIVES: To investigate photon-counting CT (PCCT)-derived virtual monoenergetic images (VMI) for artifact reduction in patients with unilateral total hip replacements (THR). METHODS: Forty-two patients with THR and portal-venous phase PCCT of the abdomen and pelvis were retrospectively included. For the quantitative analysis, region of interest (ROI)-based measurements of hypodense and hyperdense artifacts, as well as of artifact-impaired bone and the urinary bladder, were conducted, and corrected attenuation and image noise were calculated as the difference of attenuation and noise between artifact-impaired and normal tissue. Two radiologists qualitatively evaluated artifact extent, bone assessment, organ assessment, and iliac vessel assessment using 5-point Likert scales. RESULTS: VMI110keV yielded a significant reduction of hypo- and hyperdense artifacts compared to conventional polyenergetic images (CI) and the corrected attenuation closest to 0, indicating best possible artifact reduction (hypodense artifacts: CI: 237.8 ± 71.4 HU, VMI110keV: 8.5 ± 122.5 HU; p < 0.05; hyperdense artifacts: CI: 240.6 ± 40.8 HU vs. VMI110keV: 13.0 ± 110.4 HU; p < 0.05). VMI110keV concordantly provided best artifact reduction in the bone and bladder as well as the lowest corrected image noise. In the qualitative assessment, VMI110keV received the best ratings for artifact extent (CI: 2 (1-3), VMI110keV: 3 (2-4); p < 0.05) and bone assessment (CI: 3 (1-4), VMI110keV: 4 (2-5); p < 0.05), whereas organ and iliac vessel assessments were rated highest in CI and VMI70keV. CONCLUSIONS: PCCT-derived VMI effectively reduce artifacts from THR and thereby improve assessability of circumjacent bone tissue. VMI110keV yielded optimal artifact reduction without overcorrection, yet organ and vessel assessments at that energy level and higher were impaired by loss of contrast. CLINICAL RELEVANCE STATEMENT: PCCT-enabled artifact reduction is a feasible method for improving assessability of the pelvis in patients with total hip replacements at clinical routine imaging. KEY POINTS: ⢠Photon-counting CT-derived virtual monoenergetic images at 110 keV yielded best reduction of hyper- and hypodense artifacts, whereas higher energy levels resulted in artifact overcorrection. ⢠The qualitative artifact extent was reduced best in virtual monoenergetic images at 110 keV, facilitating an improved assessment of the circumjacent bone. ⢠Despite significant artifact reduction, assessment of pelvic organs as well as vessels did not profit from energy levels higher than 70 keV, due to the decline in image contrast.
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Artroplastia de Quadril , Humanos , Artefatos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Osso e Ossos , Interpretação de Imagem Radiográfica Assistida por Computador/métodosRESUMO
Purpose: The bone marrow's iodine uptake in dual-energy CT (DECT) is elevated in malignant disease. We aimed to investigate the physiological range of bone marrow iodine uptake after intravenous contrast application, and examine its dependence on vBMD, iodine blood pool, patient age, and sex. Method: Retrospective analysis of oncological patients without evidence of metastatic disease. DECT examinations were performed on a spectral detector CT scanner in portal venous contrast phase. The thoracic and lumbar spine were segmented by a pre-trained neural network, obtaining volumetric iodine concentration data [mg/ml]. vBMD was assessed using a phantomless, CE-certified software [mg/cm3]. The iodine blood pool was estimated by ROI-based measurements in the great abdominal vessels. A multivariate regression model was fit with the dependent variable "median bone marrow iodine uptake". Standardized regression coefficients (ß) were calculated to assess the impact of each covariate. Results: 678 consecutive DECT exams of 189 individuals (93 female, age 61.4 ± 16.0 years) were evaluated. AI-based segmentation provided volumetric data of 97.9% of the included vertebrae (n=11,286). The 95th percentile of bone marrow iodine uptake, as a surrogate for the upper margin of the physiological distribution, ranged between 4.7-6.4 mg/ml. vBMD (p <0.001, mean ß=0.50) and portal vein iodine blood pool (p <0.001, mean ß=0.43) mediated the strongest impact. Based thereon, adjusted reference values were calculated. Conclusion: The bone marrow iodine uptake demonstrates a distinct profile depending on vBMD, iodine blood pool, patient age, and sex. This study is the first to provide the adjusted reference values.
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Inteligência Artificial , Iodo , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Medula Óssea/diagnóstico por imagem , Valores de Referência , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Left atrial outpouching structures such as left atrial diverticula (LADs) and left-sided septal pouches (LSSPs) might be a source of cryptogenic stroke. This imaging study evaluates the association between pouch morphology, patient comorbidities and ischemic brain lesions (IBLs). METHODS: This is a retrospective single-center analysis of 195 patients who received both a cardiac CT and a cerebral MRI. LADs, LSSPs, and IBLs were retrospectively identified. Size measurements included pouch width, length and volume for LADs and circumference, area and volume for LSSPs. The association between LADs/LSSPs, IBLs and cardiovascular comorbidities was determined by univariate and bivariate regression analyses. RESULTS: The prevalence and mean volume were 36.4% and 372 ± 569 mm3 for LSSPs, and 40.5% and 415 ± 541 mm3 for LADs. The IBL prevalence was 67.6% in the LSSP group and 48.1% in the LAD group. LSSPs had 2.9-fold increased hazards of IBLs (95%CI: 1.2-7.4, p = 0.024), and LADs showed no significant correlation with IBLs. Size measurements had no impact on IBLs. A co-existing LSSP was associated with an increased prevalence of IBLs in patients with coronary artery disease (HR: 1.5, 95%CI: 1.1-1.9, p = 0.048), heart failure (HR: 3.7, 95%CI: 1.1-14.6, p = 0.032), arterial hypertension (HR: 1.9, 95%CI: 1.1-3.3, p = 0.017), and hyperlipidemia (HR: 2.2, 95%CI: 1.1-4.4, p = 0.018). CONCLUSION: Co-existing LSSPs were associated with IBLs in patients with cardiovascular risk factors, however, pouch morphology did not correlate with the IBL rate. Upon confirmation by further studies, these findings might be considered in the treatment, risk stratification, and stroke prophylaxis of these patients.
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Fibrilação Atrial , Doenças Cardiovasculares , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Fibrilação Atrial/complicações , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Fatores de Risco de Doenças Cardíacas , EncéfaloRESUMO
Artificial intelligence (AI) is an emerging technology in healthcare and holds the potential to disrupt many arms in medical care. In particular, disciplines using medical imaging modalities, including e.g. radiology but ophthalmology as well, are already confronted with a wide variety of AI implications. In ophthalmologic research, AI has demonstrated promising results limited to specific diseases and imaging tools, respectively. Yet, implementation of AI in clinical routine is not widely spread due to availability, heterogeneity in imaging techniques and AI methods. In order to describe the status quo, this narrational review provides a brief introduction to AI ("what the ophthalmologist needs to know"), followed by an overview of different AI-based applications in ophthalmology and a discussion on future challenges.Abbreviations: Age-related macular degeneration, AMD; Artificial intelligence, AI; Anterior segment OCT, AS-OCT; Coronary artery calcium score, CACS; Convolutional neural network, CNN; Deep convolutional neural network, DCNN; Diabetic retinopathy, DR; Machine learning, ML; Optical coherence tomography, OCT; Retinopathy of prematurity, ROP; Support vector machine, SVM; Thyroid-associated ophthalmopathy, TAO.
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Retinopatia Diabética , Oftalmologia , Humanos , Inteligência Artificial , Aprendizado de Máquina , Redes Neurais de Computação , Oftalmologia/métodosRESUMO
OBJECTIVE: The aim of this study was to investigate the impact of left atrial diverticula (LADs), left sided septal pouches (LSSPs) and middle right pulmonary veins (MRPVs) on recurrent atrial fibrillation (rAF) in patients undergoing laser pulmonary vein isolation procedure (PVI). MATERIAL AND METHODS: This retrospective study enrolled 139 patients with pre-procedural multiple detector computed tomography (MDCT) imaging and 12 months follow-up examination. LADs, LSSPs and MRPV were identified by two radiologists on a dedicated workstation using multiplanar reconstructions and volume rendering technique. Univariate and bivariate regression analyses with patient demographics and cardiovascular risk factors as covariates were performed to reveal independent factors associated with rAF. RESULTS: LADs were recorded in 41 patients (29%), LSSPs in 20 (14%) and MRPVs in 15 (11%). The right anterosuperior wall of the left atrium was the most prevalent location of LADs (68%). rAF occured in 20 patients, thereof, 15 exhibited an outpouching structure of the left atrium (LAD: 9, LSSP: 2 and MRPV: 3). Presence of an LAD (HR: 2.7, 95%CI: 1.0-8.4, p = 0.04) and permanent AF (HR: 4.8, 95%CI: 1.5-16.3, p = 0.01) were independently associated with rAF. CONCLUSIONS: LAD, LSSP and MRPV were common findings on pre-procedural cardiac computed tomography. LADs were revealed as potential independent risk factor of rAF, which might be considered for treatment planning and post-treatment observation.
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Fibrilação Atrial , Ablação por Cateter , Divertículo , Veias Pulmonares , Humanos , Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Estudos Retrospectivos , Recidiva , Resultado do Tratamento , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Átrios do Coração , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgiaRESUMO
OBJECTIVES: The aim of this study was to evaluate whether simple 2D measurements in axial slices of head and neck CT examinations correlate with generally established measurements of body composition in abdominal CT at the height of the third lumbar vertebra and thus allow for an estimation of muscle and fat masses. METHODS: One hundred twenty-two patients who underwent concurrent CT of the head and neck and the abdomen between July 2016 and July 2020 were retrospectively included. For a subset of 30 patients, additional bioelectrical impedance analysis (BIA) was available. Areas of paraspinal muscles at the height of the third (C3) and fifth cervical vertebrae (C5) as well as the total cross-sectional area at the height of C3 and at the submandibular level were correlated with the results of abdominal measurements and BIA. Furthermore, intra- and interreader variabilities of all measurements were assessed. RESULTS: Regarding adipose tissue, good correlations were found between the total cross-sectional area of the patient's body at the submandibular level and at the height of C3 between both abdominal measurements and BIA results (r = 0.8-0.92; all p < 0.001). Regarding muscle, the total paraspinal muscle area at the height of C3 and C5 showed strong correlations with abdominal measurements and moderate to strong correlations with BIA results (r = 0.44-0.80; all p < 0.001), with the muscle area on C5 yielding slightly higher correlations. CONCLUSIONS: Body composition information can be obtained with comparable reliability from head and neck CT using simple biplanar measurements as from abdominal CT. KEY POINTS: ⢠The total paraspinal muscle area at the height of C3 and C5 correlates strongly with abdominal muscle mass. ⢠The total cross-sectional area at the submandibular level and at the height of C3 shows good correlations with abdominal fat mass. ⢠The described measurements facilitate a rapid, opportunistic assessment of relevant body composition parameters.
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Composição Corporal , Tomografia Computadorizada por Raios X , Abdome , Composição Corporal/fisiologia , Impedância Elétrica , Humanos , Músculo Esquelético , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
Virtual non-calcium (VNCa) images from dual-energy computed tomography (DECT) have shown high potential to diagnose bone marrow disease of the spine, which is frequently disguised by dense trabecular bone on conventional CT. In this study, we aimed to define reference values for VNCa bone marrow images of the spine in a large-scale cohort of healthy individuals. DECT was performed after resection of a malignant skin tumor without evidence of metastatic disease. Image analysis was fully automated and did not require specific user interaction. The thoracolumbar spine was segmented by a pretrained convolutional neuronal network. Volumetric VNCa data of the spine's bone marrow space were processed using the maximum, medium, and low calcium suppression indices. Histograms of VNCa attenuation were created for each exam and suppression setting. We included 500 exams of 168 individuals (88 female, patient age 61.0 ± 15.9). A total of 8298 vertebrae were segmented. The attenuation histograms' overlap of two consecutive exams, as a measure for intraindividual consistency, yielded a median of 0.93 (IQR: 0.88-0.96). As our main result, we provide the age- and sex-specific bone marrow attenuation profiles of a large-scale cohort of individuals with healthy trabecular bone structure as a reference for future studies. We conclude that artificial-intelligence-supported, fully automated volumetric assessment is an intraindividually robust method to image the spine's bone marrow using VNCa data from DECT.
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PURPOSE: To investigate the diagnostic value of spectral detector CT (SDCT)-derived virtual non-contrast (VNC), virtual monoenergetic images (VMI) and iodine overlays (IO) for distinguishing infected from noninfected fluid collections (FC) in the chest or abdomen. METHOD: This retrospective study included 58 patients with venous phase SDCT with 77 FC. For all included FC, microbiological analysis of aspirated fluid served as reference. For quantitative analysis, wall thickness was measured, and (ROI)-based analysis performed within the fluid, the FC's wall (if any) and the aorta. Two radiologists qualitatively evaluated visibility of wall enhancement, diagnostic confidence regarding infection of fluid collection, confidence of CT-guided drainage catheter placement and visibility of anatomical landmarks in conventional images (CI) and VNC, VMI40keV, IO. RESULTS: Wall thickness significantly differed between infected (n = 46) and noninfected (n = 31) FC (3.5 ± 1.8 mm vs. 1.4 ± 1.8 mm, AUC = 0.81; p < 0.05). Fluid attenuation and wall enhancement was significantly higher in infected as compared to noninfected FC in all reconstructions (p < 0.05, respectively). Highest AUC regarding A) attenuation in fluid was yielded in CI and VMI70,80keV (0.75); B) wall enhancement in CI (0.88) followed by iodine concentration (0.86). Contrast-to-noise ratio of wall vs. fluid was highest in VMI40keV (p < 0.05). All assessed qualitative parameters received significantly higher ratings when using spectral reconstructions vs. CI (p for all <0.05), except for visibility of wall enhancement. CONCLUSION: Spectral reconstructions improve the assessment of infected from noninfected thoracoabdominal fluid collections and depiction of wall enhancement. Diagnostic performance of the quantitative measurements in spectral reconstructions were comparable with measurements in conventional images.
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Iodo , Tomografia Computadorizada por Raios X , Abdome , Drenagem , Humanos , Estudos Retrospectivos , Razão Sinal-RuídoRESUMO
Computed tomography in suspected urolithiasis provides information about the presence, location and size of stones. Particularly stone size is a key parameter in treatment decision; however, data on impact of reformatation and measurement strategies is sparse. This study aimed to investigate the influence of different image reformatations, slice thicknesses and window settings on stone size measurements. Reference stone sizes of 47 kidney stones representative for clinically encountered compositions were measured manually using a digital caliper (Man-M). Afterwards stones were placed in a 3D-printed, semi-anthropomorphic phantom, and scanned using a low dose protocol (CTDIvol 2 mGy). Images were reconstructed using hybrid-iterative and model-based iterative reconstruction algorithms (HIR, MBIR) with different slice thicknesses. Two independent readers measured largest stone diameter on axial (2 mm and 5 mm) and multiplanar reformatations (based upon 0.67 mm reconstructions) using different window settings (soft-tissue and bone). Statistics were conducted using ANOVA ± correction for multiple comparisons. Overall stone size in CT was underestimated compared to Man-M (8.8 ± 2.9 vs. 7.7 ± 2.7 mm, p < 0.05), yet closely correlated (r = 0.70). Reconstruction algorithm and slice thickness did not significantly impact measurements (p > 0.05), while image reformatations and window settings did (p < 0.05). CT measurements using multiplanar reformatation with a bone window setting showed closest agreement with Man-M (8.7 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05, r = 0.83). Manual CT-based stone size measurements are most accurate using multiplanar image reformatation with a bone window setting, while measurements on axial planes with different slice thicknesses underestimate true stone size. Therefore, this procedure is recommended when impacting treatment decision.
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Cálculos Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Cálculos Renais/patologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodosRESUMO
OBJECTIVE: Liver cancer is one of the most commonly diagnosed cancer, and energy-based tumor ablation is a widely accepted treatment. Automatic and robust segmentation of liver tumors and ablation zones would facilitate the evaluation of treatment success. The purpose of this study was to develop and evaluate an automatic deep learning based method for (1) segmentation of liver and liver tumors in both arterial and portal venous phase for pre-treatment CT, and (2) segmentation of liver and ablation zones in both arterial and portal venous phase for after ablation treatment. MATERIALS AND METHODS: 252 CT images from 63 patients undergoing liver tumor ablation at a large University Hospital were retrospectively included; each patient had pre-treatment and post-treatment multi-phase CT images. 3D voxel-wise manual segmentation of the liver, tumors and ablation region by the radiologist provided reference standard. Deep learning models for liver and lesion segmentation were initially trained on the public Liver Tumor Segmentation Challenge (LiTS) dataset to obtain base models. Then, transfer learning was applied to adapt the base models on the clinical training-set, to obtain tumor and ablation segmentation models both for arterial and portal venous phase images. For modeling, 2D residual-attention Unet (RA-Unet) was employed for liver segmentation and a multi-scale patch-based 3D RA-Unet for tumor and ablation segmentation. RESULTS: On the independent test-set, the proposed method achieved a dice similarity coefficient (DSC) of 0.96 and 0.95 for liver segmentation on arterial and portal venous phase, respectively. For liver tumors, the model on arterial phase achieved detection sensitivity of 71%, DSC of 0.64, and on portal venous phase sensitivity of 82%, DSC of 0.73. For liver tumors >0.5cm3 performance improved to sensitivity 79%, DSC 0.65 on arterial phase and, sensitivity 86%, DSC 0.72 on portal venous phase. For ablation zone, the model on arterial phase achieved detection sensitivity of 90%, DSC of 0.83, and on portal venous phase sensitivity of 90%, DSC of 0.89. CONCLUSION: The proposed deep learning approach can provide automated segmentation of liver tumors and ablation zones on multi-phase (arterial and portal venous) and multi-time-point (before and after treatment) CT enabling quantitative evaluation of treatment success.
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BACKGROUND: Increased vessel contrast in low-keV virtual monoenergetic images (VMI) in spectral detector CT angiography of the head and neck requires adaption of window settings. Aim of this study was to define generally applicable window settings of low-keV VMI. METHODS: Two radiologists determined ideal subjective window settings for VMI40-70 keV in 54 patients. To obtain generally applicable window settings, center and width values were modeled against the attenuation of the internal carotid artery (HUICA). This modeling was performed with and without respect to keV. Subsequently, image quality of VMI40-70 keV was assessed using the model-based determined window settings. RESULTS: With decreasing keV values, HUICA increased significantly in comparison to conventional images (CI) (P<0.05 for 40-60 keV). No significant differences between modelled and individually recorded window settings were found confirming validity of the obtained models (P values: 0.2-1.0). However, modelling with respect to keV was marginally less precise. CONCLUSIONS: Window settings of low-keV VMI can be semi-automatically determined in dependency of the ICA attenuation in spectral detector CTA of the head and neck. The reported models are a promising tool to leverage the improved image quality of these images in clinical routine.
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OBJECTIVES: To investigate whether virtual monoenergetic images (VMI) and iodine maps derived from spectral detector computed tomography (SDCT) improve early assessment of technique efficacy in patients who underwent microwave ablation (MWA) for hepatocellular carcinoma (HCC) in liver cirrhosis. METHODS: This retrospective study comprised 39 patients with 49 HCC lesions treated with MWA. Biphasic SDCT was performed 7.7±4.0 days after ablation. Conventional images (CI), VMI and IM were reconstructed. Signal- and contrast-to-noise ratio (SNR, CNR) in the ablation zone (AZ), hyperemic rim (HR) and liver parenchyma were calculated using regions-of-interest analysis and compared between CI and VMI between 40-100 keV. Iodine concentration and perfusion ratio of HR and residual tumor (RT) were measured. Two readers evaluated subjective contrast of AZ and HR, technique efficacy (complete vs. incomplete ablation) and diagnostic confidence at determining technique efficacy. RESULTS: Attenuation of liver parenchyma, HR and RT, SNR of liver parenchyma and HR, CNR of AZ and HR were significantly higher in low-keV VMI compared to CI (all p<0.05). Iodine concentration and perfusion ratio differed significantly between HR and RT (all p<0.05; e.g. iodine concentration, 1.6±0.5 vs. 2.7±1.3 mg/ml). VMI50keV improved subjective AZ-to-liver contrast, HR-to-liver contrast, visualization of AZ margin and vessels adjacent to AZ compared to CI (all p<0.05). Diagnostic accuracy for detection of incomplete ablation was slightly higher in VMI50keV compared to CI (0.92 vs. 0.89), while diagnostic confidence was significantly higher in VMI50keV (p<0.05). CONCLUSIONS: Spectral detector computed tomography derived low-keV virtual monoenergetic images and iodine maps provide superior early assessment of technique efficacy of MWA in HCC compared to CI.
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Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Algoritmos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Razão Sinal-RuídoRESUMO
The acute abdomen is a potentially life-threatening condition and requires a rapid diagnosis. After clinical inspection and in cases with unclear ultrasound findings or unclear serious symptoms computed tomography (CT) and in pregnant women and children magnetic resonance imaging (MRI) is usually necessary. This second part of "Imaging in the acute abdomen" focuses on frequent organ specific causes of the gastrointestinal tract and the urogenital system.
Assuntos
Abdome Agudo , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Criança , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Gravidez , Tomografia Computadorizada por Raios X , Sistema Urogenital/diagnóstico por imagemRESUMO
The acute abdomen is characterized by acute abdominal pain with defensive muscular tension, can be triggered by a variety of diseases and sometimes represents a life-threatening condition. After clinical inspection, in most cases dedicated imaging should be performed immediately. The frequently causal appendicitis and cholecystitis can mostly be diagnosed with ultrasound. In other cases with unclear ultrasound findings or unclear severe symptoms, computer tomography (CT) is usually necessary without delay. In contrast, magnetic resonance imaging (MRI) is predominantly indicated in pregnant women and children with unclear ultrasound findings. Thus, the radiologist is an important gatekeeper in the diagnostics of acute abdomen. The radiologist should therefore be familiar with the correct imaging indications, the frequent and rare causes as well as the corresponding morphological imaging characteristics.