Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions.

We report an iatrogenic radial arteriovenous fistula (AVF) in a 74-year-old woman presenting with right radial bruit and pain 8 months after sheath removal for cardiac catheterization. She refused surgical ligation and underwent balloon-assisted direct percutaneous embolization of the draining vein with N-butyl cyanoacrylate (NBCA). Another draining vein that developed immediately after the procedure was conservatively treated with 1 month of continuous band compression. However, its diameter gradually increased and, as the patient desired complete remission, an additional procedure was conducted 2 months after initial treatment. A second balloon-assisted direct percutaneous embolization was performed using a 50 % glucose solution, which resulted in complete resolution. Although surgical repair is considered to be the standard treatment, in patients where surgery is not indicated, endovascular intervention-although complicated-may be an alternative treatment modality.

Low-dose contrast protocol using the test bolus technique for 64-detector computed tomography coronary angiography.

PURPOSE: We evaluated low-contrast injection protocols for coronary computed tomography angiography (CTA) using a 64-detector scanner and the test bolus technique. MATERIALS AND METHODS: We randomly assigned 60 patients undergoing coronary CTA to one of two contrast material (CM) injection protocols. For the low-contrast dose protocol (P(low)), the patients received injections of iohexol-350 [0.7 ml/kg body weight (BW)] during 9 s, and the test-bolus technique was used. Under the conventional protocol (P(conv)), they received iohexol-350 (1.0 ml/kg BW) during 15 s, and bolus tracking was used. We compared the protocols for attenuation values in the ascending aorta and coronary arteries and for the amount of CM required. RESULTS: There was no significant difference in the mean CT attenuation of the ascending aorta and coronary arteries between the P(low) and P(conv) groups. The amount of CM was significantly less with P(low) than with P(conv) [49.7 ± 6.4 ml (main bolus: 39.7 ± 6.4 ml) vs. 57.0 ± 10.1 ml, P < 0.01]. CONCLUSION: With 64-detector CTA of the heart, the low-dose and short-injection-duration protocol with the test-injection technique provides vessel attenuation comparable to that obtained with the standard-dose protocol with the bolus-tracking technique.

Signal intensity of lanthanum carbonate on magnetic resonance images: phantom study.

PURPOSE: Lanthanum carbonate (LC) is used to treat hyperphosphatemia. The purpose of this study was to investigate the signal intensity (SI) of LC on magnetic resonance imaging (MRI) scans of phantoms. MATERIALS AND METHODS: LC tablets were thoroughly ground and mixed with distilled water or edible agar (0.05, 0.25, 0.5, and 2.5 mg/ml) in plastic bottles. Four intact tablets were placed in plastic bottles that did or did not contain distilled water or agar. Two radiologists consensually evaluated T1- and T2-weighted images (WIs) obtained with 1.5- and 3.0-T MRI systems for the SI of unground and ground tablets. RESULTS: On T1- and T2WI, the SIs of the LC suspensions and the solvents alone were similar; the SIs of unground tablets alone and of the air were also similar. Unground tablets in phantoms filled with solvent exhibited lower SI than the solvent. Ground tablets in suspension were not visualized on MRI or computed tomography. These results remained unchanged regardless of differences in magnetic field strength or the solvent used. CONCLUSION: Ground LC had no contrast enhancement effect on T1WI; on T2WI it did not affect the SI of the solvent. Unground LC tablets may be visualized as a "filling defect" on MRI.

Combination of a low-tube-voltage technique with hybrid iterative reconstruction (iDose) algorithm at coronary computed tomographic angiography.

We compare the performance of low tube voltage with the hybrid iterative reconstruction (iDose) with standard and low tube voltage with the filtered backprojection (FBP) using phantoms at computed tomographic coronary angiography. In computed tomographic coronary angiography, application of the combined low tube voltage with iDose resulted in significant image quality improvements compared to the low tube voltage with FBP. Image quality was the same or better despite a reduction in the radiation dose by 76% compared with standard tube voltage with FBP.

A low tube voltage technique reduces the radiation dose at retrospective ECG-gated cardiac computed tomography for anatomical and functional analyses.

RATIONALE AND OBJECTIVES: To investigate the effect of low-tube-voltage technique on a cardiac computed tomography (CT) for coronary arterial and cardiac functional analyses and radiation dose in slim patients. MATERIALS AND METHODS: We enrolled 80 patients (52women, 28 men; mean age, 68.7 ± 8.9 years) undergoing retrospective electrocardiogram-gated 64-slice cardiac CT. Forty were subjected to the low (80-kV) and 40 to the standard (120-kV) tube-voltage protocol. Quantitative parameters of the coronary arteries (ie, CT attenuation, image noise, and the contrast-to-noise ratio [CNR]) were calculated, as were the effective radiation dose and the figure of merit (FOM). Each coronary artery segment was visually evaluated using a 5-point scale. Cardiac function calculated by using low-tube-voltage cardiac CT was compared with that on echocardiographs. RESULTS: CT attenuation and image noise were significantly higher at 80- than 120-kV (P < .01). CNR of the left and right coronary artery was 18.4 ± 3.8 and 18.5 ± 3.3, respectively, at 80 kV; these values were 19.7 ± 2.7 and 19.8 ± 2.8 at 120 kV; the difference was not significant. The estimated effective radiation dose was significantly lower at 80 than 120 kV (6.3 ± 0.6 vs. 13.9 ± 1.1 mSv, P < .01) and FOM was significantly higher at 80 than 120 kV (P < .01). At visual assessment, 99% of the coronary segments were diagnostic quality; the two protocols did not differ significantly. We observed a strong correlation and good agreement between low-tube-voltage cardiac CT and echocardiography for cardiac functional analyses. CONCLUSION: Low-tube-voltage cardiac CT significantly reduced the radiation dose by approximately 55% in slim patients while maintaining anatomical image quality and accuracy of cardiac functional analysis.

Hepatocellular carcinoma in patients weighing 70 kg or less: initial trial of compact-bolus dynamic CT with low-dose contrast material at 80 kVp.

OBJECTIVE: The purpose of this study was to compare the diagnostic capability of hepatic dynamic CT with low-dose contrast material (420 mg I/kg body weight) at 80 kVp with that of the same modality performed with standard-dose contrast material at 120 kVp. SUBJECTS AND METHODS: We randomly assigned 111 patients (50 women, 61 men; mean age, 69.1 years) with known or suspected hepatocellular carcinoma and a body weight of 70 kg or less to one of two protocols. In the 80-kVp protocol, the contrast material (444 mg I/kg body weight) was delivered over 15 seconds at a tube voltage of 80 kVp. In the 120-kVp protocol, a contrast dose of 600 mg I/kg was delivered over 30 seconds at 120 kVp. Of the 111 patients, 38 had hypervascular hepatocellular carcinoma. Using the Mann-Whitney U test, we compared the two protocols for the contrast-to-noise ratio of the tumors (difference between tumor attenuation and liver attenuation divided by noise in the liver) and the figure of merit (square of contrast-to-noise ratio divided by effective dose) of the tumors during the arterial phase of imaging. Effective doses also were compared. RESULTS: The contrast-to-noise ratio of the tumors was significantly higher with the 80-kVp than with the 120-kVp protocol (median, 5.3 vs 4.2; p = 0.04). The figure of merit also was significantly higher with the 80-kVp than with the 120-kVp protocol (10.2 vs 5.3, p = 0.02). The effective dose was significantly lower with the 80-kVp than with the 120-kVp protocol (2.97 vs 3.41 mSv, p < 0.01). CONCLUSION: With 80-kVp acquisition, the contrast-to-noise ratio and figure of merit of tumors during the arterial phase improved despite the lower contrast dose and radiation exposure.

Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT.

BACKGROUND: Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. PURPOSE: To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. MATERIAL AND METHODS: A total of 6586 patients (3630 men and 2956 women; mean age 57.0 ± 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m(2)) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 < =eGFR < 90, 45 < =eGFR < 60, 30 < =eGFR < 45 and eGFR < 30, respectively. RESULTS: Of the 6586 patients, 1.6%, 3.7%, 13.7%, and 54.2% were judged to present with severe, moderate-b, moderate-a, and mild RI, respectively. While moderate-b-to-severe RI was recorded in 133 (3.2%) of 4161 patients aged 70 years or less, it was observed in 218 (9.0%) of the 2425 patients who were 71 years or older. Among the 829 CVD patients, 9.9% manifested moderate-b-to-severe- and 73.0% mild-to-moderate-a RI. The corresponding rates were 4.4% and 68.9% for oncologic disease, 16.9% and 61.2% for DM, and 4.8% and 71.5% for CLD patients. By univariate analysis, there was a significant association between moderate-b-to-severe RI and the advanced age, CVD, DM, and non-oncologic disease. Multivariate analysis showed that the advanced age, DM, and non-oncologic disease were statistically associated with moderate-b-to-severe RI. CONCLUSION: The incidence of RI of eGFR < 45mL/min/1.73 m(2) at baseline was high in patients with advanced age, CVD and DM and in patients without oncologic disease.

A low-kilovolt (peak) high-tube current technique improves venous enhancement and reduces the radiation dose at indirect multidetector-row CT venography: initial experience.

OBJECTIVE: The purpose was to evaluate the image noise, contrast-to-noise ratio, and radiation dose at indirect multidetector-row computed tomographic venography (CTV) using a low-kilovolt (peak) (kV[p]) high-tube current technique. MATERIALS AND METHODS: Thirty patients underwent indirect CTV of the lower extremity at 120 kV(p) with 170 mA and at 80 kV(p) with 426 mA (CT dose index volumes 11.8 and 9.0 mGy, respectively) on a 64-detector CT scanner. We assessed CT numbers, image noise, and contrast-to-noise ratio of deep (femoral and popliteal) veins. RESULTS: The mean (SD) CT numbers of the femoral and popliteal veins were significantly greater at 80 kV(p) than at 120 kV(p) (142.8 [24.5] and 147.0 [19.4] Hounsfield units [HU], respectively, vs 93.1 [15.5] and 105.0 [14.9] HU, respectively; P < 0.01). The mean (SD) image noise was significantly higher at 80 kV(p) than at 120 kV(p) (11.6 [2.6] and 7.4 [1.4] HU, respectively, vs 8.9 [1.6] and 6.2 [1.5] HU, respectively; P < 0.01). Contrast-to-noise ratios at the femoral and popliteal veins were significantly higher at 80 kV(p) than at 120 kV(p) (6.0 [2.2] and 9.7 [2.4], respectively vs 3.3 [1.8] and 6.9 [2.5], respectively; P < 0.01). CONCLUSION: At indirect CTV, 80 kV(p) and a high tube current setting yielded significantly improved image quality at a reduced radiation dose compared with 120 kV(p).

Volume-doubling time of pulmonary nodules with ground glass opacity at multidetector CT: Assessment with computer-aided three-dimensional volumetry.

RATIONALE AND OBJECTIVES: To investigate the volume-doubling time (VDT) of histologically proved pulmonary nodules showing ground glass opacity (GGO) at multidetector CT (MDCT) using computer-aided three-dimensional volumetry. MATERIALS AND METHODS: We retrospectively evaluated 47 GGO nodules (mixed n = 28, pure n = 19) that had been examined by thin-section helical CT more than once. They were histologically confirmed as atypical adenomatous hyperplasia (AAH, n = 13), bronchioloalveolar carcinoma (BAC, n = 22), and adenocarcinoma (AC, n = 12). Using computer-aided three-dimensional volumetry software, two radiologists independently performed volumetry of GGO nodules and calculated the VDT using data acquired from the initial and final CT study. We compared VDT among the three pathologies and also compared the VDT of mixed and pure GGO nodules. RESULTS: The mean VDT of all GGO nodules was 486.4 ± 368.6 days (range 89.0-1583.0 days). The mean VDT for AAH, BAC, and AC was 859.2 ± 428.9, 421.2 ± 228.4, and 202.1 ± 84.3 days, respectively; there were statistically significant differences for all comparative combinations of AAH, BAC, and AC (Steel-Dwass test, P < .01). The mean VDT for pure and mixed GGO nodules was 628.5 ± 404.2 and 276.9 ± 155.9 days, respectively; it was significantly shorter for mixed than pure GGO nodules (Mann-Whitney U-test, P < .01). CONCLUSION: The evaluation of VDT using computer-aided volumetry may be helpful in assessing the histological entities of GGO nodules.

Uniform vascular enhancement of lower-extremity artery on CT angiography using test-injection monitoring at the central level of the scan range: a simulation flow phantom study with clinical correlation.

RATIONALE AND OBJECTIVES: To evaluate the efficacy of variable contrast injection durations and scanning delay determined by test injection analysis of computed tomography angiography (CTA) of peripheral arteries. MATERIALS AND METHODS: We used a flow phantom that simulates the hemodynamics in a lower extremity artery. We set the flow rate at the pump to 2.0 or 5.0 L/minute. In protocol 1, we adopted a variable contrast injection duration based on the peak enhancement time of the test injection monitoring at the central level of the scan range. In protocol 2, we adopted a fixed contrast injection duration. The scanning delay was determined with a conventional bolus-tracking technique monitoring at the top of the scan range. Mean arterial attenuation and difference between the maximum and minimum attenuation values were calculated. To verify the phantom study results, clinical study, including 16 patients was performed under protocol 1. RESULTS: The mean attenuation values under protocols 1 and 2 were comparable (563.6 Hounsfield units [HU] and 535.0 HU, respectively) at a pump flow rate of 2.0 L/minute; at 5.0 L/minute, they were 289.4 HU and 328.8 HU. The difference between the maximum and minimum attenuation values was smaller under protocol 1 than protocol 2 (76.8 HU vs. 184.9 HU) at a pump flow of 2.0 L/minute and also smaller under protocol 1 than protocol 2 (79.7 HU vs. 203.8 HU) at 5.0 L/minute. In clinical study, the mean attenuation value was 332.6 +/- 51.9 HU, and the difference between the maximum and minimum attenuation values was 55.1 +/- 24.4 HU. CONCLUSION: The object-specific injection duration based on test injection at the central level of the scan range provides sufficient and constant vascular enhancement at CTA.

Comparison of standard- and low-tube voltage MDCT angiography in patients with peripheral arterial disease.

OBJECTIVE: We investigated the effect of low-tube-voltage CT angiography with a reduced volume of contrast agent on qualitative and quantitative parameters and the radiation dose in patients with peripheral arterial disease. METHODS: Eighty consecutive patients were divided into two groups; the protocol was 120 kVp and 1.8 ml/kg contrast agent (300 mgI/ml) in one group and 80 kVp and 1.2 ml/kg in the other. For quantitative analysis we calculated the mean arterial attenuation, the mean difference between maximum and minimum attenuation values, contrast-to-noise ratio (CNR), and figure of merit (FOM). For qualitative evaluation, we used visual scores. RESULTS: There were no significant intergroup differences in mean arterial attenuation (120 vs. 80 kVp: 331.6 ± 61.6 vs. 354.9 ± 61.9 HU) and in the mean difference between maximum and minimum attenuation (120 vs. 80 kVp: 52.2 ± 25.5 vs. 61.5 ± 27.5 HU). While the mean CNR was significantly higher at 120 than 80 kVp (38.4 ± 18.8 vs. 31.1 ± 15.3), the mean FOM was not significantly different (120 vs. 80 kVp: 1.3 ± 1.5 vs. 1.2 ± 1.2), and there was no significant intergroup difference in visual scores. The mean dose-length product was significantly lower at 80 than 120 kVp (1,024.3 ± 151.3 vs. 1,464.7 ± 208.7 mGy·cm). CONCLUSION: The 80-kVp protocol allows for reduction of the radiation dose by approximately 30% and the volume of contrast agent by more than 30% without deterioration of vascular enhancement and image quality.

Effects of dual-energy subtraction chest radiography on detection of small pulmonary nodules with varying attenuation: receiver operating characteristic analysis using a phantom study.

PURPOSE: The aim of this study was to investigate the detectability of simulated pulmonary nodules with different X-ray attenuation by flat-panel detector (FPD) chest radiography using a dual-exposure dual-energy subtraction (DES) technique. MATERIALS AND METHODS: Using a FPD radiography system, we obtained 108 sets of chest radiographs of a chest phantom. They consisted of 54 sets each of chest radiographs with and without simulated nodules. Each data set contained a standard and a corresponding dual-energy subtracted chest radiograph (DES image). The diameters of the simulated nodules were 8, 10, and 12 mm, respectively; nodules of each size manifested attenuation of -450, -200, and 30 Hounsfield units (HU). We performed receiver operating characteristic (ROC) analysis to compare the observers' performance in detecting nodules. RESULTS: For the -450 HU nodules the mean areas under the ROC curve (AUC) without and with DES images were 0.66 and 0.77, respectively; the difference was significant (paired t-test, P < 0.01). For nodules with -200 and 30 HU, there was no significant difference in the AUC value (0.79 vs. 0.77, P = 0.13; 0.92 vs. 0.94, P = 0.17, respectively). CONCLUSION: The addition of DES images to standard chest radiographs improved the performance of radiologists charged with detecting simulated nodules with an attenuation of -450 HU.

Contrast material injection protocol with the dose adjusted to the body surface area for MDCT aortography.

OBJECTIVE: The objective of our study was to investigate the effect on aortic enhancement of contrast material volumes adjusted for a patient's body surface area (BSA) at CT angiography (CTA). SUBJECTS AND METHODS: A 64-MDCT scanner was used to perform CTA of the whole aorta in 89 patients (mean age, 68.7 years) with confirmed or suspected aortoiliac disease. The patients were divided into groups: a body weight (BW) group (n = 45) and a BSA (n = 44) group. The contrast dose was 360 mg I/kg BW in the BW group and 12,753 mg I/m(2) BSA in the BSA group. Because the average BW of Japanese adults is approximately 60 kg, the contrast dose in the two protocols was identical in patients weighing 60 kg. We compared aortic enhancement achieved with the two protocols using the two-tailed Student's t test, and we used the generalized linear model to analyze the effect of patient age, sex, and BW on aortic enhancement in each protocol group. RESULTS: The mean aortic enhancement in the BW and BSA groups was 324.2 and 311.7 HU, respectively; the difference was not significant (p = 0.26). In the BW group, BW had a statistically significant effect on aortic enhancement (p < 0.01), whereas neither patient age nor sex did (p = 0.08 and 0.07, respectively). In the BSA group, the age, sex, BW, and BW by sex had no statistically significant effect on aortic enhancement (p = 0.33, 023, 0.10, and 0.16, respectively). CONCLUSION: Under the BSA protocol, aortic enhancement tended to be consistent and adequate regardless of patient BW.

Computer-aided volumetry of pulmonary nodules exhibiting ground-glass opacity at MDCT.

OBJECTIVE: The purpose of this study was to investigate the accuracy and reproducibility of results acquired with computer-aided volumetry software during MDCT of pulmonary nodules exhibiting ground-glass opacity. MATERIALS AND METHODS: To evaluate the accuracy of computer-aided volumetry software, we performed thin-section helical CT of a chest phantom that included simulated 3-, 5-, 8-, 10-, and 12-mm-diameter ground-glass opacity nodules with attenuation of -800, -630, and -450 HU. Three radiologists measured the volume of the nodules and calculated the relative volume measurement error, which was defined as follows: (measured nodule volume minus assumed nodule volume / assumed nodule volume) x 100. Two radiologists performed two independent measurements of 59 nodules in humans. Intraobserver and interobserver agreement was evaluated with Bland-Altman methods. RESULTS: The relative volume measurement error for simulated ground-glass opacity nodules measuring 3 mm ranged from 51.1% to 85.2% and for nodules measuring 5 mm or more in diameter ranged from -4.1% to 7.1%. In the clinical study, for intraobserver agreement, the 95% limits of agreement were -14.9% and -13.7% and -16.6% to 15.7% for observers A and B. For interobserver agreement, these values were -16.3% to 23.7% for nodules 8 mm in diameter or larger. CONCLUSION: With computer-aided volumetry of ground-glass opacity nodules, the relative volume measurement error was small for nodules 5 mm in diameter or larger. Intraobserver and interobserver agreement was relatively high for nodules 8 mm in diameter or larger.

Performance of radiologists in detection of small pulmonary nodules on chest radiographs: effect of rib suppression with a massive-training artificial neural network.

OBJECTIVE: A massive-training artificial neural network is a nonlinear pattern recognition tool used to suppress rib opacity on chest radiographs while soft-tissue contrast is maintained. We investigated the effect of rib suppression with a massive-training artificial neural network on the performance of radiologists in the detection of pulmonary nodules on chest radiographs. MATERIALS AND METHODS: We used 60 chest radiographs; 30 depicted solitary pulmonary nodules, and 30 showed no nodules. A stratified random-sampling scheme was used to select the images from the standard digital image database developed by the Japanese Society of Radiologic Technology. The mean diameter of the 30 pulmonary nodules was 14.7 +/- 4.1 (SD) mm. Receiver operating characteristic analysis was used to evaluate observer performance in the detection of pulmonary nodules first on the chest radiographs without and then on the radiographs with rib suppression. Seven board-certified radiologists and five radiology residents participated in this observer study. RESULTS: For all 12 observers, the mean values of the area under the best-fit receiver operating characteristic curve for images without and with rib suppression were 0.816 +/- 0.077 and 0.843 +/- 0.074; the difference was statistically significant (p = 0.019). The mean areas under the curve for images without and with rib suppression were 0.848 +/- 0.059 and 0.883 +/- 0.050 for the seven board-certified radiologists (p = 0.011) and 0.770 +/- 0.081 and 0.788 +/- 0.074 for the five radiology residents (p = 0.310). CONCLUSION: In the detection of pulmonary nodules, evaluation of a combination of rib-suppressed and original chest radiographs significantly improved the diagnostic performance of radiologists over the use of chest radiographs alone.

Low-dose MDCT urography: feasibility study of low-tube-voltage technique and adaptive noise reduction filter.

OBJECTIVE: The purpose of this study was to investigate the feasibility of performance of MDCT urography with low tube voltage and an adaptive noise reduction filter. SUBJECTS AND METHODS: Thirty-one patients underwent excretory phase (300 seconds after administration of 100 mL of iopamidol) 40-MDCT of the urinary tract at 120 and 80 kVp. The 80-kVp images were postprocessed with an adaptive noise reduction filter. Using a 3-point scale for homogeneity of the urinary tract and sharpness of contour, streak artifacts, and overall image quality, two radiologists evaluated coronal multiplanar reconstruction images generated from 120-kVp, unfiltered 80-kVp, and filtered 80-kVp images. Attenuation values of the abdominal aorta, renal pelvis, renal cortex, psoas muscle, vertebral body, and retroperitoneal fat and image noise of the psoas muscle were measured. The effective radiation dose was estimated for each patient. RESULTS: At visual evaluation of images of the upper urinary tract, the quality of filtered 80-kVp images was comparable with that of 120-kVp images. At evaluation of images of the lower urinary tract, however, filtered 80-kVp images were of inferior quality. Except for those of fat tissue, attenuation values were significantly higher on 80-kVp than on 120-kVp images (paired Student's t test, p < 0.01). Noise values did not differ significantly between 120- and filtered 80-kVp images (Dunnett test, p = 0.37). The mean effective doses for 120- and 80-kVp scans were 7.0 and 2.9 mSv. CONCLUSION: MDCT urography is feasible with a low-tube-voltage technique and an adaptive noise reduction filter. The technique allows reduction in radiation dose without marked degradation of image quality and can be used in clinical assessment of the renal collecting system and upper ureter. For evaluation of the pelvic ureter and urinary bladder, however, image quality is not sufficient, and a compensatory increase in tube current may be necessary.

Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas.

The objective of our study was to compare diffusion-weighted imaging (DWI) alone and DWI combined with T2-weighted MRI for the differentiation of uterine sarcomas from benign leiomyomas. T2-weighted imaging and DWI were performed in 103 patients with 103 myometrial tumours, including 8 uterine sarcomas and 95 benign leiomyomas on 3-T MR imaging. The signal intensity (SI) of the tumour on T2-weighted images was quantified as the tumour-myometrium contrast ratio (TCR) by using the following formula: (SI(tumour)-SI(myometrium))/SI(myometrium). The TCR or apparent diffusion coefficient (ADC) value alone and then the ADC value combined with T2-weighted imaging were evaluated for differentiation between sarcomas and leiomyomas. The mean ADC value of sarcomas was 0.86 +/- 0.11 x 10(-3) m(2)/s, which was significantly lower than that of leiomyomas 1.18 +/- 0.24 x 10(-3) m(2)/s; however, there was a substantial overlap. The mean TCR of sarcomas was 0.66 +/- 0.71, which was significantly higher than that of the leiomyomas, -0.37 +/- 0.34; however, again, there was a considerable overlap. When ADC was less than 1.05 x 10(-3) mm(2)/s and TCR was greater than 0 this condition was considered to confirm a sarcoma; a combination of ADC and TCR achieved a significant improvement without any overlap between sarcomas and leiomyomas (sensitivity 100%, specificity 100%). Our preliminary results indicate that combined DWI and T2-weighted MR imaging is better than DWI alone in the differentiation of uterine sarcomas from benign leiomyomas.

Effect of contrast injection protocols with dose adjusted to the estimated lean patient body weight on aortic enhancement at CT angiography.

OBJECTIVE: The objective of our study was to investigate the effect on aortic enhancement of iodine doses adjusted for the patient estimated lean body weight (LBW) at CT angiography (CTA). SUBJECTS AND METHODS: CTA for the whole aorta using a 64-MDCT scanner was performed in 97 patients (mean age, 67.4 years) with confirmed or suspected aortoiliac disease. The patients were divided into two groups: a total body weight (TBW) group (n = 49) and an estimated LBW group (n = 48). LBW was estimated from the patient weight (TBW) and height. The TBW and estimated LBW groups received 360 mg I/kg of TBW and 450 mg I/kg of estimated LBW of contrast medium, respectively. The relative dose ratio for the estimated LBW group versus the TBW group was based on the fact that the standard percentage of body fat in Japanese adults with an average TBW of 60 kg is 20% (360 = 0.8 x 450). Differences in the degree of aortic enhancement and interpatient variability in aortic enhancement between the estimated LBW and TBW group were evaluated. RESULTS: Mean aortic enhancement was 308.9 HU for the estimated LBW group and 314.1 HU for the TBW group, indicating no significant difference in the degree of enhancement (Welch's t test, p = 0.61). The interquartile range was smaller for the LBW group than the TBW group (52.8 vs 79.1 HU, respectively); interpatient variability was lower in the estimated LBW group. The aortic attenuation gradient in the TBW group and estimated LBW group was 20.7 and 25.8 HU, respectively; the difference was not statistically significant. CONCLUSION: The CTA protocol using an estimated LBW-tailored dose yielded more consistent aortic enhancement with reduced interpatient variability than the CTA protocol using a TBW-based dose.

Detection of nodules showing ground-glass opacity in the lungs at low-dose multidetector computed tomography: phantom and clinical study.

OBJECTIVE: To investigate the effect of the radiation dose (tube current second product) and the attenuation value of nodules with ground-glass opacity (GGO) on their detectability at multidetector computed tomography (MDCT). METHODS: We scanned a chest CT phantom that included simulated GGO nodules with an MDCT scanner. The attenuation value of the simulated lung parenchyma was -900 Hounsfield units (HU); it was -800 and -650 HU for the simulated GGO nodules. We used a tube current second product of 180 mA as the standard and 21, 45, 60, and 90 mAs as the low-dose and performed receiver operating characteristic analysis to compare the performance of 5 radiologists in detecting GGO nodules at each milliampere. To assess the detectability of GGO nodules on human lung images, the observers were presented with 38 GGO nodules from 15 patients. The 5 radiologists independently reviewed chest CT images at 21 and 45 mAs. RESULTS: In the phantom study, the Az value for GGO nodules with a CT number of -800 HU was significantly lower at 21 than 180 effective mA (0.86 vs. 0.96; P < 0.01). There was no statistically significant difference in the Az value of GGO nodules with a CT number of -650 HU, irrespective of milliamperes used (P = 0.165). In the clinical study, 39.5% and 25.8% of GGO were missed at 21 and 45 mAs, respectively. CONCLUSIONS: At MDCT, GGO nodules with a CT number of -650 HU or less were difficult to detect at the lower milliampere settings (21 and 45 mAs).

Cone-beam technique for 64-MDCT of lung: image quality comparison with stepwise (step-and-shoot) technique.

OBJECTIVE: The purpose of this study was to use phantom and patient data acquired with 64-MDCT to compare the image quality and characteristics of helical high-resolution CT images obtained with cone-beam reconstruction with those of stepwise high-resolution CT images obtained with fan-beam reconstruction. SUBJECTS AND METHODS: We reconstructed helical high-resolution CT images with cone-beam technique and stepwise high-resolution CT images with fan-beam technique. In the phantom study, we measured high-contrast spatial resolution and image noise using a phantom. Streak artifact was evaluated by five radiologists using the phantom. In the clinical phase of the study, two radiologists independently evaluated high-resolution helical and stepwise CT images of the lung fields of 30 patients with diffuse lung disease. Using a 3-point ordinal scale, the radiologists assessed the sharpness of peripheral vessels and interlobular fissures, artifacts, and graininess in the lung fields; overall image quality; and the sharpness of the contour of the left ventricle. RESULTS: In high-contrast spatial resolution, the contrast curves in each spatial frequency were similar on the helical and stepwise images. In the clinical study, there was no statistically significant difference between helical and stepwise images with respect to sharpness of the contour of the left ventricle, peripheral vessels, or interlobular fissures (p>0.05). With respect to streak artifacts and graininess in the lung fields, helical images received a significantly higher quality grade than did stepwise images (p<0.05). CONCLUSION: Our phantom and clinical evaluation showed that the quality of high-resolution CT images of the lung obtained with helical scanning was comparable with the quality of stepwise scans.