Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands.

PURPOSE: The study sought to assess the frequency and prognostic value of hyperattenuating adrenal glands on contrast-enhanced computed tomography (CT) scans of surgical intensive care unit (ICU) patients with acute clinical deterioration. METHODS: Eighty-eight consecutive ICU patients (63.2 ± 14.5 years of age) were included in this retrospective analysis. All patients underwent biphasic contrast-enhanced CT due to an acute clinical deterioration. Hyperattenuation of the adrenal glands was assessed subjectively and objectively. Subjective presence or absence of hyperattenuating adrenal glands was assessed by 2 blinded radiologists (J.B. and R.S.L.) in consensus. Hounsfield units (HU) were measured in the adrenal glands and in the inferior vena cava. Objective hyperattenuation was defined as HU (adrenal glands) > HU (inferior vena cava) with a 15-HU threshold. Death within 14 days following CT was set as endpoint and acquired from electronic patient data. RESULTS: Thirty-eight patients (43.2%, Group Asubj) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group Bsubj) did not. Concerning the objective analysis, 31 patients (35.2%, Group Aobj) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group Bobj) did not. Overall 27 of 88 patients (30.6%) died within 14 days following the CT examination. Lethal outcome was significantly more frequent among patients in Group Asubj and Aobj (19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group Bsubj (8 of 50 patients [16.0%]) and Group Bobj (12 of 57 patients [21.1%]; P < .05). Subjective and objective analysis correlated significantly (P < .05). CONCLUSIONS: Hyperattenuation of adrenal glands on contrast-enhanced CT of ICU patients with acute clinical deterioration is associated with a high mortality and might serve as a prognostic marker for patients' outcome.

Lenalidomide consolidation treatment in patients with multiple myeloma suppresses myelopoieses but spares erythropoiesis.

New drugs for the treatment of multiple myeloma (MM) comprise immunomodulatory substances such as lenalidomide and related compounds. While lenalidomide has found its way into first-line treatment as well as into relapse therapy, little is known about lenalidomide effects on normal hematopoietic stem and progenitor cells (HSPCs). In this study, we investigated whether HSPCs are influenced by lenalidomide on a phenotypic, functional and gene expression level. For that purpose, samples from patients with MM were obtained who underwent equivalent first-line treatment including induction therapy, cytotoxic stem cell mobilization and high-dose melphalan therapy followed by autologous blood stem cell transplantation and a subsequent uniform lenalidomide consolidation treatment within a prospective clinical trial. We found that after six months of lenalidomide therapy, the number of CD34(+) HSPCs decreased. Additionally, lenalidomide affects the numerical composition of hematopoietic cells in the bone marrow while it does not affect long-term HSPC proliferation in vitro. We found a significant amplification of fetal hemoglobin (HbF) expression on a transcriptional level and can confirm a stimulated erythropoiesis on a phenotypic level. These effects were accompanied by silencing of the TGF-ß signaling pathway on the gene expression and protein level that is known to be amplified in active MM. However, these pleiotropic effects gave no evidence for mutagenic potential. In conclusion, lenalidomide does not exert long-term effects on proliferation of HSPCs but instead promotes erythropoiesis by shifting hemoglobin expression toward HbF and by silencing the TGF-ß signaling pathway.

ACCURACY OF SIZE-SPECIFIC DOSE ESTIMATE CALCULATION FROM CENTER SLICE IN COMPUTED TOMOGRAPHY.

To evaluate the accuracy of size-specific dose estimate (SSDE) calculation from center slice with water-equivalent diameter (Dw) and effective diameter (Deff). A total of 1812 CT exams (1583 adult and 229 pediatric) were included in this retrospective study. Dw and Deff were automatically calculated for all slices of each scan. SSDEs were calculated with two methods: (1) from the center slice; and (2) from all slices of the volume, which was regarded as the reference standard. Impact of patient weight, height and body mass index (BMI) on SSDE accuracy was assessed. The mean difference between overall SSDE and the center slice approach ranged from 2.0 ± 1.7% (range: 0-15.5%) for pediatric chest to 5.0 ± 3.2% (0-17.2%) for adult chest CT. Accuracy of the center slice SSDE approach correlated with patient size (BMI: r = 0.15-0.43; weight r = 0.26-0.49) which led to SSDE overestimation in small and underestimation in large patients. SSDE calculation using the center slice leads to an error of 2-5%; however, SSDE is underestimated in large patients and overestimation in small patients.

Iterative metal artefact reduction (MAR) in postsurgical chest CT: comparison of three iMAR-algorithms.

OBJECTIVES: The purpose of this study was to evaluate the impact of three novel iterative metal artefact (iMAR) algorithms on image quality and artefact degree in chest CT of patients with a variety of thoracic metallic implants. METHODS: 27 postsurgical patients with thoracic implants who underwent clinical chest CT between March and May 2015 in clinical routine were retrospectively included. Images were retrospectively reconstructed with standard weighted filtered back projection (WFBP) and with three iMAR algorithms (iMAR-Algo1 = Cardiac algorithm, iMAR-Algo2 = Pacemaker algorithm and iMAR-Algo3 = ThoracicCoils algorithm). The subjective and objective image quality was assessed. RESULTS: Averaged over all artefacts, artefact degree was significantly lower for the iMAR-Algo1 (58.9 ± 48.5 HU), iMAR-Algo2 (52.7 ± 46.8 HU) and the iMAR-Algo3 (51.9 ± 46.1 HU) compared with WFBP (91.6 ± 81.6 HU, p < 0.01 for all). All iMAR reconstructed images showed significantly lower artefacts (p < 0.01) compared with the WFPB while there was no significant difference between the iMAR algorithms, respectively. iMAR-Algo2 and iMAR-Algo3 reconstructions decreased mild and moderate artefacts compared with WFBP and iMAR-Algo1 (p < 0.01). CONCLUSION: All three iMAR algorithms led to a significant reduction of metal artefacts and increase in overall image quality compared with WFBP in chest CT of patients with metallic implants in subjective and objective analysis. The iMARAlgo2 and iMARAlgo3 were best for mild artefacts. IMARAlgo1 was superior for severe artefacts. Advances in knowledge: Iterative MAR led to significant artefact reduction and increase image-quality compared with WFBP in CT after implementation of thoracic devices. Adjusting iMAR-algorithms to patients' metallic implants can help to improve image quality in CT.