Feasibility of half the recommended dose of IV contrast in DECT: image quality evaluation and diagnostic acceptability in cancer patients.

PURPOSE: To assess the quality of dual-energy computed tomography (DECT) images in patients receiving 50% of the recommended weight-based volume of iodinated intravenous contrast medium. METHODS: The study included cancer patients who previously underwent abdominal CT on a DECT scanner using a single source with the full recommended weight-based dose of Iohexol 350. Using the same scanner, the patients underwent a portovenous phase DECT scan following intravenous injection of half of the recommended weight-based dose. Monochromatic energy images were processed at 60 and 70kEv and compared to polychromatic 140kVp images. Three radiologists independently scored the images for overall diagnostic acceptability and image quality of solid organs and vasculature. Regions of interest were drawn on the portal vein, aorta, liver, and fat to calculate contrast to noise ratio (CNR) and signal to noise ratio (SNR). A multivariate ordinal generalized estimating equations model was used to assess image quality score. Pairwise comparisons were performed of the readers' scores, CNR, and SNR. Agreement with respect to quality score was calculated by using Fleiss's kappa value. RESULTS: Diagnostic acceptability was better for the SECT (120kVp) scans than for the 70 and 60kEv scans, and better for the 70 and 60kEv scans than for the 140kVp scans. Noise was subjectively rated as best on the 70kEv images. SNR of the liver was highest on 70kEv images. SNR of the liver on 70kEv images was significantly better than SECT images (p < 0.0001). Liver CNR was highest on SECT (120kVp) images. CONCLUSION: DECT with 50% reduction in the volume of intravenous contrast produces image quality comparable to that of SECT in cancer patients.

Locally advanced prostate cancer imaging findings and implications for treatment from the surgical perspective.

The anatomy of the prostate is reviewed in the context of discussing the staging of prostate cancer and patterns of tumor spread. The utility of prostate magnetic resonance imaging along with new advancements in tumor staging are discussed specifically in locally advanced disease. What should be included in the radiology report carries a substantial weight to formulate the urologist's decision in regards to the selection of surgical candidates, preoperative planning and avoiding postoperative complications.

Diagnostic value of PET/CT versus PET/MRI in gynecological malignancies of the pelvis: A meta-analysis.

PURPOSE: To perform a meta-analysis of the literature to compare the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) versus 18F-FDG positron emission tomography/magnetic resonance imaging (PET/MRI) for gynecological malignancies of the pelvis. MATERIALS AND METHODS: We searched for English-language studies, published through May 2019, on the diagnostic accuracy of PET/CT and PET/MRI for gynecological malignancies. To reduce inter-study heterogeneity, we focused primarily on studies in which both PET/CT and PET/MRI were performed on the entire study cohort. We pooled the sensitivity, specificity, diagnostic odds ratio, and area-under-the-receiver-operating-characteristic curve values for PET/CT and PET/MRI and determined the 95% confidence intervals (CIs). RESULTS: Out of 30 studies, nine met the inclusion criteria. On patient-based analysis, PET/CT had a pooled sensitivity and specificity of 62.6% (95% CI: 47.1%-76%) and 91.6% (95% CI: 81.9%-96.3%), respectively, compared with 73.3% (95% CI: 63.1%-81.6%) (P = 0.22) and 91.2% (95% CI: 81.8%-96%) (P = 94) for PET/MRI. On lesion-based analysis, PET/CT had a pooled sensitivity and specificity of 81.5% (95% CI: 59.3%-93.1%) and 86.6% (95% CI: 77.3%-92.5%), respectively, compared with 84.7% (95% CI: 66.8%-93.8%) (P = 0.77) and 89.3% (95% CI: 85.2%-92.3%) (P = 0.51) for PET/MRI. The diagnostic odds ratios for PET/CT compared with PET/MRI were not significantly different in the patient-based (P = 0.48) and lesion-based analyses (P = 0.4). CONCLUSION: Compared with PET/CT, PET/MRI had slightly better diagnostic performance to that of 18F-FDG PET/CT in the gynecological malignancies on lesion level (44 vs 26) and patient level analysis (28 vs 17). However, the differences between results showed no statistical significance (P = 0.4 and 0.48, respectively).

Sudden cardiac arrest as the initial presentation for left ventricular noncompaction cardiomyopathy.

A 37-year-old man without a significant medical history had an out-of-hospital sudden cardiac arrest. A bystander started cardiopulmonary resuscitation, and emergency medical services arrived promptly, confirmed ventricular fibrillation, and restored sinus rhythm. An emergent coronary arteriogram was normal. Transthoracic echocardiography revealed a severely reduced left ventricular ejection fraction and suggested left ventricular noncompaction. The patient's heart failure with reduced ejection fraction was treated with carvedilol, lisinopril, and spironolactone, and after he was weaned from the ventilator he received an implantable cardioverter-defibrillator. The patient's identical twin was treated in the same fashion for a sudden cardiac arrest. Although many experts think that left ventricular noncompaction cardiomyopathy is a distinct nosological entity, others think that it is simply a dilated cardiomyopathy with unusually prominent left ventricular trabeculae.