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Objective To explore the efficacy of a novel and simple manual bone cone drilling hematoma drainage for hypertensive intracerebral hemorrhage. Methods From January 2021 to December 2022, 103 patients with hypertensive intracerebral hemorrhage at The Affiliated Bozhou Hospital of Anhui Medical University were included. They were treated with traditional bone cone drilling hematoma drainage (traditional group, n = 51) and novel-type bone cone drilling hematoma drainage (novel-type group, n = 52). Based on pre- and post-surgery head CT results, the hematoma clearance rate and accuracy of catheter placement were calculated. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficits, and modified Rankin Scale (mRS) was used to evaluate the neurological functional prognosis. Results The hematoma clearance rate in the novel-type group [(45.54 ± 24.23)% vs. (35.08 ± 6.49)%; t = 3.008, P = 0.004] and the accuracy of catheter placement [90.38% (47/52) vs. 68.63% (35/51); χ2 = 7.509, P = 0.006] were significantly higher than those of the traditional group. The novel-type group and the traditional group showed statistically significant differences in hematoma volume (F = 9.157, P = 0.003) and mRS score (F = 4.412, P = 0.038). The postoperative hematoma volume (t = - 4.625, P = 0.000) and mRS score (t = - 2.712, P = 0.008) of the novel-type group were lower than those of the traditional group. Statistically significant differences were observed in hematoma volume (F = 280.635, P = 0.000), NIHSS score (F = 443.320, P = 0.000) and mRS score (F = 552.781, P = 0.000) before and after surgery in the 2 groups; the hematoma volume (t = 10.233, P = 0.000; t = 19.906, P = 0.000), NIHSS score (t = 14.576, P = 0.000; t = 15.286, P = 0.000) and mRS score (t = 20.201, P = 0.000; t = 13.511, P = 0.000) after operation were lower than those before operation in the 2 groups. Conclusions The novel and simple manual bone cone drilling hematoma drainage is a safe and effective treatment for hypertensive intracerebral hemorrhage.

Objective To investigate the relationship between the CT parameters of degree of brain tissue displacement and intracranial pressure (ICP) in patients with closed traumatic brain injury (TBI). Methods A total of 84 patients with closed TBI were chosen from January 2018 to March 2021 in The People's Hospital of Kaizhou District. Head CT examination was performed and CT values on both sides of the midline, the ratio of CT values on both sides of the midline and the midline shift distance were measured. Pearson and partial correlation analyses were used to investigate the correlation between head CT parameters and ICP in patients with closed TBI. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of CT parameters in increased ICP. Results Correlation analysis showed that the ratio of CT values on both sides of the midline (r = 0.478, P = 0.000) and midline shift distance (r = 0.378, P = 0.000) were positively correlated with ICP. ROC curve showed that the ratio of CT values on both sides of the midline, the midline shift distance and the combined index prediction of ICP were 0.79 (95%CI: 0.687-0.889, P = 0.000), 0.89 (95%CI: 0.794-0.943, P = 0.000) and 0.91 (95%CI: 0.845-0.970, P = 0.000), the sensitivity and specificity were 80.95% and 73.81%, 69.05% and 90.48%, 80.95% and 85.71%, and the prediction efficiency of the combined index was better than the ratio of CT values on both sides of the midline (t = - 2.964, P = 0.003). Conclusions The CT parameters of brain tissue displacement degree in patients with unilateral closed TBI are closely related to the ICP, and the combination of the ratio of CT values on both sides of the midline and midline shift distance can predict ICP increase more effectively.

Purpose: Traditional CT acquisition planning is based on scout projection images from planar anterior-posterior and lateral projections where the radiographer estimates organ locations. Alternatively, a new scout method utilizing ultra-low dose helical CT (3D Landmark Scan) offers cross-sectional imaging to identify anatomic structures in conjunction with artificial intelligence based Anatomic Landmark Detection (ALD) for automatic CT acquisition planning. The purpose of this study is to quantify changes in scan length and radiation dose of CT examinations planned using 3D Landmark Scan and ALD and performed on next generation wide volume CT versus examinations planned using traditional scout methods. We additionally aim to quantify changes in radiation dose reduction of scans planned with 3D Landmark Scan and performed on next generation wide volume CT. Methods: Single-center retrospective analysis of consecutive patients with prior CT scan of the same organ who underwent clinical CT using 3D Landmark Scan and automatic scan planning. Acquisition length and dose-length-product (DLP) were collected. Data was analyzed by paired t-tests. Results: 104 total CT examinations (48.1 % chest, 15.4 % abdomen, 36.5 % chest/abdomen/pelvis) on 61 individual consecutive patients at a single center were retrospectively analyzed. 79.8 % of scans using 3D Landmark Scan had reduction in acquisition length compared to the respective prior acquisition. Median acquisition length using 3D Landmark Scan was 26.7 mm shorter than that using traditional scout methods (p < 0.001) with a 23.3 % median total radiation dose reduction (245.6 (IQR 150.0–400.8) mGy cm vs 320.3 (IQR 184.1–547.9) mGy cm). CT dose index similarly was overall decreased for scans planned with 3D Landmark and ALD and performed on next generation CT versus traditional methods (4.85 (IQR 3.8–7) mGy vs. 6.70 (IQR 4.43–9.18) mGy, respectively, p < 0.001). Conclusion: Scout imaging using reduced dose 3D Landmark Scan images and Anatomic Landmark Detection reduces acquisition range in chest, abdomen, and chest/abdomen/pelvis CT scans. This technology, in combination with next generation wide volume CT reduces total radiation dose.

Objectives: Post-mortem interval (PMI) estimation has long been relying on sequential post-mortem changes on the body as a function of extrinsic, intrinsic, and environmental factors. Such factors are difficult to account for in complicated death scenes; thus, PMI estimation can be compromised. Herein, we aimed to evaluate the use of post-mortem CT (PMCT) radiomics for the differentiation between early and late PMI. Methods: Consecutive whole-body PMCT examinations performed between 2016 and 2021 were retrospectively included (n = 120), excluding corpses without an accurately reported PMI (n = 23). Radiomics data were extracted from liver and pancreas tissue and randomly split into training and validation sets (70:30%). Following data preprocessing, significant features were selected (Boruta selection) and three XGBoost classifiers were built (liver, pancreas, combined) to differentiate between early (< 12 h) and late (> 12 h) PMI. Classifier performance was assessed with receiver operating characteristics (ROC) curves and areas under the curves (AUC), which were compared by bootstrapping. Results: A total of 97 PMCTs were included, representing individuals (23 females and 74 males) with a mean age of 47.1 ± 23.38 years. The combined model achieved the highest AUC reaching 75% (95%CI 58.4–91.6%) (p = 0.03 compared to liver and p = 0.18 compared to pancreas). The liver-based and pancreas-based XGBoost models achieved AUCs of 53.6% (95%CI 34.8–72.3%) and 64.3% (95%CI 46.7–81.9%) respectively (p > 0.05 for the comparison between liver- and pancreas-based models). Conclusion: The use of radiomics analysis on PMCT examinations differentiated early from late PMI, unveiling a novel image-based method with important repercussions in forensic casework. Clinical relevance statement: This paper introduces the employment of radiomics in forensic diagnosis by presenting an effective automated alternative method of estimating post-mortem interval from targeted tissues, thus paving the way for improvement in speed and quality of forensic investigations. Key Points: • A combined liver-pancreas radiomics model differentiated early from late post-mortem intervals (using a 12-h threshold) with an area under the curve of 75% (95%CI 58.4–91.6%). • XGBoost models based on liver-only or pancreas-only radiomics demonstrated inferior performance to the combined model in predicting the post-mortem interval. [ABSTRACT FROM AUTHOR]

Alveolar proteinosis is a rare clinical disease that is easily misdiagnosed due to lack of specific symptoms. There is still no unified protocol for standard treatment of this disease. In this paper, we reported the diagnosis and treatment of one case of atypical alveolar proteinosis. Then we systematically searched relevant studies in Chinese published between January 1989 and September 2021 in databases of CNKI, CQVIP, and Wanfang Data using alveolar proteinosis as the keywords, and did a review of 114 studies involving 866 cases after removing the duplicates and those with incomplete data. Our analysis of the clinical manifestations, diagnosis and treatment of these cases may contribute to enhancing clinicians' understanding of alveolar proteinosis to improve their ability to diagnose and manage the disease.

Background Low attenuation area ratio (LAA%) and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function, but there are few studies at home and abroad. Objective To analyze the correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD, and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction, in order to provide clinical basis for the early detection and diagnosis of COPD. Methods A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup (FEVl%pred≥80%, n=47) , GOLD Ⅱgroup (50%≤FEVl%pred

Objectives: Differentiating benign gallbladder diseases from gallbladder cancer (GBC) remains a radiological challenge because they can appear very similar on imaging. This study aimed at investigating whether CT-based radiomic features of suspicious gallbladder lesions analyzed by machine learning algorithms could adequately discriminate benign gallbladder disease from GBC. In addition, the added value of machine learning models to radiological visual CT-scan interpretation was assessed. Methods: Patients were retrospectively selected based on confirmed histopathological diagnosis and available contrast-enhanced portal venous phase CT-scan. The radiomic features were extracted from the entire gallbladder, then further analyzed by machine learning classifiers based on Lasso regression, Ridge regression, and XG Boosting. The results of the best-performing classifier were combined with radiological visual CT diagnosis and then compared with radiological visual CT assessment alone. Results: In total, 127 patients were included: 83 patients with benign gallbladder lesions and 44 patients with GBC. Among all machine learning classifiers, XG boosting achieved the best AUC of 0.81 (95% CI 0.72–0.91) and the highest accuracy rate of 73% (95% CI 65–80%). When combining radiological visual interpretation and predictions of the XG boosting classifier, the highest diagnostic performance was achieved with an AUC of 0.98 (95% CI 0.96–1.00), a sensitivity of 91% (95% CI 86–100%), a specificity of 93% (95% CI 90–100%), and an accuracy of 92% (95% CI 90–100%). Conclusions: Machine learning analysis of CT-based radiomic features shows promising results in discriminating benign from malignant gallbladder disease. Combining CT-based radiomic analysis and radiological visual interpretation provided the most optimal strategy for GBC and benign gallbladder disease differentiation. Key Points: Radiomic-based machine learning algorithms are able to differentiate benign gallbladder disease from gallbladder cancer. Combining machine learning algorithms with a radiological visual interpretation of gallbladder lesions at CT increases the specificity, compared to visual interpretation alone, from 73 to 93% and the accuracy from 85 to 92%. Combined use of machine learning algorithms and radiological visual assessment seems the most optimal strategy for GBC and benign gallbladder disease differentiation. [ABSTRACT FROM AUTHOR]

Objectives: To systematically investigate the usability of virtual non-contrast reconstructions (VNC) derived from dual-layer CT (DLCT) for detection and size measurements of kidney stones with regards to different degrees of surrounding iodine-induced attenuation and radiation dose. Methods: Ninety-two kidney stones of varying size (3–14 mm) and composition were placed in a phantom filled with different contrast media/water mixtures exhibiting specific iodine-induced attenuation (0–1500 HU). DLCT-scans were acquired using CTDIvol of 2 mGy and 10 mGy. Conventional images (CI) and VNC0H-1500HU were reconstructed. Reference stone size was determined using a digital caliper (Man-M). Visibility and stone size were assessed. Statistical analysis was performed using the McNemar test, Wilcoxon test, and the coefficient of determination. Results: All stones were visible on CI0HU and VNC200HU. Starting at VNC400 HU, the detection rate decreased with increasing HU and was significantly lower as compared to CI0HU on VNC≥ 600HU (100.0 vs. 94.0%, p < 0.05). The overall detection rate was higher using 10 mGy as compared to 2 mGy protocol (87.9 vs. 81.8%; p < 0.001). Stone size was significantly overestimated on all VNC compared to Man-M (7.0 ± 3.5 vs. 6.6 ± 2.8 mm, p < 0.001). Again, the 10 mGy protocol tended to show a better correlation with Man-M as compared to 2 mGy protocol (R2 = 0.39–0.68 vs. R2 = 0.31–0.57). Conclusions: Detection and size measurements of kidney stones surrounded by contrast media on VNC are feasible. The detection rate of kidney stones decreases with increasing iodine-induced attenuation and with decreasing radiation dose as well as stone size, while remaining comparable to CI0HU on VNC ≤ 400 HU. Key Points: • The detection rate of kidney stones on VNC depends on the surrounding iodine-induced attenuation, the used radiation dose, and the stone size. • The detection rate of kidney stones on VNC decreases with greater iodine-induced attenuation and with lower radiation dose, particularly in small stones. • The visibility of kidney stones on VNC≤ 400 HUremains comparable to true-non-contrast scans even when using a low-dose technique. [ABSTRACT FROM AUTHOR]

Objectives: Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. Methods: Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. Results: One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. Conclusions: Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. Key Points: • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. [ABSTRACT FROM AUTHOR]

Objectives: To establish an inflammation grading system for radioactive iodine-induced sialadenitis (RAIS) based on spiral computed tomography (CT), ultrasonography and sialography., Methods: In all, 120 RAIS patients (18 males and 102 females) were retrospectively included. Spiral CT, ultrasonography and sialography appearances were analysed and categorized as follows: grade I, approximately normal or mild sialadenitis; grade II, moderate sialadenitis; and grade III, severe sialadenitis. Adenitis severity was analysed relative to sex, age, RAI treatment sessions and cumulative doses., Results: Spiral CT showed heterogeneous (78.9%) and atrophic changes (36.8%) in the parotid glands (PGs) and duct ectasia (24.8%) in the submandibular glands (SMGs). Ultrasonography showed heterogeneous echogenicity (54.3%) and diminished gland size (30.2%) in PGs and duct ectasia in SMGs (34.7%). Sialography showed duct obliteration in 25.3% PGs and 3.2% SMGs. Statistical analysis showed good consistency among the three imaging grading results. The incidence and severity of PG lesions were significantly higher than that of SMGs (p < 0.001). As for PGs, adenitis severity was associated with both treatment sessions and cumulative doses; but in SMGs, disease severity was only related to treatment sessions., Conclusions: A grading system for severity of RAIS was established based on spiral CT, ultrasonography and sialography appearances., (© 2023 Wiley Periodicals LLC.)

Background: Microgenia and the accompanying plump cheeks or hamster-like facial contour are all unattractive appearances among the Asian. Genioplasty with autogenous bone grafting is one of the effective ways to improve microgenia, in which a suitable donor area with less additional damage, lower infection rate, and more excellent effect is crucial., Methods: Patients who had undergone genioplasty and autogenous external oblique line grafting (G-EOL) were followed up. The operation-related complications, preoperative, and long-term follow-up 3-dimensional spiral computed tomography (3D-CT) were collected and analyzed., Results: Eight female patients who had received G-EOL and received 1 to 3 years of follow-up were included in this study. There were no short-term or long-term complications. CT data of bone of 8 patients and CT data of soft tissue of 6 patients at the preoperative and long term were compared. Through comparing CT data, the width at the level of the intersection of EOL and mandibular body, and the protrusion of the bony chin had improved significantly; the P values were all <0.001. Through measuring the soft tissue and analyzing the data, the ratio of lower and middle facial width, and the distance from the lower lip to Ricketts' line were all improved, with the P values 0.042 and 0.001, respectively., Conclusions: For patients with microgenia and hamster-like facial contour, the combination of genioplasty and autogenous external oblique line grafting is innovative and effective in improving both the front and side contour of the lower face simultaneously, with excellent stability, bone healing, and low complication rates., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective Among the pediatric population with minor head trauma, it is difficult to determine an indication for the usage of brain computerized tomography (CT). Our study aims to compare the efficiency of the most commonly used clinical decision rules: the Pediatric Emergency Care Applied Research Network (PECARN) and Canadian Assessment of Tomography for Childhood Head Injury 2 (CATCH2). Methods This retrospective study investigated whether the PECARN and CATCH2 rules were applicable to Korean children with minor head trauma for reducing the use of brain CT imaging, while detecting intracranial pathology. Results Overall, 251 patients (0–5 years old) admitted to emergency rooms within 24 hours of injury were included between August 2015 to August 2018. The performance results are as follows: the PECARN and CATCH2 rules had a sensitivity of 80.00% (51.91%–95.67%) and 100% (78.20%–100.00%) with a specificity of 28.39% (22.73%–34.60%) and 15.25% (10.92%–20.49%), respectively; the negative predictive values were 98.58% and 100%, respectively. Overall, the CATCH2 rule was more successful than the PECARN rule in detecting intracranial pathology; however, there was no significant difference between them. Furthermore, the PECARN and CATCH2 rules lowered the rate of head CT imaging in our study group. Conclusion Both the rules significantly lowered the rate of indicated brain CT. However, since the CATCH2 rule had higher sensitivity and negative predictive value than the PECARN rule, it is more appropriate to be used in emergency rooms for detecting intracranial pathology in children with minor head trauma.

Objective To analyze the diagnostic efficacy of orthostatic X-ray radiography in lumbar spondylolisthesis. Methods Sixty patients with lumbar spondylolisthesis diagnosed by Xuanwu Hospital of Capital Medical University from January to October 2020 were included. The orthostatic X-ray and supine CT sagittal reconstruction imaging data were collected, and the Marique. Taillard method was used to measure the relative spondylolisthesis distance (dd') and the length of the upper edge of the inferior vertebral body (cd) on the X - ray and CT image post - processing workstation. Finally, the degree of spondylolisthesis and the detection rate of lumbar spondylolisthesis based on the subjective readings of doctors in different body positions were calculated. Results Compared with the supine CT sagittal reconstruction parameters, the dd' value (Z = 5.918, P = 0.000), cd value (Z = 4.082, P = 0.000) and spondylolisthesis (Z = 6.064, P = 0.000) were significantly improved. The positive rate of lumbar spondylolisthesis was 95% (57/60), which was higher than 81.67% (49/60, P = 0.039) of the supine CT sagittal reconstruction. Conclusions Orthostatic X-ray radiography can increase the lumbar vertebra stress of patients, which is beneficial to reflect the degree of spondylolisthesis of vertebra under daily stress conditions and improve the positive rate of lumbar spondylolisthesis. If combined with supine CT sagittal reconstruction, it can be used for clinical diagnosis and provide more detailed imaging data to assist in formulating targeted surgical treatment plans. [ABSTRACT FROM AUTHOR]

The National Health Systems have been severely stressed out by the COVID-19 pandemic because 14% of patients require hospitalization and oxygen support, and 5% require admission to an Intensive Care Unit (ICU). Relationship between COVID-19 prognosis and the extent of alterations on chest CT obtained by both visual and software-based quantification that expresses objective evaluations of the percentage of ventilated lung parenchyma compared to the affected one has been proven. While commercial applications for automatic medical image computing and visualization are expensive and limited in their spread, the open-source systems are characterized by not enough standardization and time-consuming troubles. We analyzed chest CT exams on 246 patients suspected of COVID-19 performed in the Emergency Department CT room. The lung parenchyma segmentation was obtained by a threshold-based method using the open-source 3D Slicer software and software tools called "Segment Editor" and "Segment Quantification." For the three main characteristics analyzed on lungs affected by COVID-19 pneumonia, a specifical densitometry value range was defined: from − 950 to − 700 HU for well-aerated parenchyma; from − 700 to − 250 HU for interstitial lung disease; from − 250 to 250 HU for parenchymal consolidation. For the well-aerated parenchyma and the interstitial alterations, the procedure was semi-automatic with low time consumption, whereas consolidations' analysis needed manual interventions by the operator. After the chest CT, 13% of the sample was admitted to intensive care, while 34% of them to the sub-intensive care. In patients moved to intensive care, the parenchyma analysis reported a higher crazy paving presentation. The quantitative analysis of the alterations affecting the lung parenchyma of patients with COVID-19 pneumonia can be performed by threshold method segmentation on 3D Slicer. The segmentation could have an important role in the quantification in different COVID-19 pneumonia presentations, allowing to help the clinician in the correct management of patients. [ABSTRACT FROM AUTHOR]

Background Latent tuberculosis (TB) infection among TB contacts is diagnosed using plain chest radiography and interferon-gamma release assays (IGRAs). However, plain chest radiographs often miss active TB, and the results of IGRA could fluctuate over time. The purpose of this study was to elucidate changes in the results of the serial IGRAs and in the findings of the serial submillisievert chest computed tomography (CT) scans among the close contacts of active pulmonary TB patients. Methods Patients age 20 or older with active pulmonary TB and their close contacts were invited to participate in this study. Two types of IGRA (QuantiFERON-TB Gold In-Tube assay [QFT-GIT] and the T-SPOT.TB test [T-SPOT]) and submillisievert chest CT scanning were performed at baseline and at 3 and 12 months after enrollment. Results In total, 19 close contacts participated in this study. One was diagnosed with active pulmonary TB and was excluded from further analysis. At baseline, four of 18 contacts (22.2%) showed positive results for QFT-GIT and T-SPOT; there were no discordant results. During the follow-up, transient and permanent positive or negative conversions and discordant results between the two types of IGRAs were observed in some patients. Among the 17 contacts who underwent submillisievert chest CT scanning, calcified nodules were identified in seven (41.2%), noncalcified nodules in 14 (82.4%), and bronchiectasis in four (23.5%). Some nodules disappeared over time. Conclusion The results of the QFT-GIT and T-SPOT assays and the CT images may change during 1 year of observation of close contacts of the active TB patients.

Objective To discuss the application value of CT scanning technology in cause of death determination of medical dispute cases. Methods From July 2017 to December 2018, postmortem CT imaging data of 12 medical dispute cases were collected. CT imaging diagnosis results and anatomy findings as well as differences between antemortem and postmortem CT diagnosis were compared. The advantages and disadvantages of CT routine tests of the cadavers in terms of the diagnosis of disease and damage were analyzed. Results The comparison between CT imaging diagnosis and anatomical findings showed that CT scans had advantages in the diagnosis of disease and damage with large differences in density changes, such as atelectasis, pneumonia, calcification, fracture and hemorrhage, etc. The comparison of CT diagnosis in antemortem and postmortem examination showed that the cadavers of medical dispute cases were well preserved and that postmortem CT scan was meaningful for the diagnosis of antemortem diseases. Conclusion Virtual anatomy technology has a relatively high application value in postmortem examination of medical dispute cases. It can provide effective information for the appraisers before the autopsy and can also provide a reference for cause of death analysis when the anatomy cannot be performed.

Objectives: to understand the morphological characteristics of iliac crest and provide advice and assistance for jaw bone reconstruction with iliac bone flap by evaluating the thickness and curvature of iliac crest., Materials and Methods: 100 patients who had taken Spiral CT of the Abdominal region before surgeries between 2020 and 2022 were included in this study. 3D reconstruction images of the iliac bones were created. 5 vertical planes perpendicular to the iliac crest were made every 2 cm along the centerline of the iliac crest (VP2 ~ VP10). On these vertical planes, 4 perpendicular lines were made every 1 cm along the long axis of the iliac crest (D1 ~ D4). The thicknesses at these sites, horizontal angle (HA) of iliac crest and the distance between inflection point and the central point of anterior superior iliac spine (DIA) were measured., Results: The thickness of iliac bone decreased significantly from D1 ~ D4 on VP6 ~ VP10 and from VP2 ~ VP10 on D3 and D4 level (P<0.05). HA of iliac crests was 149.13 ± 6.92°, and DIA was 7.36 ± 1.01 cm. Iliac bone thickness, HA and DIA had very weak or weak correlation with patient's age, height and weight., Conclusions: The average thicknesses of iliac crest were decreased approximately from front to back, from top to bottom. The thickness and curvature of the iliac crest were difficult to predict by age, height and weight., Clinical Relevance: Virtual surgical planning is recommended before jaw bone reconstruction surgery with iliac bone flap, and iliac crest process towards alveolar process might be a better choice., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Traditional CT acquisition planning is based on scout projection images from planar anterior-posterior and lateral projections where the radiographer estimates organ locations. Alternatively, a new scout method utilizing ultra-low dose helical CT (3D Landmark Scan) offers cross-sectional imaging to identify anatomic structures in conjunction with artificial intelligence based Anatomic Landmark Detection (ALD) for automatic CT acquisition planning. The purpose of this study is to quantify changes in scan length and radiation dose of CT examinations planned using 3D Landmark Scan and ALD and performed on next generation wide volume CT versus examinations planned using traditional scout methods. We additionally aim to quantify changes in radiation dose reduction of scans planned with 3D Landmark Scan and performed on next generation wide volume CT., Methods: Single-center retrospective analysis of consecutive patients with prior CT scan of the same organ who underwent clinical CT using 3D Landmark Scan and automatic scan planning. Acquisition length and dose-length-product (DLP) were collected. Data was analyzed by paired t-tests., Results: 104 total CT examinations (48.1 % chest, 15.4 % abdomen, 36.5 % chest/abdomen/pelvis) on 61 individual consecutive patients at a single center were retrospectively analyzed. 79.8 % of scans using 3D Landmark Scan had reduction in acquisition length compared to the respective prior acquisition. Median acquisition length using 3D Landmark Scan was 26.7 mm shorter than that using traditional scout methods (p < 0.001) with a 23.3 % median total radiation dose reduction (245.6 (IQR 150.0-400.8) mGy cm vs 320.3 (IQR 184.1-547.9) mGy cm). CT dose index similarly was overall decreased for scans planned with 3D Landmark and ALD and performed on next generation CT versus traditional methods (4.85 (IQR 3.8-7) mGy vs. 6.70 (IQR 4.43-9.18) mGy, respectively, p < 0.001)., Conclusion: Scout imaging using reduced dose 3D Landmark Scan images and Anatomic Landmark Detection reduces acquisition range in chest, abdomen, and chest/abdomen/pelvis CT scans. This technology, in combination with next generation wide volume CT reduces total radiation dose., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: John Schuzer and Chloe Steveson are employees of Canon Medical, but did not participate in data collection or analysis. James Matthews, Joseph Henry-Ellis, and Marco Razeto are employees of Canon Medical Research, but did not participate in data collection or analysis. No other authors declare conflicts of interest., (© 2024 Published by Elsevier Ltd.)

Objectives: The wide-volume mode, available on wide-area detector row CTs, has the advantage of reducing exposure time and radiation dose. It is infrequently used for lung diseases. The purpose of this study is to compare image quality and radiation dose of wide-volume chest CT to those of standard helical CT in the setting of interstitial lung diseases. Methods: Retrospective monocentric study including 50 consecutive patients referred for follow-up or screening of interstitial lung diseases, requiring prone scan, acquired with the wide-volume mode, in addition to the routine supine scan, acquired with the helical mode. The optimal collimation in wide-volume mode (320 × 0.5mm or 240 × 0.5mm) was chosen according to the length of the thorax. Wide-volume acquisitions were compared to helical acquisitions for radiation dose (CTDIvol, DLP) and image quality, including analysis of normal structures, lesions, overall image quality, and artifacts (Wilcoxon signed-rank test). Results: Median CTDIvol and DLP with wide volumes (3.1 mGy and 94.6 mGy·cm) were significantly reduced (p < 0.0001) as compared to helical mode (3.7mGy and 122.1 mGy·cm), leading to a median 21% and 32% relative reduction of CTDIvol and DLP, respectively. Image noise and quality were not significantly different between the two modes. Misalignment artifact at the junction of two volumes was occasionally seen in the wide-volume scans and, when present, did not impair the diagnostic quality in the majority of cases. Conclusions: Wide-volume mode allows 32% radiation dose reduction compared to the standard helical mode and could be used routinely for diagnosis and follow-up of interstitial lung diseases. Key Points: • Retrospective monocentric study showed that wide-volume scan mode reduces radiation dose by 32% in comparison to helical mode for chest CT in the setting of interstitial lung diseases. • Mild misalignment may be observed at the junction between volumes with the wide-volume mode, without decrease of image quality in the majority of cases and without impairing diagnostic quality. • Wide-volume mode could be used routinely for the diagnosis and follow-up of interstitial lung diseases. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the proportion of fat within the skeletal muscle as a measure of muscle quality using dual-energy CT (DECT) and to validate this methodology with MRI. Methods: Twenty-one patients with abdominal contrast-enhanced DECT scans (100 kV/Sn 150 kV) underwent abdominal 3-T MRI. The fat fraction (DECT-FF), determined by material decomposition, and HU values on virtual non-contrast-enhanced (VNC) DECT images were measured in 126 regions of interest (≥ 6 cm2) within the posterior paraspinal muscle. For validation, the MR-based fat fraction (MR-FF) was assessed by chemical shift relaxometry. Patients were categorized into groups of high or low skeletal muscle mean radiation attenuation (SMRA) and classified as either sarcopenic or non-sarcopenic, according to the skeletal muscle index (SMI) and cut-off values from non-contrast-enhanced single-energy CT. Spearman's and intraclass correlation, Bland-Altman analysis, and mixed linear models were employed. Results: The correlation was excellent between DECT-FF and MR-FF (r = 0.91), DECT VNC HU and MR-FF (r = - 0.90), and DECT-FF and DECT VNC HU (r = − 0.98). Intraclass correlation between DECT-FF and MR-FF was good (r = 0.83 [95% CI 0.71–0.90]), with a mean difference of - 0.15% (SD 3.32 [95% CI 6.35 to − 6.66]). Categorization using the SMRA yielded an eightfold difference in DECT VNC HU values between both groups (5 HU [95% CI 23–11], 42 HU [95% CI 33–56], p = 0.05). No significant relationship between DECT-FF and SMI-based classifications was observed. Conclusions: Fat quantification within the skeletal muscle using DECT is both feasible and reliable. DECT muscle analysis offers a new approach to determine muscle quality, which is important for the diagnosis and therapeutic monitoring of sarcopenia, as a comorbidity associated with poor clinical outcome. Key Points: • Dual-energy CT (DECT) material decomposition and virtual non-contrast-enhanced DECT HU values assess muscle fat reliably. • Virtual non-contrast-enhanced dual-energy CT HU values allow to differentiate between high and low native skeletal muscle mean radiation attenuation in contrast-enhanced DECT scans. • Measuring muscle fat by dual-energy computed tomography is a new approach for the determination of muscle quality, an important parameter for the diagnostic confirmation of sarcopenia as a comorbidity associated with poor clinical outcome. [ABSTRACT FROM AUTHOR]

Objectives: To assess the diagnostic accuracy of physical examination findings used to identify patients at risk for midfacial or mandibular fractures.Materials and Methods: A five-year retrospective cohort was constructed from all emergency department patients with a midfacial or mandibular trauma. The sensitivity, specificity, pre-test probability, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio data was calculated for 19 and 14 physical examination findings for midfacial and mandibular fractures respectively. Computed Tomography and panoramic radiography were used as index tests.Results: A total of 1484 patients were identified among whom 40.4% midfacial and 33.4% mandibular fractures were diagnosed. Overall, specificity was found to be higher than sensitivity. Regarding midfacial fractures, high specificity was found for raccoon eyes, malar eminence flattening and all the findings that are related to palpation, the nasal, ocular and intra-oral assessment. Malar eminence flattening, external nasal deformity, nasal septum hematoma, change of globe position and palpable step-off had ad high positive predictive value and positive likelihood ratio. Regarding mandibular fractures high specificity was found for mouth opening restriction, auditory canal bleeding, intra-oral assessment related findings, palpable step-off, inferior alveolar nerve paresthesia, the angular compression test and chin axial pressure test.Conclusions: The diagnostic accuracy of relevant physical examination findings were identified for the prediction of midfacial and mandibular fractures. [ABSTRACT FROM AUTHOR]

Objectives: To reduce the dose of intravenous iodine-based contrast media (ICM) in CT through virtual contrast-enhanced images using generative adversarial networks. Methods: Dual-energy CTs in the arterial phase of 85 patients were randomly split into an 80/20 train/test collective. Four different generative adversarial networks (GANs) based on image pairs, which comprised one image with virtually reduced ICM and the original full ICM CT slice, were trained, testing two input formats (2D and 2.5D) and two reduced ICM dose levels (−50% and −80%). The amount of intravenous ICM was reduced by creating virtual non-contrast series using dual-energy and adding the corresponding percentage of the iodine map. The evaluation was based on different scores (L1 loss, SSIM, PSNR, FID), which evaluate the image quality and similarity. Additionally, a visual Turing test (VTT) with three radiologists was used to assess the similarity and pathological consistency. Results: The −80% models reach an SSIM of > 98%, PSNR of > 48, L1 of between 7.5 and 8, and an FID of between 1.6 and 1.7. In comparison, the −50% models reach a SSIM of > 99%, PSNR of > 51, L1 of between 6.0 and 6.1, and an FID between 0.8 and 0.95. For the crucial question of pathological consistency, only the 50% ICM reduction networks achieved 100% consistency, which is required for clinical use. Conclusions: The required amount of ICM for CT can be reduced by 50% while maintaining image quality and diagnostic accuracy using GANs. Further phantom studies and animal experiments are required to confirm these initial results. Key Points: • The amount of contrast media required for CT can be reduced by 50% using generative adversarial networks. • Not only the image quality but especially the pathological consistency must be evaluated to assess safety. • A too pronounced contrast media reduction could influence the pathological consistency in our collective at 80%. [ABSTRACT FROM AUTHOR]

Objective To establish a new clinical T staging model for patients with gastric cancer (GC) and to evaluate its predictive effect, so as to provide the basis for improving the predictive value of clinical T staging. Methods A total of 227 GC patients underwent radical surgery in our hospital were enrolled in this study. Among them, 102 cases were pT1-pT2 gastric cancer, 125 cases were pT3-pT4 gastric cancer. All patients underwent endoscopic ultrasonography (EUS) and multislice spiral computed tomography (CT) examination before operation. Univariate analysis was used to compare the clinical and pathological data, including gender, age, tumor location, Borrmann classification, CT based T staging, the layers of tumor invading the gastric wall under EUS and the maximum short diameter of longitudinal section of tumor under EUS, between pT1-pT2 and pT3-pT4 patients. According to the clinical experience, CT-based T staging and the layers of tumor invading the gastric wall under EUS were included to establish the traditional conventional clinical T staging model (CCTSM). Multivariate Logistic regression analysis was used to further evaluate the risk factors of pT3-pT4 after univariate analysis, and the significant variables were included in the revised clinical T staging model (RCTSM). The receiver operating characteristic (ROC) curve was constructed to assess the performance of two prediction models. Results The corresponding Logistic regression equation was Logit (P)= -2.599+2.409× CT based T staging + 2.553× the layers of tumor invading the gastric wall under EUS. The results of univariate analysis and multivariate Logistic regression analysis showed that CT based T3-T4 staging (OR=12.528, 95%CI: 4.347-36.109), the 5th layer of tumor invading the gastric wall under EUS (OR=7.533, 95%CI: 2.539-22.353), the longer maximum of the short diameter of tumor longitudinal section under EUS (OR=31.084, 95%CI: 8.681-111.307) were independent risk factors of pT3-pT4 stage in the GC patients. The Logistic regression equation of the revised clinical T staging model was established with these three variables: Logit (P)= -7.884+2.528× CT based T staging + 2.019× the layers of tumor invading the gastric wall under EUS + 3.437×the maximum short diameter of longitudinal section of tumor under EUS. The clinical value of the RCTSM in predicting pT3~pT4 was better than that of the CCTSM (AUC: 0.952 vs. 0.891, Z=3.870, P＜0.01). In the lymph node positive subgroup, the predictive value of the RCTSM was also better than that of the CCTSM (AUC: 0.916 vs. 0.864, Z=2.058，P＜0.05). Conclusion The RCTSM can better predict the pathological T staging in patients with gastric cancer and provide reliable basis for individualized treatment of GC patients. [ABSTRACT FROM AUTHOR]

Objective: Proposing a scoring tool to predict COVID-19 patients' outcomes based on initially assessed clinical and CT features. Methods: All patients, who were referred to a tertiary-university hospital respiratory triage (March 27–April 26, 2020), were highly clinically suggestive for COVID-19 and had undergone a chest CT scan were included. Those with positive rRT-PCR or highly clinically suspicious patients with typical chest CT scan pulmonary manifestations were considered confirmed COVID-19 for additional analyses. Patients, based on outcome, were categorized into outpatient, ordinary-ward admitted, intensive care unit (ICU) admitted, and deceased; their demographic, clinical, and chest CT scan parameters were compared. The pulmonary chest CT scan features were scaled with a novel semi-quantitative scoring system to assess pulmonary involvement (PI). Results: Chest CT scans of 739 patients (mean age = 49.2 ± 17.2 years old, 56.7% male) were reviewed; 491 (66.4%), 176 (23.8%), and 72 (9.7%) cases were managed outpatient, in an ordinary ward, and ICU, respectively. A total of 439 (59.6%) patients were confirmed COVID-19 cases; their most prevalent chest CT scan features were ground-glass opacity (GGO) (93.3%), pleural-based peripheral distribution (60.3%), and multi-lobar (79.7%), bilateral (76.6%), and lower lobes (RLL and/or LLL) (89.1%) involvement. Patients with lower SpO2, advanced age, RR, total PI score or PI density score, and diffuse distribution or involvement of multi-lobar, bilateral, or lower lobes were more likely to be ICU admitted/expired. After adjusting for confounders, predictive models found cutoffs of age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 (15) for ICU admission (death). A combination of all three factors showed 89.1% and 95% specificity and 81.9% and 91.4% accuracy for ICU admission and death outcomes, respectively. Solely evaluated high PI score had high sensitivity, specificity, and NPV in predicting the outcome as well. Conclusion: We strongly recommend patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score to be considered as high-risk patients for further managements and care plans. Key Points: • Chest CT scan is a valuable tool in prioritizing the patients in hospital triage. • A more accurate and novel 35-scale semi-quantitative scoring system was designed to predict the COVID-19 patients' outcome. • Patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score should be considered high-risk patients. [ABSTRACT FROM AUTHOR]

Ultrasound, chest X-ray, and computed tomography (CT) have been used with excellent results in diagnosis, first assessment, and follow-up of COVID-19 confirmed and suspected patients. Ultrasound and chest X-ray have the advantages of the wide availability and acquisition at the patient's bed; CT showed high sensitivity in COVID-19 diagnosis. Ground-glass opacities and consolidation are the main CT and X-ray features; the distribution of lung abnormalities is typically bilateral and peripheral. Less typical findings, including pleural effusion, mediastinal lymphadenopathies, the bubble air sign, and cavitation, can also be visible on chest CT. Radiologists should be aware of the advantages and limitations of the available imaging techniques and of the different pulmonary aspects of COVID-19 infection. [ABSTRACT FROM AUTHOR]

Abstract Background Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. Methods Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analysis. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed. Results Four RCTs were included. More will provide data in the future. Meta-analysis demonstrated that LDCT screening with up to 9.80 years of follow-up was associated with a statistically non-significant decrease in lung cancer mortality (pooled relative risk (RR) 0.94, 95% confidence interval (CI) 0.74 to 1.19; p = 0.62). There was a statistically non-significant increase in all-cause mortality. Given the considerable heterogeneity for both outcomes, the results should be treated with caution. Network meta-analysis including the four original RCTs plus two further RCTs assessed the relative effectiveness of LDCT, CXR and usual care. The results showed that in terms of lung cancer mortality reduction LDCT was ranked as the best screening strategy, CXR screening as the worst strategy and usual care intermediate. Conclusions LDCT screening may be effective in reducing lung cancer mortality but there is considerable uncertainty: the largest of the RCTs compared LDCT with CXR screening rather than no screening; there is imprecision of the estimates; and there is important heterogeneity between the included study results. The uncertainty about the effect on all-cause mortality is even greater. Maturing trials may resolve the uncertainty.

Introduction: Diaphragmatic injuries are a common finding in patients with penetrating thoracoabdominal trauma. Their diagnosis requires exploration through open or laparoscopic surgery. However, multislice computed tomography (MSCT) emerges as a useful noninvasive tool for this purpose. Objective: To determine the diagnostic performance of MSCT for detecting diaphragmatic injuries in hemodynamically stable patients with penetrating thoracoabdominal trauma. Materials and methods: Prospective study conducted on 119 patients treated at the Hospital Universitario del Valle, Cali, Colombia, between March 2012 and June 2015. In order to evaluate the diagnostic performance of MSCT, the results obtained through this test were compared with those reported in the reference test (open surgery). Two readings of the imaging studies were performed by 2 radiologists. Intra- and interobserver agreement on the MSCT readings were analyzed using the Fleiss’ Kappa coefficient. Results: MSCT had sensitivity and specificity of 94.4% and 46.8%, respectively. Its positive (PPV) and negative (NPV) predictive values were 44.7% and 94.8%, respectively. The positive likelihood ratio (LR+) was 1.7765, and the negative likelihood ratio (LR-) was 0.1186. Regarding interobserver agreement, Fleiss’ Kappa coefficient between the first reading of both radiologists was 0.4425. Conclusions: MSCT specificity for diagnosing diaphragmatic injuries found in this study differs considerably from that reported in the literature. Considering the sensitivity, PPV and LR- values obtained in the present study, MSCT could be an important tool for the management of these patients since conservative treatment may be used in patients whose diaphragmatic injuries are not detected with this type of scan.

Objective: To compare the classification based on contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) with that of contrast-enhanced CT and MRI (CECT/MRI) LI-RADS for liver nodules in patients at high risk of hepatocellular carcinoma.Methods: Two hundred thirty-nine patients with 273 nodules were enrolled in this retrospective study. Each nodule was categorized according to the CEUS LI-RADS version 2017 and CECT/MRI LI-RADS version 2017. The diagnostic performance of CEUS and CECT/MRI was compared. The reference standard was histopathology diagnosis. Inter-modality agreement was assessed with Cohen's kappa.Results: The inter-modality agreement for CEUS LI-RADS and CECT/MRI LI-RADS was fair with a kappa value of 0.319 (p < 0.001). The positive predictive values (PPVs) of hepatocellular carcinoma (HCC) in LR-5, LR-4, and LR-3 were 98.3%, 60.0%, and 25.0% in CEUS, and 95.9%, 65.7%, and 48.1% in CECT/MRI, respectively. The sensitivities and specificities of LR-5 for diagnosing HCC were 75.6% and 93.8% in CEUS, and 83.6% and 83.3% in CECT/MRI, respectively. The positive predictive values of non-HCC malignancy in CEUS LR-M and CECT/MRI LR-M were 33.9% and 93.3%, respectively. The sensitivity, specificity, and accuracy for diagnosing non-HCC malignancy were 90.9%, 84.5%, and 85.0% in CEUS LR-M and 63.6%, 99.6%, and 96.7% in CECT/MRI LR-M, respectively.Conclusions: The inter-modality agreement of the LI-RADS category between CEUS and CECT/MRI is fair. The positive predictive values of HCCs in LR-5 of the CEUS and CECT/MRI LI-RADS are comparable. CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M.Key Points: • The inter-modality agreement for the final LI-RADS category between CEUS and CECT/MRI is fair. • The LR-5 of CEUS and CECT/MRI LI-RADS corresponds to comparable positive predictive values (PPVs) of HCC. For LR-3 and LR-4 nodules categorized by CECT/MRI, CEUS examination should be performed, at least if they can be detected on plain ultrasound. • CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M. For LR-M nodules categorized by CEUS, re-evaluation by CECT/MRI is necessary. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of whole-body MRI (WB-MRI) including contrast-enhanced T1-weighted imaging (T1WI) and WB-DWI in rectal cancer initial staging. Methods: This retrospective study was approved by the IRB and the requirement of informed consent was waived. From September 2013 to Feb 2015, patients who underwent rectal MRI including WB-MRI, as well as chest and abdominopelvic CT for initial staging, were included. WB-MRI consisted of contrast-enhanced T1-weighted imaging and DWI covering neck to the pelvis. Three radiologists reviewed WB-MRI and CECT independently for the M-classification. The diagnostic performance of CECT and WB-MRI was compared using a reference standard incorporating histology, FDG-PET results, and clinical follow-up. Results: A total of 139 patients (male:female = 89:50, mean age 63.2 ± 12.4 years) were included and metastasis was observed in 15.2% (21/139). WB-MRI showed significantly higher specificity (96.7% [114/118] vs. 85.6% [101/118], p = 0.001) and positive predictive value (PPV) (80% [16/20] vs. 48.5% [16/33], p < 0.001) than CECT. However, there were no significant differences in sensitivity (76.2% [16/21] for both, p > 0.99) and negative predictive value (95.3% [101/106] at CECT vs. 95.8% [114/119] at WB-MRI, p = 0.77) between CECT and WB-MRI. Conclusions: WB-MRI showed higher specificity and PPV than CECT in newly diagnosed rectal cancer. Adding WB-MRI to standard rectal MRI is a feasible option for initial staging workup of rectal cancer. Key Points: • WB-MRI showed a higher specificity and PPV than those of CECT for identifying metastasis at initial staging workup of rectal cancer. • WB-MRI and CECT did not show a significant difference in sensitivity and NPV for the M-classification. • WB-MRI can be used as an alternative to CECT for the initial M-classification modality in newly diagnosed rectal cancer. [ABSTRACT FROM AUTHOR]

Objective: To assess the accuracy of a 3D camera for body contour detection in pediatric patient positioning in CT compared with routine manual positioning by radiographers.Methods and Materials: One hundred and ninety-one patients, with and without fixation aid, which underwent CT of the head, thorax, and/or abdomen on a scanner with manual table height selection and with table height suggestion by a 3D camera were retrospectively included. The ideal table height was defined as the position at which the scanner isocenter coincides with the patient's isocenter. Table heights suggested by the camera and selected by the radiographer were compared with the ideal height.Results: For pediatric patients without fixation aid like a baby cradle or vacuum cushion and positioned by radiographers, the median (interquartile range) absolute table height deviation in mm was 10.2 (16.8) for abdomen, 16.4 (16.6) for head, 4.1 (5.1) for thorax-abdomen, and 9.7 (9.7) for thorax CT scans. The deviation was less for the 3D camera: 3.1 (4.7) for abdomen, 3.9 (6.3) for head, 2.2 (4.3) for thorax-abdomen, and 4.8 (6.7) for thorax CT scans (p < 0.05 for all body parts combined).Conclusion: A 3D camera for body contour detection allows for automated and more accurate pediatric patient positioning than manual positioning done by radiographers, resulting in overall significantly smaller deviations from the ideal table height. The 3D camera may be also useful in the positioning of patients with fixation aid; however, evaluation of possible improvements in positioning accuracy was limited by the small sample size.Key Points: • A 3D camera for body contour detection allows for automated and accurate pediatric patient positioning in CT. • A 3D camera outperformed radiographers in positioning pediatric patients without a fixation aid in CT. • Positioning of pediatric patients with fixation aid was feasible using the 3D camera, but no definite conclusions were drawn regarding the positioning accuracy due to the small sample size. [ABSTRACT FROM AUTHOR]

Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses. The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years). In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05). In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The National Lung Screening Trial (NLST) identified individuals at high risk for lung cancer and showed that serial low-dose helical computed tomography could identify lung cancer at an earlier stage, leading to mortality reduction. However, there is little evidence regarding the effectiveness of the NLST criteria for the Asian population., Methods: We performed a retrospective audit in our hospital from January 2018 to December 2018, with the aim to describe the characteristics of patients diagnosed with lung cancer and to identify patients who would miss out on lung cancer screening when the NLST criteria was applied., Results: We found that only 38.1% of our cohort who were diagnosed with lung cancer met the NLST criteria strictly by age and smoking status. Patients who met the screening criteria would have derived significant benefits from it, as 85.4% of our patients had presented at an advanced stage and 54.6% died within 1 year. When the United States Preventive Services Task Force criteria was applied, it increased the sensitivity of lung cancer diagnosis to 58.7%. Only 15.5% of the female patients with lung cancer met the NLST criteria; their low smoking quantity was a significant contributing factor for exclusion., Conclusion: The majority of Singapore patients diagnosed with lung cancer, especially females, would not have been identified with the NLST criteria. However, those who met the inclusion criteria would have benefited greatly from screening. Extending the screening age upper limit may yield benefits and improved sensitivity in the Singapore context., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Objective: To evaluate the relationships between the location and extent of diffusion of free intraperitoneal air by multi-slice spiral CT (MSCT) and between the location and size of acute gastrointestinal perforation. Methods: This was a descriptive case series. We examined abdominal CT images of 33 patients who were treated for intraoperatively confirmed gastrointestinal perforation (excluding appendiceal perforation) in the Department of General Surgery, Nanfang Hospital between January and September 2022. We identified five locations of intraperitoneal air: the subphrenic space, hepatic portal space, mid-abdominal wall, mesenteric space, and pelvic cavity. We allocated the 33 patients to an upper gastrointestinal perforation ( n =23) and lower gastrointestinal perforation group ( n =10) base on intraoperative findings and analyzed the relationships between the locations of free gas and of gastrointestinal perforation. Additionally, we established two models for analyzing the extent of diffusion of free gas in the abdominal cavity and constructed receiver operating characteristic (ROC) curves to analyze the relationships between the two models and the size of the gastrointestinal perforation. Results: In the upper gastrointestinal perforation group, free gas was located around the hepatic portal area in 91.3% (21/23) of patients: this is a significantly greater proportion than that found in the lower gastrointestinal perforation group (5/10) ( P =0.016). In contrast, free gas was located in the mesenteric interspace in 8/10 patients in the lower gastrointestinal perforation group; this is a significantly greater proportion than was found in the upper gastrointestinal perforation group (8.7%, 2/23) ( P <0.010). The sensitivity of diagnosis of upper gastrointestinal perforation base on the presence of hepatic portal free gas was 84.8% and the specificity 71.4%. Further, the sensitivity of diagnosis of lower gastrointestinal perforation base on the presence of mesenteric interspace free gas was 80.0% and the specificity 91.3%. The rates of presence of free gas in the subdiaphragmatic area, mid-abdominal wall, and pelvic cavity did not differ significantly between the two groups (all P >0.05). Receiver operating characteristic curves showed that when free gas was present in four or more of the studied locations in the abdominal cavity, the optimal cutoff for perforation diameter was 2 cm, the corresponding sensitivity 66.7%, and the specificity 100%, suggesting that abdominal free gas diffuses extensively when the diameter of the perforation is >2 cm. Another model revealed that when free gas is present in three or more of the studied locations, the optimal cutoff for perforation diameter is 1 cm, corresponding to a sensitivity of 91.7% and specificity of 76.2%; suggesting that free gas is relatively confined in the abdominal cavity when the diameter of the perforation is <1 cm. Conclusion: Identifying which of five locations in the abdominal cavity contains free intraperitoneal air by examining MSCT images can be used to assist in the diagnosis of the location and size of acute gastrointestinal perforations.

Solid-state detectors (SSDs) may be used along with a lead collimator for half-value layer (HVL) measurement using computed tomography (CT) with or without a tin filter. We aimed to compare HVL measurements obtained using three SSDs (AGMS-DM+ , X2 R/F sensor, and Black Piranha) with those obtained using the single-rotation technique with lead apertures (SRTLA). HVL measurements were performed using spiral CT at tube voltages of 70-140 kV without a tin filter and 100-140 kV (Sn 100-140 kV) with a tin filter in increments of 10 kV. For SRTLA, a 0.6-cc ionization chamber was suspended at the isocenter to measure the free-in-air kerma rate ( K ˙ air ) values. Five apertures were made on the gantry cover using lead sheets, and four aluminum plates were placed on these apertures. HVLs in SRTLA were obtained from K ˙ air decline curves. Subsequently, SSDs inserted into the lead collimator were placed on the gantry cover and used to measure HVLs. Maximum HVL differences of AGMS-DM+ , X2 R/F sensor, and Black Piranha with respect to SRTLA without/with a tin filter were - 0.09/0.6 (only two Sn 100-110 kV) mm, - 0.50/ - 0.6 mm, and - 0.17/(no data available) mm, respectively. These values were within the specification limit. SSDs inserted into the lead collimator could be used to measure HVL using spiral CT without a tin filter. HVLs could be measured with a tin filter using only the X2 R/F sensor, and further improvement of its calibration accuracy with respect to other SSDs is warranted., (© 2023. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Objective: Lombardy (Italy) was the epicentre of the COVID-19 pandemic in March 2020. The healthcare system suffered from a shortage of ICU beds and oxygenation support devices. In our Institution, most patients received chest CT at admission, only interpreted visually. Given the proven value of quantitative CT analysis (QCT) in the setting of ARDS, we tested QCT as an outcome predictor for COVID-19. Methods: We performed a single-centre retrospective study on COVID-19 patients hospitalised from January 25, 2020, to April 28, 2020, who received CT at admission prompted by respiratory symptoms such as dyspnea or desaturation. QCT was performed using a semi-automated method (3D Slicer). Lungs were divided by Hounsfield unit intervals. Compromised lung (%CL) volume was the sum of poorly and non-aerated volumes (− 500, 100 HU). We collected patient's clinical data including oxygenation support throughout hospitalisation. Results: Two hundred twenty-two patients (163 males, median age 66, IQR 54–6) were included; 75% received oxygenation support (20% intubation rate). Compromised lung volume was the most accurate outcome predictor (logistic regression, p < 0.001). %CL values in the 6–23% range increased risk of oxygenation support; values above 23% were at risk for intubation. %CL showed a negative correlation with PaO2/FiO2 ratio (p < 0.001) and was a risk factor for in-hospital mortality (p < 0.001). Conclusions: QCT provides new metrics of COVID-19. The compromised lung volume is accurate in predicting the need for oxygenation support and intubation and is a significant risk factor for in-hospital death. QCT may serve as a tool for the triaging process of COVID-19. Key Points: • Quantitative computer-aided analysis of chest CT (QCT) provides new metrics of COVID-19. • The compromised lung volume measured in the − 500, 100 HU interval predicts oxygenation support and intubation and is a risk factor for in-hospital death. • Compromised lung values in the 6–23% range prompt oxygenation therapy; values above 23% increase the need for intubation. [ABSTRACT FROM AUTHOR]

Background: imaging studies, mainly computed axial tomography, are used in the diagnosis of tumors in the retroperitoneum.Objective: to characterize the patients with a presumptive diagnosis of retroperitoneal tumor, treated at the “Dr. Ernesto Guevara de la Serna” General Teaching Hospital of Las Tunas, Cuba, from September 2016 to September 2018, with emphasis on the use of imaging studies.Methods: a descriptive, longitudinal, prospective study was carried out at the aforementioned institution and during the period herein declared. The sample consisted of 17 patients over 18 years of age, with a presumptive tomographic diagnosis of retroperitoneal tumor. The following variables were assessed: age, sex, signs and symptoms, ultrasound findings, tomographic characterization and tumor location.Results: there were no significant differences between both sexes. The 60 to 69 age group presented the highest incidence (41,2 %). The most frequent form of presentation was the asymptomatic one (52,9 %), as a casual finding in tomographic studies for the diagnosis of other diseases. In the patients who presented symptoms and signs, the most frequent ones were: visible and palpable mass, nonspecific abdominal pain and ascites. In 64,7 % of the cases no ultrasound signs suggesting retroperitoneal tumor were evidenced. According to the tomographic characteristics, in all there was retroperitoneal or subperitoneal tumor mass. In most of the patients the tumor was located in the retroperitoneal space (76,5 %).Conclusions: computed axial tomography permitted the identification of retroperitoneal tumors in the studied sample of patients.

Objective To estimate lung volume in normal population by a combination of multi-slice spiral CT and Pulmo software. Methods Scans of the lung were performed on 45 normal individuals using Emotion 16-slice spiral CT and Pulmo software. A measurement instrument of work station was used to measure the vertical diameter of left and right lungs, the maximum anteroposterior and transverse diameters at the layers of apex pulmonis 1 cm below, arcus aortae, subcarinal and diaphragmatic dome, and the lung volume. Regression analysis was performed on normal lung volume and each measured parameter by SPSS 20.0 and an optimal model was selected. Results The goodness of fit between the best curvilinear equations of the normal bilateral lung volumes was 0.981. The goodness of fit between the curvilinear equations of the normal bilateral lung volume and the product of the vertical diameter and the maximum transverse diameter of diaphragmatic dome were 0.977 and 0.972, respectively. Fifteen cases were selected to make a retrospective test on the 3 models. No significant difference was found between the estimated and measured with Pulmo software lung volumes. Conclusion The normal lung volume before injury can be estimated by the curvilinear equations established in this study. The percentage of lung compression can be measured based on the volume of compressed lung, which can provide a reference for the identification of lung compression degree.

Objective To establish a method for the age estimation of adult living donor based on pubic MSCT three-dimensional reconstruction and verify its accuracy and reliability. Methods The volume rendering （VR） image data of pubic symphysis surface were collected from 300 volunteers aged over 17 years old. According to different age groups, the age estimation of these volunteers was performed by the method and formula of pubic symphysis surface. Results In the 300 volunteers, the difference between biological age and actual age was 1-2 years in 178 cases, >2 years in 5 cases. Conclusion MSCT three-dimensional reconstruction technology of pubic symphysis surface can be used to estimate the age of adult living donor, which can provide a high accurate and reliable result.

Objective To explore the clinical application value of CT values in upper urinary tract calculi with pyelonephritis and pyonephrosis. Methods The retrospective analysis was performed on 157 patients with renal infection caused by upper urinary tract calculi admitted to the hospital from March 2015 to January 2020. According to the clinical manifestations and auxiliary examinations, the patients were divided into three groups: simple hydronephrosis group (n=73), acute pyelonephritis group (n=58) and pyonephrosis group (n=26). All patients underwent multi-slice spiral CT plain scanning, and the CT values of renal pelvis hydrops were measured, calculated and compared in the three groups. The receiver operating curve (ROC) was drawn to search the optimal critical CT value as the diagnostic basis for identifying pyelonephritis andpyonephritis. Results CT values of the simple hydronephrosis group, acute pyelonephritis group and pyonephrosis group increased in turn: (2.85±1.7) HU, (9.21±4.8) HU and (17.69±4.2) HU, respectively. There were significant differences between the three groups (F=175.127, P＜0.05). The area under ROC curves of CT values of renal pelvis hydrops in identifying pyelonephritis and pyonephrosis was 0.897, and the 95%CI was 0.812-0.953. When the CT value of renal pelvis hydrops was 12 HU, the Youden index was the largest (0.768), the sensitivity was 84.48% and the specificity was 92.31%. Conclusion CT values accurately reflect the disease progression of pelvis infection caused by upper urinary tract calculi, and which has early clinical diagnostic value in identifying pyelonephritis and pyonephrosis. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively analyze the chest computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia.Methods: From January 9, 2020, to February 26, 2020, totally 56 laboratory-confirmed patients with COVID-19 underwent chest CT. For 40 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and the affected lung lobes. Furthermore, the initial CT scan and the follow-up CT scans were compared.Results: Forty patients (83.6%) had two or more opacities in the lung. Eighteen (32.7%) patients had only ground-glass opacities; twenty-nine patients (52.7%) had ground-glass and consolidative opacities; and eight patients (14.5%) had only consolidation. A total of 43 patients (78.2%) showed two or more lobes involved. The opacities tended to be both in peripheral and central (30/55, 54.5%) or purely peripheral distribution (25/55, 45.5%). Fifty patients (90.9%) had the lower lobe involved. The first follow-up CT scans showed that twelve patients (30%) had improvement, 26 (65%) patients had mild-moderate progression, and two patients (5%) had severe progression with "white lungs." The second follow-up CT showed that 22 patients (71%) showed improvement compared with the first follow-up CT, four patients (12.9%) had aggravated progression, and five patients (16.1%) showed unchanged radiographic appearance.Conclusions: The common CT features of COVID-19 pneumonia are multiple lung opacities, multiple types of the opacity (ground-glass, ground-glass and consolidation, and consolidation alone), and multiple lobes especially the lower lobe involved. Follow-up CT could demonstrate the rapid progression of COVID-19 pneumonia (either in aggravation or absorption).Key Points: • The predominant CT features of COVID-19 pneumonia are multiple ground-glass opacities with or without consolidation and, with both lungs, multiple lobes and especially the lower lobe affected. • CT plays a crucial role in early diagnosis and assessment of COVID-19 pneumonia progression. • CT findings of COVID-19 pneumonia may not be consistent with the clinical symptoms or the initial RT-PCR test results. [ABSTRACT FROM AUTHOR]

Introduction. Chronic subdural hematoma has become an important entity in radiological, neurological and neurosurgery practice. Classification. The classification of chronic subdural hematoma is most often done in relation to the time of the disease onset (acute, subacute and chronic), whereas the second classification is based on hematoma density using computed tomography. Clinical presentation. The clinical presentation may mimic a spectrum of various diseases and chronic subdural hematoma can be easily overlooked without radiological verification. Diagnosis. The diagnosis of chronic subdural hematoma is partly clinical and partly radiological. In most cases, computed tomography is the initial diagnostic method for detection of this disease. Many studies point to different management strategies in the diagnosis and treatment of the disease. Therapy. The therapy of chronic subdural hematoma depends on the patient’s neurological deficit, but generally it is divided into conservative and surgical treatment. Conclusion. The aim of this paper is to review chronic subdural hematomas with reference to their clinical and radiological characteristics for better understanding of these phenomena. [ABSTRACT FROM AUTHOR]

A serious epidemic of COVID-19 broke out in Wuhan, Hubei Province, China, and spread to other Chinese cities and several countries now. As the majority of patients infected with COVID-19 had chest CT abnormality, chest CT has become an important tool for early diagnosis of COVID-19 and monitoring disease progression. There is growing evidence that children are also susceptible to COVID-19 and have atypical presentations compared with adults. This review is mainly about the differences in clinical symptom spectrum, diagnosis of COVID-19, and CT imaging findings between adults and children, while highlighting the value of radiology in prevention and control of COVID-19 in pediatric patients. KEY POINTS: • Compared with adults, pediatric patients with COVID-19 have the characteristics of lower incidence, slighter clinical symptoms, shorter course of disease, and fewer severe cases. • The chest CT characteristics of COVID-19 in pediatric patients were atypical, with more localized GGO extent, lower GGO attenuation, and relatively rare interlobular septal thickening. • Chest CT should be used with more caution in pediatric patients with COVID-19 to protect this vulnerable population from risking radiation. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have shown that split-bolus protocols in virtual non-contrast (VNC) reconstructions of dual-energy computed tomography (DE-CT) significantly decrease radiation dose in patients with urinary stone disease. To evaluate the impact on kidney stone detection rate of stone composition, size, tube voltage, and iodine concentration for VNC reconstructions of DE-CT. Methods: In this prospective study, 16 kidney stones of different sizes (1.2–4.5 mm) and compositions (struvite, cystine, whewellite, brushite) were placed within a kidney phantom. Seventy-two scans with nine different iodine contrast agents/saline solutions with increasing attenuation (0–1400 HU) and different kilovoltage settings (70 kV/150 kV; 80 kV/150 kV; 90 kV/150 kV; 100 kV/150 kV) were performed. Two experienced radiologists independently rated the images for the presence and absence of stones. Multivariate classification tree analysis and descriptive statistics were used to evaluate the diagnostic performance. Results: Classification tree analysis revealed a higher detection rate of renal calculi > 2 mm in size compared with that of renal calculi < 2 mm (84.7%; 12.7%; p < 0.001). For stones with a diameter > 2 mm, the best results were found at 70 kV/Sn 150 kV and 80 kV/Sn 150 kV in scans with contrast media attenuation of 600 HU or less, with sensitivity of 99.6% and 96.0%, respectively. A higher luminal attenuation (> 600 HU) resulted in a significantly decreased detection rate (91.8%, 0–600 HU; 70.7%, 900–1400 HU; p < 0.001). In our study setup, the detection rates were best for cystine stones. Conclusion: Scan protocols in DE-CT with lower tube current and lower contrast medium attenuation show excellent results in VNC for stones larger than 2 mm but have limitations for small stones. Key Points: • The detection rate of virtual non-contrast reconstructions is highly dependent on the surrounding contrast medium attenuation at the renal pelvis and should be kept as low as possible, as at an attenuation higher than 600 HU the VNC reconstructions are susceptible to masking ureteral stones. • Protocols with lower tube voltages (70 kV/Sn 150 kV and 80 kV/Sn 150 kV) improve the detection rate of kidney stones in VNC reconstructions. • The visibility of renal stones in virtual non-contrast of dual-energy CT is highly associated with the size, and results in a significantly lower detection rate in stones below 2 mm. [ABSTRACT FROM AUTHOR]

Introduction. Undifferentiated pleomorphic sarcoma, previously known as malignant fibrous histiocytoma, is the most common soft tissue sarcoma in adults, and retroperitoneum is the second most common location. Case Report. We present a case of a 60-year-old female patient with a painless mass in the left hemiabdomen. Computed tomography revealed a well defined retroperitoneal mass, while magnetic resonance showed a lobulated hypointense mass on T1-weighted and heterogeneous on T2-weighted images 180 x 230 x 250 mm in size, with intense peripheral enhancement. The patient underwent complete tumor excision, as well as reoperation after local recurrence. After histopathological and immunohistochemical analysis of the operating material, the diagnosis of malignant fibrous histiocytoma (giant cell type) was made. Conclusion. Radiological imaging has a limited diagnostic accuracy in undifferentiated pleomorphic sarcomas and definitive diagnosis relies on histopathological confirmation. [ABSTRACT FROM AUTHOR]

Objectives: Develop a CT-based radiomics model and combine it with frozen section (FS) and clinical data to distinguish invasive adenocarcinomas (IA) from preinvasive lesions/minimally invasive adenocarcinomas (PM).Methods: This multicenter study cohort of 623 lung adenocarcinomas was split into training (n = 331), testing (n = 143), and external validation dataset (n = 149). Random forest models were built using selected radiomics features, results from FS, lesion volume, clinical and semantic features, and combinations thereof. The area under the receiver operator characteristic curves (AUC) was used to evaluate model performances. The diagnosis accuracy, calibration, and decision curves of models were tested.Results: The radiomics-based model shows good predictive performance and diagnostic accuracy for distinguishing IA from PM, with AUCs of 0.89, 0.89, and 0.88, in the training, testing, and validation datasets, respectively, and with corresponding accuracies of 0.82, 0.79, and 0.85. Adding lesion volume and FS significantly increases the performance of the model with AUCs of 0.96, 0.97, and 0.96, and with accuracies of 0.91, 0.94, and 0.93 in the three datasets. There is no significant difference in AUC between the FS model enriched with radiomics and volume against an FS model enriched with volume alone, while the former has higher accuracy. The model combining all available information shows minor non-significant improvements in AUC and accuracy compared with an FS model enriched with radiomics and volume.Conclusions: Radiomics signatures are potential biomarkers for the risk of IA, especially in combination with FS, and could help guide surgical strategy for pulmonary nodules patients.Key Points: • A CT-based radiomics model may be a valuable tool for preoperative prediction of invasive adenocarcinoma for patients with pulmonary nodules. • Radiomics combined with frozen sections could help in guiding surgery strategy for patients with pulmonary nodules. [ABSTRACT FROM AUTHOR]

Introduction: The pathological grading of pancreatic neuroendocrine neoplasms (pNENs) is an independent predictor of survival and indicator for treatment. Deep learning (DL) with a convolutional neural network (CNN) may improve the preoperative prediction of pNEN grading. Methods: Ninety-three pNEN patients with preoperative contrast-enhanced computed tomography (CECT) from Hospital I were retrospectively enrolled. A CNN-based DL algorithm was applied to the CECT images to obtain 3 models (arterial, venous, and arterial/venous models), the performances of which were evaluated via an eightfold cross-validation technique. The CECT images of the optimal phase were used for comparing the DL and traditional machine learning (TML) models in predicting the pathological grading of pNENs. The performance of radiologists by using qualitative and quantitative computed tomography findings was also evaluated. The best DL model from the eightfold cross-validation was evaluated on an independent testing set of 19 patients from Hospital II who were scanned on a different scanner. The Kaplan-Meier (KM) analysis was employed for survival analysis. Results: The area under the curve (AUC; 0.81) of arterial phase in validation set was significantly higher than those of venous (AUC 0.57, p = 0.03) and arterial/venous phase (AUC 0.70, p = 0.03) in predicting the pathological grading of pNENs. Compared with the TML models, the DL model gave a higher (although insignificantly) AUC. The highest OR was achieved for the p ratio <0.9, the AUC and accuracy for diagnosing G3 pNENs were 0.80 and 79.1% respectively. The DL algorithm achieved an AUC of 0.82 and an accuracy of 88.1% for the independent testing set. The KM analysis showed a statistical significant difference between the predicted G1/2 and G3 groups in the progression-free survival (p = 0.001) and overall survival (p < 0.001). Conclusion: The CNN-based DL method showed a relatively robust performance in predicting pathological grading of pNENs from CECT images. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether head CT with 3D reconstruction can replace skull radiographs (SXR) in the imaging investigation of suspected physical abuse (SPA)/abusive head trauma (AHT).Methods: PACS was interrogated for antemortem skeletal surveys performed for SPA, patients younger than 2 years, SXR and CT performed within 4 days of each other. Paired SXR and CT were independently reviewed. One reviewer analysed CT without and (3 months later) with 3D reconstructions. SXR and CT expert consensus review formed the gold standard. Observer reliability was calculated.Results: A total of 104 SXR/CT examination pairs were identified, mean age 6.75 months (range 4 days to 2 years); 21 (20%) had skull fractures; two fractures on CT were missed on SXR. There were no fractures on SXR that were not seen on CT. For SXR and CT, respectively: PPV reviewer 1, 95% confidence interval (CI) 48-82% and 85-100%; reviewer 2, 67-98% and 82-100%; and NPV reviewer 1, 95%, CI 88-98% and 96-100%; reviewer 2, 88-97% and 88-98%. Inter- and intra-observer reliability were respectively the following: SXR, excellent (kappa = 0.831) and good (kappa = 0.694); CT, excellent (kappa = 0.831) and perfect (kappa = 1). All results were statistically significant (p < 0.001).Conclusions: CT has greater diagnostic accuracy than SXR in detecting skull fractures which is increased on concurrent review of 3D reconstructions and should be performed in every case of SPA/AHT. SXR does not add further diagnostic information and can be omitted from the skeletal survey when CT with 3D reconstruction is going to be, or has been, performed.Key Points: • Head CT with 3D reconstruction is more sensitive and specific for the diagnosis of skull fractures. • Skull radiographs can be safely omitted from the initial skeletal survey performed for suspected physical abuse when head CT with 3D reconstruction is going to be, or has been, performed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.Methods: Two-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.Results: Pathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001-0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1-1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).Conclusions: EOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1-1.9 cm.Key Points: • MRI is superior to CT for HCC detection in patients with liver cirrhosis. • EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. • The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid. [ABSTRACT FROM AUTHOR]