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Anastomotic leakage (AL) after esophagectomy is the most impactful complication after esophagectomy. Ischemic conditioning (ISCON) of the stomach >14 days prior to esophagectomy might reduce the incidence of AL. The current trial was conducted to prospectively investigate the safety and feasibility of laparoscopic ISCON in selected patients. This international multicenter feasibility trial included patients with esophageal cancer at high risk for AL with major calcifications of the thoracic aorta or a stenosis in the celiac trunk. Patients underwent laparoscopic ISCON by occlusion of the left gastric and the short gastric arteries followed by esophagectomy after an interval of 12–18 days. The primary endpoint was complications Clavien-Dindo ≥ grade 2 after ISCON and before esophagectomy. Between November 2019 and January 2022, 20 patients underwent laparoscopic ISCON followed by esophagectomy. Out of 20, 16 patients (80%) underwent neoadjuvant treatment. The median duration of the laparoscopic ISCON procedure was 45 minutes (range: 25–230). None of the patients developed intraoperative or postoperative complications after ISCON. Hospital stay after ISCON was median 2 days (range: 2–4 days). Esophagectomy was completed in all patients after a median of 14 days (range: 12–28). AL occurred in three patients (15%), and gastric tube necrosis occurred in one patient (5%). In hospital, the 30-day and 90-day mortalities were 0%. Laparoscopic ISCON of the gastric conduit is feasible and safe in selected esophageal cancer patients with an impaired vascular status. Further studies have to prove whether this innovative strategy aids to reduce the incidence of AL.

Objectives This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFRCT), the transluminal attenuation gradient (TAG), and their combined use with CTA versus FFR as a reference standard for detection of hemodynamically significant coronary artery disease (CAD). Background CTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD. Methods This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFRCT values were collected. Results Overall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFRCT (0.78; 95% CI: 0.72 to 0.83) and TAG (0.77; 95% CI: 0.61 to 0.89) were substantially higher than that of CTA (0.61; 95% CI: 0.54 to 0.68). The addition of FFRCT, CTP, and TAG to CTA resulted in high to excellent specificities (0.80 to 0.92). The summary receiver-operating characteristic curve at vessel level yielded superior diagnostic accuracy for CTP, FFRCT, and combined CTA and CTP, compared with CTA. A subanalysis of on-site versus off-site FFRCT revealed no substantial differences between the sensitivity (0.84 vs. 0.85) and specificity (0.80 vs. 0.73) of the 2 techniques. In a second subanalysis, dynamic CTP showed higher sensitivity (0.85 vs. 0.72), but had a lower specificity (0.81 vs. 0.90) than static CTP. Conclusions CTP and FFRCT demonstrated a substantial improvement in the identification of hemodynamically significant CAD compared with CTA; therefore, their integration to clinical workflow before revascularization is recommended.

Low skeletal muscle mass (SMM) is associated with toxicities and decreased survival in head and neck cancer (HNC). Chemoradiotherapy (CRT) may exaggerate loss of SMM. We investigated the changes in SMM, their predictors, and prognostic impact of SMM in patients treated with CRT between 2012 and 2018. Skeletal muscle area (SMA) segmentation was performed on pre- and post-CRT imaging. Observed changes in SMM were categorized into: (I) Stable, (II) moderate gain (III), moderate loss, (IV) large gain, and (V) large loss. In total, 235 HNC patients were included, of which 39% had stable SMM, 55% moderate loss, 13% moderate gain, 0.4% large loss, and 0.4% large gain of SMM. After CRT, SMA decreased compared to pre-CRT (31.6 cm2 versus 33.3 cm2, p &lt, 0.01). The key predictor was a body mass index (BMI) of ≥30 kg/m2 (OR 3.6, 95% CI 1.4–9.3, p &lt, 0.01). Low SMM at diagnosis (HR 2.1, 95% CI 1.1–4.1, p = 0.03) and an HPV-positive oropharyngeal tumor (HR 0.1, 95% CI 0.01–0.9, p = 0.04) were prognostic for overall survival. Changes in SMM were not prognostic for survival. Loss of SMM is highly prevalent after CRT and a high BMI before treatment may aid in identifying patients at risk.

BACKGROUND: Although several deep learning (DL) calcium scoring methods have achieved excellent performance for specific CT protocols, their performance in a range of CT examination types is unknown. PURPOSE: To evaluate the performance of a DL method for automatic calcium scoring across a wide range of CT examination types and to investigate whether the method can adapt to different types of CT examinations when representative images are added to the existing training data set. MATERIALS AND METHODS: The study included 7240 participants who underwent various types of nonenhanced CT examinations that included the heart: coronary artery calcium (CAC) scoring CT, diagnostic CT of the chest, PET attenuation correction CT, radiation therapy treatment planning CT, CAC screening CT, and low-dose CT of the chest. CAC and thoracic aorta calcification (TAC) were quantified using a convolutional neural network trained with (a) 1181 low-dose chest CT examinations (baseline), (b) a small set of examinations of the respective type supplemented to the baseline (data specific), and (c) a combination of examinations of all available types (combined). Supplemental training sets contained 199–568 CT images depending on the calcium burden of each population. The DL algorithm performance was evaluated with intraclass correlation coefficients (ICCs) between DL and manual (Agatston) CAC and (volume) TAC scoring and with linearly weighted κ values for cardiovascular risk categories (Agatston score; cardiovascular disease risk categories: 0, 1–10, 11–100, 101–400, >400). RESULTS: At baseline, the DL algorithm yielded ICCs of 0.79–0.97 for CAC and 0.66–0.98 for TAC across the range of different types of CT examinations. ICCs improved to 0.84–0.99 (CAC) and 0.92–0.99 (TAC) for CT protocol–specific training and to 0.85–0.99 (CAC) and 0.96–0.99 (TAC) for combined training. For assignment of cardiovascular disease risk category, the κ value for all test CT scans was 0.90 (95% confidence interval [CI]: 0.89, 0.91) for the baseline training. It increased to 0.92 (95% CI: 0.91, 0.93) for both data-specific and combined training. CONCLUSION: A deep learning calcium scoring algorithm for quantification of coronary and thoracic calcium was robust, despite substantial differences in CT protocol and variations in subject population. Augmenting the algorithm training with CT protocol–specific images further improved algorithm performance. © RSNA, 2020 See also the editorial by Vannier in this issue.

Opportunistic screening for bone mineral density (BMD) of the first lumbar vertebra (L1) using computed tomography (CT) is increasingly used to identify patients at risk for osteoporosis. An extensive study in the United States has reported sex-specific normative values of CT-based BMD across all ages. The current study aims to validate North American reference values of CT-based bone mineral density in a Dutch population of level-1 trauma patients. All trauma patients aged 16 or older, admitted to our level-1 trauma center during 2017, who underwent a CT scan of the chest or abdomen at 120 kVp within 7 days of hospital admission, were retrospectively included. BMD measurements in Hounsfield Units (HU) were performed manually in L1 or an adjacent vertebra. Student’s t-tests were performed to compare the Dutch mean BMD value per age group to the North American reference values. Linear regression analysis and Pearson’s correlation coefficient (ρ) calculations were performed to assess the correlation between BMD and age. In total, 624 patients were included (68.4% men, aged 16–95). Mean BMD decreased linearly with 2.4 HU per year of age (ρ = −0.77). Sex-specific analysis showed that BMD of premenopausal women was higher than BMD of men at these ages. Dutch mean BMD values in the age groups over 35 years were significantly lower than the North American reference values. Our findings indicate that using North American BMD thresholds in Dutch clinical practice would result in overdiagnosis of osteoporosis and osteopenia. Dutch guidelines may benefit from population-specific thresholds.

Background Increasing evidence suggests that severe skeletal muscle index (SMI) loss (sarcopenia) is associated with poor overall survival in metastatic colorectal cancer patients, but its mechanisms are unknown. We recently found, using data of the randomized phase 3 CAIRO3 study, that SMI loss was related with shorter time to disease progression and overall survival during first‐line maintenance treatment with capecitabine + bevacizumab (CAP‐B) or observation and during more intensive capecitabine + oxaliplatin + bevacizumab (CAPOX‐B) reintroduction treatment. As a potential risk factor for reduced survival, we explored whether sarcopenia and SMI loss were associated with dose‐limiting toxicities (DLTs) during CAP‐B and CAPOX‐B. Methods Sarcopenia status and SMI loss were assessed by using consecutive computed tomography scans. DLTs were defined as any dose delay/reduction/discontinuation of systemic treatment because of reported CTCAE (version 3.0) toxicities at the start or during treatment. Poisson regression models were used to study whether sarcopenia and body mass index (BMI) at the start of treatment and SMI and BMI loss during treatment were associated with DLTs. Results One hundred eighty‐two patients (mean age 63.0 ± 8.8 years, 37% female) received CAP‐B, and 232 patients (mean age 63.0 ± 9.0 years, 34% female) received CAPOX‐B. At the start of CAP‐B and CAPOX‐B, 54% and 46% of patients were sarcopenic, respectively. Mean BMI was lower in sarcopenic patients, although patients were on average still overweight (sarcopenic vs. non‐sarcopenic at the start of CAP‐B 25.0 ± 3.9 vs. 26.7 ± 4.1 and CAPOX‐B 25.8 ± 3.8 vs. 27.1 ± 3.8 kg/m2). Sarcopenia at the start of CAP‐B was not associated with DLTs [relative risk 0.87 (95% confidence interval 0.64–1.19)], whereas patients with >2% SMI loss had a significantly higher risk of DLTs [1.29 (1.01–1.66)]. At the start of subsequent CAPOX‐B, 25% of patients received a dose reduction, and the risk of dose reduction was significantly higher for patients with preceding SMI loss [1.78 (1.06–3.01)] or sarcopenia [1.75 (1.08–2.86)]. After the received dose reductions, sarcopenia or SMI loss was not significantly associated with a higher risk of DLTs during CAPOX‐B [sarcopenia vs. non‐sarcopenic: 0.86 (0.69–1.08) and SMI loss vs. stable/gain: 0.83 (0.65–1.07)]. In contrast, BMI (loss) at the start or during either treatment was not associated with an increased risk of DLTs. Conclusions In this large longitudinal study in metastatic colorectal cancer patients during palliative systemic treatment, sarcopenia and/or muscle loss was associated with an increased risk of DLTs. BMI was not associated with DLTs and could not detect sarcopenia or SMI loss. Prospective (randomized) studies should reveal whether normalizing chemotherapeutic doses to muscle mass or muscle mass preservation (by exercise and nutritional interventions) increases chemotherapeutic tolerance and improves survival.

Background Enthesitis is thought to be a key feature driving the development of spondyloarthritis, although head-to-head studies in patients with psoriasis (Pso) versus psoriatic arthritis (PsA) are scarce. In PsA and ankylosing spondylitis (AS) patients the plantar fascia and Achilles tendon are among the entheseal structures most frequently affected clinically. MRI allows for objective detection of enthesitis in patients with rheumatic diseases. Objectives To assess the frequency of MRI-detected enthesitis at the plantar fascia and Achilles tendon in Pso, PsA and AS patients. Methods The cross-sectional observational ‘EXTEND-UP’ study* included patients with Pso (diagnosed by a dermatologist, PsA excluded by rheumatologist), PsA (fulfilling CASPAR criteria) and AS (fulfilling ASAS criteria). With the exception of two PsA patients, no study participants received DMARDs. Study participants were included regardless of the presence/absence of clinically-suspect enthesitis (nail blanching pressure on enthesis). Clinicians were blinded to the MRI-scan results. 3 Tesla MRI-scans of both ankles were performed and evaluated by one observer with over four years of experience in musculoskeletal MRIs, who was blinded to diagnosis and clinical examination. MRI-defined enthesitis was scored following the OMERACT MRI definitions for PsA. Results This study evaluated a total of 79 ankles from 13 Pso patients, 15 PsA patients and 12 AS patients. The MRI-scan of one ankle was not assessable for enthesitis because of suboptimal fat suppression. Overall, MRI-defined enthesitis either at the plantar fascia and/or Achilles tendon was detected in 30% (9/30) of PsA ankles, compared to 8% (2/26) of Pso ankles (p Conclusion This study shows a substantial incidence of MRI-detected plantar fascia and Achilles tendon enthesitis in PsA, occurring more frequently compared to PsO. The clear discrepancy between clinically-suspect enthesitis and MRI-defined enthesitis, even at prototypical sites, warrants caution before using clinical evaluation of enthesitis as part of clinical decision-making or trial outcome measures. Disclosure of Interests Nienke J. Kleinrensink: None declared, Emmerik Leijten: None declared, Wouter Foppen Grant/research support from: WF has received research grants from NovoNordisk and Pfizer. All were paid to the institution. Paid instructor for: WF has received paid instructor fees from Pfizer. All were paid to the institution., Suzanne C. Diepstraten: None declared, Nanette L. Vincken: None declared, Pim de Jong: None declared, Timothy R. Radstake: None declared

Objective.Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by bony proliferation at sites of tendinous and ligamentous insertions in the spine. Spinal mobility is reduced in DISH and may affect movement in the thorax, potentially leading to restrictive pulmonary function. This study investigated whether DISH is associated with restrictive spirometric pattern (RSP) in former and current smokers.Methods.Participants (n = 1784) with complete postbronchodilator spirometry who did not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) at time of enrollment in the COPDGene study were included in this study. Subjects were classified as RSP if they had forced expiratory volume in 1 s(FEV1) to forced vital capacity (FVC) ratio > 0.7 with an FVC < 80%. Computed tomography (CT) scans were scored for the presence of DISH in accordance with the Resnick criteria. Chest CT measures of interstitial and alveolar lung disease, clinical symptoms, health surveys, and 6-min walking distance were recorded. Uni- and multivariable analyses were performed to test the association of DISH with RSP.Results.DISH was present in 236 subjects (13.2%). RSP was twice as common in participants with DISH (n = 90/236, 38.1%) compared to those without DISH (n = 301/1548, 19.4%; p < 0.001). In multivariable analysis, DISH was significantly associated with RSP (OR 1.78; 95% CI 1.22–2.60; p = 0.003) after adjusting for potential confounders. The RSP group with and without DISH had significantly worse spirometry, dyspnea, St. George’s Respiratory Questionnaire score, BODE index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity), and Medical Outcomes Study Short Form-36 questionnaire score.Conclusion.In heavy smokers with an FEV1/FVC ratio > 0.70, DISH is associated with RSP after adjustment for intrinsic and extrinsic causes of restrictive lung function. (Clinical trial registration number: NCT00608764.)

Although architecture is often seen as the culmination of design decisions, design rationale is a suppositious child in architecture documentation. Many architecture frameworks and standards, like TOGAF and ISO/IEC 42010, recognize the importance, but do not offer any support in the rationale process. Recent initiatives have shown that simple means help in providing more rationale. However, there are very few studies that give evidence whether more rationale indeed leads to better quality. In this paper, we propose a non-invasive method, the Rationale Capture Cycle, that supports architects in capturing rationale during the design process. Through a controlled experiment with 10 experienced architects, we observe the effectiveness of the method in terms of design quality through different measures. The results of our experiments show that: (1) better rationale is strongly correlated with high quality, and (2) the test group with our proposed method outperforms the control group.

Purpose of Review With this review, we aim to summarize the role of positron emission tomography (PET) and near-infrared fluorescence imaging (NIRF) in the detection of atherosclerosis. Recent Findings 18F-FDG is an established measure of increased macrophage activity. However, due to its low specificity, new radiotracers have emerged for more specific detection of vascular inflammation and other high-risk plaque features such as microcalcification and neovascularization. Novel NIRF probes are engineered to sense endothelial damage as an early sign of plaque erosion as well as oxidized low-density lipoprotein (oxLDL) as a prime target for atherosclerosis. Integrated NIRF/OCT (optical coherence tomography) catheters enable to detect stent-associated microthrombi. Summary Novel radiotracers can improve specificity of PET for imaging atherosclerosis. Advanced NIRF probes show promise for future application in human. Intravascular NIRF might play a prominent role in the detection of stent-induced vascular injury.

This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFRCTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD.This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFROverall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFRCTP and FFR

Pulmonary complications are an important cause for treatment-related morbidity and mortality in hematopoietic cell transplantation (HCT) in children. The aim of this study was to investigate the yield of our pre-HCT pulmonary screening program. We also describe our management guidelines based on these findings and correlate them with symptomatic lung injury after HCT. Since 2008, all patients undergo a dedicated pulmonary screening consisting of pulmonary function test (PFT), chest high-resolution computed tomography (HRCT), and bronchial alveolar lavage (BAL) before HCT. We systematically evaluated the yield during the first 5 years of our screening program. We included 142 consecutive children. In 74% of patients, abnormalities were found. In 66% of patients, 1 or more PFT results were, Highlights • Pulmonary screening before hematopoietic cell transplantation reveals important abnormalities. • Testing for lung function, structure, and microbial colonization contribute separately. • Therapeutic implications of different findings are described.

Contains fulltext : 154962.pdf (Publisher’s version ) (Open Access) To determine whether semiautomatic volumetric software can differentiate part-solid from nonsolid pulmonary nodules and aid quantification of the solid component.As per reference standard, 115 nodules were differentiated into nonsolid and part-solid by two radiologists; disagreements were adjudicated by a third radiologist. The diameters of solid components were measured manually. Semiautomatic volumetric measurements were used to identify and quantify a possible solid component, using different Hounsfield unit (HU) thresholds. The measurements were compared with the reference standard and manual measurements.The reference standard detected a solid component in 86 nodules. Diagnosis of a solid component by semiautomatic software depended on the threshold chosen. A threshold of -300 HU resulted in the detection of a solid component in 75 nodules with good sensitivity (90 \%) and specificity (88 \%). At a threshold of -130 HU, semiautomatic measurements of the diameter of the solid component (mean 2.4 mm, SD 2.7 mm) were comparable to manual measurements at the mediastinal window setting (mean 2.3 mm, SD 2.5 mm [p = 0.63]).Semiautomatic segmentation of subsolid nodules could diagnose part-solid nodules and quantify the solid component similar to human observers. Performance depends on the attenuation segmentation thresholds. This method may prove useful in managing subsolid nodules.• Semiautomatic segmentation can accurately differentiate nonsolid from part-solid pulmonary nodules • Semiautomatic segmentation can quantify the solid component similar to manual measurements • Semiautomatic segmentation may aid management of subsolid nodules following Fleischner Society recommendations • Performance for the segmentation of subsolid nodules depends on the chosen attenuation thresholds.

Background: Osteoporosis is more common in patients with chronic obstructive pulmonary disease (COPD) and smokers. Bone density derived from computed tomography (CT) can be used to identify patients at risk for a vertebral fracture. Aims and objectives: We investigated whether COPD related measures on computed tomography (CT) scans were associated with lower bone density or vertebral fractures in smokers with and without COPD. Methods: We included participants from the NELSON lung cancer screening trial. Bone density was measured as the Hounsfield Unit (HU) in the first lumbar vertebra and vertebral fractures were assessed semi-quantitatively. The 15th Percentile method (Perc15) was used to assess emphysema and the airway lumen perimeter (Pi10) was used to measure airway wall thickness. The expiratory/inspiratory-ratioMeanLungDensity (E/I-ratioMLD) was used as a measure for air trapping and tracheal index (TI) was used to assess trachea deformity. Results: 1,093 male participants were included. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b = -1.29, p = 0.03 and b = -0.48, p = 0.01, respectively). Pi10 and TI were not associated with bone density changes. 95 (8.7%) participants had a vertebral fracture. All CT-derived biomarkers were not associated with fracture prevalence. Conclusions: Bone density is lower with increasing extents of emphysema and small airway disease, but is not associated with large airway disease and trachea deformity. This may indicate the necessity to measure bone density early in the disease in COPD patients with emphysema and air trapping to prevent vertebral fractures.

Background: Airway wall thickness (AWT) is associated with lower lung function in patients with chronic obstructive pulmonary disease (COPD). Longitudinal airway wall thickness measurements may be used to monitor disease progression. However, the variability of AWT measurements is not well known. Aims and objectives: We investigated the reproducibility of AWT on CT and the relation with inspiration level in participants of a lung cancer screening study (NELSON trial). Methods: Participants who underwent follow-up CT after 3 months because of an indeterminate pulmonary nodule were included. AWT was automatically analyzed and expressed as Pi10. Inter-examination reliability was assessed by intra class correlation coefficients (ICC). Limits of agreement were determined with the Bland-Altman approach. Total lung volume on CT was used as a surrogate for inspiration level. Results: In total, 591 men were included with a mean±SD Pi10 at baseline of 2.81±0.80 mm and of 2.81±0.82 mm at follow-up. ICC was 0.70. Limits of agreement for differences in AWT were -1.22 mm to 1.22 mm. Differences in Pi10 showed a strong correlation with variation in level of inspiration (r=0.744, p Conclusions: Measuring AWT on CT with Pi10 in a lung cancer screening setting has good reproducibility, but individual variation can be substantial. An increase in Pi10 of at least 1.22 mm is required for detection of an increase in the extent of airway wall thickness. However, when correcting Pi10 for lung volume changes, limits of agreement narrow and variability improves.

Aim: Intracranial carotid artery calcification (ICAC) is one of the most important risk factors for stroke. Yet, surprisingly little is known about its prevalence across the age range of individuals below the age of 60. We examined the prevalence and volume of ICAC in a large sample of young and middle aged individuals. Methods: All persons aged 0 – 55 years who visited the Emergency Department of the Erasmus MC University Medical Center and University Medical Center Utrecht between January 2010 and December 2015, and underwent CT-scanning as part of trauma-screening were included in the study. In total, we analyzed CT-data of 1759 persons (mean age 29.5 years, 62.8% males). We evaluated the presence and volume of ICAC. We determined its prevalence and median volume, stratified by sex and age. Results: The overall prevalence of ICAC was 16.3%. The median volume in person with ICAC was 6.2 mm3 (IQR: 20.8mm3). We found a linear increase in prevalence and volume of ICAC with age, with the first occurrence of ICAC in the age group of 10-15 years old. We found no significant differences between men and women for ICAC prevalence (men: 14.7%, women: 18.0%, P = 0.18) or ICAC volume (men: median volume (IQR): 7.1 (23.9) mm3), women: 5.5 (14.6) mm3, P = 0.12). Conclusions: ICAC already occurs in the second decade of life and its prevalence and amount increases with age. These findings provide important insight into the widow for early interventions targeted at the prevention of stroke.

OBJECTIVE: We evaluated the effects of hybrid and model-based iterative reconstruction (IR) algorithms from different vendors at multiple radiation dose levels on image quality of chest phantom scans. METHODS: A chest phantom was scanned on state-of-the-art computed tomography scanners from 4 vendors at 4 dose levels (4.1 mGy, 3.0 mGy, 1.9 mGy, and 0.8 mGy). All data were reconstructed with filtered back projection (FBP) and reduced-dose data also with IR (iDose4, Adaptive Iterative Dose Reduction 3D, Adaptive Statistical Iterative Reconstruction, Sinogram-Affirmed Iterative Reconstruction, prototype Iterative Model Reconstruction, and Veo). Computed tomography numbers and noise were measured in the spine and lungs. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were calculated and differences were analyzed with the Friedman test. RESULTS: For all vendors, radiation dose reduction with FBP resulted in significantly increased noise levels (?148%) as well as decreased SNR (?57%) and CNR (?58%) (P

Objective To assess the effects of famine exposure during childhood on coronary calcium deposition and, secondarily, on cardiac valve and aortic calcifications. Design Retrospective cohort. Setting Community. Patients 286 postmenopausal women with individual measurements of famine exposure during childhood in the Netherlands during World War II. Intervention/exposure Famine exposure during childhood. Main outcome measures Coronary artery calcifications measured by CT scan and scored using the Agatston method; calcifications of the aorta and cardiac valves (mitral and/or aortic) measured semiquantitatively. Logistic regression was used for coronary Agatston score of >100 or ≤100, valve or aortic calcifications as the dependent variable and an indicator for famine exposure as the independent variable. These models were also used for confounder adjustment and stratification based on age groups of 0–9 and 10–17 years. Results In the overall analysis, no statistically significant association was found between severe famine exposure in childhood and a high coronary calcium score (OR 1.80, 95% CI 0.87 to 3.78). However, when looking at specific risk periods, severe famine exposure during adolescence was related to a higher risk for a high coronary calcium score than non-exposure to famine, both in crude (OR 3.47, 95% CI 1.00 to 12.07) and adjusted analyses (OR 4.62, 95% CI 1.16 to 18.43). No statistically significant association was found between childhood famine exposure and valve or aortic calcification (OR 1.66, 95% CI 0.69 to 4.10). Conclusions Famine exposure in childhood, especially during adolescence, seems to be associated with a higher risk of coronary artery calcification in late adulthood. However, the association between childhood famine exposure and cardiac valve/aortic calcification is less clear.

Background: Matrix Gla protein (MGP) is an inhibitor of vascular calcification that requires vitamin K for its carboxylation. Circulating MGP occurs as various species with different conformations depending on carboxylation and phosphorylation. Total uncarboxylated MGP (t-ucMGP) is the sum of non-phosphorylated and phosphorylated uncarboxylated MGP (dp-ucMGP and p[[Unable to Display Character: ‑]]ucMGP) and mainly consists of p-ucMGP. Due to its phosphorylated group p-ucMGP has a strong calcium-binding capacity irrespective of the Gla content. In high risk populations, high levels of t[[Unable to Display Character: ‑]]ucMGP were associated with decreased calcification, while high levels dp-ucMGP were associated with low vitamin K status and increased vascular calcification. These relations have never been investigated in a healthy population. Objective: This prospective study investigates the association between circulating matrix Gla protein species and vascular calcifications among postmenopausal women. Design: In a prospective cohort of 571 healthy women, MGP levels were measured by ELISA techniques at baseline. Vitamin K intake was estimated from a validated food frequency questionnaire. Calcification was measured in the coronary arteries, aortic valve, mitral valve, and aortic arch by multi-detector computed tomography after 8.5 years follow-up. Coronary artery calcification (CAC) was defined present if Agatston score was ≥10 and the calcification score was calculated as the sum of the calcified areas. Multivariate adjusted relative risks (RR) and odds ratios (OR) were estimated using modified Poisson regression and multinomial logistic regression per standard deviation of MGP species and the no calcification group was used as reference. Results: Of the women, 24% had no calcification while 5% had calcification in all areas. High dp-ucMGP levels, reflecting poor vitamin K status, were (p=0.08) associated with more CAC (RR SD 1.07;95%CI 0.99-1.15) and calcification areas (OR (4 areas vs no calcification) 1.49; 95%CI 0.95-2.35, p=0.09). High t-ucMGP levels were associated with less calcification (OR (4 areas vs no calcification) 0.63; 95%CI 0.36-1.10, p=0.10). Desphospho-carboxylated MGP was not associated with calcification. High phylloquinone intake was not associated with the number of calcified areas OR (4 areas vs no calcification) 1.14 (95%CI: 0.72-1.81, p=0.57). In contrast, higher menaquinones intake was associated with less calcification areas (OR (4 areas vs no calcification) 0.39; 95%CI: 0.21-0.74, p=0.004). Conclusion: High dp-ucMGP levels, reflecting a poor vitamin K status, may be associated with more calcification, also in a healthy population. High menaquinones intake was associated with less calcification. Consistent with high-risk populations, high t-ucMGP levels seem to associated with fewer calcification areas.

PURPOSE Imaging may produce unexpected or incidental fi ndings with conse- quences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODS We report on data from a cross-sectional study in 16 European pri- mary care networks on 3,105 patients with acute cough, all of whom were under- going chest radiography as part of a research study workup. Apart from assess- ment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTS Incidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P

Contains fulltext : 89333.pdf (Publisher’s version ) (Open Access) PURPOSE: To estimate the performance of digital chest radiography for detection of lung cancer. MATERIALS AND METHODS: The study had ethics committee approval, and a nested case-control design was used and included 55 patients with lung cancer detected at computed tomography (CT) and confirmed with histologic examination and a sample of 72 of 4873 control subjects without nodules at CT. All patients underwent direct-detector digital chest radiography in two projections within 2 months of the screening CT. Four radiologists with varying experience identified and localized potential cancers on chest radiographs by using a confidence scale of level 1 (no lesion) to 5 (definite lesion). Localization receiver operating characteristic (ROC) analysis was performed. On the basis of the assumption that suspicious lesions seen at chest radiography would lead to further work-up with CT, the number of work-up CT examinations per detected cancer (CT examinations per cancer) was calculated at various confidence levels for the screening population (cancer rate in study population, 1.3%). RESULTS: Tumor size ranged from 6.8 to 50.7 mm (median, 11.8 mm). Areas under the localization ROC curve ranged from 0.52 to 0.69. Detection rates substantially varied with the observers' experience and confidence level: At a confidence level of 5, detection rates ranged from 18% at one CT examination per cancer to 53% at 13 CT examinations per cancer. At a confidence level of 2 or higher, detection rates ranged from 94% at 62 CT examinations per cancer to 78% at 44 CT examinations per cancer. CONCLUSION: A detection rate of 94% for lung tumors with a diameter of 6.8-50.7 mm found at CT screening was achievable with chest radiography only at the expense of a high false-positive rate and an excessive number of work-up CT examinations. Detection performance is strongly observer dependent. 01 mei 2010