Accuracy and time efficiency of a novel deep learning algorithm for Intracranial Hemorrhage detection in CT Scans.

PURPOSE: To evaluate a deep learning-based pipeline using a Dense-UNet architecture for the assessment of acute intracranial hemorrhage (ICH) on non-contrast computed tomography (NCCT) head scans after traumatic brain injury (TBI). MATERIALS AND METHODS: This retrospective study was conducted using a prototype algorithm that evaluated 502 NCCT head scans with ICH in context of TBI. Four board-certified radiologists evaluated in consensus the CT scans to establish the standard of reference for hemorrhage presence and type of ICH. Consequently, all CT scans were independently analyzed by the algorithm and a board-certified radiologist to assess the presence and type of ICH. Additionally, the time to diagnosis was measured for both methods. RESULTS: A total of 405/502 patients presented ICH classified in the following types: intraparenchymal (n = 172); intraventricular (n = 26); subarachnoid (n = 163); subdural (n = 178); and epidural (n = 15). The algorithm showed high diagnostic accuracy (91.24%) for the assessment of ICH with a sensitivity of 90.37% and specificity of 94.85%. To distinguish the different ICH types, the algorithm had a sensitivity of 93.47% and a specificity of 99.79%, with an accuracy of 98.54%. To detect midline shift, the algorithm had a sensitivity of 100%. In terms of processing time, the algorithm was significantly faster compared to the radiologist's time to first diagnosis (15.37 ± 1.85 vs 277 ± 14 s, p < 0.001). CONCLUSION: A novel deep learning algorithm can provide high diagnostic accuracy for the identification and classification of ICH from unenhanced CT scans, combined with short processing times. This has the potential to assist and improve radiologists' ICH assessment in NCCT scans, especially in emergency scenarios, when time efficiency is needed.

Optimization of window settings for coronary arteries assessment using spectral CT-derived virtual monoenergetic imaging.

PURPOSE: To determine the optimal window setting for virtual monoenergetic images (VMI) reconstructed from dual-layer spectral coronary computed tomography angiography (DE-CCTA) datasets. MATERIAL AND METHODS: 50 patients (30 males; mean age 61.1 ± 12.4 years who underwent DE-CCTA from May 2021 to June 2022 for suspected coronary artery disease, were retrospectively included. Image quality assessment was performed on conventional images and VMI reconstructions at 70 and 40 keV. Objective image quality was assessed using contrast-to-noise ratio (CNR). Two independent observers manually identified the best window settings (B-W/L) for VMI 70 and VMI 40 visualization. B-W/L were then normalized with aortic attenuation using linear regression analysis to obtain the optimized W/L (O-W/L) settings. Additionally, subjective image quality was evaluated using a 5-point Likert scale, and vessel diameters were measured to examine any potential impact of different W/L settings. RESULTS: VMI 40 demonstrated higher CNR values compared to conventional and VMI 70. B-W/L settings identified were 1180/280 HU for VMI 70 and 3290/900 HU for VMI 40. Subsequent linear regression analysis yielded O-W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40. VMI 40 O-W/L received the highest scores for each parameter compared to conventional (all p < 0.0027). Using O-W/L settings for VMI 70 and VMI 40 did not result in significant differences in vessel measurements compared to conventional images. CONCLUSION: Optimization of VMI requires adjustments in W/L settings. Our results recommend W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40.

Congenital Infiltrating Lipomatosis of the Face: Multimodality Assessment through CT-Scan and Magnetic Resonance Imaging.

Congenital infiltrating lipomatosis of the face is a rare and benign condition involving a hamartomatous proliferation of mature adipose cells. The final diagnosis derives from a combination of clinical data, histology, and imaging features and affects the treatment decision. This report describes the clinical case of a young patient suffering from facial lipomatosis with particular emphasis on radiological findings detected at CT-scan and magnetic resonance imaging.

Improved Coronary Artery Visualization Using Virtual Monoenergetic Imaging from Dual-Layer Spectral Detector CT Angiography.

Background: To evaluate if coronary CT angiography (CCTA) monoenergetic reconstructions, obtained with a dual-layer spectral detector computed tomography (DLCT) system, offer improved image quality compared with 120 kVp conventional images without affecting the quantitative assessment of coronary stenoses. Methods: Fifty CCTA datasets (30 men; mean age: 61.6 ± 12.3 years) acquired with a DLCT system were reconstructed using virtual monoenergetic images (VMI) from 40 to 100 keV with 10 keV increment and compared with conventional images. An analysis of objective image quality was performed, evaluating the signal- and contrast-to-noise ratio. For the subjective assessment, two readers used a 5-point Likert scoring system to evaluate sharpness, noise, demarcation of coronary plaques, vascular contrast, and an overall score. Furthermore, coronary stenoses were analyzed for each vessel to describe the diagnostic agreement between monoenergetic images and conventional images. Results: The objective image analysis showed that all reconstructions from 70 keV to 40 keV show higher SNR (from 61.33 ± 12.46 to 154.22 ± 42.91, respectively) and CNR (from 51.45 ± 11.19 to 135.63 ± 39.38, respectively) compared with conventional images (all p < 0.001). The 40 keV monoenergetic images obtained the best average score for sharpness, vascular contrast, and for the overall impression (all with p < 0.001). The detection and grading of stenoses of the coronary arteries with conventional and monoenergetic images at 70 keV and 40 keV showed an overall excellent interobserver agreement (k= 0.81 [0.72-0.91]). Conclusions: The 40 keV virtual monoenergetic images obtained with a DLCT system allow the objective and subjective image quality of coronary CT angiography to be improved.

Anomalous venoatrial connections - CT and MRI assessment.

Abnormal venous atrial (VA) connections present a congenital heart disease (CHD) challenge for pediatric cardiologists. Fully anatomical evaluation is very difficult in prenatal and perinatal follow-up, but it has a profound impact on surgical correction and outcome. The echocardiogram is first-line imaging and represents the gold standard tool for simple abnormal VA connection. CT and MRI are mandatory for more complex heart disease and "nightmare cases". 3D post-processing of volumetric CT and MRI acquisition helps to clarify anatomical relationships and allows for the creation of 3D printing models that can become crucial in customizing surgical strategy. Our article describes a ten-year (2013-2022) tertiary referral CHD center of abnormal AV connections investigated with CT and MRI, illustrating most of these complex diseases with the help of volume rendering (VR) or multiplanar reconstructions (MPR). The nightmarish cases will also be addressed due to the complex cardiovascular arrangement that requires a challenging surgical solution for correction along with the post-surgical complications.

Colonic involvement in inflammatory bowel diseases: spotlight on the role of magnetic resonance enterography.

The large bowel can be affected by inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, with the latter occurring either as a unique localization or in conjunction with simultaneous ileal involvement. The differential diagnosis among these conditions is challenging and relies on clinical symptoms, laboratory tests and endoscopy with biopsy. However, as these features can overlap, a conclusive diagnosis is not always achievable, and the underlying cause remains indeterminate. Currently, endoscopy is the reference standard for colonic assessment, although its invasiveness limits its use and repetition within a short timeframe. Magnetic Resonance Enterography is a non-invasive, radiation-free technique that has been extensively and effectively employed in the intestinal evaluation of patients with Crohn's disease in recent years. Although the main goal of this technique is generally focused on evaluating small bowel loops, it can also provide important information about the large bowel if an adequate fulfillment by the oral contrast medium is achieved. The purpose of this work is, therefore, to put emphasis on the potential role of Magnetic Resonance Enterography in assessing the large bowel. In fact, this imaging modality is capable of providing valuable information for comprehensive staging and follow-up of inflammatory bowel diseases within the large bowel, thus complementing the clinical picture and the endoscopic features in the context of a differential diagnosis.

Virtual monoenergetic dual-layer dual-energy CT images in colorectal cancer: CT diagnosis could be improved?

PURPOSE: To compare conventional CT images and virtual monoenergetic images (VMI) at dual-layer dual-energy CT (dlDECT) in patients with colorectal cancer (CRC) through quantitative analysis and to investigate the added value of VMI. MATERIAL AND METHODS: Sixty-six consecutive patients with histologically documented CRC and available VMI reconstructions were retrospectively investigated. Subsequently, forty-two patients, without any colonic disease at colonoscopy, were selected as control group. Conventional CT images and VMI reconstructions at energy levels ranging from 40 (VMI40) to 100 keV (VMI100) in 10 keV increments, were obtained from the late arterial phase. First, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were obtained to select the best VMI reconstruction. Finally, the diagnostic accuracy of conventional CT and VMI40 in late arterial phase was evaluated. RESULTS: On quantitative analysis, SNR and CNR were higher for VMI40 (19.5 ± 7.7 and 11.8 ± 6.2, respectively) with statistically significant differences compared to conventional CT (P < 0.05) and all the other VMI reconstructions (P < 0.05), except for VMI50 (P > 0.05). The addition of VMI40 to conventional CT images significantly improved the area under the curve (AUC) for the diagnosis of CRC, increasing it from 0.875 to 0.943 for reader 1 (P < 0.05) and from 0.916 to 0.954 for reader 2 (P < 0.05). The improvement was greater in the less experienced radiologist (0.068) compared to the more experienced one (0.037). CONCLUSION: VMI40 has showed the highest quantitative image parameters. Furthermore, the use of VMI40 can lead to a significant improvement in the diagnostic performance for detecting CRC.

Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE: To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS: We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS: Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS: DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.

Multi-Contrast Differentiation by Dual-Energy Spectral CT Angiography in a Patient with Pulmonary Barium Granulomas.

Barium inhalation usually relates to accidental aspiration during radiological procedures with an oral contrast agent. When present, barium lung deposits are visible as high-density opacities on chest X-ray or CT scan due to high atomic number, and they may be indistinguishable from calcifications. Dual-layer spectral CT has shown good material differentiation capabilities, due to its increased high-Z element range and smaller spectral separation between low- and high-energy spectral data. We present the case of a 17-year-old female with a history of tracheoesophageal fistula, who underwent chest CT angiography on a dual-layer spectral platform. Despite the close Z numbers and K-edge energy levels of the two different contrast materials, spectral CT was able to identify barium lung deposits from a previous swallowing study and to clearly distinguish them from calcium and the surrounding iodine-containing structures.

Diagnostic value of DECT-based colored collagen maps for the assessment of cruciate ligaments in patients with acute trauma.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic accuracy of third-generation dual-source dual-energy CT (DECT) color-coded collagen reconstructions for the assessment of the cruciate ligaments compared to standard grayscale image reconstruction. METHODS: Patients who underwent third-generation dual-source DECT followed by either 3-T MRI or arthroscopy of the knee joint within 14 days between January 2016 and December 2021 were included in this retrospective study. Five radiologists independently evaluated conventional grayscale DECT for the presence of injury to the cruciate ligaments; after 4 weeks, readers re-evaluated the examinations using grayscale images and color-coded collagen reconstructions. A reference standard for MRI was provided by a consensus reading of two experienced readers and arthroscopy. Sensitivity and specificity were the primary metrics of diagnostic performance. RESULTS: Eighty-five patients (mean age, 44 years ± 16; 50 male) with injury to the ACL or PCL (n = 31) were ultimately included. Color-coded collagen reconstructions significantly increased overall sensitivity (94/105 [90%] vs. 67/105 [64%]), specificity (248/320 [78%] vs. 215/320 [67%]), PPV (94/166 [57%] vs. 67/162 [39%]), NPV (248/259 [96%] vs. 215/253 [85%]), and accuracy (342/425 [81%] vs. 282/425 [66%]) for the detection of injury to the anterior cruciate ligament (all parameters, p < .001). For injury to the posterior cruciate ligament, diagnostic accuracy increased for complete tears (p < .001). Color-coded collagen reconstructions achieved superior diagnostic confidence, image quality, and noise scores compared to grayscale CT (all parameters, p < .001) and showed good agreement with MRI examinations. CONCLUSIONS: DECT-derived color-coded collagen reconstructions yield substantially higher diagnostic accuracy and confidence for assessing the integrity of the cruciate ligaments compared to standard grayscale CT in patients with acute trauma. KEY POINTS: • Color-coded collagen reconstructions derived from dual-energy CT yield substantially higher diagnostic accuracy and confidence for the assessment of the cruciate ligaments compared to standard grayscale CT in patients with acute trauma. • Color-coded collagen reconstructions demonstrate good agreement with MRI for the assessment cruciate ligament injury. • Dual-energy CT may serve as a readily available screening approach for patients with acute trauma to the knee when injury to the cruciate ligaments is suspected.

Artificial Intelligence in Cardiovascular CT and MR Imaging.

The technological development of Artificial Intelligence (AI) has grown rapidly in recent years. The applications of AI to cardiovascular imaging are various and could improve the radiologists' workflow, speeding up acquisition and post-processing time, increasing image quality and diagnostic accuracy. Several studies have already proved AI applications in Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance, including automatic evaluation of calcium score, quantification of coronary stenosis and plaque analysis, or the automatic quantification of heart volumes and myocardial tissue characterization. The aim of this review is to summarize the latest advances in the field of AI applied to cardiovascular CT and MR imaging.

Spectral CT Imaging of Prosthetic Valve Embolization after Transcatheter Aortic Valve Implantation.

Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve implantation (TAVI) generally caused by malpositioning, sizing inaccuracies and pacing failures. The consequences are related to the site of embolization, ranging from a silent clinical picture when the device is stably anchored in the descending aorta to potentially fatal outcomes (e.g., obstruction of flow to vital organs, aortic dissection, thrombosis, etc.). Here, we present the case of a 65-year-old severely obese woman affected by severe aortic valve stenosis who underwent TAVI complicated by embolization of the device. The patient underwent spectral CT angiography that allowed for improved image quality by means of virtual monoenergetic reconstructions, permitting optimal pre-procedural planning. She was successfully re-treated with implantation of a second prosthetic valve a few weeks later.

Diagnosis of an Acute Anterior Wall Infarction in Dual-Energy CT.

Due to its high morbidity and mortality, myocardial infarction is the leading cause of death worldwide. Against this background, rapid diagnosis is of immense importance. Especially in case of an atypical course, the correct diagnosis may be delayed and thus lead to increased mortality rates. In this report, we present a complex case of acute coronary syndrome. A triple-rule-out CT examination was performed in dual-energy CT (DECT) mode. While pulmonary artery embolism and aortic dissection could be ruled out with conventional CT series, the presence of anterior wall infarction was only detectable on DECT reconstructions. Subsequently, adequate and rapid therapy was then initiated leading to survival of the patient.

DWI ratios: New indexes for Crohn's disease activity at magnetic resonance enterography?

BACKGROUND: The aim of the study was to provide radiologists and clinicians a rapid tool for assessment of intestinal inflammation in Crohn's disease (CD) patients through quantification of diffusion-weighted imaging (DWI) signal intensity while performing magnetic resonance enterography (MRE). MATERIALS AND METHODS: A monocentric retrospective study was conducted between September 2018 and July 2021 on CD patients who underwent MRE. Two radiologists measured signal intensity on DWI scans at the highest b-value (800 s/mm2) within pathologic intestinal walls, lymph nodes, spleen and psoas muscle and calculated the relative ratios. Spearman, Mann-Whitney and Jonckheere-Terpstra tests were applied for estimating correlation among ratios, significant differences between the two patient groups and determining the trend in relation to endoscopic classes. Wilcoxon's and Cronbach's alpha tests were employed for comparison of DWI measurements and ratios between the two observers. RESULTS: Fifty-nine patients were enrolled in the study. In the non-surgical group, correlation has been found among Simple Endoscopic Score for Crohn's Disease (SES-CD) classes and the different ratios: bowel/spleen (p = 0.034), bowel/psoas (p = 0.008) and bowel/lymph node (p = 0.010). Within the surgical group, positive correlation was found only between bowel/lymph node ratio and bowel/psoas ratio (p = 0.014). The J-T test demonstrated an increasing monotonic trend for bowel/psoas ratio and bowel/lymph node ratio and SES-CD classes. Inter-reader evaluation demonstrated no statistical differences for DWI measurements and high degree of concordance for the final ratios. CONCLUSION: DWI ratios correlate with endoscopic classes in non-surgical patients and have inter-observer reproducibility.

Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis.

Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.

Coronary angiography using spectral detector dual-energy CT: is it the time to assess myocardial first-pass perfusion?

Coronary computed tomography angiography (CCTA) represents a common approach to the diagnostic workup of patients with suspected coronary artery disease. Technological development has recently allowed the integration of conventional CCTA information with spectral data. Spectral CCTA used in clinical routine may allow for improving CCTA diagnostic performance by measuring myocardial iodine distribution as a marker of first-pass perfusion, thus providing additional functional information about coronary artery disease.

The Nutraceutical Genistein-Lycopene Combination Improves Bone Damage Induced by Glucocorticoids by Stimulating the Osteoblast Formation Process.

Chronic glucocorticoid (GC) therapy is the most common cause of iatrogenic osteoporosis and represents an important risk factor for osteoporosis and bone fractures. New therapeutic approaches are required in order to treat osteoporosis and reduce the side effects related to the use of anti-osteoporotic drugs. In this context, previous studies reported the efficacy of some isoflavones and carotenoids, such as lycopene and genistein, on the reduction of the risk of fracture related to osteoporosis. The aim of this study was to investigate the effects of a combined oral treatment, consisting of genistein and lycopene, in an experimental model of glucocorticoid-induced osteoporosis (GIO). GIO was induced by subcutaneous injection of methylprednisolone (MP, 30 mg/kg) for 60 days, whereas the control group (Sham) received saline solution only. Following induction, MP animals randomly were assigned to receive alendronate, genistein, lycopene, or the association of genistein and lycopene or saline solution for additional 60 days together with MP. Femurs obtained from the Sham group were used for osteoblasts extraction; they were then incubated with dexamethasone (DEX) for 24 h to be then treated with lycopene or genistein or the association of lycopene and genistein for an additional 24 h. Treatments with lycopene and genistein restored the impaired mineralization of cells observed following DEX treatment and stimulated osteoblast differentiation by increasing the depressed expression of bALP and RUNX2 (p < 0.0001). Wnt5a, ß-catenin, and Nrf-2 expression were significantly increased following genistein and lycopene treatment (p < 0.0001), thus confirming their antioxidant activity as well as their ability in stimulating osteoblast function, mostly when genistein and lycopene were used in association. The combined treatment of genistein and lycopene improved the bone damage induced by glucocorticoids and significantly restored the normal architecture of bones as well as adequate interconnectivity of bone trabeculae, thus increasing bone mineral density parameters. The obtained data demonstrated that genistein and lycopene but in particular their association might prevent GC's adverse effects, thus stimulating bone formation and reducing bone resorption, improving bone structure and microarchitecture, through different molecular pathways, such as the Wnt/ß-catenin and the Nrf-2 signaling.

Diagnosis and Management of Button Battery Ingestion Complicated by Tracheo-Esophageal and Aorto-Esophageal Fistulas.

Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that occurred in two previously healthy infants. Both patients presented with vague symptoms and no witness of foreign body ingestion. The prolonged time of exposure to the corrosive effects of disk batteries was responsible for the development of tracheo-esophageal fistula (TEF) and aorto-esophageal fistula (AEF). We demonstrate how prompt diagnosis and management are crucial for the infants' survival.

Portal hypertensive enteropathy: multimodality assessment through computed tomography and magnetic resonance enterography.

Portal hypertension consists in an increased portal vein pressure due to prehepatic, hepatic, or posthepatic conditions, with cirrhosis representing the most common cause. The gastrointestinal tract can be secondarily affected not only with varices formation, whose rupture is one of the most dangerous complications, but also with small and large bowel involvement which can predispose to chronic intestinal bleeding. These conditions respectively take the name of portal hypertensive enteropathy and portal colonopathy and their assessment are of almost exclusive pertinence of endoscopic techniques. Up to now, only few reports have described this condition from the radiological point of view. Nevertheless, imaging modalities are not burdened by the invasiveness of endoscopic procedures and are also capable in providing useful information about the intestinal tract as well as the surrounding tissues. This is the first case reporting a diffuse involvement of the small bowel and the right colon in a patient suffering of portal hypertension due to cirrhosis evaluated through the performance of computed tomography and magnetic resonance enterography.