Second Percutaneous Transluminal Angioplasty Versus Surgical Reconstruction for Hemodialysis Access Failure Within a Short Time Period.

BACKGROUND: The purpose of this study was to compare patency and nonabandonment rates for second percutaneous transluminal angioplasty (PTA) and surgical reconstruction for the treatment of failing vascular access due to restenosis or reocclusion in a short time after initial PTA. METHODS: Seventy two consecutive patients who underwent second treatment within 90 days after the initial PTA were evaluated retrospectively. The patency (time to corrective procedure) and access abandonment were compared among patients who underwent a second PTA (n = 35) and those who underwent surgical reconstruction (n = 37). Univariate and multivariate analyses were performed to determine independent predictors of patency and access abandonment at 1 year after the treatment. RESULTS: At 1 year after the treatment, the patency rates were 35.1% and 11.4% (P = 0.02) and nonabandonment rates were 64.9% and 77.1% (P = 0.25) for surgical reconstruction and second PTA, respectively. The Kaplan-Meier survival analysis showed that the surgical reconstruction group had better patency probability (P = 0.02), but there was no difference in the nonabandonment probability between the groups (P = 0.29). Shorter time to retreatment was associated with good patency. The female gender was likely to be associated with access abandonment. CONCLUSIONS: The access abandonment between the 2 procedures had no difference, although surgical reconstruction provided better patency than second PTA.

Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type: An acute aortic dissection.

Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD.Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated.The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67-25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16-4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00-1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality (P ≤ .01).The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.

Machine Learning to Predict the Rapid Growth of Small Abdominal Aortic Aneurysm.

OBJECTIVE: The purpose of this study was to determine whether computed tomography (CT) angiography with machine learning (ML) can be used to predict the rapid growth of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: This retrospective study was approved by our institutional review board. Fifty consecutive patients (45 men, 5 women, 73.5 years) with small AAA (38.5 ± 6.2 mm) had undergone CT angiography. To be included, patients required at least 2 CT scans a minimum of 6 months apart. Abdominal aortic aneurysm growth, estimated by change per year, was compared between patients with baseline infrarenal aortic minor axis. For each axial image, major axis of AAA, minor axis of AAA, major axis of lumen without intraluminal thrombi (ILT), minor axis of lumen without ILT, AAA area, lumen area without ILT, ILT area, maximum ILT area, and maximum ILT thickness were measured. We developed a prediction model using an ML method (to predict expansion >4 mm/y) and calculated the area under the receiver operating characteristic curve of this model via 10-fold cross-validation. RESULTS: The median aneurysm expansion was 3.0 mm/y. Major axis of AAA and AAA area correlated significantly with future AAA expansion (r = 0.472, 0.416 all P < 0.01). Machine learning and major axis of AAA were a strong predictor of significant AAA expansion (>4 mm/y) (area under the receiver operating characteristic curve were 0.86 and 0.78). CONCLUSIONS: Machine learning is an effective method for the prediction of expansion risk of AAA. Abdominal aortic aneurysm area and major axis of AAA are the important factors to reflect AAA expansion.

Machine Learning to Differentiate T2-Weighted Hyperintense Uterine Leiomyomas from Uterine Sarcomas by Utilizing Multiparametric Magnetic Resonance Quantitative Imaging Features.

RATIONALE AND OBJECTIVE: Uterine leiomyomas with high signal intensity on T2-weighted imaging (T2WI) can be difficult to distinguish from sarcomas. This study assessed the feasibility of using machine learning to differentiate uterine sarcomas from leiomyomas with high signal intensity on T2WI on multiparametric magnetic resonance imaging. MATERIALS AND METHODS: This retrospective study included 80 patients (50 with benign leiomyoma and 30 with uterine sarcoma) who underwent pelvic 3 T magnetic resonance imaging examination for the evaluation of uterine myometrial smooth muscle masses with high signal intensity on T2WI. We used six machine learning techniques to develop prediction models based on 12 texture parameters on T1WI and T2WI, apparent diffusion coefficient maps, and contrast-enhanced T1WI, as well as tumor size and age. We calculated the areas under the curve (AUCs) using receiver-operating characteristic analysis for each model by 10-fold cross-validation and compared these to those for two board-certified radiologists. RESULTS: The eXtreme Gradient Boosting model gave the highest AUC (0.93), followed by the random forest, support vector machine, multilayer perceptron, k-nearest neighbors, and logistic regression models. Age was the most important factor for differentiation (leiomyoma 44.9 ± 11.1 years; sarcoma 58.9 ± 14.7 years; p < 0.001). The AUC for the eXtreme Gradient Boosting was significantly higher than those for both radiologists (0.93 vs 0.80 and 0.68, p = 0.03 and p < 0.001, respectively). CONCLUSION: Machine learning outperformed experienced radiologists in the differentiation of uterine sarcomas from leiomyomas with high signal intensity on T2WI.

The effect of heart rate on coronary plaque measurements in 320-row coronary CT angiography.

Repeatability of quantitative assessment of atherosclerotic plaques is important for the accurate detection of high-risk plaques in coronary CT angiography (CTA). We assessed the effect of heart rate (HR) on plaque CT number using a coronary artery model and a cardiac phantom capable of simulating cardiac motion. The coronary artery model with luminal stenosis on a cardiac phantom was imaged with a simulated HR of 0, 50, 60, and 70 beats per minute using a 320-row CT scanner. We reconstructed CT images for cardiac diastolic phases (for 75% R-R interval) using filtered back projection (FBP), hybrid iterative reconstruction (AIDR3D), and model-based iterative reconstruction (FIRST). Two observers measured plaque attenuation in the lesion with 75% stenosis. The coefficient of determination (R2) was obtained to evaluate interobserver agreement. At HR 70, FIRST improved the correlation between two observers compared with FBP and AIDR3D (FIRST: R2 = 0.68, p < 0.05; FBP: R2 = 0.29, p = 0.31; AIDR3D: R2 = 0.22, p = 0.18). These R2 at HR 70 were lower compared with at HR 50 (FIRST: R2 = 0.92, p < 0.05; FBP: R2 = 0.83, p < 0.05; AIDR3D: R2 = 0.87, p < 0.05) and HR 0 (FIRST: R2 = 0.97, p < 0.05; FBP: R2 = 0.89, p < 0.05; AIDR3D: R2 = 0.95, p < 0.05). Higher HR affected plaque measurement repeatability in coronary CTA. FIRST may improve plaque measurement repeatability at the higher HR compared with FBP and AIDR3D.

Comparison of the image quality of turbo spin echo- and echo-planar diffusion-weighted images of the oral cavity.

The purpose of this study was to compare the image quality of turbo spin echo (TSE) diffusion-weighted imaging (DWI) and echo-planar imaging (EPI) of the oral cavity region.This retrospective study included 26 patients who had undergone both TSE- and EPI-DWI. Misregistration of DWI with T2-TSE images was assessed in the oral cavity. We also compared geometric distortion, the signal-to-noise ratio (SNR), contrast, and the apparent diffusion coefficient (ADC) for the tongue parotid gland, and spinal cord. On a 5-point scale, 2 radiologists scored the TSE- and EPI-DWI of each patient for ghost artifacts, image contrast, and overall image quality.Distortion in the phase-encoded direction was significantly lower on TSE- than EPI-DWI. The SNR of the tongue and parotid gland was significantly higher on TSE than EPI-DWI except spinal cord. No significant difference was found in contrast and ADC values (except for the ADC of tongue). TSE-DWI yielded higher qualitative scores for all parameters except image contrast.For the oral cavity region, TSE-DWI was superior to EPI-DWI with respect to distortion-free images and superior image quality.

Tradeoff between noise reduction and inartificial visualization in a model-based iterative reconstruction algorithm on coronary computed tomography angiography.

We aimed to evaluate the image quality performance of coronary CT angiography (CTA) under the different settings of forward-projected model-based iterative reconstruction solutions (FIRST).Thirty patients undergoing coronary CTA were included. Each image was reconstructed using filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR-3D), and 2 model-based iterative reconstructions including FIRST-body and FIRST-cardiac sharp (CS). CT number and noise were measured in the coronary vessels and plaque. Subjective image-quality scores were obtained for noise and structure visibility.In the objective image analysis, FIRST-body produced the significantly highest contrast-to-noise ratio. Regarding subjective image quality, FIRST-CS had the highest score for structure visibility, although the image noise score was inferior to that of FIRST-body.In conclusion, FIRST provides significant improvements in objective and subjective image quality compared with FBP and AIDR-3D. FIRST-body effectively reduces image noise, but the structure visibility with FIRST-CS was superior to FIRST-body.

Single-Breath-Hold Whole-heart Unenhanced Coronary MRA Using Multi-shot Gradient Echo EPI at 3T: Comparison with Free-breathing Turbo-field-echo Coronary MRA on Healthy Volunteers.

PURPOSE: We investigated the feasibility of single breath hold unenhanced coronary MRA using multi-shot gradient echo planar imaging (MSG-EPI) on a 3T-scanner. METHODS: Fourteen volunteers underwent single breath hold coronary MRA with a MSG-EPI and free-breathing turbo field echo (TFE) coronary MRA at 3T. The acquisition time, signal to noise ratio (SNR), and the contrast of the sequences were compared with the paired t-test. Readers evaluated the image contrast, noise, sharpness, artifacts, and the overall image quality. RESULTS: The acquisition time was 88.1% shorter for MSG-EPI than TFE (24.7 ± 2.5 vs 206.4 ± 23.1 sec, P < 0.01). The SNR was significantly higher on MSG-EPI than TFE scans (P < 0.01). There was no significant difference in the contrast on MSG-EPI and TFE scans (1.8 ± 0.3 vs 1.9 ± 0.3, P = 0.24). There was no significant difference in image contrast, image sharpness, and overall image quality between two scan techniques. The score of image noise and artifact were significantly higher on MSG-EPI than TFE scans (P < 0.05). CONCLUSION: The single breath hold MSG-EPI sequence is a promising technique for shortening the scan time and for preserving the image quality of unenhanced whole heart coronary MRA on a 3T scanner.

Saturation Recovery Myocardial T1 Mapping with a Composite Radiofrequency Pulse on a 3T MR Imaging System.

PURPOSE: To evaluate the effect of a composite radiofrequency (RF) pulse on saturation recovery (SR) myocardial T1 mapping using a 3T MR system. MATERIALS AND METHODS: Phantom and in vivo studies were performed with a clinical 3T MR scanner. Accuracy and reproducibility of the SR T1 mapping using conventional and composite RF pulses were first compared in phantom experiments. An in vivo study was performed of 10 healthy volunteers who were imaged with conventional and composite RF pulse methods twice each. In vivo reproducibility of myocardial T1 value and the inter-segment variability were assessed. RESULTS: The phantom study revealed significant differences in the mean T1 values between the two methods, and the reproducibility for the composite RF pulse was significantly smaller than that for the conventional RF pulse. For both methods, the correlations of the reference and measured T1 values were excellent (r2 = 0.97 and 0.98 for conventional and composite RF pulses, respectively). The in vivo study showed that the mean T1 value for composite RF pulse was slightly lower than that for conventional RF pulse, but this difference was not significant (P = 0.06). The inter-segment variability for the composite RF pulse was significantly smaller than that for conventional RF pulse (P < 0.01). Inter-scan correlations of T1 measurements of the first and second scans were highly and weakly correlated to composite RF pulses (r = 0.83 and 0.29, respectively). CONCLUSION: SR T1 mapping using composite RF pulse provides accurate quantification of T1 values and can lessen measurement variability and enable reproducible T1 measurements.

Dual-region-of-interest bolus-tracking technique for coronary computed tomographic angiography on a 320-row scanner: reduction in the interpatient variability of arterial contrast enhancement.

OBJECTIVE: We compared the effect of a dual-region-of-interest (ROI) bolus-tracking technique on interpatient variability of arterial contrast enhancement with that of the conventional bolus-tracking technique in coronary computed tomographic angiography (CTA) on a 320-row scanner. METHODS: This study included 100 patients who underwent coronary CTA using one of two protocols: (1) 50 patients underwent scanning using a conventional single-ROI bolus-tracking technique (P-single) with an ROI placed in the ascending aorta, and (2) 50 patients underwent scanning using a dual-ROI technique (P-dual) with two ROIs placed in the pulmonary trunk and the ascending aorta. CT attenuation in the ascending aorta and coronary arteries, and the interpatient variability were compared between the two scanning protocols. RESULTS: The mean CT attenuation of the ascending aorta and coronary arteries tended to be higher for P-dual than for P-single, but the difference was not significant (p = 0.08-0.30). The interpatient variability of contrast enhancement (SD of the CT attenuation) was significantly smaller for P-dual than for P-single (p < 0.01). CONCLUSION: The dual-ROI bolus-tracking technique can reduce interpatient variability of arterial contrast enhancement in coronary CTA on a 320-row scanner. Advances in knowledge: The use of a dual-ROI bolus-tracking technique can provide sufficient and consistent arterial enhancement of coronary CTA.

Dual-layer DECT for multiphasic hepatic CT with 50 percent iodine load: a matched-pair comparison with a 120 kVp protocol.

OBJECTIVES: To evaluate the image quality and lesion conspicuity of virtual-monochromatic-imaging (VMI) with dual-layer DECT (DL-DECT) for reduced-iodine-load multiphasic-hepatic CT. METHODS: Forty-five adults with renal dysfunction who had undergone hepatic DL-DECT with 300-mgI/kg were included. VMI (40-70-keV, DL-DECT-VMI) was generated at each enhancement phase. As controls, 45 matched patients undergoing standard 120-kVp protocol (120-kVp, 600-mgI/kg, and iterative reconstruction) were included. We compared the size-specific dose estimate (SSDE), image noise, CT attenuation, and contrast-to-noise ratio (CNR) between protocols. Two radiologists scored the image quality and lesion conspicuity. RESULTS: SSDE was significantly lower in DL-DECT group (p < 0.01). Image noise of DL-DECT-VMI was almost constant at each keV (differences of ≤15%) and equivalent to or lower than of 120-kVp. As the energy decreased, CT attenuation and CNR gradually increased; the values of 55-60 keV images were almost equivalent to those of standard 120-kVp. The highest scores for overall quality and lesion conspicuity were assigned at 40-keV followed by 45 to 55-keV, all of which were similar to or better than of 120-kVp. CONCLUSIONS: For multiphasic-hepatic CT with 50% iodine-load, DL-DECT-VMI at 40- to 55-keV provides equivalent or better image quality and lesion conspicuity without increasing radiation dose compared with standard 120-kVp protocol. KEY POINTS: • 40-55-keV yields optimal image quality for half-iodine-load multiphasic-hepatic CT with DL-DECT. • DL-DECT protocol decreases radiation exposure compared with 120-kVp scans with iterative reconstruction. • 40-keV images maximise conspicuity of hepatocellular carcinoma especially at hepatic-arterial phase.

Contrast enhancement in abdominal computed tomography: influence of photon energy of different scanners.

OBJECTIVE: Different CT scanners have different X-ray spectra and photon energies indicating that contrast enhancement vary among scanners. However, this issue has not been fully validated; therefore, we performed phantom and clinical studies to assess this difference. METHODS: Two scanners were used: scanner-A and scanner-B. In the phantom study, we compared the contrast enhancement between the scanners at tube voltage peaks of 80, 100 and 120 kVp. Then, we calculated the effective energies of the two CT scanners. In the clinical study, 40 patients underwent abdominal scanning with scanner-A and another 40 patients with scanner-B, with each group using the same scanning protocol. The contrast enhancement of abdominal organs was assessed quantitatively (based on the absolute difference between the attenuation of unenhanced scans and contrast-enhanced scans) and qualitatively. A two-tailed independent Student's t-test and or the Mann-Whitney U test were used to compare the discrepancies. RESULTS: In the phantom study, contrast enhancement for scanner-B was 36.9, 32.6 and 30.8% higher than that for scanner-A at 80, 100 and 120 kVp, respectively. The effective energies were higher for scanner-A than for scanner-B. In the quantitative analysis for the clinical study, scanner-B yielded significantly better contrast enhancement of the hepatic parenchyma, pancreas, kidney, portal vein and inferior vena cava compared with that of scanner-A. The mean visual scores for contrast enhancement were also significantly higher on images obtained by scanner-B than those by scanner-A. CONCLUSION: There were significant differences in contrast enhancement of the abdominal organs between the compared CT scanners from two different vendors even at the same scanning and contrast parameters. Advances in knowledge: Awareness of the impact of different X-ray energies on the resultant attenuation of contrast material is important when interpreting clinical CT images.

Model-based Iterative Reconstruction in Low-radiation-dose Computed Tomography Colonography: Preoperative Assessment in Patients with Colorectal Cancer.

RATIONALE AND OBJECTIVES: To assess the effect of model-based iterative reconstruction (MBIR) on image quality and diagnostic performance of low-radiation-dose computed tomography colonography (CTC) in the preoperative assessment of colorectal cancer. MATERIALS AND METHODS: This study included 30 patients with colorectal cancer referred for surgical treatment. All patients underwent CTC with a standard dose (SD) protocol in the supine position and a low-dose (LD; radiation dose reduction of approximately 85%) protocol in the prone position. The SD protocol images were post-processed using filtered back projection (FBP), whereas the LD protocol images were post-processed using FBP and MBIR. Objective and subjective image quality parameters were compared among the three different methods. Preoperative evaluations, including site, length, and tumor and node staging were performed, and the findings were compared to the postsurgical findings. RESULTS: The mean image noise of SD-FBP, LD-FBP, and LD-MBIR images was 17.3 ± 3.2, 40.5 ± 10.9, and 11.2 ± 2.0 Hounsfield units, respectively. There were significant differences for all comparison combinations among the three methods (P < .01). For image noise, the mean visual scores were significantly higher for SD-FBP and LD-MBIR than for LD-FBP, and the scores for SD-FBP and LD-MBIR were equivalent (3.9 ± 0.3 [SD-FBP], 2.0 ± 0.5 [LD-FBP], and 3.7 ± 0.3 [LD-MBIR]). Preoperative information was more accurate under SD-FBP and LD-MBIR than under LD-FBP, and the information was comparable between SD-FBP and LD-MBIR. CONCLUSION: MBIR can yield significantly improved image quality on low-radiation-dose CTC and provide preoperative information equivalent to that of standard-radiation-dose protocol.

3D hybrid profile order technique in a single breath-hold 3D T2-weighted fast spin-echo sequence: Usefulness in diagnosis of small liver lesions.

PURPOSE: We compared the efficacy of three-dimensional (3D) isotropic T2-weighted fast spin-echo imaging using a 3D hybrid profile order technique with a single-breath-hold (3D-Hybrid BH) with a two-dimensional (2D) T2-weighted fast spin-echo conventional respiratory-gated (2D-Conventional RG) technique for visualising small liver lesions. MATERIALS AND METHODS: This study was approved by our institutional review board. The requirement to obtain written informed consent was waived. Fifty patients with small (≤15mm) hepatocellular carcinomas (HCC) (n=26), or benign cysts (n=24), had undergone hepatic MRI including both 2D-Conventional RG and 3D-Hybrid BH. We calculated the signal-to-noise ratio (SNR) and tumour-to-liver contrast (TLC). The diagnostic performance of the two protocols was analysed. RESULTS: The image acquisition time was 89% shorter with the 3D-Hybrid BH than with 2D-Conventional RG. There was no significant difference in the SNR between the two protocols. The area under the curve (AUC) of the TLC was significantly higher on 3D-Hybrid BH than on 2D-Conventional RG. CONCLUSION: The 3D-Hybrid BH sequence significantly improved diagnostic performance for small liver lesions with a shorter image acquisition time without sacrificing accuracy.

Comparison between multi-shot gradient echo EPI and balanced SSFP in unenhanced 3T MRA of thoracic aorta in healthy volunteers.

PURPOSE: The purpose of this study was to compare scan time and image quality between magnetic resonance angiography (MRA) of the thoracic aorta using a multi-shot gradient echo planar imaging (MSG-EPI) and MRA using balanced steady-state free precession (b-SSFP). MATERIALS AND METHODS: Healthy volunteers (n=17) underwent unenhanced thoracic aorta MRA using balanced steady-state free precession (b-SSFP) and MSG-EPI sequences on a 3T MRI. The acquisition time, total scan time, signal-to-noise ratio (SNR) of the thoracic aorta, and the coefficient of variation (CV) of thoracic aorta were compared with paired t-tests. Two radiologists independently recorded the images' contrast, noise, sharpness, artifacts, and overall quality on a 4-point scale. RESULTS: The acquisition time was 36.2% shorter for MSG-EPI than b-SSFP (115.5±14.4 vs 181.0±14.9s, p<0.01). The total scan time was 40.4% shorter for MSG-EPI than b-SSFP (272±78 vs 456±144s, p<0.01). There was no significant difference in mean SNR between MSG-EPI and b-SSFP scans (17.3±3.6 vs 15.2±4.3, p=0.08). The CV was significantly lower for MSG-EPI than b-SSFP (0.2±0.1 vs. 0.5±0.2, p<0.01). All qualitative scores except for image noise were significantly higher in MSG-EPI than b-SSFP scans (p<0.05). CONCLUSION: The MSG-EPI sequence is a promising technique for shortening scan time and yielding more homogenous image quality in MRA of thoracic aorta on 3T scanners compared with the b-SSFP.

Vectors through a cross-sectional image (VCI): A visualization method for four-dimensional motion analysis for cardiac computed tomography.

BACKGROUND: Cardiac computed tomography (CT) has the potential for fully four-dimensional (4D for 3D plus time) motion analysis of the heart. We aimed at developing a method for assessment and presentation of the 4D motion for multi-phase, contrast-enhanced cardiac CT data sets and demonstrating its clinical applicability. METHODS: Four patients with normal cardiac function, old myocardial infarction (OMI), takotsubo cardiomyopathy, and hypertrophic cardiomyopathy (HCM) underwent contrast-enhanced cardiac CT for one heartbeat using a 320-row CT scanner with no tube current modulation. CT images for 10 cardiac phases (with a 10%-increment of the R-R interval) were reconstructed with the isotropic effective resolution of (0.5 mm)3 An image-based motion-estimation (iME) algorithm, developed previously, has been used to estimate a time series of 3D cardiac motion, from the end-systole to the other nine phases. The iME uses down-sampled images with a resolution of (1.0 mm)3 deforms the end-systole images non-rigidly to match images at other phases. Once the agreement is maximized, iME outputs a 3D motion vector defined for each voxel for each phase, that smoothly changes over voxels and phases. The proposed visualization method, which is called "vectors through a cross-sectional image (VCI)," presents 3D vectors from the end-diastole to the end-systole as arrows with an end-diastole CT slice. We performed visual assessment of the VCI with calculated the mean vector lengths to evaluate regional left ventricular (LV) contraction. RESULTS: The VCI images showed the magnitude and direction of systolic 3D vectors, including the through-plane motion, and successfully visualized the relations of LV wall segments and abnormal regional wall motion. Decreased regional motion and asymmetric motion due to hypokinetic infarct segment, takotsubo cardiomyopathy, and hyper trophic cardiomyopathy was clearly observed. It was easy to appreciate the relation of the abnormal regional wall motion to the affected LV wall segments. The mean vector lengths of the affected segments with pathologies were clearly smaller than the other unaffected segments (1.2-1.7 mm versus 2.5-4.7 mm). CONCLUSIONS: VCI images could capture the magnitude and direction of through-plane motion and show the relations of LV wall segments and abnormal wall motion.

Granulomatosis with polyangiitis can cause periaortitis and pericarditis.

Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation usually involving the upper and lower respiratory tracts and necrotizing vasculitis predominantly affecting small-sized vessels. Although categorized as a small vessel vasculitis, GPA can cause periaortitis and pericarditis. Physicians should recognize all categories of vasculitis can affect any size arteries.

Cardiovascular magnetic resonance myocardial T1 mapping to detect and quantify cardiac involvement in familial amyloid polyneuropathy.

OBJECTIVES: This study sought to explore the potential role of non-contrast T1 mapping for the detection and quantification of cardiac involvement in familial amyloid polyneuropathy (FAP). METHODS: Japanese patients with FAP [n = 41, age 53.2 ± 13.9 years, genotype Val30Met (n = 25), non-Val30Met (n = 16)] underwent cardiac magnetic resonance imaging that included T1 mapping (saturation-recovery method) and late gadolinium-enhanced (LGE) imaging on a 3.0-T MR scanner. Their native T1 was measured on mid-ventricular short-axis images and compared with 30 controls. RESULTS: Of the 41 FAP patients 29 were LGE positive. The native T1 was significantly higher in FAP patients than in the controls (1,634.1 ± 126.3 ms vs. 1,432.4 ± 69.0 ms, p < 0.01), significantly higher in LGE-positive- than LGE-negative FAP patients (1,687.1 ± 104.4 ms vs. 1,505.4 ± 68.5 ms, p < 0.01), and significantly higher in LGE-negative FAP patients than the controls (p < 0.01). A native T1 cutoff value of 1,610 ms yielded 85.4% accuracy for identifying LGE-positive FAP. The native T1 significantly correlated with the interventricular septum wall thickness, the left ventricular mass, the LGE volume, the plasma B-type natriuretic peptide level, and the E/e' ratio (all p < 0.01). CONCLUSION: T1 mapping is of high diagnostic accuracy for the detection of LGE-positive FAP. The native myocardial T1 may be correlated with the severity of cardiac amyloid deposition. KEY POINTS: • The native T1 was higher in FAP patients than the controls. • The native T1 was higher in LGE-positive- than LGE-negative FAP patients. • The native T1 was higher in LGE-negative FAP patients than the controls. • The native T1 correlated with clinical markers of systolic and diastolic dysfunction. • Myocardial T1 mapping is of high diagnostic accuracy for detecting LGE-positive FAP.

Improved Estimation of Coronary Plaque and Luminal Attenuation Using a Vendor-specific Model-based Iterative Reconstruction Algorithm in Contrast-enhanced CT Coronary Angiography.

RATIONALE AND OBJECTIVES: To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. MATERIALS AND METHODS: We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen-plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. RESULTS: At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15-44 HU for FBP and 10-31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was -12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. CONCLUSIONS: The FIRST method controls the increase in plaque density and the lumen-plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.

Iterative Reconstruction Designed for Brain CT: A Correlative Study With Filtered Back Projection for the Diagnosis of Acute Ischemic Stroke.

OBJECTIVES: The objective of this study is to evaluate the usefulness of iterative model reconstruction designed for brain computed tomography (CT) (IMR-Neuro) for the diagnosis of acute ischemic stroke. METHODS: This retrospective study included 20 patients with acute middle cerebral artery infarction who have undergone brain CT and 20 nonstroke patients (control). We reconstructed axial images with filtered back projection (FBP) and IMR-Neuro (slice thickness, 1 and 5 mm). We compared the CT number of the infarcted area, the image noise, contrast, and the contrast to noise ratio of the infarcted and the noninfarcted areas between the different reconstruction methods. We compared the performance of 10 radiologists in the detection of parenchymal hypoattenuation between 2 techniques using the receiver operating characteristic (ROC) techniques with the jackknife method. RESULTS: The image noise was significantly lower with IMR-Neuro [5 mm: 2.5 Hounsfield units (HU) ± 0.5, 1 mm: 3.9 HU ± 0.5] than with FBP (5 mm: 4.9 HU ± 0.5, 1 mm: 10.1 HU ± 1.4) (P < 0.01). The contrast to noise ratio was significantly greater with IMR-Neuro (5 mm: 2.6 ± 2.1, 1 mm: 1.6 ± 1.3) than with FBP (5 mm: 1.2 ± 1.0; 1 mm: 0.6 ± 0.5) (P < 0.01). The value of the average area under the receiver operating curve was significantly higher with IMR-Neuro than FBP (5 mm: 0.79 vs 0.74, P = 0.04; 1 mm: 0.76 vs 0.69, P = 0.04). CONCLUSIONS: Compared with FBP, IMR-Neuro improves the image quality and the performance for the detection of parenchymal hypoattenuation with acute ischemic stroke.