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Background and purpose Brain CT Perfusion (CTP) is an X-ray imaging technique for the assessment of brain tissue perfusion, which can be used in several different entities. The aim of this study is the evaluation of the radiation dose to patients during a comprehensive brain CT prescription protocol (CPP) consisting of an unenhanced brain CT, a brain CT angiography and a CTP scan. Materials and methods Eighteen patients were studied using an 80-slice CT system, with an iterative reconstruction algorithm. The volume Computed Tomography Dose Index (CTDIvol) and dose length product (DLP) were recorded from the dose report of the system. The calculation of effective dose (ED) was accomplished using the DLP values. Results For the CTP examinations, the CTDIvol ranged from 116.0 to 134.8 mGy, with the mean value 119.5 mGy. The DLP ranged from 463.9 to 539.2 mGy·cm, with the mean value 478 mGy·cm. For the CPP, the total ED ranged from 3.31 to 5.07 mSv, with the mean value 4.37 mSv. Conclusions These values are lower than the values reported in corresponding studies, including studies utilizing CT systems with more slices.

Erectile dysfunction (ED) has been linked to obstructive sleep apnea (OSA). This study used computed tomography (CT) to identify cephalometric and upper airway anatomic features in patients with OSA that correlate with the presence of ED. In this prospective study, 20 CT cephalometric and upper airway measurements, most commonly associated with OSA, were analyzed in 53 age- and BMI-matched consecutive eligible subjects. Twenty-two were diagnosed with OSA and ED (OSA+/ED+), 17 with OSA without ED (OSA+/ED−), and 14 without OSA and ED (OSA−/ED−) serving as a control group. Although OSA+/ED+ did not differentiate significantly in CT measurements from OSA+/ED−, they showed more alterations when compared to OSA−/ED−, which included narrower bony oropharynx, longer soft palate and uvula (PNS-P), and narrower retropalatal and retrolingual airway diameter (p

Objectives: The objectives of this article are twofold: To review the value and the variability of MR imaging (MRI) findings in patients with systemic lupus erythematosus (SLE) and to reveal the frequency of central nervous system (CNS) involvement. SLE is a complex multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations. Materials and methods: We present three cases, two with neurological symptoms and one case with musculoskeletal symptoms. Patients were imaged in the MRI department of the University Hospital of Patras. All patients had a previous history of antiphospholipid syndrome and known SLE. Results: None of the pts had a normal brain MRI. Abnormal lesions were typically high on FLAIR and T2-weighted images. One patient showed myositis of the tibial muscles bilateral and although she did not reveal any neurological symptoms, because of the presence of APS, she underwent brain MRI to detect any cerebrovascular involvement. The brain MRI was abnormal and showed extensive lesions and porencephalia. In all cases the differential diagnosis of the brain MRI included vasculitis, focal ischemia, multiple sclerosis or other entities. Parenchymal volume loss-cerebral atrophy, incompatible with their age, was obvious in all patients. Conclusion: Magnetic resonance imaging is the gold standard for the investigation of central nervous system in patients suffering from lupus. Lupus patients who also develop antiphospholipid syndrome must be submitted to brain MRI because central nervous involvement is very common and serious, although symptoms may be silent as in our case.

To investigate the safety and effectiveness of lutonix paclitaxel-coated balloon (PCB) for the treatment of dysfunctional dialysis access. This was a single-center, single-arm, retrospective analysis of 39 patients (23 male, 59 %) undergoing 61 interventions using 69 PCBs in a 20-month period. There was a balance between arteriovenous fistulae (AVF) and grafts (AVG) (20 AVFs, 19AVGs), and the majority of lesions were restenotic (25/39, 64.1 %). Mean balloon diameter used was 6.6 mm and length 73.4 mm. Primary outcome measure was target lesion primary patency (TLPP) at 6 months, while secondary outcome measures included factors affecting TLPP and major complications. As there were lesions treated more than once with PCB, authors also compared patency results after first and second PCB angioplasty. TLPP was 72.2 % at 6 months with a median patency of 260 days according to the Kaplan–Meier survival analysis. No major complications occurred. TLPP between AVFs and AVGs (311 vs. 237 days, respectively; p = 0.29) and de novo and restenotic lesions was similar (270.5 vs. 267.5 days, respectively; p = 0.50). In 14 cases, in which lesions were treated with two PCB angioplasties, a statistically significant difference in TLPP after the second treatment was noted (first intervention 179.5 days vs. second intervention 273.5 days; p = 0.032). In this retrospective analysis, Lutonix PCB proved to be safe and effective in treating restenosis in dysfunctional dialysis access with results comparable to the literature available. Larger studies are needed to prove abovementioned results.

Background All patients with liver cirrhosis should undergo screening endoscopy, but there are limitations and this approach places a heavy burden upon endoscopy units. The aim of this study was to compare multidetector computed tomography (MDCT) and the platelet/spleen diameter ratio as non-invasive methods for the detection of gastroesophageal varices. Methods The study included 38 cirrhotics who underwent upper gastrointestinal (GI) endoscopy and MDCT within one month. Two radiologists reviewed the scans, in order to determine the presence and the size of varices. Blood tests and measurement of the spleen maximum diameter were also carried out and the platelet/spleen diameter ratio was calculated. Endoscopy was considered the gold standard and the results of the two methods were compared to it. Results Varices were detected by upper GI endoscopy in 24 of 38 patients. The mean sensitivity and specificity of MDCT for the two observers was 86.1% and 57.1% respectively. In patients with large varices (>5 mm), the sensitivity was 100% (4/4). Using 909 as a cut-off value of the platelet/spleen diameter ratio this method yielded a sensitivity of 56.5% and a specificity of 35.7%. The difference in sensitivity and specificity between the two methods was statistically significant P5 mm), and superior to platelet/spleen diameter ratio. MDCT could replace, in selected patients, upper GI endoscopy as a method for detecting gastroesophageal varices in cirrhotic patients.

We investigated the utility of virtual endoscopy (VE) as a diagnostic and follow-up tool in patients with renal artery stenosis, especially as a means of defining vascular patency.We performed VE in 24 patients with ostial atherosclerotic renal artery stenosis and correlated the results with those of conventional angiography. The patients were treated successfully by placement of metal stents and conventional catheter angiography and VE for patency assessment 6 and 12 months after stent insertion.In all patients, the stenotic segment was identified, and VE findings were concordant with those of angiography. The average degree of stenosis was estimated to be 70% +/- 20% when angiography was used and 62% +/- 15% when VE was used. After metal stent insertion, the 12-month patency rate was 83.3% (20 patients). Angiography and VE findings remained concordant during the follow-up period, but VE provided more information beyond the stenotic segment, allowing examination of the arterial lumen both cephalad and caudal to the point of obstruction.Virtual endoscopy provided a more dynamic, direct, minimally invasive approach that was equal to or better than angiography for both the verification of the vascular stenosis and the evaluation of the arterial lumen.

We report a case of ipsilateral double tracheal bronchi supplying a tracheal lobe in a 42-year-old man, who presented with a 10-year history of recurrent respiratory infections. Diagnosis was established by chest computed tomography (CCT), virtual endoscopy and bronchoscopy. Both bronchi were surgically resected along with the right upper lobe of the lung and the associated tracheal lobe. To our knowledge, this is the first report of ipsilateral double tracheal bronchi in the adult life to be diagnosed and treated on the basis of modern radiological techniques and especially virtual endoscopy findings.

To evaluate the efficacy of alcohol in combination with tetracycline for the treatment of symptomatic renal cysts.Twenty-four patients age 45 to 77 years (mean 66 years) with a large (5-13-cm; mean 7.5-cm) symptomatic renal cyst associated with flank pain were treated by aspiration under ultrasound guidance and injection of alcohol and tetracycline. Patients were followed with ultrasonography at 1, 6, and 12 months and once a year thereafter.The aspirated volume ranged from 65 to 1500 mL (mean 360.5 mL). Two patients experienced mild pain during alcohol injection, but the procedure was completed successfully. One patient reported severe pain after tetracycline injection. The tetracycline was immediately aspirated, and the procedure was then aborted. The remaining patients were relieved of their symptoms after treatment, and they remained symptom free during a mean follow-up of 20 months (range 7-36 months).The combination of alcohol and tetracycline is safe and effective and offers a very favorable minimally invasive therapeutic alternative for the treatment of symptomatic renal cysts.

The targeting potential of three different monoclonal antibodies (MAbs) was assessed in patients with ovarian cancer. HMFG1, OC-125 and H17E2 labelled with 111In or 123I were evaluated prospectively for their ability to localize ovarian tumour. Forty two patients with ovarian cancer, aged 40-78 years (median = 58 years) were studied using OC-125 (n = 9), HMFG1 (n = 11) and H17E2 (n = 22). Imaging data were compared with the CT and the surgical findings. Presence of tumour was confirmed in 35/42 (83%) patients (8/9 OC-125, 10/11 HMFG1 and 17/22 H17E2) and correlated well with the conventional radiology diagnostic methods. One patient with a negative H17E2 scan and a large abdominal mass detected at laparotomy revealed a PLAP-negative tumour on immunohistochemistry. Scintigraphy revealed the presence of active disease, confirmed by laparotomy/laparoscopy in 6/8 patients considered to be in clinical remission. The sensitivity of the method was high enough and the diagnostic contribution of this approach should be further evaluated.

Summary Purpose . In this study the temporal texture differentia tion associated with the bone formation properties, around loaded oral implants after Platelet Rich Plasma (PRP) employment, was investigated in Panoramic Radi ographs. Materials and methods . Thirty eligible patients are ran domly assigned to two groups. The test group received PRP application around new implants, while in the con trol group no PRP treatment was made. The bone-to-im plant contact region was analyzed in a clinical sample of 60 Digitized Panoramic Radiographs, 30 corresponding to immediate implant loading (Class-I) and 30 after an 8 month follow-up period (Class-II). This region was sam pled by 1146 circular Regions-of-Interest (ROIs), result ing from a specifically designed segmentation scheme based on Markov-Random-Fields (MRF). From each ROI, 41 textural features were extracted, then reduced to a subset of 4 features due to redundancy and employed as input to Receiver-Operating-Characteristic (ROC) analy sis, to assess the textural differentiation between two classes. Results . The selected subset, achieved Area-UnderCurve (AUC) values ranging from 0.77-0.81 in the PRP group, indicating the significant temporal textural differ entiation has been made. In the control group, the AUC values ranged from 0.56-0.68 demonstrating lesser os seo integration activity. Conclusion . This study provides evidences that PRP ap plication may favor bone formation around loaded dental implants that could modify the dental treatment plan ning.

To test the hypothesis that the ultrasound-estimated bladder weight (UEBW) will correlate with the urodynamic diagnoses in women with lower urinary tract symptoms, in particular, detrusor underactivity and bladder outflow obstruction. Ultrasonography has been increasingly used in the assessment of lower urinary tract conditions.Adult women referred to the urodynamics suite for investigation of lower urinary tract symptoms were enrolled. After urodynamic evaluation, the portable BladderScan BVM 6500 device was used to calculate the bladder wall thickness and UEBW according to a standardized protocol. The patients were categorized according to the urodynamic findings. Women with normal findings, despite the symptoms for which they were referred, were used as the control group. The UEBW and bladder wall thickness measurements were compared between the groups and controls, using the Mann-Whitney and Kolmogorov-Smirnov tests. P.05 was considered statistically significant.A total of 187 women were enrolled. The UEBW was significantly lower in the patients with detrusor underactivity than in the controls (39.3 ± 3.0 g vs 45.7 ± 3.1 g, P.001). Significant differences were also noted between the controls and patients with bladder outflow obstruction, with or without detrusor overactivity (45.7 ± 3.1 g vs 52.1 ± 3.9 g and 52.3 ± 6.2 g, respectively; P.001 for both). The difference, in terms of the UEBW, between controls and patients with detrusor overactivity was not statistically significant (45.7 ± 3.1 g vs 45.3 ± 3.0, P.05).A significantly reduced UEBW in female patients with detrusor underactivity and a significantly increased UEBW in patients with bladder outflow obstruction were found. However, the finding of a significantly increased bladder weight in patients with detrusor overactivity was not confirmed in the present study.

Accurate and automated Lung Field (LF) segmentation in volumetric computed tomography protocols is highly challenged by the presence of pathologies affecting lung borders, also affecting the performance of computer-aided diagnosis (CAD) schemes. In this work, a three-dimensional LF segmentation algorithm adapted to interstitial lung disease patterns (ILD) patterns is presented. The algorithm employs k-means clustering followed by a filling operation to obtain an initial LF order estimate. The final LF border is obtained by an iterative support vector machine neighborhood labeling of border pixels based on 3D texture features. The proposed method is evaluated on a dataset of 10 cases spanning a range of ILD patterns such as ground glass, reticular, and honeycombing. The accuracy of the method is assessed using area overlap and shape differentiation metrics (d mean , d rms , and d max ), by comparing automatically derived lung borders to manually traced ones by a radiologist, and further compared to a Gray Level Thresholding-based (GLT-based) method. The proposed method demonstrated the highest segmentation accuracy, overlap=0.942, d mean =1.835 mm, d rms =1.672 mm, and d max =4.255 mm, which is statistically significant (two-tailed student's t test for paired data, p mean =2.324 mm, d rms =3.890 mm,and d max =2.946 mm. The proposed segmentation method could be used as an initial stage of a CAD scheme for ILD patterns.

A current trend in lung CT image analysis is Computer Aided Diagnosis (CAD) schemes aiming at DLD patterns quantification. The majority of such schemes exploit textural features combined with supervised classification algorithms. In this direction, several 3D texture feature sets have been proposed. However their discriminating ability is not systematically evaluated, in terms of individual feature sets or in conjunction to different classifiers. In this paper, four classification settings combined with the RLE feature set, commonly used in the literature, and Laws feature set, first time employed for DLD characterization, are evaluated. Furthermore, the combination of RLE and Laws features was examined using the same classification settings. Although both RLE and Laws feature sets presented high discriminative ability for all classifiers considered (classification accuracy > 96.5%), their combination achieved even better results, yielding classification accuracy above 98.6%.

Computed Tomography (CT) is the modality of choice for the diagnosis of Diffuse Lung Disease (DLD) affecting lung parenchyma. The need for Computer Aided Diagnosis (CAD) schemes aimed at DLD patterns quantification in lung CT, originates from large inter- and intra observer variability characterizing DLD interpretation. The majority of the proposed CAD schemes aimed at DLD characterization exploits textural features combined with supervised classification algorithms. However, the exploitation of these features is suboptimal, since no feature reduction or evaluation is performed prior to the classification task. The aim of the current paper is to investigate 3D texture features sets (histogram signatures, co-occurrence and run length matrices’ statistics) regarding their capability in DLD patterns’ characterization (normal, ground glass, reticular and honeycombing). Earth Mover’s Distance (EMD), k-Nearest Neighbor (k-NN) and Multinomial Logistic Regression (MLR) classifiers where used to access the performance of individual feature sets. In the analysis performed Histogram Signature (HS) feature set combined with EMD classifier, achieves the lowest overall accuracy (80.2 %). Co-occurrence based feature set presented the highest overall classification accuracy (99.3 %) when combined with k-NN classifier. However, both Run Length and Co-occurrence based feature sets, presented robustness against classifier choice and higher classification accuracy than HS feature set.

In this study texture differentiation associated to bone regeneration properties, around loaded oral implants immersed to Platelets Rich Plasma (PRP), was investigated in panoramic radiographs. The bone-to-implant contact region was analyzed in a follow up clinical sample of 30 digitized panoramic radiographs, 15 corresponding to implant loading (Class I) and 15 after an 8 month period (Class II). This region was sampled by circular Regions of Interest (ROIs) resulting from a specifically designed segmentation stage resulting in 518 ROIs (254 Class I and 264 class II). From each ROI, 42 textural features were extracted, and subjected to statistical analysis in order to evaluate osseo integration of oral implants. A subset of 6 features, selected with stepwise discriminant analysis method, achieved Area Under Curve (AUC) values greater than 0.73, indicating that these features are capable of capturing temporal textural differentiation attributed bone regeneration properties in the bone-to-implant contact region.

A number of studies have shown that absence of myelotoxicity during chemotherapy is associated with worse outcome for various types of cancer, including carcinoma of the breast. The aim of this study was to determine whether myelosuppression in patients being treated with chemotherapy for advanced breast cancer has an impact on their prognosis.A retrospective review was conducted of a series of 475 patients with advanced breast cancer enrolled in two randomised trials, who received first-line chemotherapy. The impact of severe (grade 3 or 4) hematological toxicity on survival and time to disease progression was assessed.When severe myelotoxicity was evaluated as a whole, a significant negative association for time to disease progression and a trend for a worse survival were demonstrated. In multivariate analysis, hematological toxicity retained its significance as an independent negative prognostic factor for time to disease progression.Our findings do not confirm the results of previous studies which have demonstrated a better outcome for patients experiencing hematological toxicity during treatment.

Purpose To investigate the association between the clinical status of patients with metastatic bone disease and the type of bone metastases. Patients and methods 80 patients with skeletal metastases underwent both clinical and radiological assessments. Bone lesions were evaluated with computed tomography (CT), and patients were separated into three groups: lytic, mixed, sclerotic. Bone density of each lesion was measured in Hounsfield units (HU). Results Patients with osteolytic lesions had the highest mean pain score with 8.1 ± 2.2 points, the least mean scores for quality of life (QoL) and performance status (PS) with 31.4 ± 14.6 and 58.6 ± 9.7 points respectively, the highest percentage and mean opioid consumption (100% and 220.9 mg of oral daily morphine equivalent respectively), and the least mean bone density (116.3 ± 40.4 HU). On the contrary, the group with sclerotic metastases had the least mean pain score with 4.6 ± 1.3 points, the highest mean scores of QoL and PS (61.1 ± 15.5 and 66.6 ± 10 points respectively), the least percentage and mean opioid requirement (55.5% and 170.6 mg respectively), and the highest mean bone density (444 ± 86.6 HU). The differences between the three groups were statistically significant for all parameters evaluated, apart from performance status between the sclerotic and mixed groups. The correlation coefficients were statistically significant between all parameters investigated. Bone density had a strong negative correlation with pain. Conclusion Our results show a clear correlation between the type of bone metastases and the clinical status of patients. Patients with excessive bone resorption suffer the most, and may be given priority in treatment. CT proved to be a practical and efficient method to investigate and classify metastatic bone lesions.

Focal nodular hyperplasia (FNH) is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple localizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.

Although the importance of the bronchial arteries is evident in modern day thoracic surgery, the significance of their communications with coronary arteries has yet to be appreciated, especially in cases of heart-lung transplantation and aortic aneurysm repair. We conducted a study to demonstrate the coronary-bronchial anastomotic routes in a porcine model using angiography and computed tomography.Six young female white pigs were used. The heart and lungs were removed en bloc, including the lower trachea and oesophagus. Digital subtraction angiography of the bronchial circulation and spiral computed tomography scan were performed in a three-phase study before and after administration of contrast medium. This was achieved by infusion either into the cannulated bronchial artery or into the aortic root. Macroscopic evaluation was carried out using latex infusion into the bronchial or coronary circulation.We demonstrated communications between the bronchial and coronary systems in 5 of 6 subjects. This communication was located at the left atrial wall and the posterior and anterior wall of the left ventricle. In one case there were further anastomoses around the right atrial wall.There were communications between the left coronary arteries and the bronchial arteries in the majority of cases. Digital subtraction angiography and spiral computer tomography scan can demonstrate these communications directly and indirectly by measurements of contrast enhancement within the heart wall. Our study emphasises the importance of the bronchial arteries in cases of heart-lung transplantation and repair of thoracic aortic aneurysms.

Objective: In the present study we haveapplied virtual endoscopy (VE) in patients withureteral metallic stents as a follow-up toolstudy especially in the need to define ureteralpatency.Methods: We performed the suggestedtechnique in 6 patients with malignant ureteralobstruction treated successfully by placementof Wallstent intraureteral metallic stents, andcorrelated the results with antegradenephrostomography 48 hours after initial stentplacement.Results: In 2 patients restenosis wasobserved, and in the remaining 4 patients thestented ureters remained patent during thefollow up evaluation. VE and antegradenephrostomography, were concurrent as to theirfindings. Moreover, VE proceeds beyond thestenotic segment, allowing visualization of theureteral lumen both cephalad and caudal to thepoint of obstruction.Conclusion: VE is providing indeed a moreaccurate, direct and dynamic approach in theevaluation of a strictured ureteral lumenwithin the metallic stent.

Image-directed colour Doppler sonography has been successfully introduced for the detection of hepatic haemodynamic changes in the presence of liver metastases. The aim of our study was to correlate these haemodynamic changes with the liver histology at the time of measurement. We experimentally induced liver metastases in 30 male Wistar rats by inoculating Walker 256 tumour subcutaneously. The animals were assigned into three groups of ten and were studied sonographically at 4, 7 and 15 days after tumour implantation. Another group of ten normal animals were used as controls. Portal vein and hepatic artery measurements included resistance index (PVRI, HARI) and flow volume (PVFV, HAFV). Doppler perfusion index (DPI) of the liver was calculated as the ratio of HAFV/PVFV + HAFV. Liver histology followed each Doppler measurement. Metastases were first encountered on day 4, as small groups of cells in the connective tissue of the porta hepatis and the portal triads without apparent vascular association. Distinct elevation of HAFV and DPI was recorded in comparison with the controls (p = 0.0004 and p = 0.0005, respectively). PVFV reduction was subtle. Up to day 15 there were no significant changes in the measurements. Our data suggest that HAFV and DPI can efficiently detect early liver metastases and this is in accordance with existing clinical reports. Haemodynamic changes seem to originate from the early non-vascular phase of the metastases.

Delineation of lung fields in presence of diffuse lung diseases (DLPDs), such as interstitial pneumonias (IP), challenges segmentation algorithms. To deal with IP patterns affecting the lung border an automated image texture classification scheme is proposed. The proposed segmentation scheme is based on supervised texture classification between lung tissue (normal and abnormal) and surrounding tissue (pleura and thoracic wall) in the lung border region. This region is coarsely defined around an initial estimate of lung border, provided by means of Markov Radom Field modeling and morphological operations. Subsequently, a support vector machine classifier was trained to distinguish between the above two classes of tissue, using textural feature of gray scale and wavelet domains. 17 patients diagnosed with IP, secondary to connective tissue diseases were examined. Segmentation performance in terms of overlap was 0.924±0.021, and for shape differentiation mean, rms and maximum distance were 1.663±0.816, 2.334±1.574 and 8.0515±6.549 mm, respectively. An accurate, automated scheme is proposed for segmenting abnormal lung fields in HRC affected by IP