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Abstract Background Quantification of pulmonary edema in patients with acute respiratory distress syndrome (ARDS) by chest computed tomography (CT) scan has not been validated in routine diagnostics due to its complexity and time-consuming nature. Therefore, the single-indicator transpulmonary thermodilution (TPTD) technique to measure extravascular lung water (EVLW) has been used in the clinical setting. Advances in artificial intelligence (AI) have now enabled CT images of inhomogeneous lungs to be segmented automatically by an intensive care physician with no prior radiology training within a relatively short time. Nevertheless, there is a paucity of data validating the quantification of pulmonary edema using automated lung segmentation on CT compared with TPTD. Methods A retrospective study (January 2016 to December 2021) analyzed patients with ARDS, admitted to the intensive care unit of the Department of Anesthesiology and Critical Care Medicine, University Hospital Mannheim, who underwent a chest CT scan and hemodynamic monitoring using TPTD at the same time. Pulmonary edema was estimated using manually and automated lung segmentation on CT and then compared to the pulmonary edema calculated from EVLW determined using TPTD. Results 145 comparative measurements of pulmonary edema with TPTD and CT were included in the study. Estimating pulmonary edema using either automated lung segmentation on CT or TPTD showed a low bias overall (− 104 ml) but wide levels of agreement (upper: 936 ml, lower: − 1144 ml). In 13% of the analyzed CT scans, the agreement between the segmentation of the AI algorithm and a dedicated investigator was poor. Manual segmentation and automated segmentation adjusted for contrast agent did not improve the agreement levels. Conclusions Automated lung segmentation on CT can be considered an unbiased but imprecise measurement of pulmonary edema in mechanically ventilated patients with ARDS.

Abstract Objectives This study aims to investigate how radiomics analysis can help understand the association between plaque texture, epicardial adipose tissue (EAT), and cardiovascular risk. Working with a Photon-counting CT, which exhibits enhanced feature stability, offers the potential to advance radiomics analysis and enable its integration into clinical routines. Methods Coronary plaques were manually segmented in this retrospective, single-centre study and radiomic features were extracted using pyradiomics. The study population was divided into groups according to the presence of high-risk plaques (HRP), plaques with at least 50% stenosis, plaques with at least 70% stenosis, or triple-vessel disease. A combined group with patients exhibiting at least one of these risk factors was formed. Random forest feature selection identified differentiating features for the groups. EAT thickness and density were measured and compared with feature selection results. Results A total number of 306 plaques from 61 patients (mean age 61 years +/− 8.85 [standard deviation], 13 female) were analysed. Plaques of patients with HRP features or relevant stenosis demonstrated a higher presence of texture heterogeneity through various radiomics features compared to patients with only an intermediate stenosis degree. While EAT thickness did not significantly differ, affected patients showed significantly higher mean densities in the 50%, HRP, and combined groups, and insignificantly higher densities in the 70% and triple-vessel groups. Conclusion The combination of a higher EAT density and a more heterogeneous plaque texture might offer an additional tool in identifying patients with an elevated risk of cardiovascular events. Clinical relevance statement Cardiovascular disease is the leading cause of mortality globally. Plaque composition and changes in the EAT are connected to cardiac risk. A better understanding of the interrelation of these risk indicators can lead to improved cardiac risk prediction. Key Points Cardiac plaque composition and changes in the EAT are connected to cardiac risk. Higher EAT density and more heterogeneous plaque texture are related to traditional risk indicators. Radiomics texture analysis conducted on PCCT scans can help identify patients with elevated cardiac risk. Graphical Abstract

BackgroundThe liver is a frequent location of metastatic disease in various malignant tumor entities. Computed tomography (CT) is the most frequently employed modality for initial diagnosis. However, liver metastases may only be delineated vaguely on CT. Calculating radiomics features in feature maps can unravel textures not visible to the human eye on a standard CT reconstruction (SCTR). This study aimed to investigate the comparative diagnostic accuracy of radiomics feature maps and SCTR for liver metastases.Materials and methodsForty-seven patients with hepatic metastatic colorectal cancer were retrospectively enrolled. Whole-liver maps of original radiomics features were generated. A representative feature was selected for each feature class based on the visualization of example lesions from five patients. These maps and the conventional CT image data were viewed and evaluated by four readers in terms of liver parenchyma, number of lesions, visual contrast of lesions and diagnostic confidence. T-tests and chi²-tests were performed with a significance cut off of p

BackgroundMicrovascular invasion is a major histopathological risk factor of postoperative recurrence in patients with hepatocellular carcinoma. This study aimed to develop and validate a digital biopsy model using imaging features to predict microvascular invasion before hepatectomy.MethodsA total of 217 consecutive patients who underwent hepatectomy for resectable hepatocellular carcinoma were enrolled at two tertiary-care reference centers. An imaging-based digital biopsy model was developed and internally validated using logistic regression analysis with adjustments for age, sex, etiology of disease, size and number of lesions.ResultsThree imaging features, i.e., non-smoothness of lesion margin (OR = 16.40), ill-defined pseudocapsula (OR = 4.93), and persistence of intratumoral internal artery (OR = 10.50), were independently associated with microvascular invasion and incorporated into a prediction model. A scoring system with 0 - 3 points was established for the prediction model. Internal validation confirmed an excellent calibration of the model. A cutoff of 2 points indicates a high risk of microvascular invasion (area under the curve 0.87). The overall survival and recurrence-free survival stratified by the risk model was significantly shorter in patients with high risk features of microvascular invasion compared to those patients with low risk of microvascular invasion (overall survival: median 35 vs. 75 months, P = 0.027; recurrence-free survival: median 17 vs. 38 months, P < 0.001)).ConclusionA preoperative assessment of microvascular invasion by digital biopsy is reliable, easily applicable, and might facilitate personalized treatment strategies.

PurposeThis study compares phantom-based variability of extracted radiomics features from scans on a photon counting CT (PCCT) and an experimental animal PET/CT-scanner (Albira II) to investigate the potential of radiomics for translation from animal models to human scans. While oncological basic research in animal PET/CT has allowed an intrinsic comparison between PET and CT, but no 1:1 translation to a human CT scanner due to resolution and noise limitations, Radiomics as a statistical and thus scale-independent method can potentially close the critical gap.MethodsTwo phantoms were scanned on a PCCT and animal PET/CT-scanner with different scan parameters and then the radiomics parameters were extracted. A Principal Component Analysis (PCA) was conducted. To overcome the limitation of a small dataset, a data augmentation technique was applied. A Ridge Classifier was trained and a Feature Importance- and Cluster analysis was performed.ResultsPCA and Cluster Analysis shows a clear differentiation between phantom types while emphasizing the comparability of both scanners. The Ridge Classifier exhibited a strong training performance with 93% accuracy, but faced challenges in generalization with a test accuracy of 62%.ConclusionThese results show that radiomics has great potential as a translational tool between animal models and human routine diagnostics, especially using the novel photon counting technique. This is another crucial step towards integration of radiomics analysis into clinical practice.

ObjectiveEndovascular thrombectomy (EVT) is the standard of care for acute large vessel occlusion stroke. Recently, the ANGEL-ASPECT and SELECT 2 trials showed improved outcomes in patients with acute ischemic Stroke presenting with large infarcts. The cost-effectiveness of EVT for this subpopulation of stroke patients has only been calculated using data from the previously published RESCUE-Japan LIMIT trial. It is, therefore, limited in its generalizability to an international population. With this study we primarily simulated patient-level costs to analyze the economic potential of EVT for patients with large ischemic stroke from a public health payer perspective based on the recently published data and secondarily identified determinants of cost-effectiveness.MethodsCosts and outcome of patients treated with EVT or only with the best medical care based on the recent prospective clinical trials ANGEL-ASPECT, SELECT2 and RESCUE-Japan LIMIT. A A Markov model was developed using treamtment outcomes derived from the most recent available literature. Deterministic and probabilistic sensitivity analyses addressed uncertainty.ResultsEndovascular treatment resulted in an incremental gain of 1.32 QALYs per procedure with cost savings of $17,318 per patient. Lifetime costs resulted to be most sensitive to the costs of the endovascular procedure.ConclusionEVT is a cost-saving (i.e., dominant) strategy for patients presenting with large ischemic cores defined by inclusion criteria of the recently published ANGEL-ASPECT, SELECT2, and RESCUE-Japan LIMIT trials in comparison to best medical care in our simulation. Prospective data of individual patients need to be collected to validate these results.

Abstract Objectives The goal of this study is to demonstrate the performance of radiomics and CNN-based classifiers in determining the primary origin of gastrointestinal liver metastases for visually indistinguishable lesions. Methods In this retrospective, IRB-approved study, 31 pancreatic cancer patients with 861 lesions (median age [IQR]: 65.39 [56.87, 75.08], 48.4% male) and 47 colorectal cancer patients with 435 lesions (median age [IQR]: 65.79 [56.99, 74.62], 63.8% male) were enrolled. A pretrained nnU-Net performed automated segmentation of 1296 liver lesions. Radiomics features for each lesion were extracted using pyradiomics. The performance of several radiomics-based machine-learning classifiers was investigated for the lesions and compared to an image-based deep-learning approach using a DenseNet-121. The performance was evaluated by AUC/ROC analysis. Results The radiomics-based K-nearest neighbor classifier showed the best performance on an independent test set with AUC values of 0.87 and an accuracy of 0.67. In comparison, the image-based DenseNet-121-classifier reached an AUC of 0.80 and an accuracy of 0.83. Conclusions CT-based radiomics and deep learning can distinguish the etiology of liver metastases from gastrointestinal primary tumors. Compared to deep learning, radiomics based models showed a varying generalizability in distinguishing liver metastases from colorectal cancer and pancreatic adenocarcinoma.

Abstract Background Cardiovascular diseases remain the world’s primary cause of death. The identification and treatment of patients at risk of cardiovascular events thus are as important as ever. Adipose tissue is a classic risk factor for cardiovascular diseases, has been linked to systemic inflammation, and is suspected to contribute to vascular calcification. To further investigate this issue, the use of texture analysis of adipose tissue using radiomics features could prove a feasible option. Methods In this retrospective single-center study, 55 patients (mean age 56, 34 male, 21 female) were scanned on a first-generation photon-counting CT. On axial unenhanced images, periaortic adipose tissue surrounding the thoracic descending aorta was segmented manually. For feature extraction, patients were divided into three groups, depending on coronary artery calcification (Agatston Score 0, Agatston Score 1–99, Agatston Score ≥ 100). 106 features were extracted using pyradiomics. R statistics was used for statistical analysis, calculating mean and standard deviation with Pearson correlation coefficient for feature correlation. Random Forest classification was carried out for feature selection and Boxplots and heatmaps were used for visualization. Additionally, monovariable logistic regression predicting an Agatston Score > 0 was performed, selected features were tested for multicollinearity and a 10-fold cross-validation investigated the stability of the leading feature. Results Two higher-order radiomics features, namely “glcm_ClusterProminence” and “glcm_ClusterTendency” were found to differ between patients without coronary artery calcification and those with coronary artery calcification (Agatston Score ≥ 100) through Random Forest classification. As the leading differentiating feature “glcm_ClusterProminence” was identified. Conclusion Changes in periaortic adipose tissue texture seem to correlate with coronary artery calcium score, supporting a possible influence of inflammatory or fibrotic activity in perivascular adipose tissue. Radiomics features may potentially aid as corresponding biomarkers in the future.

BackgroundEconomic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening.PurposeTo introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening.Materials and methodsThe various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed.ResultsDespite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes.ConclusionEconomic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.

The clinical use of photon-counting CT (PCCT) allows for the generation of virtual non-contrast (VNC) series from contrast-enhanced images. In routine clinical practice, specific issues such as ruling out acute bleeding require non-contrast images. The aim of this study is to evaluate the use of PCCT-derived VNC reconstructions in abdominal imaging. PCCT scans of 17 patients including early arterial, portal venous and native sequences were enrolled. VNC reconstructions have been calculated. In every sequence and VNC reconstruction, 10 ROIs were measured (portal vein, descending aorta, inferior vena cava, liver parenchyma, spleen parenchyma, erector spinae muscle, subcutaneous adipose tissue, first lumbar vertebral body, air, and psoas muscle) and density values were compared. The VNC reconstructions show significant changes in density compared to the contrast-enhanced images. However, there were no significant differences present between the true non-contrast (TNC) and any VNC reconstructions in the observed organs and vessels. Significant differences (p < 0.05) between the measured mean density values in the TNC versus VNC reconstructions were found in fat and bone tissue. The PCCT-derived VNC reconstructions seemed to be comparable to the TNC images, despite some deviations shown in the adipose tissue and bone structures. However, the further benefits in terms of specific clinical issues need to be evaluated.

Objectives: The aim of this study was to analyze the extent of dental metal artifacts in virtual monoenergetic (VME) images, as they often compromise image quality by obscuring soft tissue affecting vascular attenuation reducing sensitivity in the detection of dissections. Methods: Neck photon-counting CT datasets of 50 patients undergoing contrast-enhanced trauma CT were analyzed. Hyperattenuation and hypoattenuation artifacts, muscle with and without artifacts and vessels with and without artifacts were measured at energy levels from 40 keV to 190 keV. The corrected artifact burden, corrected image noise and artifact index were calculated. We also assessed subjective image quality on a Likert-scale. Results: Our study showed a lower artifact burden and less noise in artifact-affected areas above the energy levels of 70 keV for hyperattenuation artifacts (conventional polychromatic CT images 1123 ± 625 HU vs. 70 keV VME 1089 ± 733 HU, p = 0.125) and above of 80 keV for hypoattenuation artifacts (conventional CT images −1166 ± 779 HU vs. 80 keV VME −1170 ± 851 HU, p = 0.927). Vascular structures were less hampered by metal artifacts than muscles (e.g., corrected artifact burden at 40 keV muscle 158 ± 125 HU vs. vessels −63 ± 158 HU p < 0.001), which was also reflected in the subjective image assessment, which showed better ratings at higher keV values and overall better ratings for vascular structures than for the overall artifact burden. Conclusions: Our research suggests 70 keV might be the best compromise for reducing metal artifacts affecting vascular structures and preventing vascular contrast if solely using VME reconstructions. VME imaging shows only significant effects on the general artifact burden. Vascular structures generally experience fewer metal artifacts than soft tissue due to their greater distance from the teeth, which are a common source of such artifacts.

IntroductionPericoronary adipose tissue (PCAT) stands in complex bidirectional interaction with the surrounding arteries and is known to be connected to many cardiovascular diseases involving vascular inflammation. PCAT texture may be influenced by other cardiovascular risk factors such as hypercholesterolemia. The recently established photon-counting CT could improve texture analysis and help detect those changes by offering higher spatial resolution and signal-to-noise ratio.MethodsIn this retrospective, single-center, IRB-approved study, PCAT of the left and right coronary artery was manually segmented and radiomic features were extracted using pyradiomics. The study population consisted of a test collective and a validation collective. The collectives were each divided into two groups defined by the presence or absence of hypercholesterolemia, taken from self-reported conditions and confirmed by medical records. Mean and standard deviation were calculated with Pearson correlation coefficient for correlation of features and visualized as boxplots and heatmaps using R statistics. Random forest feature selection was performed to identify differentiating features between the two groups. 66 patients were enrolled in this study (34 female, mean age 58 years).ResultsTwo radiomics features allowing differentiation between PCAT texture of the groups were identified (p-values between 0.013 and 0.24) and validated. Patients with hypercholesterolemia presented with a greater concentration of high-density values as indicated through analysis of specific texture features as “gldm_HighGrayLevelEmphasis” (23.95 vs. 22.99) and “glrlm_HighGrayLevelRunEmphasis” (24.21 vs. 23.31).DiscussionTexture analysis of PCAT allowed differentiation between patients with and without hypercholesterolemia offering a potential imaging biomarker for this specific cardiovascular risk factor.

Abstract Feature stability and standardization remain challenges that impede the clinical implementation of radiomics. This study investigates the potential of spectral reconstructions from photon-counting computed tomography (PCCT) regarding organ-specific radiomics feature stability. Abdominal portal-venous phase PCCT scans of 10 patients in virtual monoenergetic (VM) (keV 40–120 in steps of 10), polyenergetic, virtual non-contrast (VNC), and iodine maps were acquired. Two 2D and 3D segmentations measuring 1 and 2 cm in diameter of the liver, lung, spleen, psoas muscle, subcutaneous fat, and air were obtained for spectral reconstructions. Radiomics features were extracted with pyradiomics. The calculation of feature-specific intraclass correlation coefficients (ICC) was performed by comparing all segmentation approaches and organs. Feature-wise and organ-wise correlations were evaluated. Segmentation-resegmentation stability was evaluated by concordance correlation coefficient (CCC). Compared to non-VM, VM-reconstruction features tended to be more stable. For VM reconstructions, 3D 2 cm segmentation showed the highest average ICC with 0.63. Based on a criterion of ≥ 3 stable organs and an ICC of ≥ 0.75, 12—mainly non-first-order features—are shown to be stable between the VM reconstructions. In a segmentation-resegmentation analysis in 3D 2 cm, three features were identified as stable based on a CCC of > 0.6 in ≥ 3 organs in ≥ 6 VM reconstructions. Certain radiomics features vary between monoenergetic reconstructions and depend on the ROI size. Feature stability was also shown to differ between different organs. Yet, glcm_JointEntropy, gldm_GrayLevelNonUniformity, and firstorder_Entropy could be identified as features that could be interpreted as energy-independent and segmentation-resegmentation stable in this PCCT collective. PCCT may support radiomics feature standardization and comparability between sites.

ObjectivesOpportunistic quantitative computed tomography (oQCT) derived from non-dedicated routine CT has demonstrated high accuracy in diagnosing osteoporosis and predicting incident vertebral fractures (VFs). We aimed to investigate the cost-effectiveness of oQCT screening compared to dual-energy X-ray absorptiometry (DXA) as the standard of care for osteoporosis screening.MethodsThree screening strategies (“no osteoporosis screening”, “oQCT screening”, and “DXA screening”) after routine CT were simulated in a state-transition model for hypothetical cohorts of 1,000 patients (women and men aged 65 years) over a follow-up period of 5 years (base case). The primary outcomes were the cumulative costs and the quality-adjusted life years (QALYs) estimated from a U.S. health care perspective for the year 2022. Cost-effectiveness was assessed based on a willingness-to-pay (WTP) threshold of $70,249 per QALY. The secondary outcome was the number of prevented VFs. Deterministic and probabilistic sensitivity analyses were conducted to test the models’ robustness.ResultsCompared to DXA screening, oQCT screening increased QALYs in both sexes (additional 2.40 per 1,000 women and 1.44 per 1,000 men) and resulted in total costs of $3,199,016 and $950,359 vs. $3,262,934 and $933,077 for women and men, respectively. As a secondary outcome, oQCT screening prevented 2.6 and 2.0 additional VFs per 1,000 women and men, respectively. In the probabilistic sensitivity analysis, oQCT screening remained cost-effective in 88.3% (women) and 90.0% (men) of iterations.ConclusionoQCT screening is a cost-effective ancillary approach for osteoporosis screening and has the potential to prevent a substantial number of VFs if considered in daily clinical practice.

ObjectivesColorectal cancer (CRC) is a serious challenge for the health system. In 2022 CRC represented 8% of cancer diagnoses in the United States. 30% of patients already show metastases at the initial tumor staging. The majority of these metastases are sited in the liver. According to their extension and the status of the tumor colorectal liver metastases can be treated in several ways, with hepatic resection being the gold-standard. Contrast-enhanced computed tomography (CE-CT), positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) can be used for evaluation of resectability of these liver metastases. The aim of this study is to assess the most economic imaging modality for detecting liver metastases eligible for hepatic resection by analyzing their cost-effectiveness.Materials and methodsIn our study, a Markov state transition model was built to calculate the quality-adjusted life years (QALYs) and overall costs for each diagnostic strategy in accord with the stated input values obtained from scientific research. Further, probabilistic sensitivity analyses by means of Monte Carlo simulations were performed to consider possible model uncertainties. For evaluation of the cost-effectiveness on an economic threshold, the Willingness-to-pay (WTP) was set at $ 100,000. The applied values and the calculated results are based on the U.S. healthcare system.ResultsCE-CT led to overall costs of $ 42,874.02 and 8.47 QALYs, whereas MRI led to $ 40,863.65 and 8.50 QALYs. PET/CT resulted in overall costs of $ 43,216.74 and 8.48 QALYs. Therefore, MRI was determined to be the dominant strategy in the model. According to the performed sensitivity analyses, MRI remained cost-effective over a wide range of WTPs.ConclusionIn conclusion, according to our analysis, MRI is the dominant strategy for detecting hepatic metastases eligible for hepatic resection in colorectal cancer.

(1) Background: Epicardial adipose tissue influences cardiac biology in physiological and pathological terms. As it is suspected to be linked to coronary artery calcification, identifying improved methods of diagnostics for these patients is important. The use of radiomics and the new Photon-Counting computed tomography (PCCT) may offer a feasible step toward improved diagnostics in these patients. (2) Methods: In this retrospective single-centre study epicardial adipose tissue was segmented manually on axial unenhanced images. Patients were divided into three groups, depending on the severity of coronary artery calcification. Features were extracted using pyradiomics. Mean and standard deviation were calculated with the Pearson correlation coefficient for feature correlation. Random Forest classification was applied for feature selection and ANOVA was performed for group comparison. (3) Results: A total of 53 patients (32 male, 21 female, mean age 57, range from 21 to 80 years) were enrolled in this study and scanned on the novel PCCT. “Original_glrlm_LongRunEmphasis”, “original_glrlm_RunVariance”, “original_glszm_HighGrayLevelZoneEmphasis”, and “original_glszm_SizeZoneNonUniformity” were found to show significant differences between patients with coronary artery calcification (Agatston score 1–99/≥100) and those without. (4) Conclusions: Four texture features of epicardial adipose tissue are associated with coronary artery calcification and may reflect inflammatory reactions of epicardial adipose tissue, offering a potential imaging biomarker for atherosclerosis detection.

Cochlear implants (CIs) are the primary treatment method in patients with profound sensorineural hearing loss. Interpretation of postoperative imaging with conventional energy-integrating detector computed tomography (EID-CT) following CI surgery remains challenging due to metal artifacts. Still, the photon-counting detector (PCD-CT) is a new emerging technology with the potential to eliminate these problems. This study evaluated the performance of virtual monoenergetic (VME) EID-CT images versus PCD-CT in CI imaging. In this cadaveric study, two temporal bone specimens with implanted CIs were scanned with EID-CT and PCD-CT. The images were assessed according to the visibility of interelectrode wire, size of electrode contact, and diameter of halo artifacts. The visibility of interelectrode wire sections was significantly higher when reviewing PCD-CT images. The difference in diameter measurements for electrode contacts between the two CT scanner modalities showed that the PCD-CT technology generally led to significantly larger diameter readings. The larger measurements were closer to the manufacturer’s specifications for the CI electrode. The size of halo artifacts surrounding the electrode contacts did not differ significantly between the two imaging modalities. PCT-CT imaging is a promising technology for CI imaging with improved spatial resolution and better visibility of small structures than conventional EID-CT.

ObjectiveEndovascular thrombectomy is a long-established therapy for acute basilar artery occlusion (aBAO). Unlike for anterior circulation stroke, cost-effectiveness of endovascular treatment has not been evaluated and is urgently needed to calculate expected health benefits and financial rewards. The aim of this study was therefore to simulate patient-level costs, analyze the economic potential of endovascular thrombectomy in patients with acute basilar artery occlusion (aBAO), and identify major determinants of cost-effectiveness.MethodsA Markov model was developed to compare outcome and cost parameters between patients treated by endovascular thrombectomy and patients treated by best medical care, based on four recent prospective clinical trials (ATTENTION, BAOCHE, BASICS, and BEST). Treatment outcomes were derived from the most recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. Willingness to pay per QALY thresholds were set at 1x gross domestic product per capita, as recommended by the World Health Organization.ResultsEndovascular treatment of acute aBAO stroke yielded an incremental gain of 1.71 quality-adjusted life-years per procedure with an incremental cost-effectiveness ratio of $7,596 per QALY. This was substantially lower than the Willingness to pay of $63,593 per QALY. Lifetime costs were most sensitive to costs of the endovascular procedure.ConclusionEndovascular treatment is cost-effective in patients with aBAO stroke.

The analysis of circulating tumor DNA (ctDNA) is at the threshold of implementation into standard care for colorectal cancer (CRC) patients. However, data about the clinical utility of liquid profiling (LP), its acceptance by clinicians, and its integration into clinical workflows in real‐world settings remain limited. Here, LP tests requested as part of routine care since 2016 were retrospectively evaluated. Results show restrained request behavior that improved moderately over time, as well as reliable diagnostic performance comparable to translational studies, with an overall agreement of 91.7%. Extremely low ctDNA levels at

Abstract Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.

Background: Severe courses and high hospitalization rates were ubiquitous during the first pandemic SARS-CoV-2 waves. Thus, we aimed to examine whether integrative diagnostics may aid in identifying vulnerable patients using crucial data and materials obtained from COVID-19 patients hospitalized between 2020 and 2021 (n = 52). Accordingly, we investigated the potential of laboratory biomarkers, specifically the dynamic cell decay marker cell-free DNA and radiomics features extracted from chest CT. Methods: Separate forward and backward feature selection was conducted for linear regression with the Intensive-Care-Unit (ICU) period as the initial target. Three-fold cross-validation was performed, and collinear parameters were reduced. The model was adapted to a logistic regression approach and verified in a validation naïve subset to avoid overfitting. Results: The adapted integrated model classifying patients into “ICU/no ICU demand” comprises six radiomics and seven laboratory biomarkers. The models’ accuracy was 0.54 for radiomics, 0.47 for cfDNA, 0.74 for routine laboratory, and 0.87 for the combined model with an AUC of 0.91. Conclusion: The combined model performed superior to the individual models. Thus, integrating radiomics and laboratory data shows synergistic potential to aid clinic decision-making in COVID-19 patients. Under the need for evaluation in larger cohorts, including patients with other SARS-CoV-2 variants, the identified parameters might contribute to the triage of COVID-19 patients.

Background: To compare the diagnostic characteristics between arterial phase imaging versus portal venous phase imaging, applying polychromatic T3D images and low keV virtual monochromatic images using a 1st generation photon-counting CT detector, of CT in patients with hepatocellular carcinoma (HCC). Methods: Consecutive patients with HCC, with a clinical indication for CT imaging, were prospectively enrolled. Virtual monoenergetic images (VMI) were reconstructed at 40 to 70 keV for the PCD-CT. Two independent, blinded radiologists counted all hepatic lesions and quantified their size. The lesion-to-background ratio was quantified for both phases. SNR and CNR were determined for T3D and low VMI images; non-parametric statistics were used. Results: Among 49 oncologic patients (mean age 66.9 ± 11.2 years, eight females), HCC was detected in both arterial and portal venous scans. The signal-to-noise ratio, the CNR liver-to-muscle, the CNR tumor-to-liver, and CNR tumor-to-muscle were 6.58 ± 2.86, 1.40 ± 0.42, 1.13 ± 0.49, and 1.53 ± 0.76 in the arterial phase and 5.93 ± 2.97, 1.73 ± 0.38, 0.79 ± 0.30, and 1.36 ± 0.60 in the portal venous phase with PCD-CT, respectively. There was no significant difference in SNR between the arterial and portal venous phases, including between “T3D” and low keV images (p > 0.05). CNRtumor-to-liver differed significantly between arterial and portal venous contrast phases (p < 0.005) for both “T3D” and all reconstructed keV levels. CNRliver-to-muscle and CNRtumor-to-muscle did not differ in either the arterial or portal venous contrast phases. CNRtumor-to-liver increased in the arterial contrast phase with lower keV in addition to SD. In the portal venous contrast phase, CNRtumor-to-liver decreased with lower keV; whereas, CNRtumor-to-muscle increased with lower keV in both arterial and portal venous contrast phases. CTDI and DLP mean values for the arterial upper abdomen phase were 9.03 ± 3.59 and 275 ± 133, respectively. CTDI and DLP mean values for the abdominal portal venous phase were 8.75 ± 2.99 and 448 ± 157 with PCD-CT, respectively. No statistically significant differences were found concerning the inter-reader agreement for any of the (calculated) keV levels in either the arterial or portal-venous contrast phases. Conclusions: The arterial contrast phase imaging provides higher lesion-to-background ratios of HCC lesions using a PCD-CT; especially, at 40 keV. However, the difference was not subjectively perceived as significant.

Purpose: The novel photon-counting detector (PCD) technique acquires spectral data for virtual monoenergetic imaging (VMI) in every examination. The aim of this study was the evaluation of the impact of VMI of abdominal arterial vessels on quantitative and qualitative subjective image parameters. Methods: A total of 20 patients that underwent an arterial phase computed tomography (CT) scan of the abdomen with a novel PCD CT (Siemens NAEOTOM alpha) were analyzed regarding attenuation at different energy levels in virtual monoenergetic imaging. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated and compared between the different virtual monoenergetic (VME) levels with correlation to vessel diameter. In addition, subjective image parameters (overall subjective image quality, subjective image noise and vessel contrast) were evaluated. Results: Our research showed decreasing attenuation levels with increasing energy levels in virtual monoenergetic imaging regardless of vessel diameter. CNR showed best overall results at 60 keV, and SNR at 70 keV with no significant difference to 60 keV (p = 0.294). Subjective image quality was rated best at 70 keV for overall image quality, vessel contrast and noise. Conclusions: Our data suggest that VMI at 60–70 keV provides the best objective and subjective image quality concerning vessel contrast irrespective of vessel size.

Background: The duration of anti-SARS-CoV-2-antibody detectability up to 12 months was examined in individuals after either single convalescence or convalescence and vaccination. Moreover, variables that might influence an anti-RBD/S1 antibody decline and the existence of a post-COVID-syndrome (PCS) were addressed. Methods: Forty-nine SARS-CoV-2-qRT-PCR-confirmed participants completed a 12-month examination of anti-SARS-CoV-2-antibody levels and PCS-associated long-term sequelae. Overall, 324 samples were collected. Cell-free DNA (cfDNA) was isolated and quantified from EDTA-plasma. As cfDNA is released into the bloodstream from dying cells, it might provide information on organ damage in the late recovery of COIVD-19. Therefore, we evaluated cfDNA concentrations as a biomarker for a PCS. In the context of antibody dynamics, a random forest-based logistic regression with antibody decline as the target was performed and internally validated. Results: The mean percentage dynamic related to the maximum measured value was 96 (±38)% for anti-RBD/S1 antibodies and 30 (±26)% for anti-N antibodies. Anti-RBD/S1 antibodies decreased in 37%, whereas anti-SARS-CoV-2-anti-N antibodies decreased in 86% of the subjects. Clinical anti-RBD/S1 antibody decline prediction models, including vascular and other diseases, were cross-validated (highest AUC 0.74). Long-term follow-up revealed no significant reduction in PCS prevalence but an increase in cognitive impairment, with no indication for cfDNA as a marker for a PCS. Conclusion: Long-term anti-RBD/S1-antibody positivity was confirmed, and clinical parameters associated with declining titers were presented. A fulminant decrease in anti-SARS-CoV-2-anti-N antibodies was observed (mean change to maximum value 30 (±26)%). Anti-RBD/S1 antibody titers of SARS-CoV-2 recovered subjects boosted with a vaccine exceeded the maximum values measured after single infection by 235 ± 382-fold, with no influence on preexisting PCS. PCS long-term prevalence was 38.6%, with an increase in cognitive impairment compromising the quality of life. Quantified cfDNA measured in the early post-COVID-19 phase might not be an effective marker for PCS identification.

In recent years, there has been an increasing recognition of coronary computed tomographic angiography (CCTA) and gated non-contrast cardiac CT in the workup of coronary artery disease in patients with low and intermediate pretest probability, through the readjustment guidelines by medical societies. However, in routine clinical practice, these CT data sets are usually evaluated dominantly regarding relevant coronary artery stenosis and calcification. The implementation of radiomics analysis, which provides visually elusive quantitative information from digital images, has the potential to open a new era for cardiac CT that goes far beyond mere stenosis or calcification grade estimation. This review offers an overview of the results obtained from radiomics analyses in cardiac CT, including the evaluation of coronary plaques, pericoronary adipose tissue, and the myocardium itself. It also highlights the advantages and disadvantages of use in routine clinical practice.

ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

Background: Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Methods: S100B concentrations were determined in 136 matching pairs of serum and lithium heparin blood samples. The concordance of the test results was assessed by linear regression, Passing Pablok regression and Bland-Altman analysis. Bias and within- and between-run imprecision were determined by a 5 × 4 model using pooled patient samples. CT scans were performed as clinically indicated. Results: Overall, S100B levels between both blood constituents correlated very well. The suitability of S100B testing from plasma was verified according to ISO15189 requirements. Using a cut-off of 0.105 ng/ml, a sensitivity and negative predictive value of 100% were obtained for identifying patients with pathologic CT scans. Importantly, plasma-based testing reduced the TAT to 26 min allowing for quicker clinical decision-making. The clinical utility of integrating S100B in TBI management is highlighted by two case reports. Conclusions: Plasma-based S100B testing compares favorably with serum-based testing, substantially reducing processing times as the prerequisite for integrating S100B level into management of TBI patients. The proposed new clinical decision algorithm for TBI management needs to be validated in further prospective large-scale studies.

BackgroundIn certain malignancies, patients with oligometastatic disease benefit from radical ablative or surgical treatment. The SABR-COMET trial demonstrated a survival benefit for oligometastatic patients randomized to local stereotactic ablative radiation (SABR) compared to patients receiving standard care (SC) alone. Our aim was to determine the cost-effectiveness of SABR.Materials and MethodsA decision model based on partitioned survival simulations estimated costs and quality-adjusted life years (QALY) associated with both strategies in a United States setting from a health care perspective. Analyses were performed over the trial duration of six years as well as a long-term horizon of 16 years. Model input parameters were based on the SABR-COMET trial data as well as best available and most recent data provided in the published literature. An annual discount of 3% for costs was implemented in the analysis. All costs were adjusted to 2019 US Dollars according to the United States Consumer Price Index. SABR costs were reported with an average of $11,700 per treatment. Deterministic and probabilistic sensitivity analyses were performed. Incremental costs, effectiveness, and cost-effectiveness ratios (ICER) were calculated. The willingness-to-pay (WTP) threshold was set to $100,000/QALY.ResultsBased on increased overall and progression-free survival, the SABR group showed 0.78 incremental QALYs over the trial duration and 1.34 incremental QALYs over the long-term analysis. Treatment with SABR led to a marginal increase in costs compared to SC alone (SABR: $304,656; SC: $303,523 for 6 years; ICER $1,446/QALY and SABR: $402,888; SC: $350,708 for long-term analysis; ICER $38,874/QALY). Therapy with SABR remained cost-effective until treatment costs of $88,969 over the trial duration (i.e. 7.6 times the average cost). Sensitivity analysis identified a strong model impact for ongoing annual costs of oligo- and polymetastatic disease states.ConclusionOur analysis suggests that local treatment with SABR adds QALYs for patients with certain oligometastatic cancers and represents an intermediate- and long-term cost-effective treatment strategy.

Abstract Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. This is a serious obstacle to the learning process of the modality due to a missing report structure and terminology. Therefore, there is a great inter-observer variability in overall report quality. Aim of the present study was to evaluate the impact of structured reporting on the learning process as indicated by the overall report quality of head and neck ultrasound examinations within medical school education. Methods Following an immersion course on head and neck ultrasound, previously documented images of three common pathologies were handed out to 58 medical students who asked to create both standard free text reports (FTR) and structured reports (SR). A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion and readability by two independent raters (Paired Wilcoxon test, 95% CI). Ratings were assessed for inter-rater reliability (Fleiss’ kappa). Additionally, a questionnaire was utilized to evaluate user satisfaction. Results SRs received significantly better ratings in terms of report completeness (97.7% vs. 53.5%, p

Abstract Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner’s individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations. Methods Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss’ kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI). Results By comparison, completeness scores of SRs were significantly higher than FTRs’ completeness scores (94.4% vs. 45.6%, p

The coronary artery calcium score is an independent risk factor of the development of adverse cardiac events. The severity of coronary artery calcification may influence the myocardial texture. Due to higher spatial resolution and signal-to-noise ratio, new CT technologies such as PCCT may improve the detection of texture alterations depending on the severity of coronary artery calcification. In this retrospective, single-center, IRB-approved study, left ventricular myocardium was segmented and radiomics features were extracted using pyradiomics. The mean and standard deviation with the Pearson correlation coefficient for correlations of features were calculated and visualized as boxplots and heatmaps. Random forest feature selection was performed. Thirty patients (26.7% women, median age 58 years) were enrolled in the study. Patients were divided into two subgroups depending on the severity of coronary artery calcification (Agatston score 0 and Agatston score ≥ 100). Through random forest feature selection, a set of four higher-order features could be defined to discriminate myocardial texture between the two groups. When including the additional Agatston 1–99 groups as a validation, a severity-associated change in feature intensity was detected. A subset of radiomics features texture alterations of the left ventricular myocardium was associated with the severity of coronary artery calcification estimated by the Agatston score.

The implementation of radiomics-based, quantitative imaging parameters is hampered by a lack of stability and standardization. Photon-counting computed tomography (PCCT), compared to energy-integrating computed tomography (EICT), does rely on a novel detector technology, promising better spatial resolution and contrast-to-noise ratio. However, its effect on radiomics feature properties is unknown. This work investigates this topic in myocardial imaging. In this retrospective, single-center IRB-approved study, the left ventricular myocardium was segmented on CT, and the radiomics features were extracted using pyradiomics. To compare features between scanners, a t-test for non-paired samples and F-test was performed, with a threshold of 0.05 set as a benchmark for significance. Feature correlations were calculated by the Pearson correlation coefficient, and visualization was performed with heatmaps. A total of 50 patients (56% male, mean age 56) were enrolled in this study, with equal proportions of PCCT and EICT. First-order features were, nearly, comparable between both groups. However, higher-order features showed a partially significant difference between PCCT and EICT. While first-order radiomics features of left ventricular myocardium show comparability between PCCT and EICT, detected differences of higher-order features may indicate a possible impact of improved spatial resolution, better detection of lower-energy photons, and a better signal-to-noise ratio on texture analysis on PCCT.

Abdominal aortic aneurysms (AAA) may remain clinically silent until they enlarge and patients present with a potentially lethal rupture. This necessitates early detection and elective treatment. The goal of this study was to develop an easy-to-train algorithm which is capable of automated AAA screening in CT scans and can be applied to an intra-hospital environment. Three deep convolutional neural networks (ResNet, VGG-16 and AlexNet) were adapted for 3D classification and applied to a dataset consisting of 187 heterogenous CT scans. The 3D ResNet outperformed both other networks. Across the five folds of the first training dataset it achieved an accuracy of 0.856 and an area under the curve (AUC) of 0.926. Subsequently, the algorithms performance was verified on a second data set containing 106 scans, where it ran fully automated and resulted in an accuracy of 0.953 and an AUC of 0.971. A layer-wise relevance propagation (LRP) made the decision process interpretable and showed that the network correctly focused on the aortic lumen. In conclusion, the deep learning-based screening proved to be robust and showed high performance even on a heterogeneous multi-center data set. Integration into hospital workflow and its effect on aneurysm management would be an exciting topic of future research.

Background and Objectives: Preoperative planning utilizing computed tomographies (CT) is of utmost importance in functional endoscopic sinus surgery (FESS). Frequently, no uniform documentation and planning structures are available to residents in training. Consequently, overall completeness and quality of operation planning may vary greatly. The objective of the present study was to evaluate the impact of a structured operation planning (SOP) approach on the report quality and user convenience during a 4-day sinus surgery course. Materials and Methods: Fifteen participant were requested to plan a FESS procedure based on a CT scan of the paranasal sinuses that exhibited common pathological features, in a conventional manner, using a free text. Afterwards, the participants reevaluated the same scans by means of a specifically designed structured reporting template. Two experienced ENT surgeons assessed the collected conventional operation planning (COP) and SOP methods independently with regard to time requirements, overall quality, and legibility. User convenience data were collected by utilizing visual analogue scales. Results: A significantly greater time expenditure was associated with SOPs (183 s vs. 297 s, p = 0.0003). Yet, legibility (100% vs. 72%, p < 0.0001) and overall completeness (61.3% vs. 22.7%, p < 0.0001) of SOPs was significantly superior to COPs. Additionally, description of highly relevant variants in anatomy and pathologies were outlined in greater detail. User convenience data delineated a significant preference for SOPs (VAS 7.9 vs. 6.9, p = 0.0185). Conclusions: CT-based planning of FESS procedures by residents in training using a structured approach is more time-consuming while producing a superior report quality in terms of detailedness and readability. Consequently, SOP can be considered as a valuable tool in the process of preoperative evaluations, especially within residency.

Background: In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.

Background The diagnosis of ischemic cerebellar stroke is challenging because of nonspecific symptoms and very limited accuracy of commonly applied computed tomography (CT) imaging. Advances in CT perfusion imaging provide increasing value in the detection of posterior circulation stroke, but the prognostic value remains unclear. We aimed to identify imaging parameters that predict morphologic outcome in cerebellar stroke patients using advanced CT including whole‐brain CT perfusion (WB‐CTP). Methods and Results We selected all subjects with cerebellar WB‐CTP perfusion deficits and follow‐up‐confirmed cerebellar infarction from a consecutive cohort with suspected stroke who underwent WB‐CTP. Posterior‐circulation‐Acute‐Stroke‐Prognosis‐Early‐CT‐Score (pc‐ASPECTS) was determined on noncontrast CT, CT angiography source images, and on parametric WB‐CTP maps. Cerebellar perfusion deficit volumes on all maps and the final infarction volume on follow‐up imaging were quantified. Uni‐ and multivariate regression analyses were performed. Sixty patients fulfilled the inclusion criteria. pc‐ASPECTS on CT angiography source images (ß, −9.239; 95% CI, −14.220 to −4.259; P0.05). Conclusions In contrast to noncontrast CT and CT angiography, WB‐CTP imaging contains prognostic information for morphologic outcome in patients with acute cerebellar stroke.

Background: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. Methods: Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality. Results: The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR (p < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR (p < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR (p < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR (p < 0.001)). Conclusions: SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future.

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1–2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.

Background and objectives: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. Materials and Methods: Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). Results: Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. Conclusions: In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.

Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent. Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%). Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.