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Individual Optimization of Contrast Media Injection Protocol at Hepatic Dynamic Computed Tomography Using Patient-Specific Contrast Enhancement Optimizer.
Matsumoto, Y, Higaki, T, Arataki, K, Masuda, T, Sato, T, Fukumoto, W, Nakamura, Y, Tatsugami, F, Awai, K
Journal of computer assisted tomography. 2020;(2):230-235
Abstract
OBJECTIVE We developed a patient-specific contrast enhancement optimizer (p-COP) that can exploratorily calculate the contrast injection protocol required to obtain optimal enhancement at target organs using a computer simulator. Appropriate contrast media dose calculated by the p-COP may minimize interpatient enhancement variability. Our study sought to investigate the clinical utility of p-COP in hepatic dynamic computed tomography (CT). METHODS One hundred thirty patients (74 men, 56 women; median age, 65 years) undergoing hepatic dynamic CT were randomly assigned to 1 of 2 contrast media injection protocols using a random number table. Group A (n = 65) was injected with a p-COP-determined iodine dose (developed by Higaki and Awai, Hiroshima University, Japan). In group B (n = 65), a standard protocol was used. The variability of measured CT number (SD) between the 2 groups of aortic and hepatic enhancement was compared using the F test. In the equivalence test, the equivalence margins for aortic and hepatic enhancement were set at 50 and 10 Hounsfield units (HU), respectively. The rate of patients with an acceptable aortic enhancement (250-350 HU) for the diagnosis of hypervascular liver tumors was compared using the χ test. RESULTS The mean ± SD values of aortic and hepatic enhancement were 311.0 ± 39.9 versus 318.7 ± 56.5 and 59.0 ± 11.5 versus 58.6 ± 11.8 HU in groups A and B, respectively. Although the SD for aortic enhancement was significantly lower in group A (P = 0.006), the SD for hepatic enhancement was not significantly different (P = 0.871). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 groups was within the range of the equivalence margins. The number of patients with acceptable aortic enhancement was significantly greater in group A than in group B (P < 0.01). CONCLUSIONS The p-COP software reduced interpatient variability in aortic enhancement and obtained acceptable aortic enhancement at a significantly higher rate compared with the standard injection protocol for hepatic dynamic CT.
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Iodine dose optimization in portal venous phase virtual monochromatic images of the abdomen: Prospective study on rapid kVp switching dual energy CT.
Noda, Y, Goshima, S, Nakashima, Y, Miyoshi, T, Kawai, N, Kambadakone, A, Matsuo, M
European journal of radiology. 2020;:108746
Abstract
PURPOSE To investigate iodine dose concentration required for adequate hepatic parenchymal enhancement on fast-kilovoltage-switching dual-energy computed tomography (DECT) of the abdomen based on patient body weight. MATERIALS AND METHODS The protocol of this prospective study was approved by the local Institutional Review Board and written informed consent for study participation was obtained from all patients. The study cohort of 204 consecutive patients who underwent whole body single-source DECT to screen for tumor metastases and/or recurrence after surgical resection of malignant tumors were randomly assigned to one of three protocols according to the iodine dose (400, 500, and 600 mgI/kg). For each case, two radiologists quantitatively and qualitatively reviewed three energy levels (65, 70, and 75 kilo electron volt [keV]) of the portal venous phase virtual monochromatic images (VMIs). CT numbers of the liver and the qualitative hepatic parenchymal enhancement were compared among the VMIs with the three protocols and three energy levels. RESULTS Hepatic enhancement (ΔHU > 50HU) was achieved at 65 keV with 400, 500, and 600 mgI/kg, at 70 keV with 500 and 600 mgI/kg, and at 75 keV with 600 mgI/kg. The hepatic parenchymal enhancement was graded as sufficient hepatic enhancement in 97%, 100%, and 99% at 65 keV with 400, 500, and 600 mgI/kg, 88% and 97% at 70 keV with 500 and 600 mgI/kg, and 84% at 75 keV with 600 mgI/kg, respectively. CONCLUSION The iodine dose can be reduced to 400 mgI/kg at 65 keV or 500 mgI/kg at 70 keV in DECT without compromising hepatic parenchymal enhancement.
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Contrast Material Injection Protocol With the Dose Determined According to Lean Body Weight at Hepatic Dynamic Computed Tomography: Comparison Among Patients With Different Body Mass Indices.
Matsumoto, Y, Masuda, T, Sato, T, Arataki, K, Nakamura, Y, Tatsugami, F, Awai, K
Journal of computer assisted tomography. 2019;(5):736-740
Abstract
OBJECTIVE The objective of this study was to compare enhancement of the aorta and liver on hepatic dynamic computed tomography scans acquired with contrast material doses based on the lean body weight (LBW) or the total body weight (TBW). METHODS We randomly divided 529 patients (279 men, 250 women; median age, 66 years) scheduled for hepatic dynamic computed tomography into 2 groups. The LBW patients (n = 278) were injected with 679 mg iodine/kg (men) or 762 mg iodine/kg (women). The TBW group (n = 251) was injected with 600 mg iodine/kg TBW. Each group was subdivided into the 3 classes based on the body mass index (BMI; low, normal, high). Aortic enhancement during the hepatic arterial phase and hepatic enhancement during the portal venous phase was compared. The aortic and hepatic equivalence margins were 100 and 20 Hounsfield units, respectively. RESULTS Comparison of the median iodine dose in patients with a normal or high BMI showed that it was significantly lower under the LBW protocol than the TBW protocol (558.2 and 507.0 mg iodine/kg, P < 0.001, respectively). However, in patients with a low BMI, the LBW protocol delivered a significantly higher dose than the TBW protocol (620.7 vs 600.0 mg iodine/kg, P < 0.001). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 protocols was within the range of the predetermined equivalence margins in all BMI subgroups. CONCLUSIONS Contrast enhancement was equivalent under both protocols. The LBW protocol can avoid iodine overdosing, especially in patients with a high BMI.
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The prognostic value of early onset, CT derived loss of muscle and adipose tissue during chemotherapy in metastatic non-small cell lung cancer.
Degens, JHRJ, Sanders, KJC, de Jong, EEC, Groen, HJM, Smit, EF, Aerts, JG, Schols, AMWJ, Dingemans, AC
Lung cancer (Amsterdam, Netherlands). 2019;:130-135
Abstract
OBJECTIVES To evaluate the relationship between early changes in muscle and adipose tissue during chemotherapy and overall survival (OS) in stage IV non-small cell lung cancer (NSCLC). MATERIALS AND METHODS In this post-hoc analysis of the first line NVALT12 trial (NCT01171170) in stage IV NSCLC, skeletal muscle (SM), radiation attenuation (RA), subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were assessed at the third lumbar level on CT-images obtained before initiation of chemotherapy and shortly after administration of the second cycle. The contribution of changes in different body compartments to overall survival was assessed. RESULTS CT scans of 111 patients were included. Analysis of body composition changes between the baseline and the follow-up scan, revealed that overall SM cross sectional area (CSA), radiation attenuation and SAT CSA decreased respectively by -1.2 ± 2.9 cm2/m2 (p < 0.001), -0.7 ± 3.3 HU (p = 0.026) and -1.9 ± 8.7 cm2/m2 (p = 0.026), while no significant changes in VAT tissue were observed. Longitudinally, median OS was significantly shorter among patients losing SM compared to patients with preserved SM (9.4 versus 14.2 months; HR 1.9, 95% CI: 1.23, 2.79, p = 0.003). Multivariate analyses showed that proportional loss of muscle mass was associated with poor OS (HR 0.949, 95% CI: 0.915, 0.985, p = 0.006) independent from important clinical prognostic factors including WHO-PS, gender, age and Charlson comorbidity index. CONCLUSION Early loss of SM during first line chemotherapy is a poor prognostic factor in stage IV NSCLC patients. Future studies have to reveal whether early supportive intervention guided by initial CT muscle response to chemotherapy can influence the wasting process and related mortality risk.
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Can radiomics help to predict skeletal muscle response to chemotherapy in stage IV non-small cell lung cancer?
de Jong, EEC, Sanders, KJC, Deist, TM, van Elmpt, W, Jochems, A, van Timmeren, JE, Leijenaar, RTH, Degens, JHRJ, Schols, AMWJ, Dingemans, AC, et al
European journal of cancer (Oxford, England : 1990). 2019;:107-113
Abstract
BACKGROUND Muscle depletion negatively impacts treatment efficacy and survival rates in cancer. Prevention and timely treatment of muscle loss require prediction of patients at risk. We aimed to investigate the potential of skeletal muscle radiomic features to predict future muscle loss. METHODS A total of 116 patients with stage IV non-small cell lung cancer included in a randomised controlled trial (NCT01171170) studying the effect of nitroglycerin added to paclitaxel-carboplatin-bevacizumab were enrolled. In this post hoc analysis, muscle cross-sectional area and radiomic features were extracted from computed tomography images obtained before initiation of chemotherapy and shortly after administration of the second cycle. For internal cross-validation, the cohort was randomly split in a training set and validation set 100 times. We used least absolute shrinkage and selection operator method to select features that were most significantly associated with muscle loss and an area under the curve (AUC) for model performance. RESULTS Sixty-nine patients (59%) exhibited loss of skeletal muscle. One hundred ninety-three features were used to construct a prediction model for muscle loss. The average AUC was 0.49 (95% confidence interval [CI]: 0.36, 0.62). Differences in intensity and texture radiomic features over time were seen between patients with and without muscle loss. CONCLUSIONS The present study shows that skeletal muscle radiomics did not predict future muscle loss during chemotherapy in non-small cell lung cancer. Differences in radiomic features over time might reflect myosteatosis. Future imaging analysis combined with muscle tissue analysis in patients and in experimental models is needed to unravel the biological processes linked to the radiomic features.
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Prognostic value of radiologically enlarged lymph nodes in patients with metastatic colorectal cancer: Subgroup findings of the randomized, open-label FIRE-3/AIO KRK0306 trial.
Hofmann, FO, Holch, JW, Heinemann, V, Ricard, I, Reiser, MF, Baumann, AB, Hesse, N, D'Anastasi, M, Modest, DP, Stintzing, S, et al
European journal of radiology. 2018;:124-129
Abstract
PURPOSE To determine the prognostic impact of radiologically enlarged lymph nodes ≥ 10 mm on the survival of patients with metastatic colorectal cancer. MATERIALS AND METHODS The prospective, randomized, open-label FIRE-3/AIO KRK0306 trial evaluated the first-line therapy of patients with KRAS exon 2 wild-type metastatic colorectal cancer with fluorouracil, folinic acid and irinotecan plus either cetuximab or bevacizumab. In the RAS wild-type population (n = 400), adequately evaluable baseline computed tomographies (n = 339) were reviewed for enlarged regional and distant lymph nodes. Their prognostic relevance was retrospectively analyzed in uni- and multivariable Cox proportional hazard regressions. RESULTS Median overall survival was 21.7 months in patients with enlarged lymph nodes and 33.2 months in patients without (hazard rate ratio [HR] = 1.61, 95% confidence interval [CI], 1.23-2.09; P < 0.001). This was confirmed in multivariable analysis (HR = 1.37, 95% CI, 1.02-1.83; P = 0.036). Progression-free survival of patients with enlarged lymph nodes showed a consistent but insignificant trend (9.9 vs. 11.1 months; HR = 1.23, 95% CI, 0.98-1.54; P = 0.072). Enlarged lymph nodes were also associated with BRAF-mutations (P = 0.004). CONCLUSION The presence of radiologically enlarged lymph nodes in baseline staging has a negative prognostic value beyond established and potential prognostic parameters.
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Automatic spectral imaging protocol and iterative reconstruction for radiation dose reduction in typical hepatic hemangioma computed tomography with reduced iodine load: a preliminary study.
Li, W, Li, A, Wang, B, Niu, X, Cao, X, Wang, X, Shi, H
The British journal of radiology. 2018;(1087):20170978
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Abstract
OBJECTIVE To evaluate the effect of automatic spectral imaging protocol selection (ASIS) and adaptive statistical iterative reconstruction (ASiR) technique in the reduction of radiation and contrast medium dose in typical hepatic hemangioma (HH) dual energy spectral CT (DEsCT). METHODS 62 patients with suspected HH were randomly divided into two groups equally: Group A, conventional 120-kVp CT with standard iodine load; Group B, DEsCT with ASIS technique and reduced iodine load, two sets of monochromatic spectral images were reconstructed: 69 keV level with 30% ASiR (Group B1) and 52 keV level with 50% ASiR (Group B2). The radiation and total iodine dose, quantitative analysis (standard deviation value, contrast-to-noise and contrast enhancement ratio) and qualitative analysis were evaluated. RESULTS No difference was observed in the standard deviation values, subjective image noise, and the diagnostic acceptability score among the three groups (p > 0.05). Contrast to noise [Group B2 vs A, B1 in arterial phase (AP): 19.51 ± 6.29 vs 15.77 ± 5.93, 11.46 ± 2.84; Group B2 vs A, B1 in portal venous phase (PVP): 9.96 ± 2.18 vs 8.19 ± 3.04, 6.01 ± 1.82], contrast enhancement ratio (Group B2 vs A, B1 in AP: 6.88 ± 2.01 vs 5.47 ± 2.01, 4.15 ± 1.28; Group B2 vs A, B1 in PVP: 5.58 ± 1.02 vs 4.54 ± 1.13, 3.49 ± 0.83), and the lesion conspicuity score (Group B2 vs A, B1 in AP: 3.93 ± 0.26 vs 3.45 ± 0.51, 3.10 ± 0.49; Group B2 vs A, B1 in PVP: 3.90 ± 0.31 vs 3.48 ± 0.57, 3.14 ± 0.44) for Group B2 were higher than those in Group A and B1 (p < 0.05). Compared to Group A, the radiation dose and total iodine dose in Group B were reduced by 30 and 41%, respectively (radiation dose in Group B vs A: 5.53 ± 1.59 vs 7.91± 2.71 mSv; iodine dose in Group B vs A: 18.85 ± 2.88 vs 31.78±3.89 ml; p < 0.05). CONCLUSION DEsCT with ASIS and ASiR technique can reduce the radiation dose without image quality degradation as compared to the conventional 120-kVp CT. The monochromatic spectral images at 52 keV level with 50% ASiR allows the reduction in total iodine dose without deteriorating diagnostic performance. Advances in knowledge: ASIS combined with ASiR technique, by using monochromatic spectral images at 52 keV level, represents a feasible imaging protocol to reduce the radiation and total iodine dose in assessment of typical HH.
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Dual-Energy CT in Differentiating Nonperforated Gangrenous Appendicitis From Uncomplicated Appendicitis.
Elbanna, KY, Mohammed, MF, Chahal, T, Khosa, F, Ali, IT, Berger, FH, Nicolaou, S
AJR. American journal of roentgenology. 2018;(4):776-782
Abstract
OBJECTIVE The hypothesis of this study was that the use of dual-energy spectral techniques in CT can improve accuracy in the diagnosis of acute gangrenous appendicitis. MATERIALS AND METHODS This retrospective study included 209 patients with a pathologic diagnosis of appendicitis. Two board-certified abdominal radiologists reviewed 120-kV simulated images, 40-keV virtual monoenergetic images, and color-coded iodine overlay images. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, and interobserver agreement were calculated for each set of images. RESULTS Forty-four patients (21.0%) had histopathologic results positive for gangrenous appendicitis. The sensitivity of 40-kV virtual monoenergetic imaging was 100% (44/44); specificity, 81.2% (134/165); PPV, 58.7% (44/75); NPV, 100% (134/134); accuracy, 85.2%; and interobserver agreement, 0.99. The corresponding values for the iodine overlay imaging datasets were 100% (44/44), 80.0% (132/165), 57.1% (44/77), 100% (132/132), 84.2%, and 0.99 and for 120-kV simulated imaging were 22.7% (10/44), 96.4% (159/165), 62.5% (10/16), 82.4% (159/193), 77.5%, and 0.93. All cases of gangrenous appendicitis had true-positive results of virtual monoenergetic and iodine overlay imaging. There were no false-negative results of virtual monoenergetic or iodine overlay imaging. CONCLUSION In cases of suspected appendicitis, dual-energy CT that includes virtual monoenergetic and iodine overlay imaging is accurate for confirming and excluding the presence of gangrenous appendicitis with high sensitivity and specificity.
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Efficacy and safety of a balanced salt solution versus a 0.9% saline infusion for the prevention of contrast-induced acute kidney injury (BASIC trial): a study protocol for a randomized controlled trial.
Jo, HA, Park, S, Kim, CD, Jung, HY, Cho, JH, Cha, RH, Kang, EW, Chang, TI, Kim, S, Kim, HJ, et al
Trials. 2017;(1):461
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of iatrogenic kidney injury and, therefore, its prevention is an important issue. However, whether the administration of 0.9% saline is the optimal prophylaxis method remains uncertain due to its supra-physiologic chloride component. In particular, recent studies suggest that chloride-restricted solutions showed superiority over 0.9% saline in several clinical settings. METHODS/DESIGN The investigators designed a multicenter randomized controlled trial to compare the efficacy of a balanced salt solution and 0.9% saline in CI-AKI prophylaxis. This study will recruit patients who are scheduled for contrast-enhanced computed tomography (CT) scans with CI-AKI prophylaxis. In this study, participants will be randomized into two study arms; the study group will receive a balanced salt solution, and the control group will receive 0.9% saline. Fluids will be administered as designated in the protocol before and after the CT scan, and an evaluation of baseline clinical status will be performed by obtaining blood and urine samples. During the follow-up visits, the incidence of CI-AKI and long-term outcomes, including the start of renal replacement therapy or all-cause mortality, will be assessed. DISCUSSION To our knowledge, this study will be the first study assessing the preventive value of a balanced salt solution over 0.9% saline for CI-AKI. If the trial shows that the balanced salt solution is as effective for CI-AKI prophylaxis as 0.9% saline, the use of the balanced salt solution could be promoted due to the reduced possibility of consequent metabolic acidosis compared to 0.9% saline. TRIALS REGISTRATION ClinicalTrials.gov, ID: NCT02799368 . Registered on 14 June 2016.
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Evaluation of the ablation margin of hepatocellular carcinoma using CEUS-CT/MR image fusion in a phantom model and in patients.
Li, K, Su, Z, Xu, E, Huang, Q, Zeng, Q, Zheng, R
BMC cancer. 2017;(1):61
Abstract
BACKGROUND To assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients. METHODS Twenty-four phantoms were randomly divided into a complete ablation group (n = 6) and an incomplete ablation group (n = 18). After radiofrequency ablation (RFA), the AM was evaluated using ultrasound (US)-CT image fusion, and the results were compared with the AM results that were directly measured in a gross specimen. CEUS-CT/MR image fusion and CT-CT / MR-MR image fusion were used to evaluate the AM in 37 tumors from 33 HCC patients who underwent RFA. RESULTS The sensitivity, specificity, and accuracy of US-CT image fusion for evaluating AM in the phantom model were 93.8, 85.7 and 91.3%, respectively. The maximal thicknesses of the residual AM were 3.5 ± 2.0 mm and 3.2 ± 2.0 mm in the US-CT image fusion and gross specimen, respectively. No significant difference was observed between the US-CT image fusion and direct measurements of the AM of HCC. In the clinical study, the success rate of the AM evaluation was 100% for both CEUS-CT/MR and CT-CT/MR-MR, and the duration was 8.5 ± 2.8 min (range: 4-12 min) and 13.5 ± 4.5 min (range: 8-16 min) for CEUS-CT/MR and CT-CT/MR-MR, respectively. The sensitivity, specificity, and accuracy of CEUS-CT/MR imaging for evaluating the AM were 100.0, 80.0, and 90.0%, respectively. CONCLUSIONS A phantom model composed of carrageenan gel and additives was suitable for the evaluation of HCC AM. CEUS-CT/MR image fusion can be used to evaluate HCC AM with high accuracy.