-
1.
Dual-Energy CT Perfusion of Invasive Tumor Front in Non-Small Cell Lung Cancers.
Dewaguet, J, Copin, MC, Duhamel, A, Faivre, JB, Deken, V, Sedlmair, M, Flohr, T, Schmidt, B, Cortot, A, Wasielewski, E, et al
Radiology. 2022;(2):448-456
Abstract
Background Active endothelial cell proliferation occurs at the tumor edge, known as the invading-tumor front. This study focused on perfusion analysis of non-small cell lung cancers. Purpose To analyze dual-phase, dual-energy CT perfusion according to the degree of tumor hypoxia. Materials and Methods This prospective study was performed 2016-2017. A two-phase dual-energy CT protocol was obtained for consecutive participants with operable non-small cell lung cancer. The first pass and delayed iodine concentration within the tumor and normalized iodine uptake, corresponding to the iodine concentration within the tumor normalized to iodine concentration within the aorta, were calculated for the entire tumor and within three peripheral layers automatically segmented (ie, 2-mm-thick concentric subvolumes). The expression of the membranous carbonic anhydrase (mCA) IX, a marker of tumor hypoxia, was assessed in tumor specimens. Comparative analyses according to the histologic subtypes, type of resected tumors, and mCA IX expression were performed. Results There were 33 mCA IX-positive tumors and 16 mCA IX-negative tumors. In the entire tumor, the mean normalized iodine uptake was higher on delayed than on first-pass acquisitions (0.35 ± 0.17 vs 0.13 ± 0.15, respectively; P < .001). A single layer, located at the edge of the tumor, showed higher values of the iodine concentration (median, 0.53 mg/mL vs 0.21 mg/mL, respectively; P = .03) and normalized iodine uptake (0.04 vs 0.02, respectively; P = .03) at first pass in mCA IX-positive versus mCA IX-negative tumors. Within this layer, a functional profile of neovascularization was found in 23 of 33 (70%) of mCA IX-positive tumors, and the median mCA IX score of these tumors was higher than in tumors with a nonfunctional profile of neovascularization (median mCA IX score, 20 vs 2, respectively; P = .03). Conclusion A two-phase dual-energy CT examination depicted higher perfusion between the tumor edge and lung parenchyma in hypoxic tumors. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Murphy and Ryan in this issue.
-
2.
The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients.
Besutti, G, Pellegrini, M, Ottone, M, Cantini, M, Milic, J, Bonelli, E, Dolci, G, Cassone, G, Ligabue, G, Spaggiari, L, et al
PloS one. 2021;(5):e0251768
Abstract
We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.
-
3.
CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19.
Schiaffino, S, Albano, D, Cozzi, A, Messina, C, Arioli, R, Bnà, C, Bruno, A, Carbonaro, LA, Carriero, A, Carriero, S, et al
Radiology. 2021;(2):E328-E336
-
-
Free full text
-
Abstract
Background Lower muscle mass is a known predictor of unfavorable outcomes, but its prognostic impact on patients with COVID-19 is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in patients with COVID-19. Materials and Methods Clinical or laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. The extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation by paravertebral muscles were measured on axial CT images at the T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation of odds ratios (ORs) with 95% CIs, were used to build four models to predict ICU admission and death, which were tested and compared by using receiver operating characteristic curve analysis. Results A total of 552 patients (364 men and 188 women; median age, 65 years [interquartile range, 54-75 years]) were included. In a CT-based model, lower-than-median T5 paravertebral muscle areas showed the highest ORs for ICU admission (OR, 4.8; 95% CI: 2.7, 8.5; P < .001) and death (OR, 2.3; 95% CI: 1.0, 2.9; P = .03). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle areas still showed the highest ORs for both ICU admission (OR, 4.3; 95%: CI: 2.5, 7.7; P < .001) and death (OR, 2.3; 95% CI: 1.3, 3.7; P = .001). At receiver operating characteristic analysis, the CT-based model and the model including clinical variables showed the same area under the receiver operating characteristic curve (AUC) for ICU admission prediction (AUC, 0.83; P = .38) and were not different in terms of predicting death (AUC, 0.86 vs AUC, 0.87, respectively; P = .28). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT images was independently associated with intensive care unit admission and in-hospital mortality. © RSNA, 2021 Online supplemental material is available for this article.
-
4.
Thoracoscopic Localization of Small Peripheral Pulmonary Lesions Using Percutaneous Computed Tomography-guided Pleural Dye Marking: A Retrospective Analysis.
Kubo, Y, Watanabe, M, Choshi, H, Matsubara, K, Shiotani, T, Kataoka, K
Acta medica Okayama. 2021;(1):55-61
Abstract
Small pulmonary lesions are often difficult to localize during thoracoscopic surgery. We describe a new com-puted tomography (CT)-guided pleural dye-marking method for small peripheral pulmonary lesions that does not involve a visceral pleural puncture. We used this technique for 23 lesions (22 patients) who underwent tho-racoscopic partial lung resection (Nov. 2016-Jan. 2018). With the patient in the lateral decubitus position, pre-operative CT-guided marking on the skin over the lesion was performed. During the surgery, we marked the visceral pleura with a skin marker directly or with an infant-size nutrition catheter with crystal violet at the tip through a venous indwelling needle inserted perpendicular to the skin marking. We localized and resected the lesions in all cases, without complications. The median nodule size measured histopathologically was 8 (4-20) mm overall, and 7 (0-20) mm of the solid part; the median distance from the visceral pleura to the nodule was 9 (1-33) mm. The median operation time was 67 (37-180) min. The median postoperative hospital stay was 3 (3-11) days. Our CT-guided pleural dye-marking method is useful and safe for the localization of small periph-eral pulmonary lesions in thoracoscopic partial lung resections.
-
5.
Study of Thoracic CT in COVID-19: The STOIC Project.
Revel, MP, Boussouar, S, de Margerie-Mellon, C, Saab, I, Lapotre, T, Mompoint, D, Chassagnon, G, Milon, A, Lederlin, M, Bennani, S, et al
Radiology. 2021;(1):E361-E370
-
-
Free full text
-
Abstract
Background There are conflicting data regarding the diagnostic performance of chest CT for COVID-19 pneumonia. Disease extent at CT has been reported to influence prognosis. Purpose To create a large publicly available data set and assess the diagnostic and prognostic value of CT in COVID-19 pneumonia. Materials and Methods This multicenter, observational, retrospective cohort study involved 20 French university hospitals. Eligible patients presented at the emergency departments of the hospitals involved between March 1 and April 30th, 2020, and underwent both thoracic CT and reverse transcription-polymerase chain reaction (RT-PCR) testing for suspected COVID-19 pneumonia. CT images were read blinded to initial reports, RT-PCR, demographic characteristics, clinical symptoms, and outcome. Readers classified CT scans as either positive or negative for COVID-19 based on criteria published by the French Society of Radiology. Multivariable logistic regression was used to develop a model predicting severe outcome (intubation or death) at 1-month follow-up in patients positive for both RT-PCR and CT, using clinical and radiologic features. Results Among 10 930 patients screened for eligibility, 10 735 (median age, 65 years; interquartile range, 51-77 years; 6147 men) were included and 6448 (60%) had a positive RT-PCR result. With RT-PCR as reference, the sensitivity and specificity of CT were 80.2% (95% CI: 79.3, 81.2) and 79.7% (95% CI: 78.5, 80.9), respectively, with strong agreement between junior and senior radiologists (Gwet AC1 coefficient, 0.79). Of all the variables analyzed, the extent of pneumonia at CT (odds ratio, 3.25; 95% CI: 2.71, 3.89) was the best predictor of severe outcome at 1 month. A score based solely on clinical variables predicted a severe outcome with an area under the curve of 0.64 (95% CI: 0.62, 0.66), improving to 0.69 (95% CI: 0.6, 0.71) when it also included the extent of pneumonia and coronary calcium score at CT. Conclusion Using predefined criteria, CT reading is not influenced by reader's experience and helps predict the outcome at 1 month. ClinicalTrials.gov identifier: NCT04355507 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Rubin in this issue.
-
6.
Prognostic value of muscle measurement using the standardized phase of computed tomography in patients with advanced ovarian cancer.
Huang, CY, Sun, FJ, Lee, J
Nutrition (Burbank, Los Angeles County, Calif.). 2020;:110642
Abstract
OBJECTIVES The prognostic role of sarcopenia or myosteatosis is controversial in advanced-stage epithelial ovarian cancer (EOC). The phase of computed tomography (CT) could influence muscle measurement and confound its association with outcomes. This study evaluated the prognostic value of muscle measurement in patients with stage III EOC using a standardized phase of computed tomography. METHODS Pretreatment CT images of 147 patients with stage III EOC were analyzed. All CT images were contrast-enhanced and acquired according to the standardized protocol. Skeletal muscle index (SMI) and radiodensity (SMD) were measured using CT images at the level of the third lumbar vertebra. The skeletal muscle gauge (SMG) was calculated by multiplying SMI and SMD. Harrell's concordance index (C-index) and time-dependent receiver operating characteristic curves were used to measure the predictive value of the models. RESULTS The median follow-up period was 37.5 mo. SMI, SMD, and SMG were independently associated with overall survival when adjusted for clinical variables. Adding SMG to the model including stage, residual tumor, and malignant ascites significantly improved C-indices (0.704 vs. 0.629; P < 0.001). Models including SMG had a superior C-index compared with models including SMI and SMD (0.704 vs. 0.668; P = 0.01). The SMG model achieved the highest area under the curve for 5-year overall survival prediction (0.619 for clinical model, 0.702 for SMI model, and 0.710 for SMG model). CONCLUSIONS Muscle measurements obtained from a standardized phase of CT images were associated with survival in advanced-stage EOC. The integration of SMI and SMD into SMG may improve prognostication and unify findings in future studies.
-
7.
Measurement of body mass by bioelectrical impedance analysis and computed tomography in cancer patients with malnutrition - a cross-sectional observational study.
Mueller, TC, Reik, L, Prokopchuk, O, Friess, H, Martignoni, ME
Medicine. 2020;(50):e23642
-
-
Free full text
-
Abstract
Malnutrition and cachexia affects the majority of cancer patients and significantly worsens their quality of life and prognosis. However, the diagnostic criteria of malnutrition and cachexia remain a topic under constant debate. To overcome this hurdle, diagnostic tools to objectively detect and quantify the loss of muscle and fat mass are needed. Computed tomography (CT)-based measurement is currently considered the golden standard. Bioelectrical impedance analysis (BIA) is an economical, non-invasive tool but it is seen controversial in patients with cancer and malnutrition because of possible estimation errors.BIA and CT-based analysis of body mass compartments were performed 172 times in 118 cancer patients, within the nutrition program of our institution. Prevalence of malnutrition was determined according to the global leadership initiative on malnutrition criteria. Data obtained for muscle and fat mass from both BIA and CT were correlated using Pearson's ρ. All analyses were performed with an explorative significance level of 5%.45.7% of the cohort were classified as "malnourished." No significant differences were observed between the 2 groups regarding demographic data. Median body mass index, Karnofsky performance status, and nutritional risk score were lower in the malnourished group. Values for muscle and fat mass by BIA and CT were significantly lower in malnourished patients. Correlation of the measured parameters were highly significant between CT-based and BIA measurement. In the overall cohort, correlation of measured muscle mass values by CT and BIA was significant with Pearson's ρ = 0.794 (P < .01). Looking at patients without malnutrition only, Pearson's ρ was 0.754 (P < .01). The correlation of measured fat mass values was equally significant, with Pearson's ρ of 0.748 (P < .01) in the overall cohort and 0.771 (P < .01) in patients with malnutrition.To our knowledge, this is the first study comparing BIA to CT-based body mass analysis in a large cohort of cancer patients with malnutrition. The results suggest that BIA is a valid diagnostic tool for the assessment of muscle and fat mass, even in patients with malnutrition, and could be implemented for the early detection and short-term follow-up of malnutrition and cachexia.
-
8.
Association between Scored Patient-Generated Subjective Global Assessment and Skeletal Muscle Determined by Computed Tomography in Patients with Cervical Cancer.
de Oliveira Pereira, F, Pereira Mota, A, Azevedo Aredes, M, Villaça Chaves, G, Ramos Cardoso, IC
Nutrition and cancer. 2020;(4):595-601
Abstract
Introduction: Myopenia is a significant problem in oncology patients and the use of reliable instruments for its identification in clinical practice is necessary.Objective: To evaluate the association between the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and skeletal muscle (SM) measured by computed tomography (CT) in patients with cervical cancer.Methods: This is an observational, cross-sectional study which enrolled women with cervical cancer, over 20 years, who started treatment between January 2015 and September 2018. The ones who presented PG-SGA and imaging of CT with a maximum interval of 45 days between them were included. The SM index (SMI) was used to classify myopenia and a significance level of 5% was adopted.Results: According to the PG-SGA, malnutrition was found in 56% patients and 23% were classified with myopenia by CT. The PG-SGA parameters were significantly associated with the SMI. The cutoff points that best discriminated myopenia were the PG-SGA total score ≥ 10, muscle depletion ≥ 2.0, and physical examination score ≥ 2.0.Conclusion: The PG-SGA showed to be a useful and viable method that shows good association and correlation with the SMI.
-
9.
Evaluation of an AI-based, automatic coronary artery calcium scoring software.
Sandstedt, M, Henriksson, L, Janzon, M, Nyberg, G, Engvall, J, De Geer, J, Alfredsson, J, Persson, A
European radiology. 2020;(3):1671-1678
-
-
Free full text
-
Abstract
OBJECTIVES To evaluate an artificial intelligence (AI)-based, automatic coronary artery calcium (CAC) scoring software, using a semi-automatic software as a reference. METHODS This observational study included 315 consecutive, non-contrast-enhanced calcium scoring computed tomography (CSCT) scans. A semi-automatic and an automatic software obtained the Agatston score (AS), the volume score (VS), the mass score (MS), and the number of calcified coronary lesions. Semi-automatic and automatic analysis time were registered, including a manual double-check of the automatic results. Statistical analyses were Spearman's rank correlation coefficient (⍴), intra-class correlation (ICC), Bland Altman plots, weighted kappa analysis (κ), and Wilcoxon signed-rank test. RESULTS The correlation and agreement for the AS, VS, and MS were ⍴ = 0.935, 0.932, 0.934 (p < 0.001), and ICC = 0.996, 0.996, 0.991, respectively (p < 0.001). The correlation and agreement for the number of calcified lesions were ⍴ = 0.903 and ICC = 0.977 (p < 0.001), respectively. The Bland Altman mean difference and 1.96 SD upper and lower limits of agreements for the AS, VS, and MS were - 8.2 (- 115.1 to 98.2), - 7.4 (- 93.9 to 79.1), and - 3.8 (- 33.6 to 25.9), respectively. Agreement in risk category assignment was 89.5% and κ = 0.919 (p < 0.001). The median time for the semi-automatic and automatic method was 59 s (IQR 35-100) and 36 s (IQR 29-49), respectively (p < 0.001). CONCLUSIONS There was an excellent correlation and agreement between the automatic software and the semi-automatic software for three CAC scores and the number of calcified lesions. Risk category classification was accurate but showing an overestimation bias tendency. Also, the automatic method was less time-demanding. KEY POINTS • Coronary artery calcium (CAC) scoring is an excellent candidate for artificial intelligence (AI) development in a clinical setting. • An AI-based, automatic software obtained CAC scores with excellent correlation and agreement compared with a conventional method but was less time-consuming.
-
10.
Late iodine enhancement cardiac computed tomography for detection of myocardial scars: impact of experience in the clinical practice.
Palmisano, A, Vignale, D, Benedetti, G, Del Maschio, A, De Cobelli, F, Esposito, A
La Radiologia medica. 2020;(2):128-136
Abstract
BACKGROUND Cardiac CT with late iodine enhancement (LIE-CT) may characterize the scarred myocardium, but the role of readers' experience and scar pattern on LIE-CT diagnostic performance is unknown. Aim was to assess the diagnostic performance of LIE-CT according to readers' experience, scar pattern and contrast-to-noise ratio (CNR) using late gadolinium enhancement MRI (LGE-MRI) as reference. METHODS LIE-CT and LGE-MRI images of 40 consecutive patients were analyzed. Two readers with different experience (8 and 2 years) independently analyzed LIE-CT images defining the presence/absence of scar and scar CNR, segmental involvement, transmural pattern and scar etiology. The same parameters were extracted from LGE-MRI by two expert readers in consensus, blinded to the LIE-CT results. RESULTS Scars were identified at LGE-MRI in 29/40 patients and 141/680 segments. Scar burden at LIE-CT versus LGE-MRI correlated better for the most experienced reader than for the least experienced one (ρ = 0.954 and ρ = 0.797, p < 0.001). The most experienced reader missed scars in 2 patients and in 21/141 segments; the least experienced in 5 patients and 53/141 segments. The most experienced reader showed higher accuracy and sensitivity compared to the least experienced in per-patient (accuracy: 95% vs. 88%; sensitivity: 93% vs. 83%) and per-segment analysis (accuracy: 96% vs. 92%; sensitivity: 85% vs. 62%). Specificity was excellent (100% per-patient, 99% per-segment,) regardless of readers' experience. Missed scars had non-ischemic pattern, low scar burden (< 6%) and lower CNR compared to ischemic scars (2.33 vs. 3.54, p = 0.005). CONCLUSION LIE-CT represents an alternative to LGE-MRI, although the impact of readers' experience on sensitivity for small non-ischemic scars should be considered.