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Coronary artery calcification is a significant predictor of cardiovascular disease, with current detection methods like Agatston scoring having limitations in sensitivity. This study aimed to evaluate the effectiveness of a novel CAC quantification method using dual-energy material decomposition, particularly its ability to detect low-density calcium and microcalcifications. A simulation study was conducted comparing the dual-energy material decomposition technique against the established Agatston scoring method and the newer volume fraction calcium mass technique. Detection accuracy and calcium mass measurement were the primary evaluation metrics. The dual-energy material decomposition technique demonstrated fewer false negatives than both Agatston scoring and volume fraction calcium mass, indicating higher sensitivity. In low-density phantom measurements, material decomposition resulted in only 7.41% false-negative (CAC = 0) measurements compared to 83.95% for Agatston scoring. For high-density phantoms, false negatives were removed (0.0%) compared to 20.99% in Agatston scoring. The dual-energy material decomposition technique presents a more sensitive and reliable method for CAC quantification.

IntroductionCoronary artery calcium (CAC) scans contain useful information beyond the Agatston CAC score that is not currently reported. We recently reported that artificial intelligence (AI)-enabled cardiac chambers volumetry in CAC scans (AI-CAC™) predicted incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we investigated the performance of AI-CAC cardiac chambers for prediction of incident heart failure (HF).MethodsWe applied AI-CAC to 5750 CAC scans of asymptomatic individuals (52% female, White 40%, Black 26%, Hispanic 22% Chinese 12%) free of known cardiovascular disease at the MESA baseline examination (2000-2002). We used the 15-year outcomes data and compared the time-dependent area under the curve (AUC) of AI-CAC volumetry versus NT-proBNP, Agatston score, and 9 known clinical risk factors (age, gender, diabetes, current smoking, hypertension medication, systolic and diastolic blood pressure, LDL, HDL for predicting incident HF over 15 years.ResultsOver 15 years of follow-up, 256 HF events accrued. The time-dependent AUC [95% CI] at 15 years for predicting HF with AI-CAC all chambers volumetry (0.86 [0.82,0.91]) was significantly higher than NT-proBNP (0.74 [0.69, 0.77]) and Agatston score (0.71 [0.68, 0.78]) (p ​

We present here a user-friendly calculator for the setting of a pediatric split-bolus polytrauma computed tomography (CT) protocol with a mixed arterial and venous phase, aiming to both reduce radiation dose and improve workflow while assuring optimal image quality. All the different parameters are calculated based on patient's weight with rapid computation of the injected contrast media and saline volumes, injection's flow rate, injection's timing, and optimal acquisition time. The designed calculator is built in a widely available Google Sheets file, accessible by a quick response (QR) code. Although polytrauma imaging represents the main goal of the technique, it can be used in a wide variety of contexts, including oncological, infectious, and vascular pathologies. [ABSTRACT FROM AUTHOR]

This study aimed to systematically evaluate the impact of a low-dose (LD) protocol using tube current reduction on image quality, the confidence for intervention planning and guidance, and diagnostic yield for computed tomography (CT) myelography. We retrospectively analyzed 68 patients who underwent CT myelography, with 34 investigations performed with a standard-dose (SD) and 34 investigations performed with a LD protocol (using tube current reduction). The different scans were matched considering variables such as sex, age, presence of spinal instrumentation, and body diameter. All images were evaluated by two readers (R1 and R2) using Likert scales. Image noise was measured using attenuation values of paraspinal muscle tissue. Images were reconstructed with model-based iterative reconstruction (post-myelography diagnostic scans) or hybrid reconstruction (planning, periprocedural, and diagnostic scans). Image quality, overall artifacts, image contrast, and confidence for planning or intervention guidance were rated good to perfect for both SD and LD scans according to evaluations of both readers. Inter-reader agreement was good to very good for the images from intervention planning (κ ≥ 0.80) as well as for intervention guidance (κ ≥ 0.77), as well as for diagnostic scans (κ ≥ 0.85). Image noise was similar between SD and LD scans performed for planning of the interventional procedures (model-based iterative reconstruction: SD 45.37 ± 7.29 HU vs. LD 45.17 ± 9.12 HU; hybrid reconstruction: SD 46.05 ± 7.43 HU vs. LD 45.05 ± 8.69 HU; p > 0.05). The volume-weighted CT dose index (CTDIvol) and size-specific dose estimate (SSDE) were significantly lower for the planning scans as well as the periprocedural scans when using the LD protocol as compared to the SD protocol (p < 0.05). In conclusion, implementation of a LD protocol with tube current reduction for CT myelography is a feasible option to reduce radiation exposure, especially when combined with iterative image reconstruction. In our study, LD imaging did not have a relevant negative impact on image quality, confidence for intervention planning or guidance, or diagnostic certainty for CT myelography. [ABSTRACT FROM AUTHOR]

Background: Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. Purpose: To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. Material and Methods: A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). Results: The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42–2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73–1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. Conclusion: CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy. [ABSTRACT FROM AUTHOR]

Purpose: The Reporting and Data System (RADS) has proven successful in various medical settings, but a standardized reporting system for abdominal emergencies is lacking. In this study, the Abdominal Emergency Reporting and Data System (AEM-RADS) for urgent findings on abdominal CT scans is introduced to address the need for consistency in emergency radiology. Methods: In this prospective observational study, conducted over a six-month period, the urgency of abdominal CT scans was assessed using the proposed AEM-RADS scoring system. The committee developed a scale ranging from AEM-RADS 1 (normal) to AEM-RADS 5 (urgent disease). Interobserver agreement between two observers with different experience was evaluated, and robust AEM-RADS reference values were established by radiologists who were not observers. Statistical analysis used mean, standard deviations and Kendall's tau analysis for interobserver agreement. Results: Among 2656 patients who underwent CT for abdominal emergencies, the AEM-RADS distribution was 17.50% AEM-RADS 1, 28.57% AEM-RADS 2, 7.22% AEM-RADS 3, 35.61% AEM-RADS 4, and 11.06% AEM-RADS 5. Interobserver agreement was high, especially for urgent and emergent cases (p < 0.0001). Notable discrepancies were observed in AEM-RADS categories 2C–D and 3B–C, emphasizing the influence of radiologists' experience on interpretation. However, the interobserver agreement for both AEM-RADS 2C–D and 3B–C were statistically significant (p < 0.001). Conclusions: AEM-RADS showed promising reliability, particularly in identifying urgent and emergent cases. Despite some inter-observer discrepancies, the system showed potential for standardized emergency workups. AEM-RADS could significantly enhance diagnostic accuracy in abdominal emergencies and provide a structured framework for shared decision-making between clinicians and radiologists.0 [ABSTRACT FROM AUTHOR]

Objectives: To investigate the feasibility of low-radiation dose and low iodinated contrast medium (ICM) dose protocol combining low-tube voltage and deep-learning reconstruction (DLR) algorithm in thin-slice abdominal CT. Methods: This prospective study included 148 patients who underwent contrast-enhanced abdominal CT with either 120-kVp (600 mgL/kg, n = 74) or 80-kVp protocol (360 mgL/kg, n = 74). The 120-kVp images were reconstructed using hybrid iterative reconstruction (HIR) (120-kVp-HIR), while 80-kVp images were reconstructed using HIR (80-kVp-HIR) and DLR (80-kVp-DLR) with 0.5 mm thickness. Size-specific dose estimate (SSDE) and iodine dose were compared between protocols. Image noise, CT attenuation, and contrast-to-noise ratio (CNR) were quantified. Noise power spectrum (NPS) and edge rise slope (ERS) were used to evaluate noise texture and edge sharpness, respectively. The subjective image quality was rated on a 4-point scale. Results: SSDE and iodine doses of 80-kVp were 40.4% (8.1 ± 0.9 vs. 13.6 ± 2.7 mGy) and 36.3% (21.2 ± 3.9 vs. 33.3 ± 4.3 gL) lower, respectively, than those of 120-kVp (both, p < 0.001). CT attenuation of vessels and solid organs was higher in 80-kVp than in 120-kVp images (all, p < 0.001). Image noise of 80-kVp-HIR and 80-kVp-DLR was higher and lower, respectively than that of 120-kVp-HIR (both p < 0.001). The highest CNR and subjective scores were attained in 80-kVp-DLR (all, p < 0.001). There were no significant differences in average NPS frequency and ERS between 120-kVp-HIR and 80-kVp-DLR (p ≥ 0.38). Conclusion: Compared with the 120-kVp-HIR protocol, the combined use of 80-kVp and DLR techniques yielded superior subjective and objective image quality with reduced radiation and ICM doses at thin-section abdominal CT. Clinical relevance statement: Scanning at low-tube voltage (80-kVp) combined with the deep-learning reconstruction algorithm may enhance diagnostic efficiency and patient safety by improving image quality and reducing radiation and contrast doses of thin-slice abdominal CT. Key Points: Reducing radiation and iodine doses is desirable; however, contrast and noise degradation can be detrimental. The 80-kVp scan with the deep-learning reconstruction technique provided better images with lower radiation and contrast doses. This technique may be efficient for improving diagnostic confidence and patient safety in thin-slice abdominal CT. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the value of extracellular volume (ECV) fraction and fat fraction (FF) derived from dual- energy CT (DECT) for predicting postpancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD). Methods: This retrospective study included patients who underwent DECT and PD between April 2022 and September 2022. PPAP was determined according to the International Study Group for Pancreatic Surgery (ISGPS) definition. Iodine concentration (IC) and FF of the pancreatic parenchyma were measured on preoperative DECT. The ECV fraction was calculated from iodine map images of the equilibrium phase. The independent predictors for PPAP were assessed by univariate and multivariable logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results: Sixty-nine patients were retrospectively enrolled (median age, 60 years; interquartile range, 55–70 years; 47 men). Of these, nine patients (13.0%) developed PPAP. These patients had lower portal venous phase IC, equilibrium phase IC, FF, and ECV fraction, and higher pancreatic parenchymal-to-portal venous phase IC ratio and pancreatic parenchymal-to-equilibrium phase IC ratio, compared with patients without PPAP. After multivariable analysis, ECV fraction was independently associated with PPAP (odd ratio [OR], 0.87; 95% confidence interval [CI]: 0.79, 0.96; p < 0.001), with an area under the curve (AUC) of 0.839 (sensitivity 100.0%, specificity 58.3%). Conclusions: A lower ECV fraction is independently associated with the occurrence of PPAP after PD. ECV fraction may serve as a potential predictor for PPAP after PD. Clinical relevance statement: DECT-derived ECV fraction of pancreatic parenchyma is a promising biomarker for surgeons to preoperatively identify patients with higher risk for postpancreatectomy acute pancreatitis after PD and offer selective perioperative management. Key Points: PPAP is a complication of pancreatic surgery, early identification of higher-risk patients allows for risk mitigation. Lower DECT-derived ECV fraction was independently associated with the occurrence of PPAP after PD. DECT aids in preoperative PAPP risk stratification, allowing for appropriate treatment to minimize complications. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair. Materials and methods: Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010–2021 were retrospectively reviewed. Patients with hemorrhage extending along the PA were identified as the PA-IMH group. Multivariable logistics regression was used to obtain the odds ratio (OR), and the Kaplan-Meier method was used to estimate the survival rate. Results: Of the 2046 ATAAD patients, 324 (15.8%) patients were identified with PA-IMH, and 1722 (84.2%) were without PA-IMH. PA-IMH had a higher prevalence in patients with older age, female gender, aortic IMH, and type II aortic dissection. PA-IMH patients incurred excess early mortality compared with non-PA-IMH patients (9.3% vs. 5.6%, OR = 1.86, 95%CI 1.19–2.91, p = 0.006). The results were stable in the subgroup analysis, with an increased risk in older (> 70 years) or DeBakey type II ATAAD patients. Notably, an increase in the degree and extent of PA-IMH exacerbated the risk of early mortality. However, after landmark analysis at 30-day postsurgery, no significant difference was noted in the long-term outcomes between PA-IMH and non-PA-IMH groups (p = 0.440). The 5-year survival rates were 87.1% (95%CI: 83.3%, 91.1%) and 90.1% (95%CI: 88.5%, 91.7%), respectively. Conclusions: The presence of PA-IMH in ATAAD patients is common and is independently associated with increased early mortality after surgical repair, especially in those with older age (> 70) or type II dissection. However, such detrimental effects do not persist in the long-term follow-up among patients who survived hospital discharge. Clinical relevance statement: We confirmed that PA-IMH significantly increases early postoperative mortality in patients with acute type A aortic dissection, especially in older patients or DeBakey type II dissection. This should prompt further investigation of the incremental role of PA-IMH in this pathology. Key Points: Acute type A aortic dissection mortality gets worse when pulmonary artery intramural hematoma is present. Pulmonary artery-intramural hematoma increased the risk of early mortality but not affect long-term prognosis. Further research should investigate the effects of pulmonary artery intramural thrombus on aortic dissection. [ABSTRACT FROM AUTHOR]

Objective: Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard. Materials and methods: Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann–Whitney U test and Fisher's exact test. Results: Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P <.001) in detecting individual rib fractures. Most fractures involved the 4th–9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries. Conclusion: Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT. [ABSTRACT FROM AUTHOR]

Myocardial fibrosis is a common endpoint of many cardiac diseases and increasingly recognized as a predictor of heart failure, arrhythmia, and death. Recent studies have utilised cardiac computed tomography (CT) scans with delayed phase imaging to quantify diffuse fibrosis of the myocardium. CT extracellular volume (CT-ECV) measurement correlates well with CMR and histological myocardial fibrosis. Furthermore, CT-ECV predicts outcomes such as death, heart failure and arrhythmia in various disease states. This review summarizes the rationale and methodology behind CT-ECV measurement and provides a detailed summary of the current clinical evidence for the use of CT-ECV. [ABSTRACT FROM AUTHOR]

The Coronary Artery Disease—Reporting and Data System (CAD-RADS) is a standardised reporting method which was created in order to improve communication with referring physicians as well as for management considerations. The CAD-RADS score denotes the absence or presence of stenosis, while plaque burden and potential modifiers provide insight into plaque extent and characteristics. The modifier ischaemia enables the incorporation of fractional flow reserve CT and CT perfusion, while the modifier exception is used to denote potential coronary abnormalities. Higher CAD-RADS categories demonstrate incremental prognostic value, with further improvement when taking plaque burden into account. CAD-RADS improves communication with the referring clinician as well as guiding therapeutic management and as such is relevant to uniform patient care in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: This study investigated the image quality and detectability of double low-dose hepatic multiphase CT (DLDCT, which targeted about 30% reductions of both the radiation and iodine concentration) using a vendor-agnostic deep-learning-based contrast-boosting model (DL-CB) compared to those of standard-dose CT (SDCT) using hybrid iterative reconstruction. Methods: The CT images of 73 patients with chronic liver disease who underwent DLDCT between June 2023 and October 2023 and had SDCT were analyzed. Qualitative analysis of the overall image quality, artificial sensation, and liver contour sharpness on the arterial and portal phase, along with the hepatic artery clarity was conducted by two radiologists using a 5-point scale. For quantitative analysis, the image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured. The lesion conspicuity was analyzed using generalized estimating equation analysis. Lesion detection was evaluated using the jackknife free-response receiver operating characteristic figures-of-merit. Results: Compared with SDCT, a significantly lower effective dose (16.4 ± 7.2 mSv vs. 10.4 ± 6.0 mSv, 36.6% reduction) and iodine amount (350 mg iodine/mL vs. 270 mg iodine/mL, 22.9% reduction) were utilized in DLDCT. The mean overall arterial and portal phase image quality scores of DLDCT were significantly higher than SDCT (arterial phase, 4.77 ± 0.45 vs. 4.93 ± 0.24, AUCVGA 0.572 [95% CI, 0.507–0.638]; portal phase, 4.83 ± 0.38 vs. 4.92 ± 0.26, AUCVGA 0.535 [95% CI, 0.469–0.601]). Furthermore, DLDCT showed significantly superior quantitative results for the lesion contrast-to-noise ratio (7.55 ± 4.55 vs. 3.70 ± 2.64, p < 0.001) and lesion detectability (0.97 vs. 0.86, p = 0.003). Conclusions: In patients with chronic liver disease, DLDCT using DL-CB can provide acceptable image quality without impairing the detection and evaluation of hepatic focal lesions compared to SDCT. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion This study assesses the safety and efficacy of using indocyanine green (ICG) for preoperative CT‐guided localization of multiple pulmonary nodules.We included patients who underwent CT‐guided preoperative ICG localization followed by video‐assisted thoracoscopic surgery (VATS). Four primary outcomes were evaluated: technical success, pneumothorax, pulmonary hemorrhage, and postoperative hospital stay (PHS). Patients were classified into single nodule and multiple nodules groups, with further subgroups based on the side of localization including unilateral and bilateral subgroups. Univariate and multivariate analyses were used to evaluate risk factors for PHS and pneumothorax.A total of 374 patients (54.8 ± 11.4 years, 99 with multiple nodules). The success rate in the multiple nodules group was 98.3%, similar to single nodules. Apart from PHS, no significant differences were observed in outcomes between patients with single and multiple nodules. Longer PHS was observed for patients with multiple nodules (3 [2–4] days vs. 3 [3–4] days, p = 0.022). Multivariable analysis indicated longer stays were associated with pulmonary hemorrhage during localization, surgical blood loss, postoperative complications, and non‐segmentectomy procedures. Advanced age emerged as the sole independent risk factor for pneumothorax. The success rate in the unilateral subgroup and the bilateral subgroup was 97.8% and 99%, respectively, with higher pneumothorax rates in the unilateral subgroup (38.3% vs. 20%).CT‐guided preoperative ICG localization of multiple pulmonary nodules is safe and effective. It can be applied to both unilateral and bilateral nodules, supporting simultaneous VATS resection. [ABSTRACT FROM AUTHOR]

Background: In liver computed tomography (CT), tailoring the contrast injection to the patient's specific characteristics is relevant for optimal imaging and patient safety. We evaluated a novel algorithm engineered for personalized contrast injection to achieve reproducible liver enhancement centered on 50 HU. Methods: From September 2020 to August 31, 2022, CT data from consecutive adult patients were prospectively collected at our multicenter premises. Inclusion criteria consisted of an abdominal CT referral for cancer staging or follow-up. For all examinations, a web interface incorporating data from the radiology information system (patient details and examination information) and radiographer-inputted data (patient fat-free mass, imaging center, kVp, contrast agent details, and imaging phase) were used. Calculated contrast volume and injection rate were manually entered into the CT console controlling the injector. Iopamidol 370 mgI/mL or Iohexol 350 mgI/mL were used, and kVp varied (80, 100, or 120) based on patient habitus. Results: We enrolled 384 patients (mean age 61.2 years, range 21.1–94.5). The amount of administered iodine dose (gI) was not significantly different across contrast agents (p = 0.700), while a significant increase in iodine dose was observed with increasing kVp (p < 0.001) and in males versus females (p < 0.001), as expected. Despite the differences in administered iodine load, image quality was reproducible across patients with 72.1% of the examinations falling within the desirable range of 40–60 HU. Conclusion: This study validated a novel algorithm for personalized contrast injection in adult abdominal CT, achieving consistent liver enhancement centered at 50 HU. Relevance statement: In healthcare's ongoing shift towards personalized medicine, the algorithm offers excellent potential to improve diagnostic accuracy and patient management, particularly for the detection and follow-up of liver malignancies. Key Points: The algorithm achieves reproducible liver enhancement, promising improved diagnostic accuracy and patient management in diverse clinical settings. The real-world study demonstrates this algorithm's adaptability to different variables ensuring high-quality liver imaging. A personalized algorithm optimizes liver CT, improving the visibility, conspicuity, and follow-up of liver lesions. [ABSTRACT FROM AUTHOR]

Background: Square faces, which are influenced by genetic factors and structural features, are considered undesirable among the Asian population. Surgical interventions, such as mandibular angle reduction, aim to alter these characteristics, though complications may arise. We aimed to investigate the morphology of the mandibular angle and masseter muscle thickness using computed tomography (CT) and to analyze hard and soft tissue correlations to enhance surgical outcomes for patients with square faces. Methods: This retrospective clinical study included 100 Taiwanese patients aged 18–50 years. CT was used to analyze key clinical parameters, including bilateral mandibular width, mandibular divergence angle, ramus height, distance from the mandibular angle to the inferior alveolar nerve (IAN), and the thickness of the masseter muscle. Results: Significant correlations were noted between the patients' physical height and weight, mandibular width, ramus height, masseter thickness, and distance from the angle to the IAN. Males exhibited a significantly longer and thicker ramus height (66.48 ± 4.28 mm), greater masseter thickness (15.46 ± 2.35 mm), and greater safety range for mandibular angle reduction surgery (18.35 ± 3.19 mm) (p < 0.00008). Significant correlations were observed among all parameters, except between mandibular width and gonial angle and the distance from the angle to the IAN and between mandibular divergence and masseter muscle thickness (p > 0.1). Conclusions: Our study highlighted the complex interplay among factors that contribute to square facial morphology. Careful preoperative assessments and customized surgical planning are essential for addressing this multifaceted clinical challenge. [ABSTRACT FROM AUTHOR]

In this preliminary study, we investigated the value of fusion techniques by flat detector computed tomography based dual volume rotational angiography (DVRA) for the evaluation of the anatomical relationship of cavernous sinus dural arteriovenous fistula (CSDAVF) and assessed the possibility of transvenous target segment embolization. Twenty-six patients with CSDAVF supplied by multiple feeders underwent DVRA for each feeding large vessel separately. We assessed the anatomical relationship of feeders, fistula points, and venous drainage with 3 dual volume image fusion techniques. Transvenous embolization was targeted to the segment of fistulous point for preserving those not involved and reducing coil mass effect. Dual vessel multi-planar reconstruction fusion technique could show which segment of the cavernous sinus supplied by feeding arteries. In the dual vessel volume rendering fusion technique, the association between feeding arteries, fistula points, and draining veins of 2 different vessels could be accurately identified in 3 dimensions. In addition, we could visualize the exact anatomical relationship between the components of CSDAVF and skull anatomy with the single vessel fusion technique. Based on various fusion images, target segment embolization was successfully performed in 8 patients. In this group, we achieved complete or near complete occlusion without complications, including cranial nerve palsy. Detailed anatomical information including accurate fistula point, specific feeding arteries, and draining veins could be obtained with various dual volume image fusion techniques. In addition, the target segment embolization of CSDAVF could be possible with understanding of the precise CSDAVF architectures. [ABSTRACT FROM AUTHOR]

Primary bone lymphoma, a rare oncologic entity, may initially present with minimal symptoms. Presenting symptoms range from local pain and mild systemic symptoms to large palpable masses and pathologic fractures. The term "primary bone lymphoma" indicates the finding of bone involvement without other organ sites for at least 6 months. Although some radiological features may raise suspicion about this tumor form, there are no pathognomonic imaging findings, and the diagnosis will likely be delayed for a long time. The most critical radiological feature is soft tissue involvement associated with a preserved cortical layer, much more than expected for an infiltrating lesion. Anyway, very different radiological findings may be displayed in patients with primary bone lymphoma. Although these radiological features of primary bone lymphoma have been discussed in the literature by various authors, there is little data concerning imaging in pediatric patients. This paper aims to depict the possible spectrum of imaging features of primary bone lymphoma in the pediatric age, providing an exemplification pictorial essay extracted from a single institution experience in the year range period 2006–2022. [ABSTRACT FROM AUTHOR]

Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, "life-threatening hemoptysis" may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be > 8 ml/kg in 24 h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient 's clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90–95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver. Methods: This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test. Results: The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias. Conclusions: Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias. [ABSTRACT FROM AUTHOR]

Objectives: To distinguish histological subtypes of renal tumors using radiomic features and machine learning (ML) based on multiphase computed tomography (CT). Material and methods: Patients who underwent surgical treatment for renal tumors at two tertiary centers from 2012 to 2022 were included retrospectively. Preoperative arterial (corticomedullary) and venous (nephrogenic) phase CT scans from these centers, as well as from external imaging facilities, were manually segmented, and standardized radiomic features were extracted. Following preprocessing and addressing the class imbalance, a ML algorithm based on extreme gradient boosting trees (XGB) was employed to predict renal tumor subtypes using 10-fold cross-validation. The evaluation was conducted using the multiclass area under the receiver operating characteristic curve (AUC). Algorithms were trained on data from one center and independently tested on data from the other center. Results: The training cohort comprised n = 297 patients (64.3% clear cell renal cell cancer [RCC], 13.5% papillary renal cell carcinoma (pRCC), 7.4% chromophobe RCC, 9.4% oncocytomas, and 5.4% angiomyolipomas (AML)), and the testing cohort n = 121 patients (56.2%/16.5%/3.3%/21.5%/2.5%). The XGB algorithm demonstrated a diagnostic performance of AUC = 0.81/0.64/0.8 for venous/arterial/combined contrast phase CT in the training cohort, and AUC = 0.75/0.67/0.75 in the independent testing cohort. In pairwise comparisons, the lowest diagnostic accuracy was evident for the identification of oncocytomas (AUC = 0.57–0.69), and the highest for the identification of AMLs (AUC = 0.9–0.94) Conclusion: Radiomic feature analyses can distinguish renal tumor subtypes on routinely acquired CTs, with oncocytomas being the hardest subtype to identify. Clinical relevance statement: Radiomic feature analyses yield robust results for renal tumor assessment on routine CTs. Although radiologists routinely rely on arterial phase CT for renal tumor assessment and operative planning, radiomic features derived from arterial phase did not improve the accuracy of renal tumor subtype identification in our cohort. Key Points: Radiomic feature analyses and ML algorithms can be utilized in routinely acquired CT studies from multiple imaging centers. Discrimination of renal tumor subtypes using CT-based radiomics and ML yields a moderate diagnostic performance (multiclass AUC = 0.75 in independent testing data). For renal tumor subtype discrimination using radiomic features, venous contrast phase CT yields the most pertinent imaging information, without evident diagnostic benefit of an added arterial contrast phase. [ABSTRACT FROM AUTHOR]

Background: Lung cancer, the second most common cancer, presents persistently dismal prognoses. Radiomics, a promising field, aims to provide novel imaging biomarkers to improve outcomes. However, clinical translation faces reproducibility challenges, despite efforts to address them with quality scoring tools. Objective: This study had two objectives: 1) identify radiomics biomarkers in post-radiotherapy stage III/IV nonsmall cell lung cancer (NSCLC) patients, 2) evaluate research quality using the CLEAR (CheckList_for_EvaluAtion_of_Radiomics_research), RQS (Radiomics_Quality_Score) frameworks, and formulate an amalgamated CLEAR-RQS tool to enhance scientific rigor. Materials and methods: A systematic literature review (Jun-Aug 2023, MEDLINE/PubMed/SCOPUS) was conducted concerning stage III/IV NSCLC, radiotherapy, and radiomic features (RF). Extracted data included study design particulars, such as sample size, radiotherapy/CT technique, selected RFs, and endpoints. CLEAR and RQS were merged into a CLEAR-RQS checklist. Three readers appraised articles utilizing CLEAR, RQS, and CLEAR-RQS metrics. Results: Out of 871 articles, 11 met the inclusion/exclusion criteria. The Median cohort size was 91 (range: 10–337) with 9 studies being single-center. No common RF were identified. The merged CLEAR-RQS checklist comprised 61 items. Most unreported items were within CLEAR's "methods" and "open-source," and within RQS's "phantom-calibration," "registry-enrolled prospective-trial-design," and "cost-effective-analysis" sections. No study scored above 50% on RQS. Median CLEAR scores were 55.74% (32.33/58 points), and for RQS, 17.59% (6.3/36 points). CLEAR-RQS article ranking fell between CLEAR and RQS and aligned with CLEAR. Conclusion: Radiomics research in post-radiotherapy stage III/IV NSCLC exhibits variability and frequently low-quality reporting. The formulated CLEAR-RQS checklist may facilitate education and holds promise for enhancing radiomics research quality. Clinical relevance statement: Current radiomics research in the field of stage III/IV postradiotherapy NSCLC is heterogenous, lacking reproducibility, with no identified imaging biomarker. Radiomics research quality assessment tools may enhance scientific rigor and thereby facilitate radiomics translation into clinical practice. Key Points: There is heterogenous and low radiomics research quality in postradiotherapy stage III/IV nonsmall cell lung cancer. Barriers to reproducibility are small cohort size, nonvalidated studies, missing technical parameters, and lack of data, code, and model sharing. CLEAR (CheckList_for_EvaluAtion_of_Radiomics_research), RQS (Radiomics_Quality_Score), and the amalgamated CLEAR-RQS tool are useful frameworks for assessing radiomics research quality and may provide a valuable resource for educational purposes in the field of radiomics. [ABSTRACT FROM AUTHOR]

The use of computed tomography (CT) for craniofacial measurements is common in medical imaging, but concerns about accuracy and reliability persist, especially with different CT technologies. This study assessed the accuracy of twenty-six common measurements on consecutive CT images from the same patients, using multidetector CT (MDCT) and cone-beam CT (CBCT) with two software programs (Amira and Dolphin). Ten adult subjects with consecutive CBCT scans within one year were randomly selected. Another ten subjects with consecutive MDCT scans were paired with the CBCT group based on age, gender, race, occlusion, and craniofacial pattern. All digital imaging and communications in medicine (DICOM) files were randomly coded and analyzed using the two software programs. Intra-examiner reliability was assessed using the intraclass correlation coefficient. Successive measurement errors from consecutive scans for both imaging modalities and software programs were compared. For most skeletal linear and angular measurements, Dolphin showed greater successive measurement errors compared to Amira. Eight of the 26 common measurements had errors greater than one unit (millimeter or degree). Despite almost perfect intra-examiner reliability for upper airway analysis, average successive measurement errors were notably high, particularly for intraoral and oropharyngeal airway volumes. The successive Dolphin measurement error for oropharyngeal airway volume on CBCT images was over three times that on MDCT images. Given the substantial successive measurement errors observed during consecutive CT scanning for the upper airway, this study does not support the quantitative use of CT for analyzing changes in airway dimensions for research purposes. [ABSTRACT FROM AUTHOR]

This study aimed to develop a diagnostic model based on clinical and CT features for identifying clear cell renal cell carcinoma (ccRCC) in small renal masses (SRMs). This retrospective multi-centre study enroled patients with pathologically confirmed SRMs. Data from three centres were used as training set (n = 229), with data from one centre serving as an independent test set (n = 81). Univariate and multivariate logistic regression analyses were utilised to screen independent risk factors for ccRCC and build the classification and regression tree (CART) diagnostic model. The area under the curve (AUC) was used to evaluate the performance of the model. To demonstrate the clinical utility of the model, three radiologists were asked to diagnose the SRMs in the test set based on professional experience and re-evaluated with the aid of the CART model. There were 310 SRMs in 309 patients and 71% (220/310) were ccRCC. In the testing cohort, the AUC of the CART model was 0.90 (95% CI: 0.81, 0.97). For the radiologists' assessment, the AUC of the three radiologists based on the clinical experience were 0.78 (95% CI:0.66,0.89), 0.65 (95% CI:0.53,0.76), and 0.68 (95% CI:0.57,0.79). With the CART model support, the AUC of the three radiologists were 0.93 (95% CI:0.86,0.97), 0.87 (95% CI:0.78,0.95) and 0.87 (95% CI:0.78,0.95). Interobserver agreement was improved with the CART model aids (0.323 vs 0.654, P < 0.001). The CART model can identify ccRCC with better diagnostic efficacy than that of experienced radiologists and improve diagnostic performance, potentially reducing the number of unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Objectives An important aspect of forensic investigation is determining the sex of an unidentified person. The frontal sinus is unique and remains intact, thus making it suitable for forensic analysis. The main objective of this study is to determine the sex of an individual by frontal sinus using a multidetector computed tomography scan. Materials and Methods A total of 100 patients (50 males and 50 females) were included in the study, and different parameters of the frontal sinus for both sides were analyzed, that is height, width, depth, and total length. Statistical Analysis Descriptive statistics of all the variables were computed and compared. SPSS version 16 was used to perform the Mann–Whitney U test, binary logistic regression, and receiver operating characteristic (ROC) curve analysis on the acquired data. Results The result suggested that males have higher mean values than females, with the left frontal sinus height being the only variable to be statistically significant (p < 0.05). Based on the ROC curve analysis, the optimum cutoff value was 0.489, which means if the predicted probability value was less than 0.489, the individual was considered a male; and if the predicted probability value was ≥0.489, the individual was considered a female. The accuracy of the mathematical model based on binary logistic regression analysis for determining sex was 70% for females and 66% for males. Conclusion The present study plays a significant role in determining sex in the Indian population by using left frontal sinus height measurement through a multidetector computed tomography scan. [ABSTRACT FROM AUTHOR]

This article discusses the detection of soft tissue emphysema in emergency head and neck imaging. Soft tissue emphysema can occur in various situations, including trauma, infections, and medical procedures. Prompt diagnosis through diagnostic imaging, particularly multidetector computed tomography, is crucial for effective management. The article highlights specific conditions such as Boerhaave syndrome, which can lead to subcutaneous emphysema in the neck and has potentially life-threatening complications. The use of endoscopic management with stent placement has changed the treatment approach for oesophageal perforation. Overall, diagnostic imaging plays a vital role in identifying the cause and location of soft tissue emphysema. [Extracted from the article]

Background: The recently introduced super-resolution (SR) deep learning image reconstruction (DLR) is potentially effective in reducing noise level and enhancing the spatial resolution. We aimed to investigate whether SR-DLR has advantages in the overall image quality and intensity homogeneity on coronary computed tomography (CT) angiography with four different approaches: filtered-back projection (FBP), hybrid iterative reconstruction (IR), DLR, and SR-DLR. Methods: Sixty-three patients (mean age, 61 ± 11 years; range, 18–81 years; 40 men) who had undergone coronary CT angiography between June and October 2022 were retrospectively included. Image noise, signal to noise ratio, and contrast to noise ratio were quantified in both proximal and distal segments of the major coronary arteries. The left ventricle myocardium contrast homogeneity was analyzed. Two independent reviewers scored overall image quality, image noise, image sharpness, and myocardial homogeneity. Results: Image noise in Hounsfield units (HU) was significantly lower (P < 0.001) for the SR-DLR (11.2 ± 2.0 HU) compared to those associated with other image reconstruction methods including FBP (30.5 ± 10.5 HU), hybrid IR (20.0 ± 5.4 HU), and DLR (14.2 ± 2.5 HU) in both proximal and distal segments. SR-DLR significantly improved signal to noise ratio and contrast to noise ratio in both the proximal and distal segments of the major coronary arteries. No significant difference was observed in the myocardial CT attenuation with SR-DLR among different segments of the left ventricle myocardium (P = 0.345). Conversely, FBP and hybrid IR resulted in inhomogeneous myocardial CT attenuation (P < 0.001). Two reviewers graded subjective image quality with SR-DLR higher than other image reconstruction techniques (P < 0.001). Conclusions: SR-DLR improved image quality, demonstrated clearer delineation of distal segments of coronary arteries, and was seemingly accurate for quantifying CT attenuation in the myocardium. [ABSTRACT FROM AUTHOR]

Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 ± 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment. [ABSTRACT FROM AUTHOR]

Introduction and Objective: The aim of this study was to evaluate the coronary arteries in patients undergoing thoracic CT angiography for congenital heart disease, to determine the frequency of detection of coronary artery anomalies in congenital heart diseases, and to determine which type of anomaly is more common in which disease. Materials and Methods: In our investigation, a 128-detector multidetector computed tomography machine was used to perform thorax CT angiography. The acquisition parameters were set to 80–100 kVp based on the patient's age and mAs that the device automatically determined based on the patient's weight. During the examination, an intravenous (IV) nonionic contrast material dose of 1–1.5 mL/kg was employed. An automated injector was used to inject contrast material at a rate of 1.5–2 mL/s. In the axial plane, 2.5 mm sections were extracted, and they were rebuilt with 0.625 mm section thickness. Results: Between October 2022 and May 2024, 132 patients who were diagnosed with congenital heart disease by echocardiography and underwent Thorax CT angiography in our department were retrospectively evaluated. Of the evaluated patients, 32 were excluded with exclusion criteria such as patients being younger than 3 months, older than 18 years, insufficient contrast enhancement in imaging and contrast-enhanced imaging, thin vascular structure, and motion and contrast artifacts; the remaining 100 patients were included in this study. The age range of these patients was 3 months to 18 years (mean age 4.4 years). Conclusion: In congenital heart diseases, attention to the coronary arteries on thoracic CT angiography examination in the presence of possible coronary anomalies may provide useful information. [ABSTRACT FROM AUTHOR]

The heterogeneous anatomy of the left atrial appendage (LAA) necessitates preprocedural imaging essential for planning of percutaneous LAA occlusion (LAAO) procedures. While transoesophageal echocardiography (TOE) remains the gold standard, cardiac computed tomography (CT) is becoming increasingly popular. To address the lack of consensus on the optimal imaging modality, we compared the outcomes of preprocedural TOE versus CT for LAAO procedure planning. A retrospective single-center cohort study of all LAAO procedures was performed to compare the outcomes of patients receiving preprocedural TOE versus those receiving CT. The primary outcome was procedural success and rate of major adverse events. The secondary outcomes were total procedure time, rate of device size change, and maximum landing zone diameter. A total of 64 patients was included. Of these, 25 (39.1%) underwent TOE and 39 (60.9%) underwent CT. There was no significant difference in the procedural success rate (96.0% vs. 100%, P = 0.39) or major adverse event rate (4.0% vs. 5.1%, P > 0.99) between TOE and CT patients. Compared with TOE, CT was associated with significantly shorter median procedure time (103 min vs. 124 min, P = 0.02) and a lower rate of device size change (7.7% vs. 28.0%, P = 0.04). Compared to CT, TOE was associated with a significantly smaller mean maximum landing zone diameter (20.8 mm vs. 25.8 mm, P < 0.01) and a higher rate of device upsizing (24.0% vs. 2.6%, P = 0.01). No significant difference in detected residual leak rates was found between TOE and CT (50.0% vs. 52.2%, P > 0.99). Planning of LAAO procedures with CT is associated with a shorter total procedure time and a lower rate of device size change and is less likely to underestimate the maximum landing zone diameter. [ABSTRACT FROM AUTHOR]

Background: The best settings of deep learning image reconstruction (DLIR) algorithm for abdominal low-kiloelectron volt (keV) virtual monoenergetic imaging (VMI) have not been determined. Purpose: To determine the optimal settings of the DLIR algorithm for abdominal low-keV VMI. Material and Methods: The portal-venous phase computed tomography (CT) scans of 109 participants with 152 lesions were reconstructed into four image series: VMI at 50 keV using adaptive statistical iterative reconstruction (Asir-V) at 50% blending (AV-50); and VMI at 40 keV using AV-50 and DLIR at medium (DLIR-M) and high strength (DLIR-H). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of nine anatomical sites were calculated. Noise power spectrum (NPS) using homogenous region of liver, and edge rise slope (ERS) at five edges were measured. Five radiologists rated image quality and diagnostic acceptability, and evaluated the lesion conspicuity. Results: The SNR and CNR values, and noise and noise peak in NPS measurements, were significantly lower in DLIR images than AV-50 images in all anatomical sites (all P < 0.001). The ERS values were significantly higher in 40-keV images than 50-keV images at all edges (all P < 0.001). The differences of the peak and average spatial frequency among the four reconstruction algorithms were significant but relatively small. The 40-keV images were rated higher with DLIR-M than DLIR-H for diagnostic acceptance (P < 0.001) and lesion conspicuity (P = 0.010). Conclusion: DLIR provides lower noise, higher sharpness, and more natural texture to allow 40 keV to be a new standard for routine VMI reconstruction for the abdomen and DLIR-M gains higher diagnostic acceptance and lesion conspicuity rating than DLIR-H. [ABSTRACT FROM AUTHOR]

Background: A renal artery lumen reduction of ≥60% indicates hemodynamically significant stenosis and is one of the main criteria for invasive revascularization. We hypothesize that direct parameters describing renal artery stenosis (RAS) could better correlate with renal blood flow and improve the criterion for revascularization. This study aimed to investigate RAS parameters independently associated with renal blood flow estimated in contrast-enhanced multidetector computed tomography (CE-MDCT). Methods: Ultrasound Doppler dynamic renal cortical perfusion (dRCP), CE-MDCT with cortical blood flow (CBF), and RAS assessment in the form of cross-sectional area reduction (CSAR), maximal diameter reduction (MaxDR), mean diameter (MeD), and minimal diameter (MinD) were investigated. Results: CBF correlated with CSAR (r = −0.422, p = 0.003), MeD (r = 0.344, p = 0.005) and MinD (r = 0.348, p= 0.005), whereas RCP correlated only with MeD (r = 0.357, p = 0.005) and MinD (r = 0.427, p< 0.001). In multivariable regression, only MeD was independently associated with CBF (R2 = 0.179; p < 0.001), and MeD < 3.5 mm substantially indicated CBF < 175 mL/100 g/min in ROC analysis. Conclusions: The directly measured mean diameter of RAS is independently associated with renal cortex blood flow and is probably a more appropriate parameter for the invasive RAS treatment criterion. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the clinical utility of fully-automated 3D organ segmentation in assessing hepatic steatosis on pre-contrast and post-contrast CT images using magnetic resonance spectroscopy (MRS)-proton density fat fraction (PDFF) as reference standard. Materials and methods: This retrospective study analyzed 362 adult potential living liver donors with abdominal CT scans and MRS-PDFF. Using a deep learning-based tool, mean volumetric CT attenuation of the liver and spleen were measured on pre-contrast (liver(L)_pre and spleen(S)_pre) and post-contrast (L_post and S_post) images. Agreements between volumetric and manual region-of-interest (ROI)-based measurements were assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Diagnostic performances of volumetric parameters (L_pre, liver-minus-spleen (L-S)_pre, L_post, and L-S_post) were evaluated for detecting MRS-PDFF ≥ 5% and ≥ 10% using receiver operating characteristic (ROC) curve analysis and compared with those of ROI-based parameters. Results: Among the 362 subjects, 105 and 35 had hepatic steatosis with MRS-PDFF ≥ 5% and ≥ 10%, respectively. Volumetric and ROI-based measurements revealed ICCs of 0.974, 0.825, 0.992, and 0.962, with mean differences of −4.2 HU, −3.4 HU, −1.2 HU, and −7.7 HU for L_pre, S_pre, L_post, and S_post, respectively. Volumetric L_pre, L-S_pre, L_post, and L-S_post yielded areas under the ROC curve of 0.813, 0.813, 0.734, and 0.817 for MRS-PDFF ≥ 5%; and 0.901, 0.915, 0.818, and 0.868 for MRS-PDFF ≥ 10%, comparable with those of ROI-based parameters (0.735–0.818; and 0.816–0.895, Ps = 0.228–0.911). Conclusion: Automated 3D segmentation of the liver and spleen in CT scans can provide volumetric CT attenuation-based parameters to detect and grade hepatic steatosis, applicable to pre-contrast and post-contrast images. Clinical relevance statement: Volumetric CT attenuation-based parameters of the liver and spleen, obtained through automated segmentation tools from pre-contrast or post-contrast CT scans, can efficiently detect and grade hepatic steatosis, making them applicable for large population data collection. Key Points: • Automated organ segmentation enables the extraction of CT attenuation-based parameters for the target organ. • Volumetric liver and spleen CT attenuation-based parameters are highly accurate in hepatic steatosis assessment. • Automated CT measurements from pre- or post-contrast imaging show promise for hepatic steatosis screening in large cohorts. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic performance of machine learning (ML)–based computed tomography–derived fractional flow reserve (CT-FFR) and cardiac magnetic resonance (MR) perfusion mapping for functional assessment of coronary stenosis. Methods: Between October 2020 and March 2022, consecutive participants with stable coronary artery disease (CAD) were prospectively enrolled and underwent coronary CTA, cardiac MR, and invasive fractional flow reserve (FFR) within 2 weeks. Cardiac MR perfusion analysis was quantified by stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Hemodynamically significant stenosis was defined as FFR ≤ 0.8 or > 90% stenosis on invasive coronary angiography (ICA). The diagnostic performance of CT-FFR, MBF, and MPR was compared, using invasive FFR as a reference. Results: The study protocol was completed in 110 participants (mean age, 62 years ± 8; 73 men), and hemodynamically significant stenosis was detected in 36 (33%). Among the quantitative perfusion indices, MPR had the largest area under receiver operating characteristic curve (AUC) (0.90) for identifying hemodynamically significant stenosis, which is in comparison with ML-based CT-FFR on the vessel level (AUC 0.89, p = 0.71), with comparable sensitivity (89% vs 79%, p = 0.20), specificity (87% vs 84%, p = 0.48), and accuracy (88% vs 83%, p = 0.24). However, MPR outperformed ML-based CT-FFR on the patient level (AUC 0.96 vs 0.86, p = 0.03), with improved specificity (95% vs 82%, p = 0.01) and accuracy (95% vs 81%, p < 0.01). Conclusion: ML-based CT-FFR and quantitative cardiac MR showed comparable diagnostic performance in detecting vessel-specific hemodynamically significant stenosis, whereas quantitative perfusion mapping had a favorable performance in per-patient analysis. Clinical relevance statement: ML-based CT-FFR and MPR derived from cardiac MR performed well in diagnosing vessel-specific hemodynamically significant stenosis, both of which showed no statistical discrepancy with each other. Key Points: • Both machine learning (ML)–based computed tomography–derived fractional flow reserve (CT-FFR) and quantitative perfusion cardiac MR performed well in the detection of hemodynamically significant stenosis. • Compared with stress myocardial blood flow (MBF) from quantitative perfusion cardiac MR, myocardial perfusion reserve (MPR) provided higher diagnostic performance for detecting hemodynamically significant coronary artery stenosis. • ML-based CT-FFR and MPR from quantitative cardiac MR perfusion yielded similar diagnostic performance in assessing vessel-specific hemodynamically significant stenosis, whereas MPR had a favorable performance in per-patient analysis. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is known for its non-invasiveness, fast procedure, and also for providing detailed diagnostic information to physicians. It also utilises low-dose-rate ionising radiation (X-rays) as a source for imaging. Multidetector computed tomography (MDCT) is an advanced system that uses iodinated contrast media for more accurate diagnostic results. Studies suggest using these contrasts will lead to greater radiation adsorption with significant DNA damage. No studies have been taken comparing the physical dose with the biological effect. The present study sheds light on the same by assessing the biological effect of CT with and without contrast intervention. The present study is timebound; thus, 21 participants attending for CT thorax and abdomen with no history of any cancer were included. The same participants underwent both pre-contrast and post-contrast studies. The blood sample was taken before the procedure and used as a control. Physical parameters like DLP and CTDI obtained from the instrument were compared with the MN frequency obtained (CBMN Assay). The study showed a significant increase (p-value < 0.05) in the Physical and MN frequency in the Post-Contrast group compared to the pre-contrast group. Although a positive correlation was observed between pre and post-contrast groups, the results were not found to be statistically significant (p-value < 0.05). The study confirms increased physical dose and MN frequency upon contrast intervention. This study recommends the judicial use of MDCT in disease diagnostics. [ABSTRACT FROM AUTHOR]

This article provides information on the diagnosis and management of pulmonary embolism (PE) for healthcare professionals. It covers the definition, pathophysiology, and risk factors of PE, as well as the clinical presentation and diagnostic evaluation. The article suggests using clinical prediction scores and D-dimer tests to assess the probability of PE and recommends computed tomography pulmonary angiogram (CTPA) as the imaging modality of choice. It also discusses the management of PE, including reperfusion therapy for high-risk cases and anticoagulation therapy for low-risk cases. The article aims to provide a comprehensive approach to the management of PE for frontline clinicians. [Extracted from the article]

Computed tomography (CT) is the primary source of diagnostic radiation in pediatric patients. Patient head size and tissue attenuation are critical factors for estimating CT radiation doses. This study aimed to determine a size-specific dose estimate based on the water-equivalent diameter (SSDEDw) for pediatric CT head examinations, categorized by age group, and to investigate the parameters influencing the SSDEDw. This retrospective analysis included 274 pediatric patients aged 0 to 15 years who underwent non-contrast CT head examinations using an age-based protocol without automatic exposure control systems. The SSDEDw was calculated using the CTDIvol, and the conversion factor was derived from AAPM Report No. 293, based on the water-equivalent diameter (Dw). We found that the SSDEDw of age groups of 0 to 6 months, 6 months to 3 years, 3 to 6 years, 6 to 12 years, and 12 to 15 years were 15.4 (14.8, 15.8), 20.1 (19.6, 20.6), 25.3 (24.6, 25.7), 28.1 (27.3, 28.8), and 35.1 (34.6, 36) mGy, respectively. Age and body weight significantly affected the SSDEDw, with high R-squared values of 0.87 and 0.63, respectively (p < 0.001). The SSDE, particularly when based on the water-equivalent diameter (SSDEDW), is a valuable supplement to the DLP and the CTDIvol as it closely relates to patient dose, especially for pediatric head scans of different patient sizes. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of radiation dose and focal spot size on the image quality of super-resolution deep-learning reconstruction (SR-DLR) in comparison with iterative reconstruction (IR) and normal-resolution DLR (NR-DLR) algorithms for cardiac CT. Catphan-700 phantom was scanned on a 320-row scanner at six radiation doses (small and large focal spots at 1.4–4.3 and 5.8–8.8 mGy, respectively). Images were reconstructed using hybrid-IR, model-based-IR, NR-DLR, and SR-DLR algorithms. Noise properties were evaluated through plotting noise power spectrum (NPS). Spatial resolution was quantified with task-based transfer function (TTF); Polystyrene, Delrin, and Bone-50% inserts were used for low-, intermediate, and high-contrast spatial resolution. The detectability index (d′) was calculated. Image noise, noise texture, edge sharpness of low- and intermediate-contrast objects, delineation of fine high-contrast objects, and overall quality of four reconstructions were visually ranked. Results indicated that among four reconstructions, SR-DLR yielded the lowest noise magnitude and NPS peak, as well as the highest average NPS frequency, TTF50%, d′ values, and visual rank at each radiation dose. For all reconstructions, the intermediate- to high-contrast spatial resolution was maximized at 4.3 mGy, while the lowest noise magnitude and highest d′ were attained at 8.8 mGy. SR-DLR at 4.3 mGy exhibited superior noise performance, intermediate- to high-contrast spatial resolution, d′ values, and visual rank compared to the other reconstructions at 8.8 mGy. Therefore, SR-DLR may yield superior diagnostic image quality and facilitate radiation dose reduction compared to the other reconstructions, particularly when combined with small focal spot scanning. [ABSTRACT FROM AUTHOR]

We report a case of small bowel obstruction (SBO) caused by internal hernia from Meckel's diverticulum (MD). Abdominal CT scan showed an abnormal dilated blind-ending structure in continuity with the distal ileum in the right lower quadrant, suggesting Meckel's diverticulum. MPR images revealed a “double beak-sign” at the point of MD and a collapsed closed loop with mesenteric vessels converging to the diverticulum. Since the patient has no prior history of abdominal surgery, the diagnosis of internal hernia caused by Meckel's diverticulum was considered. On laparoscopic exploration, an abnormal orifice for internal hernia created by adhesion from the tip of Meckel's diverticulum to the adjacent mesentery was revealed, confirming the diagnosis. The patient was discharged after 7 days without postoperative complications. MD-associated internal hernia is a rare cause of small bowel obstruction and should be considered to avoid delay in treatment. Multidetector Computed Tomography (MDCT) is the first-line imaging modality of choice and may offer some suggestive imaging features to make an accurate preoperative diagnosis.

Abstract Background In liver computed tomography (CT), tailoring the contrast injection to the patient’s specific characteristics is relevant for optimal imaging and patient safety. We evaluated a novel algorithm engineered for personalized contrast injection to achieve reproducible liver enhancement centered on 50 HU. Methods From September 2020 to August 31, 2022, CT data from consecutive adult patients were prospectively collected at our multicenter premises. Inclusion criteria consisted of an abdominal CT referral for cancer staging or follow-up. For all examinations, a web interface incorporating data from the radiology information system (patient details and examination information) and radiographer-inputted data (patient fat-free mass, imaging center, kVp, contrast agent details, and imaging phase) were used. Calculated contrast volume and injection rate were manually entered into the CT console controlling the injector. Iopamidol 370 mgI/mL or Iohexol 350 mgI/mL were used, and kVp varied (80, 100, or 120) based on patient habitus. Results We enrolled 384 patients (mean age 61.2 years, range 21.1–94.5). The amount of administered iodine dose (gI) was not significantly different across contrast agents (p = 0.700), while a significant increase in iodine dose was observed with increasing kVp (p

Background/purpose: The use of computed tomography (CT) for craniofacial measurements is common in medical imaging, but concerns about accuracy and reliability persist, especially with different CT technologies. This study assessed the accuracy of twenty-six common measurements on consecutive CT images from the same patients, using multidetector CT (MDCT) and cone-beam CT (CBCT) with two software programs (Amira and Dolphin). Materials and methods: Ten adult subjects with consecutive CBCT scans within one year were randomly selected. Another ten subjects with consecutive MDCT scans were paired with the CBCT group based on age, gender, race, occlusion, and craniofacial pattern. All digital imaging and communications in medicine (DICOM) files were randomly coded and analyzed using the two software programs. Intra-examiner reliability was assessed using the intraclass correlation coefficient. Successive measurement errors from consecutive scans for both imaging modalities and software programs were compared. Results: For most skeletal linear and angular measurements, Dolphin showed greater successive measurement errors compared to Amira. Eight of the 26 common measurements had errors greater than one unit (millimeter or degree). Despite almost perfect intra-examiner reliability for upper airway analysis, average successive measurement errors were notably high, particularly for intraoral and oropharyngeal airway volumes. The successive Dolphin measurement error for oropharyngeal airway volume on CBCT images was over three times that on MDCT images. Conclusion: Given the substantial successive measurement errors observed during consecutive CT scanning for the upper airway, this study does not support the quantitative use of CT for analyzing changes in airway dimensions for research purposes.

Photon counting CT was recently introduced into clinical practice [Rajendran K, Petersilka M, Henning A, Shanblatt ER, Schmidt B, Flohr TG, Ferrero A, Baffour F, Diehn FE, Yu L, Rajiah P, Fletcher JG, Leng S, McCollough CH. First Clinical Photon-counting Detector CT System: Technical Evaluation. Radiology 2022;303(1):130–138. doi: https://doi.org/10.1148/radiol.212579]. Photon counting detectors (PCD) afford better spatial resolution, radiation dose efficiency, and iodine contrast-to-noise than EID-CT [Leng S, Bruesewitz M, Tao S, Rajendran K, Halaweish AF, Campeau NG, Fletcher JG, McCollough CH. Photon-counting Detector CT: System Design and Clinical Applications of an Emerging Technology. Radiographics 2019;39(3):729–743. doi: https://doi.org/10.1148/rg.2019180115); (Leng S, Rajendran K, Gong H, Zhou W, Halaweish AF, Henning A, Kappler S, Baer M, Fletcher JG, McCollough CH. 150-mum Spatial Resolution Using Photon-Counting Detector Computed Tomography Technology: Technical Performance and First Patient Images. Invest Radiol 2018;53(11):655–662. doi: https://doi.org/10.1097/RLI.0000000000000488)(Booij R, van der Werf NR, Dijkshoorn ML, van der Lugt A, van Straten M. Assessment of Iodine Contrast-To-Noise Ratio in Virtual Monoenergetic Images Reconstructed from Dual-Source Energy-Integrating CT and Photon-Counting CT Data. Diagnostics (Basel) 2022;12(6). doi: https://doi.org/10.3390/diagnostics12061467); (Sawall S, Klein L, Amato C, Wehrse E, Dorn S, Maier J, Heinze S, Schlemmer HP, Ziener CH, Uhrig M, Kachelriess M. Iodine contrast-to-noise ratio improvement at unit dose and contrast media volume reduction in whole-body photon-counting CT. Eur J Radiol 2020;126:108909. doi: https://doi.org/10.1016/j.ejrad.2020.108909] while also maintaining multienergy CT (MECT) capabilities[Flohr T, Petersilka M, Henning A, Ulzheimer S, Ferda J, Schmidt B. Photon-counting CT review. Phys Med 2020;79:126–136. doi: https://doi.org/10.1016/j.ejmp.2020.10.030]. This article will review the clinical adoption of PCD-CT including protocol development, clinical applications, clinical integration and workflow considerations. Protocol development is institution specific and involves collaborative decision-making among radiologists, physicists, and technologists. Key PCD clinical applications include radiation exposure reduction, intravenous contrast volume reduction, and improved lesion conspicuity. Patients who would most benefit from these improvements may preferentially be scanned with PCD CT. With numerous available reconstructions, radiologists should be strategic in the series sent to PACS for interpretation and routinely sending spectral series to PACS can facilitate integration with clinical workflow. The Society of Abdominal Radiology PCD Emerging Technology Commission endorsed this article. [ABSTRACT FROM AUTHOR]

Gastric cancer is rising in prevalence associated with high mortality, primarily due to late-stage detection, underscoring the imperative for early and precise diagnosis. Etiology involves an interplay of genetic susceptibilities and environmental factors with a prominent role of Helicobacter pylori infection. Due to its often-delayed symptom presentation, prompt and accurate diagnosis is necessary. A multimodal imaging approach, including endoscopic ultrasound (EUS), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) is critical for accurate staging. Each modality contributes unique advantages and limitations, highlighting the importance of integrating diagnostic strategy. Moreover, multidisciplinary conferences offer a vital collaborative platform, bringing together specialists from diverse fields for treatment planning. This synergistic approach not only enhances diagnostic precision but also improves patient outcome. This review highlights the critical role of imaging in diagnosis, staging, and management and advocates for interdisciplinary collaboration in early detection and comprehensive management of gastric cancer, aiming to reduce mortality. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the image quality of ultra-high-resolution CT (U-HRCT) images reconstructed using an improved deep-learning-reconstruction (DLR) method. Additionally, we assessed the utility of U-HRCT in visualizing gastric wall structure, detecting gastric cancer, and determining the depth of invasion. Methods: Forty-six patients with resected gastric cancer who underwent preoperative contrast-enhanced U-HRCT were included. The image quality of U-HRCT reconstructed using three different methods (standard DLR [AiCE], improved DLR—AiCE-Body Sharp [improved AiCE-BS], and hybrid-IR [AIDR3D]) was compared. Visualization of the gastric wall's three-layered structure in four regions and the visibility of gastric cancers were compared between U-HRCT and conventional HRCT (C-HRCT). The diagnostic ability of U-HRCT with the improved AiCE-BS for determining the depth of invasion of gastric cancers was assessed using postoperative pathology specimens. Results: The mean noise level of U-HRCT with the improved AiCE-BS was significantly lower than that of the other two methods (p < 0.001). The overall image quality scores of the improved AiCE-BS images were significantly higher (p < 0.001). U-HRCT demonstrated significantly better conspicuity scores for the three-layered structure of the gastric wall than C-HRCT in all regions (p < 0.001). In addition, U-HRCT was found to have superior visibility of gastric cancer in comparison to C-HRCT (p < 0.001). The correct diagnostic rates for determining the depth of invasion of gastric cancer using C-HRCT and U-HRCT were 80%. Conclusions: U-HRCT reconstructed with the improved AiCE-BS provides clearer visualization of the three-layered gastric wall structure than other reconstruction methods. It is also valuable for detecting gastric cancer and assessing the depth of invasion. [ABSTRACT FROM AUTHOR]

The article presents a comprehensive review of the diagnosis, surgical treatment, and rehabilitation of patients with complex hand fractures, with a particular focus on phalangeal fractures. It highlights the prevalence of such injuries, especially in low- and middle-income countries, and underscores the significant socio-economic burden they impose due to healthcare costs and loss of productivity. The review compares various diagnostic tools, including conventional radiography, multislice computed tomography, and cone beam computed tomography, emphasizing the latter's potential for reducing radiation exposure while maintaining diagnostic accuracy. It also explores the use of automated diagnostic systems supported by deep learning techniques like convolutional neural networks, though noting their limited clinical application due to cost and accessibility. In terms of treatment, the article discusses both conservative and surgical approaches, with a detailed examination of external fixation methods, particularly the Ilizarov method and newer dynamic distraction external fixators. The Wide-Awake Local Anesthesia No Tourniquet technique is highlighted for its effectiveness and cost-efficiency in surgical settings. Rehabilitation strategies, including mirror therapy, robotic exoskeletons, and the use of 3D printing for customfit splints, are also reviewed, offering insights into improving functional outcomes post-surgery. As a result of the review, it is concluded that despite the availability of various diagnostic and treatment methods, further research is necessary to establish more effective, evidence-based protocols, particularly in resource-limited settings. This review serves as a valuable resource for microsurgeons and healthcare providers, emphasizing the need for continued innovation and research to improve the quality of care for patients with complex hand fractures. [ABSTRACT FROM AUTHOR]

The awareness of anatomical variations of hepatic arteries and celiac trunk is very important in interventional radiology, liver transplant and intra-abdominal oncologic surgeries. Radiology plays an important role in the identification of these variants non-invasively. Digital subtraction angiography was the gold standard for their identification. Computed tomography (CT) angiography non-invasively provides detailed knowledge of various anatomical vascular variations. This pictorial review highlights the role of multidetector computed tomography (MDCT) in the identification of celiac trunk–hepatic arterial system variations and clinical consequences. [ABSTRACT FROM AUTHOR]

Background: Square faces, which are influenced by genetic factors and structural features, are considered undesirable among the Asian population. Surgical interventions, such as mandibular angle reduction, aim to alter these characteristics, though complications may arise. We aimed to investigate the morphology of the mandibular angle and masseter muscle thickness using computed tomography (CT) and to analyze hard and soft tissue correlations to enhance surgical outcomes for patients with square faces. Methods: This retrospective clinical study included 100 Taiwanese patients aged 18–50 years. CT was used to analyze key clinical parameters, including bilateral mandibular width, mandibular divergence angle, ramus height, distance from the mandibular angle to the inferior alveolar nerve (IAN), and the thickness of the masseter muscle. Results: Significant correlations were noted between the patients’ physical height and weight, mandibular width, ramus height, masseter thickness, and distance from the angle to the IAN. Males exhibited a significantly longer and thicker ramus height (66.48 ± 4.28 mm), greater masseter thickness (15.46 ± 2.35 mm), and greater safety range for mandibular angle reduction surgery (18.35 ± 3.19 mm) (p < 0.00008). Significant correlations were observed among all parameters, except between mandibular width and gonial angle and the distance from the angle to the IAN and between mandibular divergence and masseter muscle thickness (p > 0.1). Conclusions: Our study highlighted the complex interplay among factors that contribute to square facial morphology. Careful preoperative assessments and customized surgical planning are essential for addressing this multifaceted clinical challenge.

Introduction: Biomedical models (rapid prototyping) had a vast use in maxillofacial diagnosis and surgeries. Using this technology can lead to improvement in preoperative treatment planning and an increase in surgery quality. In this study, we investigated and compared the models derived from multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) radiography systems. Aim: In this study, we investigated and compared the models derived from MDCT and CBCT radiography systems to see which is the most accurate. Materials and Methods: Five dried human mandibles were chosen in this study. These landmarks were chosen to investigate the reproduction ability: mental foramen, genial tubercle, central incisor, alveolar crest edge to the inferior mandibular border in midline, two bone defects in approximate dimensions of 3 × 3 mm2, first molar socket depth in the mesiobuccal line angle, mesiodistal length of tooth socket bone at the buccal and buccolingual width of tooth socket bone at mesial. Radiographs were taken using one MDCT and two CBCT systems. Then, models were built through a three-dimensional (3D) printer, and the mentioned landmarks were measured using a digital caliper. Data were entered in SPSS version 23 software and were analyzed with the ANOVA and Tukey tests. Results: In the reproduction of superior-inferior dimension and mesiodistal width of all mentioned landmarks, there were no significant differences between models made by data derived from Cranex 3D and NewTom 3G with a small field of view, in comparison with the gold standard (P > 0.05). However, there is a significant difference in the reproduction of landmarks between models made from MDCT and NewTom 3G with a large field of view, in comparison with the gold standard (P < 0.05). Conclusion: Models made from CBCT Devices with a small field of view have an acceptable and reliable accuracy for assessing bone structures. However, for CBCT devices with a large field of view and computed tomography-scan devices, models have less accuracy.