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1.
Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome: Part II Noncardiovascular Findings.
Nattenmüller, J, Schlett, CL, Tsuchiya, N, Reeder, SB, Pickhardt, PJ, Kramer, H, Kauczor, HU, Wielpütz, MO, Seo, JB, Hatabu, H, et al
Journal of thoracic imaging. 2019;(2):126-135
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Abstract
The purpose of this review article is to acquaint the reader with the current state of the art for the noncardiovascular imaging biomarkers of metabolic syndrome found on noncontrast computed tomography (NCCT) of the chest and their prognostic significance. Routine chest NCCT includes quantitative information with regard to tissue density and organ volumes in the neck, chest, and upper abdomen. The specific imaging biomarkers that may be seen in association with metabolic syndrome include low thyroid iodine organification, hepatic steatosis, sarcopenia (muscle volume and density), demineralization of the thoracic and upper lumbar vertebral bodies, loss of axial skeletal muscle mass, premature lung inflammation, and an increased deposition of subcutaneous and visceral fat. These easily identified imaging biomarkers can have prognostic implications, which include nonalcoholic steatohepatitis, cirrhosis, hypothyroidism, early lung fibrosis with interstitial abnormalities, sarcopenia, and osteoporotic thoracic and lumbar spine vertebral body compression fractures. NCCT examinations of the chest have the opportunity to become an important imaging tool for outcomes research.
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Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos.
Maisonneuve, P, Rampinelli, C, Bertolotti, R, Misotti, A, Lococo, F, Casiraghi, M, Spaggiari, L, Bellomi, M, Novellis, P, Solinas, M, et al
Lung cancer (Amsterdam, Netherlands). 2019;:23-30
Abstract
OBJECTIVES Smoking is the main risk factor for lung cancer, but environmental and occupational exposure to carcinogens also increase lung cancer risk. We assessed whether extending low-dose computed tomography (LDCT) screening to persons with occupational exposure to asbestos may be an effective way reducing lung cancer mortality. MATERIALS AND METHODS We conducted a nested case-control study within the COSMOS screening program, assessing past asbestos exposure with a questionnaire. LDCT scans of asbestos-exposed participants were reviewed to assess the presence of pulmonary, interstitial and pleural alterations in comparison to matched unexposed controls. We also performed an exhaustive review, with meta-analysis, of the literature on LDCT screening in asbestos-exposed persons. RESULTS Exposure to asbestos, initially self-reported by 9.8% of COSMOS participants, was confirmed in 216 of 544 assessable cases, corresponding to 2.6% of the screened population. LDCT of asbestos-exposed persons had significantly more pleural plaques, diaphragmatic pleural thickening and pleural calcifications, but similar frequency of parenchymal and interstitial alterations to unexposed persons. From 16 papers, including this study, overall lung cancer detection rates at baseline were 0.81% (95% CI 0.50-1.19) in asbestos-exposed persons, 0.94% (95% CI 0.47-1.53) in asbestos-exposed smokers (12 studies), and 0.11% (95% CI 0.00-0.43) in asbestos-exposed non-smokers (9 studies). CONCLUSION Persons occupationally exposed to asbestos should be monitored to gather more information about risks. Although LDCT screening is effective in the early detection lung cancer in asbestos-exposed smokers, our data suggest that screening of asbestos-exposed persons with no additional risk factors for cancer does is not viable due to the low detection rate.
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Role of dual energy CT to improve diagnosis of non-traumatic abdominal vascular emergencies.
Shaqdan, KW, Parakh, A, Kambadakone, AR, Sahani, DV
Abdominal radiology (New York). 2019;(2):406-421
Abstract
Computed tomography angiography (CTA) is the modality of choice to evaluate abdominal vascular emergencies (AVE). CTA protocols are often complex and require acquisition of multiple phases to enable a variety of diagnosis such as acute bleeding, pseudoaneurysms, bowel ischemia, and dissection. With single energy CT (SECT), differentiating between calcium, coagulated blood, and contrast agents can be challenging based on their attenuation, especially when in small quantity or present as a mixture. With dual-energy CT (DECT), virtual monoenergetic (VM) and material decomposition (MD) image reconstructions enable more robust tissue characterization, improve contrast-enhancement, and reduce beam hardening artifacts. This article will demonstrate how radiologists can utilize DECT for various clinical scenarios in assessment of non-traumatic AVE.
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Current technologies in body composition assessment: advantages and disadvantages.
Ceniccola, GD, Castro, MG, Piovacari, SMF, Horie, LM, Corrêa, FG, Barrere, APN, Toledo, DO
Nutrition (Burbank, Los Angeles County, Calif.). 2019;:25-31
Abstract
The interest in non-invasive methods of body composition assessment is on the rise in health care, especially because of its association with clinical outcomes. Technology has revolutionized our understanding of body composition abnormalities, clinical prognostication, and disease follow-up, but translation to bedside is limited, especially in terms of cost effectiveness. Computed tomography gained increased attention in cancer and sarcopenia studies, for instance. Other methods also have interesting features and applications, including bedside ultrasonography, bioelectrical impedance analysis, and dual x-ray absorptiometry. Compelling evidence indicates these methods can be used to accurately and precisely measure skeletal muscle mass, adipose tissue, and edema; diagnose malnutrition-related diseases; and aid in determining prognoses. To apply this technology properly, it is important to understand the advantages and disadvantages of each technique in specific situations of interest. This review introduces concepts and reference studies published in the scientific literature about these techniques and describes important limitations and considerations necessary to incorporate these methods into clinical practice.
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Evaluation and Management of Enterocutaneous Fistula.
Bhama, AR
Diseases of the colon and rectum. 2019;(8):906-910
Abstract
A 36-year-old woman presents with an abscess at her midline wound 4 weeks following an ileocecectomy for Crohn's disease. After the abscess is incised, there is purulent drainage followed by the drainage of enteric contents; the output is 750 mL per 24 hours.
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Superior mesenteric artery syndrome: a radiographic review.
Warncke, ES, Gursahaney, DL, Mascolo, M, Dee, E
Abdominal radiology (New York). 2019;(9):3188-3194
Abstract
PURPOSE To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. METHODS A literature review of 24 relevant articles regarding SMA syndrome was performed. RESULTS Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. CONCLUSION SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.
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Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography.
Pedrosa, JF, Barreto, SM, Bittencourt, MS, Ribeiro, ALP
Current atherosclerosis reports. 2019;(12):51
Abstract
PURPOSE OF REVIEW Thoracic aortic calcium (TAC) has received some interest in recent studies as an important subclinical marker of atherosclerosis. Besides that, using computed tomography (CT) scans performed with cardiac or chest protocols, ECG-gated, or non-gated, TAC can be easily evaluated with no addition in radiation dose. This review discusses the particularities of the aortic wall calcium formation, as well as the differences between the aortic segments and summarizes the current status of TAC evaluation, mainly concerning the anatomical references used in the studies. RECENT FINDINGS The studies have evaluated TAC considering different anatomical references. It was identified two different study groups. In the first one, researchers have analyzed the aorta as the sum of calcium in the ascending aorta (ATAC), aortic arch (AAC), and descending thoracic aorta (DTAC). The second group has used cardiac CT scans to assess TAC; therefore, they did not include AAC; however, the aortic root calcium (ARC) was added in the analysis. So, caution is advisable when interpreting and comparing studies that used different TAC anatomical references. The broad methodological variability, in addition to the variations in the population characteristics of the studies on TAC, may be in part contributing to the differences between results of different studies. Currently TAC does not have a role in clinical decisions, so it is necessary to create a standard protocol for the aortic calcium research as well as exists for the coronary artery calcium evaluation.
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Calcium Scoring for Cardiovascular Computed Tomography: How, When and Why?
Carr, JJ
Radiologic clinics of North America. 2019;(1):1-12
Abstract
Cardiovascular disease is the leading cause of death in the United States and worldwide. Despite major advances in the treatment of acute myocardial infarction, enhanced prevention of ischemic heart disease remains critical to improving the health of individuals and communities. The computed tomographic coronary artery calcium score is an established imaging biomarker that identifies the presence and amount of coronary atherosclerosis in an individual and their future risk for clinical cardiovascular disease and premature cardiovascular death. This article describes the process of performing a computed tomography scan for coronary artery calcium, quantifying the score and interpreting the results.
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124I Positron Emission Tomography/Computed Tomography Versus Conventional Radioiodine Imaging in Differentiated Thyroid Cancer: A Review.
Wu, D, Ylli, D, Heimlich, SL, Burman, KD, Wartofsky, L, Van Nostrand, D
Thyroid : official journal of the American Thyroid Association. 2019;(11):1523-1535
Abstract
Background: Studies report a wide spectrum of 124I positron emission tomography (PET)/computed tomography (CT) sensitivity and specificity in the detection of differentiated thyroid cancer (DTC) lesions. This study reviews the lesion detection rate of pretherapy 124I PET/CT in different patient populations and further analyzes the factors necessary for a better detection on 124I PET/CT. Methods: A literature search was performed using multiple different databases (MEDLINE, EMBASE, Northern Lights, and handsearching) covering 1996 to April 2018. Two reviewers reviewed and extracted study data for 124I, 123I, and 131I scans in DTC. Results: This review includes 4 retrospective and 10 prospective studies in which 495 DTC patients underwent 124I and 131I imaging; no studies made comparisons with 123I. In the reports that compared 124I PET/CT with diagnostic 131I scans, there were a total of 72 patients in whom 120 lesions were detected on 124I imaging, whereas only 52 were detected on diagnostic 131I scans. In publications that compared 124I with post-therapy 131I scans in 266 patients, 410 lesions were detected with 124I PET, whereas 390 were detected on post-therapy 131I scans. Based on 124I PET/CT in six studies, TNM staging was revised in 15-21% of patients, and disease management was altered in 5-29% of patients. Conclusions:124I PET/CT is able to identify a greater number of foci compared with diagnostic 131I scans. 124I PET may have better detection compared with post-therapy 131I scans in patients who are 131I therapy naive, have less aggressive pathology, or do not have disseminated lung metastases. Additional metastatic lesion detection by 124I PET may have a significant clinical impact in the management of patients before 131I therapy in some patients.
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Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT.
Albrecht, MH, Vogl, TJ, Martin, SS, Nance, JW, Duguay, TM, Wichmann, JL, De Cecco, CN, Varga-Szemes, A, van Assen, M, Tesche, C, et al
Radiology. 2019;(2):260-271
Abstract
In this article, the authors discuss the technical background and summarize the current body of literature regarding virtual monoenergetic (VM) images derived from dual-energy CT data, which can be reconstructed between 40 and 200 keV. Substantially improved iodine attenuation at lower kiloelectron volt levels and reduced beam-hardening artifacts at higher kiloelectron volt levels have been demonstrated from all major manufacturers of dual-energy CT units. Improved contrast attenuation with VM imaging at lower kiloelectron volt levels enables better delineation and diagnostic accuracy in the detection of various vascular or oncologic abnormalities. Low-kiloelectron-volt VM imaging may be useful for salvaging CT studies with suboptimal contrast material delivery or providing additional information on the arterial vasculature obtained from venous phase acquisitions. For patients with renal impairment, substantial reductions in the use of iodinated contrast material can be achieved by using lower-energy VM imaging. The authors recommend routine reconstruction of VM images at 50 keV when using dual-energy CT to exploit the increased contrast properties. For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment.