Radiation dose reduction and image quality improvement with ultra-high resolution temporal bone CT using deep learning-based reconstruction: An anatomical study.

PURPOSE: The purpose of this study was to evaluate the achievable radiation dose reduction of an ultra-high resolution computed tomography (UHR-CT) scanner using deep learning reconstruction (DLR) while maintaining temporal bone image quality equal to or better than high-resolution CT (HR-CT). MATERIALS AND METHODS: UHR-CT acquisitions were performed with variable tube voltages and currents at eight different dose levels (volumic CT dose index [CTDIvol] range: 4.6-79 mGy), 10242 matrix, and 0.25 mm slice thickness and reconstructed using DLR and hybrid iterative reconstruction (HIR) algorithms. HR-CT images were acquired using a standard protocol (120 kV/220 mAs; CTDI vol, 54.2 mGy, 5122 matrix, and 0.5 mm slice thickness). Two radiologists rated the image quality of seven structures using a five point confidence scale on six cadaveric temporal bone CTs. A global image quality score was obtained for each CT protocol by summing the image quality scores of all structures. RESULTS: With DLR, UHR-CT at 120 kV/220 mAs (CTDIvol, 50.9 mGy) and 140 kV/220 mAs (CTDIvol, 79 mGy) received the highest global image quality scores (4.88 ± 0.32 [standard deviation (SD)] [range: 4-5] and 4.85 ± 0.35 [range: 4-5], respectively; P = 0.31), while HR-CT at 120 kV/220 mAs and UHR-CT at 120 kV/20 mAs received the lowest (i.e., 3.14 ± 0.75 [SD] [range: 2-5] and 2.97 ± 0.86 [SD] [range: 1-5], respectively; P = 0.14). All the DLR protocols had better image quality scores than HR-CT with HIR. CONCLUSION: UHR-CT with DLR can be performed with up to a tenfold reduction in radiation dose compared to HR-CT with HIR while maintaining or improving image quality.

MR imaging signs of shoulder adhesive capsulitis: analysis of potential differentials and improved diagnostic criteria.

OBJECTIVE: To evaluate the prevalence of shoulder adhesive capsulitis (AC) signs on MR studies of patients with various common shoulder conditions. METHODS: MR images of 316 patients were retrospectively evaluated. Patients were divided into three groups: controls (66 patients), clinical AC (63 patients), and study group (187 patients). The final diagnosis of AC was reached clinically. The study group was composed of patients with focal and massive rotator cuff tears, active hydroxyapatite deposition disease, fractures around the shoulder, and post-surgery. The following AC signs were evaluated: inferior glenohumeral ligament (IGHL) thickening; coracohumeral ligament (CHL) thickening; and hyperintensity of the inferior glenohumeral ligament, which was graded in four classes. RESULTS: The IGHL signal intensity was statistically higher in patients with fractures than in controls (P = 0.008). There was no statistically significant difference in IGHL signal between the AC group and patients with massive rotator cuff tears and active hydroxyapatite deposition disease (P > 0.1). IGHL thickness in patients with fractures, massive rotator ruptures, and active hydroxyapatite deposition disease was significantly higher compared to controls (P < 0.02) and significantly lower compared to the AC group (P < 0.0001). Based on these findings, a grading system for fibro-inflammatory capsular changes is proposed. CONCLUSION: MR AC signs are frequent in patients with shoulder conditions other than AC; however, in these patients, capsular changes are less prominent than in patients with clinical AC.

Measurement of stapes footplate thickness using ultra-high-resolution computed tomography: stapes axial plane correlates better with otosclerosis than lateral semicircular canal plane.

BACKGROUND, AIMS: Stapes footplate thickness measurement using ultra-high-resolution CT has been described only in the lateral semicircular canal plane. The purpose of this study was to compare stapes footplate thickness between the lateral semicircular canal and stapes axial planes in patients with otosclerosis compared to controls. MATERIAL AND METHODS: We performed a retrospective single-center study of patients undergoing high-resolution temporal bone CT. Two radiologists measured stapes footplate thickness in both the lateral semicircular canal and stapes axial planes. RESULTS: Between February 2020 and October 2022, we collected 81 ears from 49 patients (75% of women; mean age 51.22 ± 16.6 years, 17 otosclerosis, and 64 controls). In the stapes axial plane, there was a significant anterior thickening in otosclerosis patients (Reader 1: 0.52 ± 0.12 [0.3-0.7] vs. 0.41 ± 0.08 [0.3-0.6], p = 0.001; Reader 2: 0.54 ± 0.06 [0.5-0.7] vs. 0.39 ± 0.08 [0.2-0.6], P < 0.001) compared to controls. These differences were not significant using the lateral semicircular canal plane. CONCLUSION: The stapes footplate was thickened at its AC in otosclerosis patients using only the stapes axial plane. SIGNIFICANCE: We propose to use the stapes axial plane instead of the lateral semicircular canal plane when analyzing the stapes.

Ultra-high-resolution CT of the temporal bone: The end of stapes prosthesis dimensional error and correlation with patient symptoms.

PURPOSE: To describe the reliability of ultra-high-resolution computed tomography (UHR-CT) in the measurement of titanium stapes prostheses using manufacturer data as a reference. MATERIALS AND METHODS: This retrospective study included patients treated by stapedectomy with titanium prostheses who underwent UHR-CT between January 2020 and October 2023. Images were acquired using an ultra-high-resolution mode (slice thickness: 0.25 mm; matrix, 1024 × 1024). Two radiologists independently evaluated the length, diameter, and intra-vestibular protrusion of the prosthesis. Post-operative air-bone gaps (ABGs) were recorded. RESULTS: Fourteen patients were enrolled (mean age, 44.3 ± 13.8 [SD] years, 9 females), resulting in 16 temporal bone UHR-CTs. The exact length was obtained in 81.3 % (n = 13/16) and underestimated by 0.1 to 0.3 mm in the remaining 18.7 % (n = 3/16) CT scans for both readers (mean misestimation: -0.02 ± 0.06 [SD] mm, overall underestimation of 0.43 %). The exact diameter was reported in 75 % (n = 12/16) and 87.5 % (n = 14/16) of the CT scans for readers 1 and 2, respectively, and was off by 0.1 mm in all discrepancies (mean misestimation: 0.01 ± 0.04 [SD] mm, overall overestimation of 2.43 %). Intravestibular prosthesis protrusion was of 0.5 ± 0.43 [SD] mm (range: 0-1) and 0.49 ± 0.44 [SD] mm (range: 0-1.1) for readers 1 and 2, respectively, and did not correlate with ABGs (r = 0.25 and 0.22; P = 0.39 and 0.47 for readers 1 and 2, respectively). Intra and interobserver agreements were excellent. CONCLUSION: UHR-CT provides 99.6 % and 97.6 % accuracy for prosthesis length and diameter measurements, respectively.

Benefits of simulation for ultrasound-guided midline placement training: MC-in-Sim pilot study.

INTRODUCTION: Ultrasound-guided placement of Midlines catheters (MCs) is a standard procedure with many benefits for patients. Even if there are some guidelines worldwide, this invasive technique is still taught at the patient's bed and relies on mentoring in many care centers. The performance of this care by novice practitioners raises ethical and quality of care issues mainly because of its risk of complications. This study aimed to propose and assess a simulation-based learning method for the placement of MCs in novice practitioners. METHODS: A single-center prospective observational study was conducted with anesthesia residents who had no prior experience of Midline placement. Two workshops were planned. The first one consisted of a theoretical training and a simulated practical phase. The second workshop included an assessment of theoretical memorization, a practical exercise and adherence to the training program. RESULTS: The median score of the theoretical memorization was 14.6 (interquartile range [IQR]: 13.5-15.8). The MCs placement time was significantly higher (Med: 12.23 min; IQR: 12.21-12.80) for novice practitioners who did not successfully complete solo MCs placement in simulation versus novice practitioners who successfully completed solo MCs placement in simulation 6.66 min (IQR: 5.92-8.93) (p = 0.002). The number of attempts was significantly higher (p = 0.034) for the novice practitioners who did not successfully complete solo MCs placement in simulation with 67% having performed three punctures, against 0% for the novice practitioners who successfully completed solo MCs placement in simulation. All novice practitioners found this training model efficient for learning how to place MCs and considered it allows for reproducibility in care situations. CONCLUSION: This ultrasound-guided MCs training on simulation is an agile and fast alternative to traditional bedside training for anesthesia novice practitioners.

Comparison between scaphotrapeziotrapezoid arthrodesis and Pyrocardan® implant for isolated scaphotrapeziotrapezoid osteoarthritis.

INTRODUCTION: Scaphotrapeziotrapezoid (STT) arthrodesis and Pyrocardan® implant for painful isolated STT osteoarthritis have shown good results, but no paper has compared their medium-term outcomes. HYPOTHESES: Our main hypothesis would be that the Pyrocardan® implant, by preserving the carpal biomechanics, could lead to better wrist mobility. Our secondary hypotheses would be that no other clinical and radiological differences will be found between these two procedures at a mean 5 years follow-up. PATIENTS: In this non-randomised retrospective study, performed at two healthcare facilities, we report and compare the outcomes of STT arthrodesis with staple fixation versus the Pyrocardan® implant in 38 patients (40 thumbs) from 2 previously published cohorts. Twenty-one patients with a mean age of 68 years (range, 46-79) underwent STT arthrodesis in facility 1. Seventeen patients with a mean age of 61 years (range, 41-80) received a Pyrocardan® implant in facility 2. Patients were reviewed at both facilities by the same examiner who performed a clinical and radiographical assessment. RESULTS: At a mean follow-up of 8 years (range, 2-20 years) for the STT group and 5 years (range 3-8 years) for the Pyrocardan® group, we found no significant differences in the clinical and radiological outcomes between the two procedures except in wrist active extension and ulnar deviation, where Pyrocardan® appears to produce better mobility (extension 58°± 9 vs. 38°± 14 and ulnar deviation 35°[25, 40] versus 45°[40, 50]) (p<.001 and p<.008 respectively). The two surgical techniques led to significantly improvement in terms of pain relief, function, and strength. For the STT arthrodesis group, two complete non-unions were found (9%), while narrowing of the styloscaphoid joint space was found in eight thumbs (36%). For the Pyrocardan® group, four postoperative DISI (22%), four calcifications around the trapezium and/or distal scaphoid (22%) and one asymptomatic dislocation (6%) of the implant were observed. DISCUSSION: Pyrocardan® implant seems to result in better mobility in extension and ulnar deviation. STT arthrodesis and Pyrocardan® implant to treat isolated STT osteoarthritis led to less pain, better strength and functional scores, and restored wrist stability. A future study with a larger population will be needed to confirm these results. LEVEL OF EVIDENCE: IV.

Ultra-high-resolution CT of the temporal bone: Comparison between deep learning reconstruction and hybrid and model-based iterative reconstruction.

PURPOSE: The purpose of this study was to evaluate the ability of ultra-high-resolution computed tomography (UHR-CT) to assess stapes and chorda tympani nerve anatomy using a deep learning (DLR), a model-based, and a hybrid iterative reconstruction algorithm compared to simulated conventional CT. MATERIALS AND METHODS: CT acquisitions were performed with a Mercury 4.0 phantom. Images were acquired with a 1024 × 1024 matrix and a 0.25 mm slice thickness and reconstructed using DLR, model-based, and hybrid iterative reconstruction algorithms. To simulate conventional CT, images were also reconstructed with a 512 × 512 matrix and a 0.5 mm slice thickness. Spatial resolution, noise power spectrum, and objective high-contrast detectability were compared. Three radiologists evaluated the clinical acceptability of these algorithms by assessing the thickness and image quality of the stapes footplate and superstructure elements, as well as the image quality of the chorda tympani nerve bony and tympanic segments using a 5-point confidence scale on 13 temporal bone CT examinations reconstructed with the four algorithms. RESULTS: UHR-CT provided higher spatial resolution than simulated conventional CT at the penalty of higher noise. DLR and model-based iterative reconstruction provided better noise reduction than hybrid iterative reconstruction, and DLR had the highest detectability index, regardless of the dose level. All stapedial structure thicknesses were thinner using UHR-CT by comparison with conventional simulated CT (P < 0.009). DLR showed the best visualization scores compared to the other reconstruction algorithms (P < 0.032). CONCLUSION: UHR-CT with DLR results in less noise than UHR-CT with hybrid iterative reconstruction and significantly improves stapes and tympanic chorda tympani nerve depiction compared to simulated conventional CT and UHR-CT with iterative reconstruction.

Neural mechanisms of odour imagery induced by non-figurative visual cues.

Odour imagery, the ability to experience smell when an appropriate stimulus is absent, has widely been documented as being particularly difficult. However, previous studies have shown the beneficial effect of visual cues (e.g., pictures or words) to facilitate performance in numerous tasks of olfactory nature. Therefore, the use of visual cues to evoke odours seems relevant. In this study, our interest is directed towards non-figurative coloured arrangements, which result from a patented technology and aim at chromatically representing any smell from its chemical composition and sensory description. The aim of this study was to characterise the neural mechanisms of odour imagery facilitated by these non-figurative coloured arrangements. Using functional magnetic resonance imaging, we recorded and compared hemodynamic responses during odour imagery facilitated by non-figurative coloured arrangements and pictures. Our findings reveal that the use of non-figurative coloured arrangements during odour imagery solicits olfactory and non-olfactory brain regions (orbitofrontal cortex, insula, hippocampus, thalamus, dorsolateral prefrontal cortex and supplementary motor area), which are mainly involved in olfactory processing and multimodal integration. Moreover, very similar cortical activity was found between the use of non-figurative coloured arrangements and pictures during odour imagery, with increased activity in the supplementary motor area during the use of coloured arrangements only. Overall, non-figurative coloured arrangements could become a robust tool to visually evoke odours without requiring prior familiarity with the depicted odour. Future studies should use psychometric measures to determine the relationships between brain activation, odour imagery ability and vividness of the generated odour images.

Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings?

OBJECTIVE(S): To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS: This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS: A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION: OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT: Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS: • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.

Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers.

OBJECTIVES: Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors. METHODS: This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed. RESULTS: Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99). DISCUSSION: There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response. CLINICAL RELEVANCE STATEMENT: This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions. KEY POINTS: • Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.

In vivo depiction of cortical bone vascularization with ultra-high resolution-CT and deep learning algorithm reconstruction using osteoid osteoma as a model.

PURPOSE: The purpose of this study was to evaluate the ability to depict in vivo bone vascularization using ultra-high-resolution (UHR) computed tomography (CT) with deep learning reconstruction (DLR) and hybrid iterative reconstruction algorithm, compared to simulated conventional CT, using osteoid osteoma as a model. MATERIALS AND METHODS: Patients with histopathologically proven cortical osteoid osteoma who underwent UHR-CT between October 2019 and October 2022 were retrospectively included. Images were acquired with a 1024 × 1024 matrix and reconstructed with DLR and hybrid iterative reconstruction algorithm. To simulate conventional CT, images with a 512 × 512 matrix were also reconstructed. Two radiologists (R1, R2) independently evaluated the number of blood vessels entering the nidus and crossing the bone cortex, as well as vessel identification and image quality with a 5-point scale. Standard deviation (SD) of attenuation in the adjacent muscle and that of air were used as image noise and recorded. RESULTS: Thirteen patients with 13 osteoid osteomas were included. There were 11 men and two women with a mean age of 21.8 ± 9.1 (SD) years. For both readers, UHR-CT with DLR depicted more nidus vessels (11.5 ± 4.3 [SD] (R1) and 11.9 ± 4.6 [SD] (R2)) and cortical vessels (4 ± 3.8 [SD] and 4.3 ± 4.1 [SD], respectively) than UHR-CT with hybrid iterative reconstruction (10.5 ± 4.3 [SD] and 10.4 ± 4.6 [SD], and 4.1 ± 3.8 [SD] and 4.3 ± 3.8 [SD], respectively) and simulated conventional CT (5.3 ± 2.2 [SD] and 6.4 ± 2.5 [SD], 2 ± 1.2 [SD] and 2.4 ± 1.6 [SD], respectively) (P < 0.05). UHR-CT with DLR provided less image noise than simulated conventional CT and UHR-CT with hybrid iterative reconstruction (P < 0.05). UHR-CT with DLR received the greatest score and simulated conventional CT the lowest score for vessel identification and image quality. CONCLUSION: UHR-CT with DLR shows less noise than UHR-CT with hybrid iterative reconstruction and significantly improves cortical bone vascularization depiction compared to simulated conventional CT.

Computed Tomography Bone Imaging: Pushing the Boundaries in Clinical Practice.

Bone microarchitecture has several clinical implications over and above estimating bone strength. Computed tomography (CT) analysis mainly uses high-resolution peripheral quantitative CT and micro-CT, research imaging techniques, most often limited to peripheral skeleton assessment. Ultra-high-resolution (UHR) CT and photon-counting detector CT, two commercially available techniques, provide images that can approach the spatial resolution of the trabeculae, bringing bone microarchitecture analysis into clinical practice and improving depiction of bone vascularization, tumor matrix, and cortical and periosteal bone. This review presents bone microarchitecture anatomy, principles of analysis, reference measurements, and an update on the performance and potential clinical applications of these new CT techniques. We also share our clinical experience and technical considerations using an UHR-CT device.

Initial Evaluation of Focal Bone Lesions: How Do We Do It?

Focal bone lesions are frequent, and management greatly depends on the characteristics of their images. After briefly discussing the required work-up, we analyze the most relevant imaging signs for assessing potential aggressiveness. We also describe the imaging aspects of the various types of lesion matrices and their clinical implications.

Assessment of Scapholunate Instability on 4D CT Scans in Patients with Inconclusive Conventional Images.

Background Initial imaging work-up using radiography and CT arthrography sometimes can be insufficient to identify a scapholunate (SL) instability (SLI) in patients suspected of having SL ligament tears. Purpose To determine the diagnostic performance of four-dimensional (4D) CT in the identification of SLI and apply the findings to patients suspected of having SLI and with inconclusive findings on radiographs and CT arthrograms. Materials and Methods This prospective single-center study enrolled participants suspected of having SLI (recent trauma, dorsal pain, positive Watson test results, decreased grip strength) between March 2015 and March 2020. Participants with wrist fractures, substantial joint stiffness, or history of wrist surgery were excluded. Each participant underwent radiography, CT arthrography, and 4D CT on the same day. Participants were divided into three groups: those with no SLI, those with SLI, and those with inconclusive results. SL gap and radioscaphoid and lunocapitate angle were measured using semiautomatic quantitative analysis of 4D CT images by two independent readers. Receiver operating characteristic curves were used to evaluate the diagnostic performance of 4D CT. Thresholds were determined with the Youden index and were applied to the inconclusive group. Results Of the 150 included participants (mean age, 41 years ± 14 [SD]; 102 male, 48 female), there were 63 with no SLI, 48 with SLI, and 39 with inconclusive results. The maximum value and range of SL gap measurements on 4D CT scans showed high sensitivity (83% [40 of 48] and 90% [43 of 48], respectively) and high specificity (95% [59 of 62] and 81% [50 of 62], respectively) in the identification of SLI. At least one of these parameters was abnormal on 4D CT scans in 17 of 39 (44%) participants in the inconclusive group, and 10 of 17 (59%) participants had confirmed SLI. In the 22 participants in the inconclusive group with no indication of SLI at 4D CT, follow-up showed no evidence of SLI in 10 (45%) and enabled confirmation of SLI via arthroscopy in three (14%). Conclusion Scapholunate gap measurements on kinematic 4D CT scans enabled correct identification of SLI in 59% of participants with inconclusive results on conventional images. ClinicalTrials.gov registration no. NCT02401568 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.

Contribution of contrast-enhanced ultrasound in the diagnosis of adnexal torsion (AGATA): protocol for a prospective comparative study.

INTRODUCTION: Adnexal torsion is a surgical emergency and its prognosis depends on the time elapsed prior to treatment. The diagnosis relies on pelvic ultrasound in which sensitivity remains low and may lead to misdiagnosis.The primary objective is to evaluate the diagnostic performance of contrast-enhanced ultrasound for the diagnosis of adnexal torsion in women with suspected adnexal torsion. The secondary objectives are: (1) to describe the perfusion parameters of the ovaries by contrast-enhanced ultrasound, (2) to compare diagnostic performance of contrast ultrasound with bidimensional (2D) Doppler for the detection of adnexal torsion, (3) to describe the perfusion parameters of the ovarian as a function of the degree of adnexal torsion, (4) to compare perfusion parameters before and after ovarian detorsion and (5) to describe perfusion parameters of the ovarian by using MicroVascular Flow technique. METHODS AND ANALYSIS: This is a monocentric, prospective comparative, non-randomised, open and interventional study. We hypothesise to include 30 women: 20 positive cases compared with 10 control cases. Women are informed and recruited in the emergency ward, over a period of 36 months.The primary endpoint is the signal intensity measurement to assess sensitivity, specificity, positive and negative predictive values of contrast-enhanced ultrasound for detection of adnexal torsion in women with suspected adnexal torsion. The presence or absence of adnexal torsion is confirmed during the surgical intervention. ETHICS AND DISSEMINATION: The study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) OUEST I on 3 July 2020 with reference number 2020T1-16. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT04522219); EudraCT registry (2020-000993-27).

Identification of resting-state networks using dynamic brain perfusion SPECT imaging: A fSPECT case report.

Connectivity studies with nuclear medicine systems are scarce in literature. They mainly employ PET imaging and group level analyses due to the low temporal resolution of PET and especially SPECT imaging. Our current study analyses connectivity at an individual level using dynamic SPECT imaging, which has been enabled by the improved temporal resolution performances provided by the 360°CZT cameras. We present the case of an 80-year-old man referred for brain perfusion SPECT imaging for cognitive disorders for whom a dynamic SPECT acquisition was performed utilizing a 360°CZT camera (temporal sampling of 15 frames × 3 s, 10 frames × 15 s, 14 frames × 30 s), followed by a conventional static acquisition of 15 m. Functional SPECT connectivity (fSPECT) was assessed through a seed correlation analysis and 5 well-known resting-state networks were identified: the executive, the default mode, the sensory motor, the salience, and the visual networks. This case report supports the feasibility of fSPECT imaging to identify well known resting-state networks, thanks to the novel properties of a 360°CZT camera, and opens the way to the development of more dedicated functional connectivity studies using brain perfusion SPECT imaging.

Deep learning HASTE sequence compared with T2-weighted BLADE sequence for liver MRI at 3 Tesla: a qualitative and quantitative prospective study.

OBJECTIVES: To qualitatively and quantitatively compare a single breath-hold fast half-Fourier single-shot turbo spin echo sequence with deep learning reconstruction (DL HASTE) with T2-weighted BLADE sequence for liver MRI at 3 T. METHODS: From December 2020 to January 2021, patients with liver MRI were prospectively included. For qualitative analysis, sequence quality, presence of artifacts, conspicuity, and presumed nature of the smallest lesion were assessed using the chi-squared and McNemar tests. For quantitative analysis, number of liver lesions, size of the smallest lesion, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in both sequences were assessed using the paired Wilcoxon signed-rank test. Intraclass correlation coefficients (ICCs) and kappa coefficients were used to assess agreement between the two readers. RESULTS: One hundred and twelve patients were evaluated. Overall image quality (p = .006), artifacts (p < .001), and conspicuity of the smallest lesion (p = .001) were significantly better for the DL HASTE sequence than for the T2-weighted BLADE sequence. Significantly more liver lesions were detected with the DL HASTE sequence (356 lesions) than with the T2-weighted BLADE sequence (320 lesions; p < .001). CNR was significantly higher for the DL HASTE sequence (p < .001). SNR was higher for the T2-weighted BLADE sequence (p < .001). Interreader agreement was moderate to excellent depending on the sequence. Of the 41 supernumerary lesions visible only on the DL HASTE sequence, 38 (93%) were true-positives. CONCLUSION: The DL HASTE sequence can be used to improve image quality and contrast and reduces artifacts, allowing the detection of more liver lesions than with the T2-weighted BLADE sequence. CLINICAL RELEVANCE STATEMENT: The DL HASTE sequence is superior to the T2-weighted BLADE sequence for the detection of focal liver lesions and can be used in daily practice as a standard sequence. KEY POINTS: • The half-Fourier acquisition single-shot turbo spin echo sequence with deep learning reconstruction (DL HASTE sequence) has better overall image quality, reduced artifacts (particularly motion artifacts), and improved contrast, allowing the detection of more liver lesions than with the T2-weighted BLADE sequence. • The acquisition time of the DL HASTE sequence is at least eight times faster (21 s) than that of the T2-weighted BLADE sequence (3-5 min). • The DL HASTE sequence could replace the conventional T2-weighted BLADE sequence to meet the growing indication for hepatic MRI in clinical practice, given its diagnostic and time-saving performance.

Zero echo time MRI in shoulder MRI protocols for the diagnosis of rotator cuff calcific tendinopathy improves identification of calcific deposits compared to conventional MR sequences but remains sub-optimal compared to radiographs.

OBJECTIVE: To compare the diagnostic performance of standard MRI and standard MRI + ZTE images for the detection of rotator cuff calcific tendinopathy (RCCT) and to describe the artifacts encountered with ZTE images, using computed radiography (CR) as a reference. METHODS: In a retrospective study, patients with suspicion of rotator cuff tendinopathy who underwent standard MRI + ZTE images after radiography were enrolled between June 2021 and June 2022. Images were independently analyzed for calcific deposit presence and ZTE images artifacts, by two radiologists. Diagnostic performance was calculated individually with MRI + CR as the reference standard. RESULTS: A total of 46 RCCT subjects (27 women; mean age, 55.3 years ± 12.4) and 51 control subjects (27 men; mean age, 45.5 ± 12.9) were evaluated. For both readers, there was an increase in the sensitivity for the identification of calcific deposits of MRI + ZTE compared to MRI (77% (95% CI: 64.5-86.8) and 75.4% (95% CI: 62.7-85.5) versus 57.4% (95% IC: 44.1-70) and 47.5% (95% IC: 34.6-60.7), for R1 and R2, respectively). Specificity was quite similar for both readers and both imaging techniques and ranged from 96.6% (95% IC: 93.3-98.5) to 98.7% (95% IC: 96.3-99.7). Hyperintense joint fluid (62.8% of patients), long head of the biceps tendon (in 60.8%), and subacromial bursa (in 27.8%) on ZTE were considered artifactual. CONCLUSION: The addition of ZTE images to a standard MRI protocol improved MRI diagnostic performance of RCCT, but with a suboptimal detection rate and a relatively high frequency of artifactual soft tissue signal hyperintensity. KEY POINTS: • Adding ZTE images to standard shoulder MRI improves the MR-based detection of rotator cuff calcific tendinopathy, but half of the calcification unseen with standard MRI remained unseen with ZTE MRI. On ZTE images, joint fluid and long head biceps tendon were hyperintense in about 60% of the shoulders, as well as the subacromial bursa in about 30%, without calcific deposit on conventional radiographs. • The detection rate of calcific deposits using ZTE images was dependent on the disease phase. In the calcific stage, it reached 100% in this study but remained at a maximum of 80.7% in the resorptive phase.

Comparison of the Outcomes of Flexor Tendon Repair in Zone II Using the Original and Adjusted Strickland Scores and the 400-Points Hand Test.

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests - the original and adjusted Strickland scores - and a global hand function test, the 400-points test. Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19-82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists. Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test. Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score. Level of Evidence: Level IV (Therapeutic).