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1.
Sci Rep ; 9(1): 14586, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601919

RESUMO

Thin-section computed tomography (TSCT) imaging biomarkers are uncertain to distinguish progressive adenocarcinoma from benign lesions in pGGNs. The purpose of this study was to evaluate the usefulness of TSCT characteristics for differentiating among transient (TRA) lesions, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) presenting as pure ground-glass nodules (pGGNs). Between January 2016 and January 2018, 255 pGGNs, including 64 TRA, 22 AAH, 37 AIS, 108 MIA and 24 IAC cases, were reviewed on TSCT images. Differences in TSCT characteristics were compared among these five subtypes of pGGNs. Logistic analysis was performed to identify significant factors for predicting MIA and IAC. Progressive pGGNs were more likely to be round or oval in shape, with clear margins, air bronchograms, vascular and pleural changes, creep growth, and bubble-like lucency than were non-progressive pGGNs. The optimal cut-off values of the maximum diameter for differentiating non-progressive from progressive pGGNs and IAC from non-IAC were 6.5 mm and 11.5 mm, respectively. For the prediction of IAC vs. non-IAC and non-progressive vs. progressive adenocarcinoma, the areas under the receiver operating characteristics curves were 0.865 and 0.783 for maximum diameter and 0.784 and 0.722 for maximum CT attenuation, respectively. The optimal cut-off values of maximum CT attenuation were -532 HU and -574 HU for differentiating non-progressive from progressive pGGNs and IAC from non-IAC, respectively. Maximum diameter, maximum attenuation and morphological characteristics could help distinguish TRA lesions from MIA and IAC but not from AAH. So, CT morphologic characteristics, diameter and attenuation parameters are useful for differentiating among pGGNs of different subtypes.

2.
Thorac Cancer ; 10(10): 1893-1903, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31426132

RESUMO

BACKGROUND: The aim of this study was to investigate the influence of convolution kernel and iterative reconstruction on the diagnostic performance of radiomics and deep learning (DL) in lung adenocarcinomas. METHODS: A total of 183 patients with 215 lung adenocarcinomas were included in this study. All CT imaging data was reconstructed with three reconstruction algorithms (ASiR at 0%, 30%, 60% strength), each with two convolution kernels (bone and standard). A total of 171 nodules were selected as the training-validation set, whereas 44 nodules were selected as the testing set. Logistic regression and a DL framework-DenseNets were selected to tackle the task. Three logical experiments were implemented to fully explore the influence of the studied parameters on the diagnostic performance. The receiver operating characteristic curve (ROC) was used to evaluate the performance of constructed models. RESULTS: In Experiments A and B, no statistically significant results were found in the radiomic method, whereas two and six pairs were statistically significant (P < 0.05) in the DL method. In Experiment_C, significant differences in one and four models were found in the radiomics and DL methods, respectively. Moreover, models constructed with standard convolution kernel data outperformed that constructed with bone convolution kernel data in all studied ASiR levels in the DL method. In the DL method, B0 and S60 performed best in bone and standard convolution kernel, respectively. CONCLUSION: The results demonstrated that DL was more susceptible to CT parameter variability than radiomics. Standard convolution kernel images seem to be more appropriate for imaging analysis. Further investigation with a larger sample size is needed.

3.
Cancer Med ; 8(7): 3532-3543, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31074592

RESUMO

To develop a deep learning system based on 3D convolutional neural networks (CNNs), and to automatically predict EGFR-mutant pulmonary adenocarcinoma in CT images. A dataset of 579 nodules with EGFR mutation status labels of mutant (Mut) or wild-type (WT) was retrospectively analyzed. A deep learning system, namely 3D DenseNets, was developed to process 3D patches of nodules from CT data, and learn strong representations with supervised end-to-end training. The 3D DenseNets were trained with a training subset of 348 nodules and tuned with a development subset of 116 nodules. A strong data augmentation technique, mixup, was used for better generalization. We evaluated our model on a holdout subset of 115 nodules. An independent public dataset of 37 nodules from the cancer imaging archive (TCIA) was also used to test the generalization of our method. Conventional radiomics analysis was also performed for comparison. Our method achieved promising performance on predicting EGFR mutation status, with AUCs of 75.8% and 75.0% for our holdout test set and public test set, respectively. Moreover, strong relations were found between deep learning feature and conventional radiomics, while deep learning worked through an enhanced radiomics manner, that is, deep learned radiomics (DLR), in terms of robustness, compactness and expressiveness. The proposed deep learning system predicts EGFR-mutant of lung adenocarcinomas in CT images noninvasively and automatically, indicating its potential to help clinical decision-making by identifying eligible patients of pulmonary adenocarcinoma for EGFR-targeted therapy.

4.
World Neurosurg ; 129: e48-e55, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31051310

RESUMO

OBJECTIVE: To investigate potential risk factors for cerebral hyperperfusion syndrome (CHS) after surgery in patients with moyamoya disease (MMD) using phase-contrast magnetic resonance imaging (MRI). METHODS: The study included 84 adult patients (89 brain hemispheres) with MMD who underwent surgery. Preoperative phase-contrast MRI scans were performed for all patients. Peak velocity, average velocity, average flow, forward volume, and region of interest area of the bilateral internal and external carotid arteries, superficial temporal artery, and vertebral artery were calculated and analyzed. Patients were divided into CHS and non-CHS groups. Patients' age, sex, clinical symptoms, Suzuki stage, and MRI flow examination results were compared between the 2 groups. RESULTS: Nineteen of 84 patients (89 hemispheres) with MMD were in the CHS group. Patients with ischemic onset symptoms were more likely to develop CHS after surgery (P < 0.05). There were no significant differences in age, sex, and Suzuki stage between the 2 groups. For surgery ipsilateral vessels, peak velocity, average flow and forward volume of superficial temporal artery and average flow of external carotid artery and region of interest area of internal carotid artery in the CHS group were significantly lower compared with the non-CHS group (P < 0.05). For surgery contralateral vessels, forward volume of superficial temporal artery and external carotid artery in the CHS group was significantly lower compared with the non-CHS group (P < 0.05). CONCLUSIONS: Patients with MMD and ischemic onset symptoms are more likely to develop CHS after surgery. Preoperative phase-contrast MRI analysis may be helpful to predict CHS in patients with MMD after surgery.

5.
Eur Radiol ; 29(10): 5423-5430, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30903336

RESUMO

OBJECTIVE: To retrospectively analyze the computed tomography (CT) features in patients with pre-invasive lesions and early-stage lung adenocarcinoma and to explore the correlation between tumor morphological changes and pathological diagnoses. MATERIALS AND METHODS: CT morphological characteristics in 2106 patients with pre-invasive (stage 0) and early-stage (stage I) lung adenocarcinoma were analyzed; lesions were confirmed by surgical pathology. Based on the morphological characteristics, the lesions were divided into eight types: I (cotton ball, ground-glass nodules), II (solid fill), III (granular), IV (dendriform), V (bubble-like lucencies), VI (alveolate or honeycomb), VII (scar-like), and VIII (notched or umbilication). The different distributions of eight morphological types in pathological types of the lesions and subtypes of invasive adenocarcinoma were analyzed by chi-squared or Fisher's exact test. Correlation between the percentage of ground-glass opacity in the lesions and pathology types were analyzed by two-tailed Pearson's test. RESULTS: A negative correlation was observed between the pathological types and proportion of ground-glass component in the lesions (p < 0.001 and r = - 0.583). Significant differences in morphological characteristics among various pathological types of pre-invasive lesions and early lung adenocarcinomas were observed (p < 0.05). Furthermore, among the different pathological subtypes of stage I invasive adenocarcinoma, the differences in their manifestation as morphological types I, II, III, and VI were statistically significant (p < 0.05). CONCLUSION: The eight types of morphological classification of pre-invasive lesions and early-stage (stage 0 or stage I) lung adenocarcinoma has different pathological bases, and morphological classification may be useful for the diagnosis and differential diagnosis of lung adenocarcinoma. KEY POINTS: • CT morphological classification of pre-invasive lesions and lung adenocarcinoma is intuitive. • CT morphological classification characterizes morphological changes of the entire lesion. • Different pathological types of lung adenocarcinoma have different morphological features.

6.
Eur J Radiol ; 112: 161-168, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30777206

RESUMO

The aim of the present study was to develop and validate a radiomics-based nomogram for differentiation of pre-invasive lesions from invasive lesions that appearing as ground-glass opacity nodules (GGNs) ≤10 mm (sub-centimeter) in diameter at CT. A total of 542 consecutive patients with 626 pathologically confirmed pulmonary subcentimeter GGNs were retrospectively studied from October 2011 to September 2017. All the GGNs were divided into a training set (n = 334) and a validation set (n = 292). Researchers extracted 475 radiomics features from the plain CT images; a radiomics signature was constructed with the least absolute shrinkage and selection operator (LASSO) based on multivariable regression in the training set. Based on the multivariable logistic regression model, a radiomics nomogram was developed in the training set. The performance of the nomogram was evaluated with respect to its calibration, discrimination, and clinical-utility and this was assessed in the validation set. The constructed radiomics signature, which consisted of 15 radiomics features, was significantly associated with the invasiveness of subcentimeter GGNs (P < 0.0001 for both training set and validation set). To build the nomogram model, radiomics signature and mean CT value were used. The nomogram model demonstrated good discrimination and calibration in both training set (C-index, 0.716 [95% CI, 0.632 to 0.801]) and validation set (C-index, 0.707 [95% CI, 0.625 to 0.788]). Decision curve analysis (DCA) indicated that radiomics-based nomogram was clinically useful. A radiomics-based nomogram that incorporates both radiomics signature and mean CT value is constructed in the study, which can be conveniently used to facilitate the preoperative individualized prediction of the invasiveness in patients with subcentimeter GGNs.


Assuntos
Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Nomogramas , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
7.
Diagn Interv Radiol ; 25(1): 42-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30644367

RESUMO

PURPOSE: We aimed to analyze multislice computed tomography (MSCT) imaging features of vasculitis in immunoglobulin G4-related disease (IgG4-RD). METHODS: In this retrospective study, we diagnosed 21 definite or possible IgG4-RD patients (71.4% male; mean age, 52.1±4.5 years) with vasculitis by MSCT and pathologic examination. The clinical background, laboratory analysis, pathologic results, CT images, and response to therapy were assessed and analyzed. RESULTS: Under enhanced MSCT, 50 vasculitic lesions were identified and were divided into five types (types A-E) according to the CT findings on the basis of luminal changes. There were more vasculitic lesions observed below the diaphragm (n=30) than above it (n=20). Aneurysms and aneurysmal dilatation were more likely to be found in the aortaventralis (n=5), aortic arch (n=3) and iliac arteries (n=3). Most of the vascular lesions were characterized by wall thickening with a normal lumen (n=15) and slight stenosis (n=22). The affected vascular walls were all thickened between 4 and 18 mm. The walls of 19 patients (90.4%) were well circumscribed. The wall thickness of the aorta, including the aortaventralis and aortic arch, was more notable than that of the other vascular sites. Fourteen patients were followed up for 2-24 months. Wall thickness decreased in all cases. The average maximum thicknesses before and after therapy were 12.2±2.7 mm and 6.1±1.8 mm, which were significantly different (P < 0.001). The lumens of two patients were found to be slightly enlarged, while those of the other cases were unchanged after therapy. CONCLUSION: IgG4-RD vascular lesions can be divided into five types, which are more likely to be present in the aorta and its main branches, and can rapidly diminish after steroid therapy. The lumen may be unchanged or slightly enlarged.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Imunoglobulina G/metabolismo , Tomografia Computadorizada Multidetectores/métodos , Doenças Vasculares/diagnóstico por imagem , Vasculite/diagnóstico por imagem , Assistência ao Convalescente , Biomarcadores/sangue , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteroides/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/imunologia , Doenças Vasculares/patologia , Vasculite/tratamento farmacológico , Vasculite/imunologia , Vasculite/patologia
8.
Cancer Res ; 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30279243

RESUMO

Identification of early-stage pulmonary adenocarcinomas prior to surgery, especially in cases of sub-centimeter cancers, would be clinically important and could provide guidance to clinical decision making. In this study, we developed a deep learning system based on 3D convolutional neural networks and multi-task learning, which automatically predicts tumor invasiveness, together with 3D nodule segmentation masks. The system processes a 3D nodule-centered patch of pre-processed CT and learns a deep representation of a given nodule without the need for any additional information. A dataset of 651 nodules with manually segmented voxel-wise masks and pathological labels of atypical adenomatous hyperplasia (AAH), adenocarcinomas in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive pulmonary adenocarcinoma (IA) was used in this study. We trained and validated our deep learning system on 523 nodules and tested its performance on 128 nodules. An observer study with 2 groups of radiologists, 2 senior and 2 junior, was also investigated. We merged AAH and AIS into one single category AAH-AIS, comprising a 3-category classification in our study. The proposed deep learning system achieved better classification performance than the radiologists; in terms of 3-class weighted average F1 score, the model achieved 63.3% while the radiologists achieved 55.6%, 56.6%, 54.3%, and 51.0%, respectively. These results suggest that deep learning methods improve the yield of discriminative results and hold promise in the CADx application domain, which could help doctors work efficiently and facilitate the application of precision medicine.

9.
Br J Radiol ; : 20180204, 2018 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-30260240

RESUMO

OBJECTIVE: To explore the CT characteristics of small lung nodules and improve the diagnosis of pulmonary ground-glass nodules less than 10 mm in size. METHODS: We retrospectively analyzed CT images of 161 pulmonary nodules (less than 10 mm in size) with spiculation, lobulation, vacuoles, and pleural indentation and compared these images with pathological results or follow-up CT images. The relationships between the ground-glass nodules (GGNs) and blood vessels were observed. The GGN-vessel relationship was divided into four types, Type I (pass-by), Type II (pass-through), Type III (distorted/dilated), Type IV (complicated). The vessels traveling through a GGN were divided into three categories, category A (arteries), category B (veins), category C (arteries and veins). RESULTS: 161 GGNs were divided into three groups (benign group, pre-invasive group, and adenocarcinoma group) according to their pathological diagnosis. Significant differences in density of nodules were observed among the three different groups (p < 0.05). Significant differences in the shape (round/round-like or not) of the nodules were observed between the benign group and the pre-invasive group and between the pre-invasive group and the adenocarcinoma group (p < 0.05). No significant differences in the presence of vacuoles were observed between the benign group and the pre-invasive group or between the pre-invasive group and the adenocarcinoma group (p >0.05), but a significant difference was observed between the benign group and the adenocarcinoma group (p < 0.05). The differences in the vascularization of the lesions among the three groups were statistically significant (p < 0.05). No significant differences or correlations were observed between vascular categories and GGN groups (p > 0.05). CONCLUSION: For subcentimeter nodules, mixed GGNs with vacuoles, well-defined border, combined with Type III or Type IV GGN-vessel relationship may strongly suggest malignant. ADVANCES IN KNOWLEDGE: Previous studies mainly focused on CT diagnosis of pulmonary nodules (≤ 3 cm in diameter), but this study focused on ground-glass nodules less than 10 mm in diameter, which had not been fully studied. For subcentimeter nodules, mixed GGNs with vacuoles, well-defined border, especially the GGN-vessel relationship manifest as Type III (distorted/dilated) or Type IV (complicated) may strongly suggest malignant.

10.
J Comput Assist Tomogr ; 42(4): 614-622, 2018 Jul/Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29613988

RESUMO

OBJECTIVE: The objective of this study was to investigate the correlation between dual-energy computed tomography (DECT)-based iodine quantitation and fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging for response evaluation of lung cancers to treatment. METHODS: In this prospective study, a total of 32 pairs of DECT and F-FDG PET/CT imaging acquired consecutively from 13 patients with primary or metastatic lung cancers receiving either radiotherapy alone or chemoradiotherapy were analyzed. Imaging examinations were performed before, immediately, and no later than 6 months after treatment for response evaluation. Iodine-related parameters including the total iodine uptake (TIU) and vital volume (VIV) from DECT and metabolic metrics such as the standardized uptake value normalized to lean body mass (SULpeak), metabolic tumor volume (MTV), and the total lesion glycolysis (TLG) from F-FDG-PET/CT were generated and measured by semiautomatic approaches. Dual-energy CT and PET/CT metrics were calculated and followed up with comparison with response evaluation criteria in solid tumors (RECIST). RESULTS: Analysis of pretreatment imaging data revealed a strong correlation between DECT metrics (RECIST, TIU, and VIV) and F-FDG PET/CT metrics (MTV, TLG) with coefficients of R ranging from 0.86 to 0.90 (P < 0.01). With the delivery of treatment, all measured DECT and PET/CT metrics significantly decreased whereas the descending amplitude in RECIST was significantly smaller than that of the remaining parameters (P < 0.05). During follow-up examinations, both metrics followed a similar changing pattern. Overall, strong consistency was found between RECIST, TIU, VIV and SULpeak, MTV, TLG (R covers 0.78-0.96, P < 0.05). CONCLUSIONS: Semiautomatic iodine-related quantitation in DECT correlated well with metabolism-based measurements in F-FDG PET/CT, suggesting that DECT-based iodine quantitation might be a feasible substitute for assessment of lung cancer response to chemoradiotherapy/radiotherapy with comparison with F-FDG PET/CT.


Assuntos
Quimiorradioterapia , Fluordesoxiglucose F18/farmacocinética , Iodo/farmacocinética , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Compostos Radiofarmacêuticos/farmacocinética , Resultado do Tratamento
11.
IEEE J Biomed Health Inform ; 22(1): 161-172, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28500014

RESUMO

OBJECTIVE: an innovative concept and method is introduced to use a 3-D anatomical graphic pattern called visual patient (VP) visually to index, represent, and render the medical diagnostic records (MDRs) of a patient, so that a doctor can quickly learn the current and historical medical status of the patient by manipulating VP. The MDRs can be imaging diagnostic reports and DICOM images, laboratory reports and clinical summaries which can have clinical information relating to medical status of human organs or body parts. METHODS: the concept and method included three steps. First, a VP data model called visual index object (VIO) and a VP graphic model called visual anatomic object (VAO) were introduced. Second, a series of processing methods of parsing and extracting key information from MDRs were used to fill the attributes of the VIO model of a patient. Third, a VP system (VPS) was designed to map VIO to VAO, to create a VP instance for each patient. RESULTS: a prototype VPS has been implemented in a simulated hospital PACS/RIS integrated environment. Two evaluation results showed that more than 70% participating radiologists would like to use the VPS in their radiological imaging tasks, and the efficiency of using VPS to review the tested patients' MDRs was 2.24 times higher than that of using PACS/RIS, while the average accuracy by using PACS/RIS was better than that by using VPS; however, this difference was only about 4%. CONCLUSION: the developed VPS can show the medical status of patient organs/sub-organs with 3-D anatomical graphic pattern and will be welcomed by radiologists with better efficiency in reviewing the patients' MDRs and with acceptable accuracy. SIGNIFICANCE: the VP introduces a new way for medical professionals to access and interact with a huge amount of patient records with better efficiency in the big data era.


Assuntos
Gráficos por Computador , Registros Eletrônicos de Saúde , Imagem Tridimensional , Modelos Biológicos , Adulto , Humanos , Radiologistas
12.
Medicine (Baltimore) ; 96(43): e7742, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29068976

RESUMO

This study aimed to explore the value of contrast-enhanced computed tomography (CT) scans in the differential diagnosis of atypical adenomatous hyperplasia, adenocarcinoma in situ, minimal invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC), which manifested as ground glass nodules (GGNs) or mixed GGNs.Unenhanced and contrast-enhanced presurgical CT images of 136 cases of GGNs were compared. The nodules were diagnosed based on their solid portions and maximum dimensions, and the findings obtained using both contrast-enhanced and unenhanced CT images were analyzed in corroboration with the pathological diagnosis.Most (53/56) preinvasive nodules showed increased mean CT values after contrast administration. In the MIA group, after contrast administration, enlargements of the solid portions were seen in 48 nodules (48/60), and the elevation of the mean CT value was observed in 12 nodules (12/60). The vast majority of IAC nodules (29/30) showed enlargement of the solid portions after contrast administration. Moreover, for group differences, findings obtained using this approach statistically match the pathological findings.Contrast-enhanced CT scans are more useful than unenhanced CT scans for the diagnosis of GGNs, especially for pure GGNs, before surgery.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X , Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão , Meios de Contraste , Diagnóstico Diferencial , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Invasividade Neoplásica , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
Acad Radiol ; 24(12): 1482-1490, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28800951

RESUMO

RATIONALE AND OBJECTIVES: The study aimed to prospectively evaluate the radiation dose reduction potential and image quality (IQ) of a high-concentration contrast media (HCCM) injection protocol in combination with a low tube current (mAs) in coronary computed tomography angiography. MATERIALS AND METHODS: Eighty-one consecutive patients (mean age: 62 years; 34 females; body mass index: 18-31) were included and randomized-assigned into two groups. All computed tomography (CT) examinations were performed in two groups with the same tube voltage (100 kV), flow rate of contrast medium (5.0 mL/s), and iodine dose (22.8 g). An automatic mAs and low concentration contrast medium (300 mgI/mL) were used in group A, whereas effective mAs was reduced by a factor 0.6 along with HCCM (400 mgI/mL) in group B. Radiation dose was assessed (CT dose index [CTDIvol] and dose length product), and vessel-based objective IQ for various regions of interest (enhancement, noise, signal-to-noise ratio, and contrast-to-noise ratio), subjective IQ, noise, and motion artifacts were analyzed overall and vessel-based with a 5-point Likert scale. RESULTS: The CT attenuation of coronary arteries and image noise in group B were significantly higher than those in group A (ranges: 507.5-548.1 Hounsfield units vs 407.5-444.5 Hounsfield units; and 20.3 ± 8.6 vs 17.7 ± 8.0) (P ≤ 0.0166). There was no significant difference between the two groups in signal-to-noise ratio, contrast-to-noise ratio, and subjective IQ of coronary arteries (29.4-31.7, 30.0-37.0, and medium score of 5 in group A vs 29.4-32.4, 27.7-36.3, and medium score of 5 in group B, respectively, P ≥ 0.1859). Both mean CTDIvol and dose length product in group B were 58% of those of group A. CONCLUSIONS: HCCM combined with low tube current allows dose reduction in coronary computed tomography angiography and does not compromise IQ.


Assuntos
Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Angiografia Coronária , Iohexol/análogos & derivados , Iopamidol/análogos & derivados , Doses de Radiação , Artefatos , Protocolos Clínicos , Feminino , Humanos , Iohexol/administração & dosagem , Iopamidol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Eur J Radiol ; 85(6): 1208-18, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27161072

RESUMO

OBJECTIVE: To characterize solitary pulmonary nodules (SPN) in terms of perfusion parameters using low-dose volume perfusion computed tomography (VPCT) and two different calculation methods, compare their results, look for interobserver agreement of measurements and investigate the feasibility of low-dose VPCT. MATERIALS AND METHODS: This study was approved by the local Institutional Review Board and all patients provided written informed consent. Seventy-one patients (mean age 60.8 years ±9.6) with solitary pulmonary nodules were enrolled. Low-dose VPCT was performed for 38.63s covering the involved lung (70kV, 120mAs, 22 consecutive volume measurements, 50mL iodinated contrast, flow rate 4mL/s). Mean blood flow (BF), blood volume (BV) and k-trans were determined both with the maximum slope+Patlak vs. deconvolution method. Additionally, the difference of VPCT parameters between different type lesions and normal tissue was analyzed. Interobserver agreement for all perfusion parameters was calculated using intraclass correlation coefficients (ICC). The effective radiation dose of the VPCT and the total CT scan protocol were recorded. All CT findings were histologically confirmed by surgical intervention. RESULTS: The mean lesion size was 18.6mm. Interobserver agreement measure with ICC shows high agreement between the measurements (κ=0.85). The effective radiation dose of the VPCT was 9.3mSv. The mean perfusion values for BF, BV and k-trans of 120.6mL/100g tissue/', 11.6mL/100g tissue/', and 18.5mL/100g tissue/' for the deconvolution method, and 50.1mL/100g tissue/', 11.6mL/100g tissue/' and 24.3mL/100g tissue/' for the maximum slope+Patlak method, which were significantly higher than those of normal muscle (20.7mL/100g tissue/', 2.6mL/100g tissue/', and 7.6mL/100g tissue/' for the deconvolution method and 10.9mL/100g tissue/', 3.1mL/100g tissue/' and 8.1mL/100g tissue/' for the maximum slope method). The best overall correlation between calculation methods was achieved for measurements of BF. CONCLUSION: The low-dose volume perfusion CT of the solitary pulmonary nodules can effectively reduce the radiation dose and non-invasively assess perfusion of SPN within the entire lesion volume.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Iopamidol , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
Radiol Med ; 121(4): 279-90, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26612322

RESUMO

While conventional ultrasound and laboratory testing can differentiate most thyroid conditions and malignancies, spectral dual-energy computed tomography (DECT) provides molecular data potentially useful in differential diagnosis of small, complex, and partially obscured hemorrhaged nodules with recent bleeding. To demonstrate that Gemstone Spectral Imaging (GSI) analysis of DECT data differentiates challenging benign thyroid nodule conditions in patients with intranodular hemorrhages. A retrospective study was conducted of 30 intranodular hemorrhage patients from 2010 to 2013, including 18 that underwent surgery and provided thyroid tissues for prospective histological analysis. Iodine and water content were determined in patient CT scans and ex vivo tissue specimen scans by reconstruction of raw CT data at 65 keV (optimal contrast). Slope of spectral curve (λ HU), effective atomic number (Z eff), and final pathological diagnosis were recorded. Iodine content, water content, Z eff, and λ HU significantly varied by region (intranodular hemorrhage, solid thyroid nodule, and adjacent margins) in patients and tissue specimens (P < 0.05). Intranodular hemorrhage exhibited elevated water concentrations (~1100 mg/mL), suggesting a practical threshold of 1075 mg/mL for differentiating intra-plaque hemorrhage and solid nodular regions. Spectral CT provided diagnostic information in 14 thyroid adenomas and four goiters (histologically confirmed in donor specimens), and eight thyroid adenomas and four nodular goiters based on clinical diagnosis. Diagnostically useful regional characteristic of intranodular hemorrhage in the thyroid was visualized via spectral CT employing material decomposition, potentially yielding additional molecular data about complex lesion characteristics no apparent in conventional imaging or laboratory methods.


Assuntos
Hemorragia/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Feminino , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nódulo da Glândula Tireoide/complicações
16.
J Thorac Dis ; 7(9): 1606-15, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26543608

RESUMO

BACKGROUND: To evaluate the information gain by the application of both non-contrast and contrast enhanced computed tomography (CT) with extended mediastinal display window settings in the evaluation of pure ground glass nodules (pGGNs) and or mixed ground glass nodules (mGGNs) in the context of pre-invasive or early stage lung adenocarcinoma. METHODS: One hundred and fifty patients with ground glass nodules (GGNs) and mGGNs, with contrast enhanced CT scans within 2 weeks of thoracic surgery were included in the study. Quantitative evaluation of all nodules was performed in a conventional mediastinal window (CMW) and an extended mediastinal window (EMW) both on non-contrast images and contrast-enhanced images. RESULTS: Contrast-enhanced images with CMW demonstrated amplification of solid portion in 23 (43%), 41 (77%) with EMW out of 53 minimally invasive adenocarcinoma (MIA) nodules, and in 34 of 37 (91%) of invasive adenocarcinoma (IAC) nodules. Using the increase in size of solid portion of the nodule measured on the enhanced CT images with EMW, area under the receiver operating characteristic (ROC) curve of 0.872 and 0.899 was utilized for differentiating between the pre-invasive nodules and MIA and between MIA and IAC nodules, respectively. Statistically significant differences existed between the pre-invasive and the MIA groups, and MIA and the IAC groups in smaller nodules (P<0.01). CONCLUSIONS: Comparative quantitative analysis of the pre and post contrast images can help differentiate between atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), MIAs, and IACs. Extension of the CT mediastinal window setting improves the evaluation of small GGNs, and can augment the diagnostic accuracy when evaluating small pGGNs and mGGNs.

17.
Diagn Interv Radiol ; 21(5): 391-6, 2015 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26268300

RESUMO

PURPOSE: We aimed to explore the value of localizing small ground-glass nodules (GGNs; <10 mm) or multiple GGNs within the same lobe in re-aerated lung specimens using CT-guided fine-needle localization. METHODS: Thirty-five lung specimens containing single small GGNs (<10 mm) and eight specimens containing two or more GGNs in the same lobe were re-aerated with an inflatable aerator. All lesions were localized via CT-guided fine-needle localization following re-aeration. The specimens were then sent for pathologic sampling and qualitative diagnosis. RESULTS: All 69 nodules from 43 cases were successfully localized using CT-guided fine-needle localization following re-aeration. CONCLUSIONS: CT-guided fine-needle localization of lesions in surgical specimens under constant, moderate mechanical aeration allows for the rapid and accurate localization of lesions and helps avoid damage from preoperative localization.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/instrumentação , Adulto , Idoso , Biópsia por Agulha Fina , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X/métodos
18.
J Comput Assist Tomogr ; 39(4): 572-7, 2015 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26182226

RESUMO

OBJECTIVES: This study was to assess the diagnostic performance of multidetector computed tomography (MDCT) angiographic protocol for dissection of the coronary artery (DCA) detection compared with coronary angiology (CAG). METHODS: Intravascular ultrasound was used as the gold standard for DCA diagnosis. Thirty-six DCA patients and 34 non-DCA (control) participants were retrospectively reviewed. The CAG and MDCT angiography images were separately reviewed by 4 independent observers, and a 5-point grading scale was used for DCA diagnosis. Diagnostic performance was compared using receiver operating characteristic analysis. Sensitivity, specificity, and negative predictive values were calculated. RESULTS: The MDCT performed significantly better than that of CAG (AZ = 0.9943 ± 0.0034 vs AZ = 0.8411 ± 0.0274, respectively) for DCA detection. The sensitivity (98.6%), specificity (89.7%), and negative predictive value (98.4%) of MDCT for DCA were higher than those of CAG (77.8%, 79.4%, and 77.1%, respectively). CONCLUSIONS: Multidetector computed tomography angiography was a more sensitive and specific technique for the diagnosis of DCA compared with CAG.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Doenças Vasculares/congênito , Adulto , Meios de Contraste , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Sensibilidade e Especificidade , Doenças Vasculares/diagnóstico por imagem
19.
J Thorac Dis ; 7(3): 273-80, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25922703

RESUMO

OBJECTIVE: To explore the CT features of lung scar cancer (LSC). METHODS: CT images of 41 LSCs and 66 non-LSCs were retrospectively compared in terms of location, size, shape, border, speculation, lobulation, pleural indentation, surrounding ground-glass opacification (sGGO), vessel convergence, vacuolation, calcification and satellite opacification. RESULTS: Thirty-eight LSCs were histopathologically identified as adenocarcinoma. The LSCs and non-LSCs were located 8.73±8.65 and 12.55±10.67 mm from the pleura, respectively. The mean lesion sizes (3-D ratios) in the initial LSC, pre-surgical LSC and non-LSC images were 24.28±6.29 (0.33±0.65), 32.23±8.14 (0.60±0.18) and 23.24±3.73 (0.35±0.61) mm, respectively. The initial and pre-surgical LSC images showed significant differences in speculation and sGGO (P<0.05). Significant differences were also noted in vacuolation, vessel convergence and sGGO between the pre-surgical LSC and the non-LSC images (P<0.05) and in vacuolation between the initial LSC and the non-LSC images (P<0.05). CONCLUSIONS: Despite similar CT features of LSCs and non-LSCs, the early detection and diagnosis of LSCs is possible by studying scar-tissue changes such as enlargement and sGGO associated with well-defined lesion borders in follow-up CT images.

20.
Zhonghua Zhong Liu Za Zhi ; 36(3): 188-92, 2014 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-24785278

RESUMO

OBJECTIVE: To explore the CT features of ground-glass nodules (GGN) including preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). METHODS: Ninety-seven GGN lesions confirmed by operation pathology were included in this study. The lesions were divided into three groups: preinvasive lesion group (24 cases), MIA group (39 cases), IAC group (34 cases). The lesion size, 3-dimensional ratio, 2-dimensional ratio in axial images, lesion density, shape, speculation, lobulation, air-containing space and pleural indentation on the preoperative CT images in the three groups were analyzed and compared with pathological results. The data were statistically analyzed using SPSS 17.0. RESULTS: All preinvasive lesions presented as pure GGN on CT image, most showed round-like shape, clear and smooth border. MIA presented as pure GGN or mixed GGN on CT image, most showed round-like shape, with a clear and smooth border. IAC most presented as mixed GGN on CT image, often showed irregular shape. Speculation, lobulation, air-containing space and pleural indentation displayed gradually increasing from preinvasive lesions to MIA and IAC. There were statistically significant differences in lesion size, CT density, shape, air-containing space, speculation, pleural indentation and long diameter of solid component between the MIA and IAC groups (P < 0.05 for all). There were statistically significant differences in CT density values and long diameters of solid component of the lesions between the preinvasive lesion group and MIA group (P < 0.05). The AUC of solid component of the preinvasive lesion group and MIA group was 0.705, and that of the MIA and IAC groups was 0.814. CONCLUSION: Comprehensive analysis of the CT image features of GGNs, especially the solid component in the lesions, may help to the preoperative and differential diagnosis of preinvasive lesions, MIA and IAC.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Lesões Pré-Cancerosas/patologia , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X
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