Comparison of detection of trauma-related injuries using combined "all-in-one" fused images and conventionally reconstructed images in acute trauma CT.

OBJECTIVES: To compare the accuracy of lesion detection of trauma-related injuries using combined "all-in-one" fused (AIO) and conventionally reconstructed images (CR) in acute trauma CT. METHODS: In this retrospective study, trauma CT of 66 patients (median age 47 years, range 18-96 years; 20 female (30.3%)) were read using AIO and CR. Images were independently reviewed by 4 blinded radiologists (two residents and two consultants) for trauma-related injuries in 22 regions. Sub-analyses were performed to analyze the influence of experience (residents vs. consultants) and body region (chest, abdomen, skeletal structures) on lesion detection. Paired t-test was used to compare the accuracy of lesion detection. The effect size was calculated (Cohen's d). Linear mixed-effects model with patients as the fixed effect and random forest models were used to investigate the effect of experience, reconstruction/image processing, and body region on lesion detection. RESULTS: Reading time of residents was significantly faster using AIO (AIO: 266 ± 72 s, CR: 318 ± 113 s; p < 0.001; d = 0.46) while no significant difference was observed in the accuracy of lesion detection (AIO: 93.5 ± 6.0%, CR: 94.6 ± 6.0% p = 0.092; d = - 0.21). Reading time of consultants showed no significant difference (AIO: 283 ± 82 s, CR: 274 ± 95 s; p = 0.067; d = 0.16). Accuracy was significantly higher using CR; however, the difference and effect size were very small (AIO 95.1 ± 4.9%, CR: 97.3 ± 3.7%, p = 0.002; d = - 0.39). The linear mixed-effects model showed only minor effect of image processing/reconstruction for lesion detection. CONCLUSIONS: Residents at the emergency department might benefit from faster reading time without sacrificing lesion detection rate using AIO for trauma CT. KEY POINTS: • Image fusion techniques decrease the reading time of acute trauma CT without sacrificing diagnostic accuracy.

Computer-Aided Detection of Seven Chest Pathologies on Standard Posteroanterior Chest X-Rays Compared to Radiologists Reading Dual-Energy Subtracted Radiographs.

RATIONALE AND OBJECTIVES: Retrospective performance evaluation of a computer-aided detection (CAD) system on standard posteroanterior (PA) chest radiographs (PA-CXR) in detection of pulmonary nodules, infectious consolidation, pneumothorax, pleural effusion, aortic calcification, cardiomegaly and rib fractures compared to radiologists analyzing PA-CXR including dual-energy subtraction radiography (further termed as DESR). MATERIALS AND METHODS: PA-CXR/DESR images of 197 patients were included. All patients underwent chest CT (gold standard) within a short interval (mean 28 hours). All images were evaluated by three blinded readers for the presence of pulmonary nodules, infectious consolidation, pneumothorax, pleural effusion, aortic calcification, cardiomegaly, and rib fractures. Meanwhile PA-CXR were analyzed by a CAD software. CAD results were compared to the majority result of the three readers. Sensitivity and specificity were calculated. McNemar's test was applied to test for significant differences. Interobserver agreement was defined using Cohen's kappa (κ). RESULTS: Sensitivity of the CAD software was significantly higher (p < 0.05) for detection of infectious consolidation and pulmonary nodules (67.9% vs 26.8% and 54% vs 35.6%, respectively; p < 0.001) compared to radiologists analyzing DESR images. For the residual evaluated pathologies no statistical significant differences could be found. Overall, mean inter observer agreement between the three radiologists was moderate (k = 0.534). The best interobserver agreement could be reached for pneumothorax (k = 0.708) and pleural effusion (k = 0.699), while the worst was obtained for rib fractures (k = 0.412). CONCLUSION: The CAD system has the potential to improve the detection of infectious consolidation and pulmonary nodules on CXR images.

Impact of potassium citrate on urinary risk profile, glucose and lipid metabolism of kidney stone formers in Switzerland.

BACKGROUND: Hypocitraturia and hypercalciuria are the most prevalent risk factors in kidney stone formers (KSFs). Citrate supplementation has been introduced for metaphylaxis in KSFs. However, beyond its effects on urinary parameters and stone recurrence, only a few studies have investigated the impact of citrate on other metabolic pathways such as glucose or lipid metabolism. METHODS: We performed an observational study using data from the Swiss Kidney Stone Cohort. Patients were subdivided into two groups based on treatment with potassium citrate or not. The outcomes were changes of urinary risk parameters, haemoglobin A1c (HbA1c), fasting glucose, cholesterol and body mass index (BMI). RESULTS: Hypocitraturia was present in 19.3% of 428 KSFs and potassium citrate was administered to 43 patients (10.0%) at a mean dosage of 3819 ± 1796 mg/day (corresponding to 12.5 ± 5.9 mmol/ day). Treatment with potassium citrate was associated with a significantly higher mean change in urinary citrate (P = 0.010) and urinary magnesium (P = 0.020) compared with no potassium citrate treatment. Exogenous citrate administration had no effect on cholesterol, fasting glucose, HbA1c and BMI. Multiple linear regression analysis demonstrated no significant association of 1,25-dihydroxyvitamin D3 [1,25(OH)2 D3] levels with urinary citrate excretion. CONCLUSION: Potassium citrate supplementation in KSFs in Switzerland resulted in a beneficial change of the urinary risk profile by particularly increasing anti-lithogenic factors. Fasting glucose, HbA1c, cholesterol levels and BMI were unaffected by potassium citrate therapy after 3 months, suggesting that potassium citrate is safe and not associated with unfavourable metabolic side effects. Lastly, 1,25(OH)2 D3 levels were not associated with urinary citrate excretion.