How reliably can computed tomography predict thyroid invasion prior to laryngectomy?

PubMed

Harris, Andrew S; Passant, Carl D; Ingrams, Duncan R

2018-05-01

There is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid. Ambispective cohort study. All patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues. Seventy-nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%-76.1%) and the negative predictive value was 100% (95% CI: 92.7%-100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%-100%), and the negative predictive value was also 100% (95% CI: 93.5%-100%). This study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI. 4. Laryngoscope, 128:1099-1102, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Relationship between the Self-Rating Anxiety Scale score and the success rate of 64-slice computed tomography coronary angiography.

PubMed

Li, Hui; Jin, Dan; Qiao, Fang; Chen, Jianchang; Gong, Jianping

Computed tomography coronary angiography, a key method for obtaining coronary artery images, is widely used to screen for coronary artery diseases due to its noninvasive nature. In China, 64-slice computed tomography systems are now the most common models. As factors that directly affect computed tomography performance, heart rate and rhythm control are regulated by the autonomic nervous system and are highly related to the emotional state of the patient. The aim of this prospective study is to use a pre-computed tomography scan Self-Rating Anxiety Scale assessment to analyze the effects of tension and anxiety on computed tomography coronary angiography success. Subjects aged 18-85 years who were planned to undergo computed tomography coronary angiography were enrolled; 1 to 2 h before the computed tomography scan, basic patient data (gender, age, heart rate at rest, and family history) and Self-Rating Anxiety Scale score were obtained. The same group of imaging department doctors, technicians, and nurses performed computed tomography coronary angiography for all the enrolled subjects and observed whether those subjects could finish the computed tomography coronary angiography scan and provide clear, diagnostically valuable images. Participants were divided into successful (obtained diagnostically useful coronary images) and unsuccessful groups. Basic data and Self-Rating Anxiety Scale scores were compared between the groups. The Self-Rating Anxiety Scale standard score of the successful group was lower than that of the unsuccessful group (P = 0.001). As the Self-Rating Anxiety Scale standard score rose, the success rate of computed tomography coronary angiography decreased. The Self-Rating Anxiety Scale score has a negative relationship with computed tomography coronary angiography success. Anxiety can be a disadvantage in computed tomography coronary angiography examination. The pre-computed tomography coronary angiography scan Self-Rating Anxiety Scale score may be a useful tool for assessing whether a computed tomography coronary angiography scan will be successful or not. © The Author(s) 2015.

Corneal thickness and elevation measurements using swept-source optical coherence tomography and slit scanning topography in normal and keratoconic eyes.

PubMed

Jhanji, Vishal; Yang, Bingzhi; Yu, Marco; Ye, Cong; Leung, Christopher K S

2013-11-01

To compare corneal thickness and corneal elevation using swept source optical coherence tomography and slit scanning topography. Prospective study. 41 normal and 46 keratoconus subjects. All eyes were imaged using swept source optical coherence tomography and slit scanning tomography during the same visit. Mean corneal thickness and best-fit sphere measurements were compared between the instruments. Agreement of measurements between swept source optical coherence tomography and scanning slit topography was analyzed. Intra-rater reproducibility coefficient and intraclass correlation coefficient were evaluated. In normal eyes, central corneal thickness measured by swept source optical coherence tomography was thinner compared with slit scanning topography (p < 0.0001) and ultrasound pachymetry (p = < .0001). Ultrasound pachymetry readings had better 95% limits of agreement with swept source optical coherence tomography than slit scanning topography. In keratoconus eyes, central corneal thickness was thinner on swept source optical coherence tomography than slit scanning topography (p = 0.081) and ultrasound pachymetry (p = 0.001). There were significant differences between thinnest corneal thickness, and, anterior and posterior best-fit sphere measurements between both instruments (p < 0.05 for all). Overall, reproducibility coefficients and intraclass correlation coefficients were significantly better with swept source optical coherence tomography for measurement of central corneal thickness, anterior best-fit sphere and, posterior best-fit sphere (all p < 0.001). Corneal thickness and elevation measurements were significantly different between swept source optical coherence tomography and slit scanning topography. With better reproducibility coefficients and intraclass correlation coefficients, swept source optical coherence tomography may provide a reliable alternative for measurement of corneal parameters. © 2013 The Authors. Clinical and Experimental Ophthalmology © 2013 Royal Australian and New Zealand College of Ophthalmologists.

A Prospective Study of Bone Tumor Response Assessment in Metastatic Breast Cancer

PubMed Central

Hayashi, Naoki; Costelloe, Colleen M.; Hamaoka, Tsuyoshi; Wei, Caimiao; Niikura, Naoki; Theriault, Richard L.; Hortobagyi, Gabriel N.; Madewell, John E.; Ueno, Naoto T.

2013-01-01

In this pilot study, we prospectively compared the response of bone metastasis assessed by our MD Anderson (MDA) bone tumor response criteria (computed tomography [CT], plain radiography [XR], and skeletal scintigraphy [SS]) with the response assessed by the World Health Organization (WHO) criteria (XR and SS). Both MDA and WHO criteria predicted progression-free survival (PFS) of patients at 6 months but not at an earlier time point. Background In our previous study, new MD Anderson (MDA) bone tumor response criteria (based on computed tomography [CT], plain radiography [XR], and skeletal scintigraphy [SS]) predicted progression-free survival (PFS) better than did World Health Organization (WHO) bone tumor response criteria (plain radiography [XR] and SS) among patients with breast cancer and bone-only metastases. In this pilot study, we tested whether MDA criteria could reveal bone metastasis response earlier than WHO criteria in patients with newly diagnosed breast cancer with osseous and measurable nonosseous metastases. Methods We prospectively analyzed bone metastasis response using each imaging modality and set of bone response criteria to distinguish progressive disease (PD) from non-PD and their association with PFS and overall survival (OS). We also compared the response of osseous metastases assessed by both criteria with the response of nonosseous measurable lesions. Results The median follow-up period was 26.7 months (range, 6.1–53.3 months) in 29 patients. PFS rates differed at 6 months based on the classification of PD or non-PD using either set of criteria (MDA, P = .002; WHO, P = .014), but these rates, as well as OS, did not differ at 3 months. Response in osseous metastases by either set of criteria did not correlate with the response in nonosseous metastases. Conclusion MDA and WHO criteria predicted PFS of patients with osseous metastases at 6 months but not at an earlier time point. We plan a well-powered study to determine the role of MDA criteria in predicting bone tumor response by incorporating 18-fluorodeoxyglucose (18F) positron emission tomography (FDG-PET)/CT to see if findings using this modality are earlier than those with WHO criteria. PMID:23098575

Clinical determinants of fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)iodine whole body scans after (131)iodine therapy.

PubMed

Shamim, Syed Ejaz; Nang, Lee Boon; Shuaib, Ibrahim Lutfi; Muhamad, Nor Asiah

2014-05-01

A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative (131)Iodine ((131)I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells. Thirty-five patients with histologically proven DTC that have undergone total or near total thyroidectomy, and post (131)I radioactive iodine ablation therapy, were selected and prospectively analysed. The patients also had to show at least one negative whole body scan and Tg levels of 10 μg/L and above. The results of the FDG-Positron Emission Tomography/Computed Tomography (PET/CT) were then studied to determine the association and the predictors influencing the outcome by using univariable and multivariable analyses. Out of the thirty-five patients, 60% of them (twenty-one) showed positive results and 40% (fourteen) showed negative. Age, gender, and type of histopathology (HPE) showed significant associations with the positive results of the FDG-PET/CT. The results also showed no correlations observed between the Tg levels and standardised uptake value (SUV)max in the DTC patients with positive disease findings in the FDG-PET/CT. The predictor for this study was age. The prevalence of the conversion of differentiated to dedifferentiated thyroid cancer among patients with negative (131)I and elevated Tg was 60%, with age as the predictor. DTC patients aged 45 year-old and older were seven times more likely to have positive results of FDG-PET/CT imaging.

Clinical Determinants of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Differentiated Thyroid Cancer Patients with Elevated Thyroglobulin and Negative 131Iodine Whole Body Scans after 131Iodine Therapy

PubMed Central

SHAMIM, Syed Ejaz; NANG, Lee Boon; SHUAIB, Ibrahim Lutfi; MUHAMAD, Nor Asiah

2014-01-01

Background: A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative 131Iodine (131I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells. Methods: Thirty-five patients with histologically proven DTC that have undergone total or near total thyroidectomy, and post 131I radioactive iodine ablation therapy, were selected and prospectively analysed. The patients also had to show at least one negative whole body scan and Tg levels of 10 μg/L and above. The results of the FDG-Positron Emission Tomography/Computed Tomography (PET/CT) were then studied to determine the association and the predictors influencing the outcome by using univariable and multivariable analyses. Results: Out of the thirty-five patients, 60% of them (twenty-one) showed positive results and 40% (fourteen) showed negative. Age, gender, and type of histopathology (HPE) showed significant associations with the positive results of the FDG-PET/CT. The results also showed no correlations observed between the Tg levels and standardised uptake value (SUV)max in the DTC patients with positive disease findings in the FDG-PET/CT. The predictor for this study was age. Conclusion: The prevalence of the conversion of differentiated to dedifferentiated thyroid cancer among patients with negative 131I and elevated Tg was 60%, with age as the predictor. DTC patients aged 45 year-old and older were seven times more likely to have positive results of FDG-PET/CT imaging. PMID:25246834

Fusion Imaging: A Novel Staging Modality in Testis Cancer

PubMed Central

Sterbis, Joseph R.; Rice, Kevin R.; Javitt, Marcia C.; Schenkman, Noah S.; Brassell, Stephen A.

2010-01-01

Objective: Computed tomography and chest radiographs provide the standard imaging for staging, treatment, and surveillance of testicular germ cell neoplasms. Positron emission tomography has recently been utilized for staging, but is somewhat limited in its ability to provide anatomic localization. Fusion imaging combines the metabolic information provided by positron emission tomography with the anatomic precision of computed tomography. To the best of our knowledge, this represents the first study of the effectiveness using fusion imaging in evaluation of patients with testis cancer. Methods: A prospective study of 49 patients presenting to Walter Reed Army Medical Center with testicular cancer from 2003 to 2009 was performed. Fusion imaging was compared with conventional imaging, tumor markers, pathologic results, and clinical follow-up. Results: There were 14 true positives, 33 true negatives, 1 false positive, and 1 false negative. Sensitivity, specificity, positive predictive value, and negative predictive value were 93.3, 97.0, 93.3, and 97.0% respectively. In 11 patient scenarios, fusion imaging differed from conventional imaging. Utility was found in superior lesion detection compared to helical computed tomography due to anatomical/functional image co-registration, detection of micrometastasis in lymph nodes (pathologic nodes < 1cm), surveillance for recurrence post-chemotherapy, differentiating fibrosis from active disease in nodes < 2.5cm, and acting as a quality assurance measure to computed tomography alone. Conclusions: In addition to demonstrating a sensitivity and specificity comparable or superior to conventional imaging, fusion imaging shows promise in providing additive data that may assist in clinical decision-making. PMID:21103077

Fusion imaging: a novel staging modality in testis cancer.

PubMed

Sterbis, Joseph R; Rice, Kevin R; Javitt, Marcia C; Schenkman, Noah S; Brassell, Stephen A

2010-11-05

Computed tomography and chest radiographs provide the standard imaging for staging, treatment, and surveillance of testicular germ cell neoplasms. Positron emission tomography has recently been utilized for staging, but is somewhat limited in its ability to provide anatomic localization. Fusion imaging combines the metabolic information provided by positron emission tomography with the anatomic precision of computed tomography. To the best of our knowledge, this represents the first study of the effectiveness using fusion imaging in evaluation of patients with testis cancer. A prospective study of 49 patients presenting to Walter Reed Army Medical Center with testicular cancer from 2003 to 2009 was performed. Fusion imaging was compared with conventional imaging, tumor markers, pathologic results, and clinical follow-up. There were 14 true positives, 33 true negatives, 1 false positive, and 1 false negative. Sensitivity, specificity, positive predictive value, and negative predictive value were 93.3, 97.0, 93.3, and 97.0% respectively. In 11 patient scenarios, fusion imaging differed from conventional imaging. Utility was found in superior lesion detection compared to helical computed tomography due to anatomical/functional image co-registration, detection of micrometastasis in lymph nodes (pathologic nodes < 1cm), surveillance for recurrence post-chemotherapy, differentiating fibrosis from active disease in nodes < 2.5cm, and acting as a quality assurance measure to computed tomography alone. In addition to demonstrating a sensitivity and specificity comparable or superior to conventional imaging, fusion imaging shows promise in providing additive data that may assist in clinical decision-making.

New Prospecting Standarts and Its Comparison with International Regulations in Sinkhole and Cave Investigations

NASA Astrophysics Data System (ADS)

Karabulut, S.; Cengiz Cinku, M.; Tezel, O.

2016-12-01

The aim of this study is to investigate the prospecting standarts in sinkhole and cave characterization comparing it with the present standarts given by the American Society for Testing and Materials (ASTM) and the British Standart (BSI). Cave and sinkholes which are important geological occurences could cause hazard and collapse of the ground where residental areas could be under risk. The depth of sinkholes could reach up to hundreds of meters and their width to tens of meters. Most caves which are under conserve and characterized as a natural protected area, a non-destructive investigation is required which is only undertaken by geophysical applications. Two different type of standarts are given in the literature to investigate this kind of geological occurences. The first is the ASTM (1999) standart which offers to use Gravity/Microgravity, Ground Penetrating Radar (GPR) and Electromagnetic, while the BSI standart (1999) depends on the initial application of GPR, Electromagnetic, Electrical Resistivity and Crosshole Seismic. In Turkey however, there are limited studies in cave/sinkhole detection and no standartization in prospecting is presented. For this purpose, we applied a geophysical study in the Yarımburgaz cave, Istanbul/Turkey. In the scope of this study, Microgravity, Electric Tomography, Tomography of Seismic Refraction and Surface Wave Analysis, GPR and Microtremor methods are applied on four different profiles. It has been shown that the outputs of the methods differ as a result of the climatic conditions, properties of the geological environment and the depth/size/shape of the sinkhole/cave. Besides this, the area of application which is either inside the city center, steep valley or on the sea/streamside show also discrepancy in the order of preference of the geophysical application methods when considering the anomalies on different mediums. The results obtained from GPR are deep in relation with the thickness of the clayey unit, the water content of the medium and the thickness of the cave/sinkhole. Microgravity, GPR and Microtremor measurements were applied successfull and easily in the inner-city, while Electric Tomography, Seismic Refraction and MASW Methods showed reliable results which are obtained rapidly.

Dual-energy computed tomography for the detection of focal liver lesions.

PubMed

Lago, K N; Vallejos, J; Capuñay, C; Salas, E; Reynoso, E; Carpio, J B; Carrascosa, P M

To qualitatively and quantitatively explore the spectral study of focal liver lesions, comparing it with the usual polychromatic assessment with single-energy computed tomography. We prospectively studied 50 patients with at least one focal liver lesion who were referred for abdominal multidetector computed tomography with intravenous contrast material. The portal phase was acquired with dual energy sources. The density of the lesions and of the surrounding liver parenchyma was measured both in the baseline polychromatic acquisition and in the posterior monochromatic reconstructions at 40 keV, 70 keV, and 140 keV. Spectral curves were traced and the dual-energy indices and contrast-to-noise ratio were calculated. Lastly, the quality of the images and the detectability of the lesions were assessed qualitatively. Densitometric differences between the different types of lesions (avascular and vascularized) and the liver were greater at low energy levels (left side of the spectral curve) than in the polychromatic evaluation. In the subjective assessment, the 40keV energy level had the greatest lesion detectability. Monochromatic spectral study with dual-energy computed tomography provides better lesion detectability at 40keV compared to that provided by the ordinary polychromatic evaluation. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

In-vitro tomography and non-destructive imaging at depth of pharmaceutical solid dosage forms.

PubMed

Zeitler, J Axel; Gladden, Lynn F

2009-01-01

Tomographic imaging techniques offer new prospects for a better understanding of the quality, performance and release mechanisms of pharmaceutical solid dosage forms. It is only over the last fifteen years that tomography has been applied for the in-vitro characterisation of dosage forms. This review aims to introduce the concept of tomography in a pharmaceutical context, and describes the current state-of-the-art of the four most promising techniques: X-ray computed microtomography, magnetic resonance imaging, terahertz imaging and optical coherence tomography. The basic working principles of the techniques are introduced and the current pharmaceutical applications of the technologies are discussed, together with a comparison of their specific strengths and weaknesses. Possible future developments in these fields are also discussed.

Cross-sectional changes in lung volume measured by electrical impedance tomography are representative for the whole lung in ventilated preterm infants.

PubMed

van der Burg, Pauline S; Miedema, Martijn; de Jongh, Frans H; Frerichs, Inez; van Kaam, Anton H

2014-06-01

Electrical impedance tomography measures lung volume in a cross-sectional slice of the lung. Whether these cross-sectional volume changes are representative of the whole lung has only been investigated in adults, showing conflicting results. This study aimed to compare cross-sectional and whole lung volume changes using electrical impedance tomography and respiratory inductive plethysmography. A prospective, single-center, observational, nonrandomized study. The study was conducted in a neonatal ICU in the Netherlands. High-frequency ventilated preterm infants with respiratory distress syndrome. Cross-sectional and whole lung volume changes were continuously and simultaneously measured by, respectively, electrical impedance tomography and respiratory inductive plethysmography during a stepwise recruitment procedure. End-expiratory lung volume changes were assessed by mapping the inflation and deflation limbs using both the pressure/impedance and pressure/inductance pairs and characterized by calculating the inflection points. In addition, oscillatory tidal volume changes were assessed at each pressure step. Twenty-three infants were included in the study. Of these, eight infants had to be excluded because the quality of the registration was insufficient for analysis (two electrical impedance tomography and six respiratory inductive plethysmography). In the remaining 15 infants (gestational age 28.0 ± 2.6 wk; birth weight 1,027 ± 514 g), end-expiratory lung volume changes measured by electrical impedance tomography were significantly correlated to respiratory inductive plethysmography measurements in 12 patients (mean r = 0.93 ± 0.05). This was also true for the upper inflection point on the inflation (r = 0.91, p < 0.01) and deflation limb (r = 0.83, p < 0.01). In 13 patients, impedance and inductance data also correlated significantly on oscillatory tidal volume/pressure relationships (mean r = 0.81 ± 0.18). This study shows that cross-sectional lung volume changes measured by electrical impedance tomography are representative for the whole lung and that this concept also applies to newborn infants.

Combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) prospective study. Rationale and design.

PubMed

Kennedy, Mark W; Fabris, Enrico; Ijsselmuiden, Alexander J; Nef, Holger; Reith, Sebastian; Escaned, Javier; Alfonso, Fernando; van Royen, Niels; Wojakowski, Wojtek; Witkowski, Adam; Indolfi, Ciro; Ottervanger, Jan Paul; Suryapranata, Harry; Kedhi, Elvin

2016-10-10

Fractional flow reserve (FFR) is a widely used tool for the identification of ischaemia-generating stenoses and to guide decisions on coronary revascularisation. However, the safety of FFR-based decisions in high-risk subsets, such as patients with Diabetes Mellitus (DM) or vulnerable stenoses presenting thin-cap fibro-atheroma (TCFA), is unknown. This study will examine the impact of optical coherence tomography (OCT) plaque morphological assessment and the identification of TCFA, in combination with FFR to better predict clinical outcomes in DM patients. COMBINE (OCT-FFR) is a prospective, multi-centre study investigating the natural history of DM patients with ≥1 angiographically intermediate target lesion in three subgroups of patients; patients with FFR negative lesions without TCFA (group A) and patients with FFR negative lesions with TCFA (group B) as detected by OCT and to compare these two groups with each other, as well as to a third group with FFR-positive, PCI-treated intermediate lesions (group C). The study hypothesis is that DM patients with TCFA (group B) have a worse outcome than those without TCFA (group A) and also when compared to those patients with lesions FFR ≤0.80 who underwent complete revascularisation. The primary endpoint is the incidence of target lesion major adverse cardiac events (MACE); a composite of cardiac death, myocardial infarction or rehospitalisation for unstable/progressive angina in group B vs. group A. COMBINE (OCT-FFR) is the first prospective study to examine whether the addition of OCT plaque morphological evaluation to FFR haemodynamic assessment of intermediate lesions in DM patients will better predict MACE and possibly lead to new revascularisation strategies. Trial Registration Netherlands Trial Register: NTR5376.

Prospects and Techniques for Eddy-Resolving Acoustic Tomography in the Eastern Gulf of Mexico

NASA Astrophysics Data System (ADS)

Caruthers, J. W.; Nechaev, D.; Roman, D. A.; Sidorovskaia, N. A.; Ioup, G. E.; Ioup, J.; Yaremchuk, M.

2007-05-01

For several decades monitoring and modeling the dynamics and physical structure of the Gulf of Mexico have been major efforts undertaken by oceanographers of the United States and other American countries. There are very interesting physical oceanographic features in the Gulf, not the least of which are the Gulf Loop Current and the eddies it spawns. Satellite sensing of IR and altimeter imagery has been a major input to modeling those features. Such efforts are very important to the economy and well being of much of the United States and Mexico, including fisheries, mineral economies, hurricane strengths and paths in the summer, and severe snow storms in the eastern US in the winter. A major shortcoming of the present monitoring of the Gulf is the lack of subsurface input to the dynamic models of the Gulf. Acoustic tomography is a viable means of providing that missing input. Several universities have come together to investigate the prospects for establishing a Gulf Eddy Monitoring System (GEMS) for the deep eastern half of the Gulf using acoustic tomography. The group has conducted several acoustics experiments and propagation studies to determine the feasibility of long-range propagation in the eastern Gulf and the mitigation of adverse effects on marine mammal populations in that region under the Office of Naval Research project entitled the Littoral Acoustic Demonstration Center (LADC). The group has also convened an invited session for the 9th World Multiconference on Systemics, Cybernetics and Informatics (WMSCI 2005) Orlando, FL, July 2005. This paper discusses prospects for establishing the GEMS tomographic system, its technical characteristics, and its contributions to advancing the knowledge of the dynamics of the Gulf. This presentation will concentrate on the characteristics of a single-slice tomographic system, called GEMS Phase I, across the approaches to the DeSoto Canyon in the northeastern Gulf and its prospect for monitoring the movements of eddies into the canyon. It will also touch on the prospects for expanding the network to include the entire eastern Gulf with a moored system on the Campeche Bank and several along the US Gulf shelf. This projected tomographic system is called GEMS Phase II. The paper will invite the participation of Mexican organizations to help plan and develop this proposed extensive project.

Fusion Imaging: A Novel Staging Modality in Testis Cancer

DTIC Science & Technology

2010-01-01

the anatomic precision of computed tomography. To the best of our knowledge, this represents the first study of the effectiveness using fusion...imaging in evaluation of patients with testis cancer. Methods: A prospective study of 49 patients presenting to Walter Reed Army Medical Center with...incidence of testis cancer has been increasing at an annual rate of 3%, leading to a doubling in cases world-wide over the last 40 years. With the advent

Optical Coherence Tomography Angiography and Ultra-widefield Fluorescein Angiography for Early Detection of Adolescent Sickle Retinopathy.

PubMed

Pahl, Daniel A; Green, Nancy S; Bhatia, Monica; Lee, Margaret T; Chang, Jonathan S; Licursi, Maureen; Briamonte, Courtney; Smilow, Elana; Chen, Royce W S

2017-11-01

Based on standard screening techniques, sickle retinopathy reportedly occurs in 10% of adolescents with sickle cell disease (SCD). We performed a prospective, observational clinical study to determine if ultra-widefield fluorescein angiography (UWFA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCT-A) detect more-frequent retinopathy in adolescents with SCD. Cross-sectional study. Setting: Institutional. Sixteen adolescents with SCD, aged 10-19 years (mean age 14.9 years), and 5 age-equivalent controls (mean age 17.4 years). Examinations including acuity, standard slit-lamp biomicroscopy, UWFA, SD-OCT, and OCT-A were performed. Sickle retinopathy defined by biomicroscopic changes, Goldberg stages I-V, Penman scale, flow void on OCT-A, or macular thinning on SD-OCT. While 22 of 32 SCD eyes (68.8%) had retinopathy on biomicroscopy, by UWFA 4 of 24 (16.7%) SCD eyes had peripheral arterial occlusion (Goldberg I), and 20 of 24 eyes (83.3%) had peripheral arteriovenous anastomoses (Goldberg II) in addition. No patients had Goldberg stages III-V. By SD-OCT and OCT-A, thinning of the macula and flow voids in both the superficial and deep retinal capillary plexus were found in 6 of 30 (20%) eyes. All 24 eyes with adequate UWFA studies demonstrated sickle retinopathy. SD-OCT and OCT-A, which have not been previously reported in the adolescent population, detected abnormal macular thinning and flow abnormalities undetected by biomicroscopy. These findings suggest that pediatric sickle retinopathy may be more prevalent than previously suspected. If these findings are confirmed with larger cross-sectional and prospective analyses, these approaches may enhance early screening for sickle retinopathy. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospective Evaluation of 18F-Fluorodeoxyglucose Uptake in Postischemic Myocardium by Simultaneous Positron Emission Tomography/Magnetic Resonance Imaging as a Prognostic Marker of Functional Outcome.

PubMed

Rischpler, Christoph; Dirschinger, Ralf J; Nekolla, Stephan G; Kossmann, Hans; Nicolosi, Stefania; Hanus, Franziska; van Marwick, Sandra; Kunze, Karl P; Meinicke, Alexander; Götze, Katharina; Kastrati, Adnan; Langwieser, Nicolas; Ibrahim, Tareq; Nahrendorf, Matthias; Schwaiger, Markus; Laugwitz, Karl-Ludwig

2016-04-01

The immune system orchestrates the repair of infarcted myocardium. Imaging of the cellular inflammatory response by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/magnetic resonance imaging in the heart has been demonstrated in preclinical and clinical studies. However, the clinical relevance of post-MI (18)F-FDG uptake in the heart has not been elucidated. The objective of this study was to explore the value of (18)F-FDG positron emission tomography/magnetic resonance imaging in patients after acute myocardial infarction as a biosignal for left ventricular functional outcome. We prospectively enrolled 49 patients with ST-segment-elevation myocardial infarction and performed (18)F-FDG positron emission tomography/magnetic resonance imaging 5 days after percutaneous coronary intervention and follow-up cardiac magnetic resonance imaging after 6 to 9 months. In a subset of patients, (99m)Tc-sestamibi single-photon emission computed tomography was performed with tracer injection before revascularization. Cellular innate immune response was analyzed at multiple time points. Segmental comparison of (18)F-FDG-uptake and late gadolinium enhancement showed substantial overlap (κ=0.66), whereas quantitative analysis demonstrated that (18)F-FDG extent exceeded late gadolinium enhancement extent (33.2±16.2% left ventricular myocardium versus 20.4±10.6% left ventricular myocardium, P<0.0001) and corresponded to the area at risk (r=0.87, P<0.0001). The peripheral blood count of CD14(high)/CD16(+) monocytes correlated with the infarction size and (18)F-FDG signal extent (r=0.53, P<0.002 and r=0.42, P<0.02, respectively). (18)F-FDG uptake in the infarcted myocardium was highest in areas with transmural scar, and the standardized uptake valuemean was associated with left ventricular functional outcome independent of infarct size (Δ ejection fraction: P<0.04, Δ end-diastolic volume: P<0.02, Δ end-systolic volume: P<0.005). In this study, the intensity of (18)F-FDG uptake in the myocardium after acute myocardial infarction correlated inversely with functional outcome at 6 months. Thus, (18)F-FDG uptake in infarcted myocardium may represent a novel biosignal of myocardial injury. © 2016 American Heart Association, Inc.

[Value of computer tomography in the managment of brain injuries].

PubMed

Keita, A D; Toure, M; Sissako, A; Doumbia, S; Coulibaly, Y; Doumbia, D; Kane, M; Diallo, A K; Toure, A A; Traore, I

2005-11-01

The purpose of this prospective study conducted from January 2001 to December 2001 was to ascertain the value of computer tomography for evaluation of brain injuries. Computer tomography was performed using a Toshiba X VID system with contiguous 5 mm axial sections through the posterior fossa and 10 mm contiguous axial sections through the subtentorial region without contrast injection. A total of 107 patients with brain injuries were enrolled over the one-year study period. These patients accounted for 0.8% of all admissions to surgical emergency unit of Gabriel Toure Hospital in Bamako, Mali. The predominant age group for brain injuries was the 20- to 29-year-old group (35 cases). The male-to-female sex ratio was 5:1. Vehicular accident was the most frequent cause of brain injury (76 cases). Trauma was severe in 48 patients with a Glasgow score less than 8. Coma occurred immediately after injury in 90 cases. Ventricular hemorrhage led to coma in 100% of cases whereas brain hemorrhage and hematoma led to coma in 93.3% and 83.3% of cases respectively. Treatment was medical in 99 cases and neurosurgical in 8. The mortality rate was 34% and the morbidity rate (permanent sequels) was 36%. Computer tomography is a valuable tool for therapeutic decision-making in medico-surgical emergencies involving brain injuries.

Imaging for uterine myomas and adenomyosis.

PubMed

Shwayder, James; Sakhel, Khaled

2014-01-01

Uterine myomas and adenomyosis are common findings, in particular in patients with symptoms of abdominal enlargement, pelvic pressure, abnormal uterine bleeding, dysmenorrhea, and dyspareunia. Diagnosis and differentiation between the 2 entities are critical in establishing treatment options and the operative approach for surgical management. Herein are reviewed diagnostic options, their relative accuracy, and the effect of accurate diagnosis on treatment. A review was performed using PubMed, MdConsult, OVID, and reviews including cross-referenced articles and prospective and retrospective studies published from 1980 to 2013. Also reviewed are use of ultrasound with its various methods, magnetic resonance imaging, computed tomography, and positron emission tomography in the diagnosis, pretreatment evaluation, and differentiation of myomas and adenomyosis. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Two-phase computed tomography study of warthin tumor of parotid gland: differentiation from other parotid gland tumors and its pathologic explanation.

PubMed

Woo, Seung Hoon; Choi, Dae-Seob; Kim, Jin-pyeong; Park, Jung Je; Joo, Yeon Hee; Chung, Phil-Sang; Kim, Bo-Young; Ko, Young-Hyeh; Jeong, Han-Sin; Kim, Hyung-Jin

2013-01-01

The objective of this study was to define the radiological characteristics of 2-phase computed tomography (CT) of parotid gland Warthin tumors (WTs) with a pathologic basis for these findings. We prospectively enrolled 116 patients with parotid gland tumor who underwent preoperative 2-phase CT scans(scanning delays of 30 and 120 seconds). The attenuation changes and enhancement patterns were analyzed according to pathology. We also evaluated size-matched samples of WTs and pleomorphic adenoma by staining CD31, vascular endothelial growth factor-receptor 2, collagen IV, and smooth muscle actin. Computed tomography numbers in WTs were significantly higher than those in other tumors in early-phase scans and lower in delayed scans. Pathologically, CD31(+) blood vessel area was significantly higher in WTs than in pleomorphic adenomas. In addition, WTs had an extensive capillary network and many leaky blood vessels. The enhancement pattern of early fill-in and early washout is the typical finding of WTs on 2-phase CT scans, which may be attributed pathologically to abundant blood vessel and extensive capillary network.

Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study).

PubMed

Brenkman, H J F; Gertsen, E C; Vegt, E; van Hillegersberg, R; van Berge Henegouwen, M I; Gisbertz, S S; Luyer, M D P; Nieuwenhuijzen, G A P; van Lanschot, J J B; Lagarde, S M; de Steur, W O; Hartgrink, H H; Stoot, J H M B; Hulsewe, K W E; Spillenaar Bilgen, E J; van Det, M J; Kouwenhoven, E A; van der Peet, D L; Daams, F; van Sandick, J W; van Grieken, N C T; Heisterkamp, J; van Etten, B; Haveman, J W; Pierie, J P; Jonker, F; Thijssen, A Y; Belt, E J T; van Duijvendijk, P; Wassenaar, E; van Laarhoven, H W M; Wessels, F J; Haj Mohammad, N; van Stel, H F; Frederix, G W J; Siersema, P D; Ruurda, J P

2018-04-20

Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3-4b, N0-3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. NCT03208621 . This trial was registered prospectively on June 30, 2017.

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study.

PubMed

Kouijzer, Ilse J E; Scheper, Henk; de Rooy, Jacky W J; Bloem, Johan L; Janssen, Marcel J R; van den Hoven, Leon; Hosman, Allard J F; Visser, Leo G; Oyen, Wim J G; Bleeker-Rovers, Chantal P; de Geus-Oei, Lioe-Fee

2018-05-01

The aim of this study was to determine the diagnostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis. From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18 F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others' image interpretation. 18 F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines. For 18 F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18 F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%). 18 F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18 F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer.

PubMed

Rhee, H; Thomas, P; Shepherd, B; Gustafson, S; Vela, I; Russell, P J; Nelson, C; Chung, E; Wood, G; Malone, G; Wood, S; Heathcote, P

2016-10-01

Positron emission tomography using ligands targeting prostate specific membrane antigen has recently been introduced. Positron emission tomography imaging with (68)Ga-PSMA-HBED-CC has been shown to detect metastatic prostate cancer lesions at a high rate. In this study we compare multiparametric magnetic resonance imaging and prostate specific membrane antigen positron emission tomography of the prostate with whole mount ex vivo prostate histopathology to determine the true sensitivity and specificity of these imaging modalities for detecting and locating tumor foci within the prostate. In a prospective clinical trial setting 20 patients with localized prostate cancer and a planned radical prostatectomy were recruited. All patients underwent multiparametric magnetic resonance imaging and positron emission tomography before surgery, and whole mount histopathology slides were directly compared to the images. European Society of Urogenital Radiology guidelines for reporting magnetic resonance imaging were used as a template for regional units of analysis. The uropathologist and radiologists were blinded to individual components of the study, and the final correlation was performed by visual and deformable registration analysis. A total of 50 clinically significant lesions were identified from the whole mount histopathological analysis. Based on regional analysis the sensitivity, specificity, positive predictive value and negative predictive value for multiparametric magnetic resonance imaging were 44%, 94%, 81% and 76%, respectively. With prostate specific membrane antigen positron emission tomography the sensitivity, specificity, positive predictive value and negative predictive value were 49%, 95%, 85% and 88%, respectively. Prostate specific membrane antigen positron emission tomography yielded a higher specificity and positive predictive value. A significant proportion of cancers are potentially missed and underestimated by both imaging modalities. Prostate specific membrane antigen positron emission tomography may be used in addition to multiparametric magnetic resonance imaging to help improve local staging in those patients undergoing retropubic radical prostatectomy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Feasibility and safety of augmented-reality glass for computed tomography-assisted percutaneous revascularization of coronary chronic total occlusion: A single center prospective pilot study.

PubMed

Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Staruch, Adam D; Kepka, Cezary; Rokicki, Jakub K; Sieradzki, Bartosz; Witkowski, Adam

2017-11-01

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) may be facilitated by projection of coronary computed tomography angiography (CTA) datasets in the catheterization laboratory. There is no data on the feasibility and safety outcomes of CTA-assisted CTO PCI using a wearable augmented-reality glass. A total of 15 patients scheduled for elective antegrade CTO intervention were prospectively enrolled and underwent preprocedural coronary CTA. Three-dimensional and curved multiplanar CT reconstructions were transmitted to a head-mounted hands-free computer worn by interventional cardiologists during CTO PCI to provide additional information on CTO tortuosity and calcification. The results of CTO PCI using a wearable computer were compared with a time-matched prospective angiographic registry of 59 patients undergoing antegrade CTO PCI without a wearable computer. Operators' satisfaction was assessed by a 5-point Likert scale. Mean age was 64 ± 8 years and the mean J-CTO score was 2.1 ± 0.9 in the CTA-assisted group. The voice-activated co-registration and review of CTA images in a wearable computer during CTO PCI were feasible and highly rated by PCI operators (4.7/5 points). There were no major adverse cardiovascular events. Compared with standard CTO PCI, CTA-assisted recanalization of CTO using a wearable computer showed more frequent selection of the first-choice stiff wire (0% vs 40%, p < 0.001) and lower contrast exposure (166 ± 52 vs 134 ± 43 ml, p = 0.03). Overall CTO success rates and safety outcomes remained similar between both groups. CTA-assisted CTO PCI using an augmented-reality glass is feasible and safe, and might reduce the resources required for the interventional treatment of CTO. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

[Comparison of radiation dose reduction of prospective ECG-gated one beat scan using 320 area detector CT coronary angiography and prospective ECG-gated helical scan with high helical pitch (FlashScan) using 64 multidetector-row CT coronary angiography].

PubMed

Matsutani, Hideyuki; Sano, Tomonari; Kondo, Takeshi; Fujimoto, Shinichiro; Sekine, Takako; Arai, Takehiro; Morita, Hitomi; Takase, Shinichi

2010-12-20

A high radiation dose associated with 64 multidetector-row computed tomography (64-MDCT) is a major concern for physicians and patients alike. A new 320 row area detector computed tomography (ADCT) can obtain a view of the entire heart with one rotation (0.35 s) without requiring the helical method. As such, ADCT is expected to reduce the radiation dose. We studied image quality and radiation dose of ADCT compared to that of 64-MDCT in patients with a low heart rate (HR≤60). Three hundred eighty-five consecutive patients underwent 64-MDCT and 379 patients, ADCT. Patients with an arrhythmia were excluded. Prospective ECG-gated helical scan with high HP (FlashScan) in 64 was used for MDCT and prospective ECG-gated conventional one beat scan, for 320-ADCT. Image quality was visually evaluated by an image quality score. Radiation dose was estimated by DLP (mGy･cm) for 64-MDCT and DLP.e (mGy･cm) for 320-ADCT. Radiation dose of 320-ADCT (208±48 mGy･cm) was significantly (P<0.0001) lower than that of 64-MDCT (484±112 mGy･cm), and image quality score of 320-ADCT (3.0±0.2) was significantly (P=0.0011) higher than that of 64-MDCT (2.9±0.4). Scan time of 320-ADCT (1.4±0.1 s) was also significantly (P<0.0001) shorter than that of 64-MDCT (6.8±0.6 s). 320-ADCT can achieve not only a reduction in radiation dose but also a superior image quality and shortening of scan time compared to 64-MDCT.

Total Mucosal Irradiation with Intensity-modulated Radiotherapy in Patients with Head and Neck Carcinoma of Unknown Primary: A Pooled Analysis of Two Prospective Studies.

PubMed

Richards, T M; Bhide, S A; Miah, A B; Del Rosario, L; Bodla, S; Thway, K; Gujral, D M; Rooney, K P; Schick, U; McGovern, T; Grove, L; Newbold, K L; Harrington, K J; Nutting, C M

2016-09-01

To determine the clinical outcomes of an intensity-modulated radiotherapy technique for total mucosal irradiation (TM-IMRT) in patients with head and neck carcinoma of unknown primary (HNCUP). A single-centre prospective phase II trial design was used in two sequential studies to evaluate TM-IMRT for HNCUP. Patients were investigated for primary tumour site using examination under anaesthetic and biopsies, computed tomography ± magnetic resonance imaging (MRI) or 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Patients received IMRT to the potential primary tumour sites and elective cervical nodes. Concomitant chemotherapy was used in patients who received primary radiotherapy or those with nodal extracapsular extension. Thirty-six patients with HNCUP were recruited; 72% male. Twenty-five patients (69.4%) had p16-positive disease. Two year mucosal and local nodal control rates were 97.1% (95% confidence interval 91.4-100) and 89.8% (78.4-100), respectively. One mucosal primary was detected 7.3 months after TM-IMRT and three patients died from recurrent/metastatic squamous cell carcinoma of the head and neck. Twelve patients (33%) developed grade 3 (Late Effects in Normal Tissue-Subjective, Objective, Management and Analytical; LENT-SOMA) dysphagia with a 1 year enteric tube feeding rate of 2.7%. The high-grade subjective xerostomia rate (LENT-SOMA) at 24 months after IMRT was 15%. At a median follow-up of 36.1 months, the use of TM-IMRT was associated with good local control. Toxicity was comparable with previously reported TM-IMRT regimens encompassing similar mucosal volumes. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

... Radiation Therapy (IMRT) (APC 0305) f. Computed Tomography of Abdomen/Pelvic (APCs 0331 and 0334) g. Complex Interstitial Radiation Source Application (APC 0651) h. Radioelement Applications (APC 0312) 8. Respiratory...

Crestal Approach to Sinus Floor Elevation for Atrophic Maxilla Using Platelet-Rich Fibrin as the Only Grafting Material: A 1-Year Prospective Study.

PubMed

Kanayama, Takeo; Horii, Koichiro; Senga, Yasuko; Shibuya, Yasuyuki

2016-02-01

Platelet-rich fibrin (PRF) has been recently used as the sole grafting material in sinus floor elevation procedures. The aim of this prospective study was to measure the bone gain around the dental implant after using the crestal approach to sinus floor elevation using platelet-rich fibrin as the only grafting material in atrophic posterior maxillae with residual bone height <5 mm. Two different types of implants were used: hydroxyapatite (HA) and sandblasted acid-etched (SA) implants. Panoramic radiography and computed tomography were used to measure the endosinus bone gain. Twenty-seven patients with 39 implants (19 HA and 20 SA) were included in this study. The mean residual bone measurements before surgery in the SA and HA groups were 2.85 and 2.68 mm, respectively. The mean average bone gains for 1 year in the SA and HA groups were 4.38 and 4.00 mm, respectively. This prospective study showed that platelet-rich fibrin promoted endosinus bone gain when used as the grafting material in the crestal approach to sinus floor elevation.

PET measurement of receptor occupancy as a tool to guide dose selection in neuropharmacology: are we asking the right questions?

PubMed

Barrett, Jeffrey S; McGuire, Jennifer; Vezina, Heather; Spitsin, Serguei; Douglas, Steven D

2013-12-01

Receptor occupancy studies are becoming commonplace for verifying drug mechanism of action and selecting early development candidates. Positron emission tomography (PET) has been applied to pharmacodynamic (PD) studies in several therapeutic areas including neurology, cardiology, and oncology. Prospective use of PET to define dosing requirements has been proposed particularly for central nervous system (CNS)-targeted drugs; however, correlations with clinical outcomes have been mostly anecdotal and not causally established.

Prospective of 68Ga-Radiopharmaceutical Development

PubMed Central

Velikyan, Irina

2014-01-01

Positron Emission Tomography (PET) experienced accelerated development and has become an established method for medical research and clinical routine diagnostics on patient individualized basis. Development and availability of new radiopharmaceuticals specific for particular diseases is one of the driving forces of the expansion of clinical PET. The future development of the 68Ga-radiopharmaceuticals must be put in the context of several aspects such as role of PET in nuclear medicine, unmet medical needs, identification of new biomarkers, targets and corresponding ligands, production and availability of 68Ga, automation of the radiopharmaceutical production, progress of positron emission tomography technologies and image analysis methodologies for improved quantitation accuracy, PET radiopharmaceutical regulations as well as advances in radiopharmaceutical chemistry. The review presents the prospects of the 68Ga-based radiopharmaceutical development on the basis of the current status of these aspects as well as wide range and variety of imaging agents. PMID:24396515

THE RELATIONSHIP BETWEEN FOVEAL AVASCULAR ZONE AREA, VESSEL DENSITY, AND CYSTOID CHANGES IN DIABETIC RETINOPATHY, AN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY STUDY.

PubMed

Tarassoly, Kia; Miraftabi, Arezoo; Soltan Sanjari, Mostafa; Parvaresh, Mohammad Mehdi

2017-06-29

To measure the foveal avascular zone (FAZ) areas and vessel densities of patients with diabetic retinopathy and to study their relationship with diabetic cystoid changes and retinal thickness. Prospective case series of 51 eyes of 31 patients with diabetic retinopathy. The eyes were grouped based on the presence or absence of cystoid edema and evaluated using optical coherence tomography angiography. The FAZ areas and vessel density were compared. The FAZ area at the superficial capillary plexus level was equal between the eyes with and without cystoid edema. Vessel density did not differ as well. There was no correlation with retinal thickness. In eyes with cystoid changes, FAZ area changes at the deep capillary plexus level were difficult to interpret. The FAZ area and vessel density at the superficial capillary plexus level are reproducible and independent of the presence of cystoid edema.

Dynamic gonioscopy using optical coherence tomography.

PubMed

Matonti, Frederic; Chazalon, Elodie; Trichet, Elodie; Khaled, El Samak; Denis, Danièle; Hoffart, Louis

2012-01-01

To describe the use of anterior segment optical coherence tomography (AS-OCT) in studying the dynamic changes of the anterior chamber angle by corneal indentation. In a prospective observational study, the anterior segments of 21 eyes were imaged using AS-OCT. After the initial scan, a second scan was executed on the same areas with a central corneal indentation. An evaluation of the reopening of the angle and its measurement were performed. With AS-OCT, the indirect signs were accurate enough to guide the diagnosis in all plateau iris confirmed by ultrabiomicroscopy. The angle widths were significantly increased after indentation. This method would appear to offer a convenient and rapid method of assessing the configuration of the anterior chamber; it may help during the routine clinical assessment and treatment of patients with narrow or closed angles, particularly when gonioscopy is difficult to interpret. Copyright 2012, SLACK Incorporated.

CHOROIDAL THICKNESS IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PubMed

Laíns, Inês; Talcott, Katherine E; Santos, Ana R; Marques, João H; Gil, Pedro; Gil, João; Figueira, João; Husain, Deeba; Kim, Ivana K; Miller, Joan W; Silva, Rufino; Miller, John B

2018-01-01

To compare the choroidal thickness (CT) of diabetic eyes (different stages of disease) with controls, using swept-source optical coherence tomography. A multicenter, prospective, cross-sectional study of diabetic and nondiabetic subjects using swept-source optical coherence tomography imaging. Choroidal thickness maps, according to the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields, were obtained using automated software. Mean CT was calculated as the mean value within the ETDRS grid, and central CT as the mean in the central 1 mm. Diabetic eyes were divided into four groups: no diabetic retinopathy (No DR), nonproliferative DR (NPDR), NPDR with diabetic macular edema (NPDR + DME), and proliferative DR (PDR). Multilevel mixed linear models were performed for analyses. The authors included 50 control and 160 diabetic eyes (n = 27 No DR, n = 51 NPDR, n = 61 NPDR + DME, and n = 21 PDR). Mean CT (ß = -42.9, P = 0.022) and central CT (ß = -50.2, P = 0.013) were statistically significantly thinner in PDR eyes compared with controls, even after adjusting for confounding factors. Controlling for age, DR eyes presented a significantly decreased central CT than diabetic eyes without retinopathy (β = -36.2, P = 0.009). Swept-source optical coherence tomography demonstrates a significant reduction of CT in PDR compared with controls. In the foveal region, the choroid appears to be thinner in DR eyes than in diabetic eyes without retinopathy.

Rationale and design of the dual-energy computed tomography for ischemia determination compared to "gold standard" non-invasive and invasive techniques (DECIDE-Gold): A multicenter international efficacy diagnostic study of rest-stress dual-energy computed tomography angiography with perfusion.

PubMed

Truong, Quynh A; Knaapen, Paul; Pontone, Gianluca; Andreini, Daniele; Leipsic, Jonathon; Carrascosa, Patricia; Lu, Bin; Branch, Kelley; Raman, Subha; Bloom, Stephen; Min, James K

2015-10-01

Dual-energy CT (DECT) has potential to improve myocardial perfusion for physiologic assessment of coronary artery disease (CAD). Diagnostic performance of rest-stress DECT perfusion (DECTP) is unknown. DECIDE-Gold is a prospective multicenter study to evaluate the accuracy of DECT to detect hemodynamic (HD) significant CAD, as compared to fractional flow reserve (FFR) as a reference standard. Eligible participants are subjects with symptoms of CAD referred for invasive coronary angiography (ICA). Participants will undergo DECTP, which will be performed by pharmacological stress, and participants will subsequently proceed to ICA and FFR. HD-significant CAD will be defined as FFR ≤ 0.80. In those undergoing myocardial stress imaging (MPI) by positron emission tomography (PET), single photon emission computed tomography (SPECT) or cardiac magnetic resonance (CMR) imaging, ischemia will be graded by % ischemic myocardium. Blinded core laboratory interpretation will be performed for CCTA, DECTP, MPI, ICA, and FFR. Primary endpoint is accuracy of DECTP to detect ≥1 HD-significant stenosis at the subject level when compared to FFR. Secondary and tertiary endpoints are accuracies of combinations of DECTP at the subject and vessel levels compared to FFR and MPI. DECIDE-Gold will determine the performance of DECTP for diagnosing ischemia.

Tomography with energy dispersive diffraction

NASA Astrophysics Data System (ADS)

Stock, S. R.; Okasinski, J. S.; Woods, R.; Baldwin, J.; Madden, T.; Quaranta, O.; Rumaiz, A.; Kuczewski, T.; Mead, J.; Krings, T.; Siddons, P.; Miceli, A.; Almer, J. D.

2017-09-01

X-ray diffraction can be used as the signal for tomographic reconstruction and provides a cross-sectional map of the crystallographic phases and related quantities. Diffraction tomography has been developed over the last decade using monochromatic x-radiation and an area detector. This paper reports tomographic reconstruction with polychromatic radiation and an energy sensitive detector array. The energy dispersive diffraction (EDD) geometry, the instrumentation and the reconstruction process are described and related to the expected resolution. Results of EDD tomography are presented for two samples containing hydroxyapatite (hAp). The first is a 3D-printed sample with an elliptical crosssection and contains synthetic hAp. The second is a human second metacarpal bone from the Roman-era cemetery at Ancaster, UK and contains bio-hAp which may have been altered by diagenesis. Reconstructions with different diffraction peaks are compared. Prospects for future EDD tomography are also discussed.

Computed tomography versus water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy (Ivor Lewis): a prospective study in 97 patients.

PubMed

Strauss, Christiane; Mal, Frederic; Perniceni, Thierry; Bouzar, Nadia; Lenoir, Stephane; Gayet, Brice; Palau, Robert

2010-04-01

Water-soluble contrast swallow (CS) is usually performed before refeeding for anastomosis assessment after esophagectomy with intrathoracic anastomosis but the sensitivity of CS is low. Another diagnostic approach is based on analysis of computed tomography (CT) scan with oral contrast and of CT mediastinal air images. We undertook to compare them prospectively. Ninety-seven patients with an esophageal carcinoma operated by intrathoracic anastomosis were included prospectively in a study based on a CT scan at postoperative day 3 (without oral and intravenous contrast) and CT scan and CS at day 7. CT scan analysis consisted of assessing contrast and air leakage. In case of doubt, an endoscopy was done. A diagnosis of anastomotic leak was made in 13 patients (13.4%), in 2 cases before day 7 and in 3 beyond day 7. At day 3, 94 CT scans were performed, but the diagnostic value was poor. In 95 patients with both CS and CT scan at day 7, CS disclosed a leak in 5 of 11, and CT scan was abnormal in 8 of 11. Leakage of contrast and/or presence of mediastinal gas had the best negative predictive value (95.8%). Endoscopy was done in 16 patients with only mediastinal gas at day 7 CT scan. It disclosed a normal anastomosis in 11, fibrin deposits in 4, and a leak in 1. In comparison with CS only, CT at day 7 improves the sensitivity and negative predictive value for diagnosing an anastomotic leak. In case of doubt endoscopy is advisable. This approach provides an accurate assessment of the anastomosis before refeeding.

Prospective ECG-gated high-pitch dual-source cardiac CT angiography in the diagnosis of congenital cardiovascular abnormalities: Radiation dose and diagnostic efficacy in a pediatric population.

PubMed

Koplay, M; Kizilca, O; Cimen, D; Sivri, M; Erdogan, H; Guvenc, O; Oc, M; Oran, B

2016-11-01

The goal of this study was to investigate the radiation dose and diagnostic efficacy of cardiac computed tomography angiography (CCTA) using prospective ECG-gated high-pitch dual-source computed tomography (DSCT) in the diagnosis of congenital cardiovascular abnormalities in pediatric population. One hundred five pediatric patients who were clinically diagnosed with congenital heart disease with suspected extracardiac vascular abnormalities were included in the study. All CCTAs were performed on a 128×2-section DSCT scanner. CCTA findings were compared with surgical and/or conventional cardiac angiography findings. Dose-length product (DLP) and effective doses (ED) were calculated for each patient. Patients were divided into 4 groups by age, and ED and DLP values were compared among groups. The image quality was evaluated using a five-point scale. CCTA showed 173 abnormalities in 105 patients. There were 2 patients with false positive and 3 with false negative findings. The sensitivity and specificity of CCTA were 98.3% and 99.9%, respectively. The positive predictive value and negative predictive value of CCT were 98.9% and 99.9%, respectively. The average DLP and ED values were 15.6±9.6 (SD) mGy.cm and 0.34±0.10 (SD) mSv, respectively. The mean image quality score was 4.8±0.5 (SD) in all patients. The inter-observer agreement for the image quality scores was good (κ=0.80). CCTA is an excellent imaging modality for evaluation of cardiovascular abnormalities and provides excellent image quality with very low radiation exposure when low-dose prospective ECG-triggered high-pitch DSCT is used. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

The utility of breast cone-beam computed tomography, ultrasound, and digital mammography for detecting malignant breast tumors: A prospective study with 212 patients.

PubMed

He, Ni; Wu, Yao-Pan; Kong, Yanan; Lv, Ning; Huang, Zhi-Mei; Li, Sheng; Wang, Yue; Geng, Zhi-Jun; Wu, Pei-Hong; Wei, Wei-Dong

2016-02-01

Breast cone-beam computed tomography (BCBCT) is a flat-panel detector (FPD)-based X-ray imaging system that provides high-quality images of the breast. The purpose of this study was to investigate the ability to detect breast abnormalities using non-contrast BCBCT and contrast-enhanced BCBCT (BCBCT and CE-BCBCT) compared to ultrasound (US) and digital mammography (MG). A prospective study was performed from May 2012 to August 2014. Ninety-two patients (172 lesions) underwent BCBCT alone, and 120 patients (270 lesions) underwent BCBCT and CE-BCBCT, all the patients underwent US and MG. Cancer diagnosis was confirmed pathologically in 102 patients (110 lesions). BCBCT identified 97 of 110 malignant lesions, whereas 93 malignant lesions were identified using MG and US. The areas under the receiver operating curves (AUCs) for breast cancer diagnosis were 0.861 (BCBCT), 0.856 (US), and 0.829 (MG). CE-BCBCT improved cancer diagnostic sensitivity by 20.3% (78.4-98.7%). The AUC values were 0.869 (CE-BCBCT), 0.846 (BCBCT), 0.834 (US), and 0.782 (MG). In this preliminary study, BCBCT was found to accurately identify malignant breast lesions in a diagnostic setting. CE-BCBCT provided additional information and improved cancer diagnosis in style c or d breasts compared to the use of BCBCT, US, or MG alone. Copyright © 2015. Published by Elsevier Ireland Ltd.

Assessment of β-zone peripapillary atrophy by optical coherence tomography and scanning laser ophthalmoscopy imaging in glaucoma patients

PubMed Central

Seidensticker, Florian; Reznicek, Lukas; Mann, Thomas; Hübert, Irene; Kampik, Anselm; Ulbig, Michael; Hirneiss, Christoph; Neubauer, Aljoscha S; Kernt, Marcus

2014-01-01

Purpose To assess β-zone peripapillary atrophy (β-PPA) using spectral domain optical coherence tomography (SD-OCT), scanning laser ophthalmoscopy (SLO), and fundus auto-fluorescence (FAF) imaging in patients with primary open-angle glaucoma with advanced glaucomatous visual field defects. Methods A consecutive, prospective series of 82 study eyes with primary open-angle glaucoma were included in this study. All study participants underwent a full ophthalmic examination followed by SD-OCT, wide-field SLO, and FAF imaging of the optic nerve head and the peripapillary region. Results Eighty-four glaucomatous eyes were included in our prospective study. Correlation analyses for horizontally and vertically obtained β-PPA for all three imaging modalities (color SLO, FAF, and SD-OCT) revealed highest correlations between FAF and color SLO (Pearson correlation coefficient: 0.904 [P<0.001] for horizontal β-PPA and 0.786 [P<0.001] for vertical β-PPA). Bland–Altman plotting revealed highest agreements between color SLO and FAF, with −2.1 pixels ±1.96 standard deviation (SD) for horizontal β-PPA, SD: 10.5 pixels and 2.4 pixels ±1.96 SD for vertical β-PPA. Conclusion β-PPA can be assessed using en-face SLO and cross-sectional SD-OCT imaging. Correlation analyses revealed highest correlations between color SLO and FAF imaging, while correlations between SLO and SD-OCT were weak. A more precise structural definition of β-PPA is needed. PMID:25061270

The poppy seed test for colovesical fistula: big bang, little bucks!

PubMed

Kwon, Eric O; Armenakas, Noel A; Scharf, Stephen C; Panagopoulos, Georgia; Fracchia, John A

2008-04-01

Diagnosis of a colovesical fistula is often challenging, and usually involves numerous invasive and expensive tests and procedures. The poppy seed test stands out as an exception to this rule. We evaluated the accuracy and cost-effectiveness of various established diagnostic tests used to evaluate a suspected colovesical fistula. We identified 20 prospectively entered patients with surgically confirmed colovesical fistulas between 2000 and 2006. Each patient was evaluated preoperatively with a (51)chromium nuclear study, computerized tomography of the abdomen and pelvis with oral and intravenous contrast medium, and the poppy seed test. Costs were calculated using institutional charges, 2006 Medicare limiting approved charges and the market price, respectively. The z test was used to compare the proportion of patients who tested positive for a fistula with each of these modalities. The chromium study was positive in 16 of 20 patients (80%) at a cost of $490.83 per study. Computerized tomography was positive in 14 of 20 patients (70%) at a cost of $652.92 per study. The poppy seed test was positive in 20 of 20 patients (100%) at a cost of $5.37 per study. The difference in the proportion of patients who tested positive for a fistula on computerized tomography and the poppy seed test was statistically significant (p = 0.03). There was no difference between the chromium group and the computerized tomography or poppy seed group (p = 0.72 and 0.12, respectively). The poppy seed test is an accurate, convenient and inexpensive diagnostic test. It is an ideal initial consideration for evaluating a suspected colovesical fistula.

Definition of a positive test result in computed tomography screening for lung cancer: a cohort study.

PubMed

Henschke, Claudia I; Yip, Rowena; Yankelevitz, David F; Smith, James P

2013-02-19

Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-positive" findings may result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a positive result on the rates of positive results and cancer diagnoses is unknown. To assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Prospective cohort study. Multi-institutional International Early Lung Cancer Action Program. 21 136 participants with baseline computed tomography performed between 2006 and 2010. The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. The frequency of positive results in the baseline round by using the current definition of positive result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of positive results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. These findings suggest that using a threshold of 7 or 8 mm to define positive results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.

ULTRAHIGH SPEED SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL AND CHORIOCAPILLARIS ALTERATIONS IN DIABETIC PATIENTS WITH AND WITHOUT RETINOPATHY.

PubMed

Choi, WooJhon; Waheed, Nadia K; Moult, Eric M; Adhi, Mehreen; Lee, ByungKun; De Carlo, Talisa; Jayaraman, Vijaysekhar; Baumal, Caroline R; Duker, Jay S; Fujimoto, James G

2017-01-01

To investigate the utility of ultrahigh speed, swept source optical coherence tomography angiography in visualizing retinal microvascular and choriocapillaris (CC) changes in diabetic patients. The study was prospective and cross-sectional. A 1,050 nm wavelength, 400 kHz A-scan rate swept source optical coherence tomography prototype was used to perform volumetric optical coherence tomography angiography of the retinal and CC vasculatures in diabetic patients and normal subjects. Sixty-three eyes from 32 normal subjects, 9 eyes from 7 patients with proliferative diabetic retinopathy, 29 eyes from 16 patients with nonproliferative diabetic retinopathy, and 51 eyes from 28 diabetic patients without retinopathy were imaged. Retinal and CC microvascular abnormalities were observed in all stages of diabetic retinopathy. In nonproliferative diabetic retinopathy and proliferative diabetic retinopathy, optical coherence tomography angiography visualized a variety of vascular abnormalities, including clustered capillaries, dilated capillary segments, tortuous capillaries, regions of capillary dropout, reduced capillary density, abnormal capillary loops, and foveal avascular zone enlargement. In proliferative diabetic retinopathy, retinal neovascularization above the inner limiting membrane was visualized. Regions of CC flow impairment in patients with proliferative diabetic retinopathy and nonproliferative diabetic retinopathy were also observed. In 18 of the 51 of eyes from diabetic patients without retinopathy, retinal mircrovascular abnormalities were observed and CC flow impairment was found in 24 of the 51 diabetic eyes without retinopathy. The ability of optical coherence tomography angiography to visualize retinal and CC microvascular abnormalities suggests it may be a useful tool for understanding pathogenesis, evaluating treatment response, and earlier detection of vascular abnormalities in patients with diabetes.

Empiric versus imaging guided left ventricular lead placement in cardiac resynchronization therapy (ImagingCRT): study protocol for a randomized controlled trial.

PubMed

Sommer, Anders; Kronborg, Mads Brix; Poulsen, Steen Hvitfeldt; Böttcher, Morten; Nørgaard, Bjarne Linde; Bouchelouche, Kirsten; Mortensen, Peter Thomas; Gerdes, Christian; Nielsen, Jens Cosedis

2013-04-26

Cardiac resynchronization therapy (CRT) is an established treatment in heart failure patients. However, a large proportion of patients remain nonresponsive to this pacing strategy. Left ventricular (LV) lead position is one of the main determinants of response to CRT. This study aims to clarify whether multimodality imaging guided LV lead placement improves clinical outcome after CRT. The ImagingCRT study is a prospective, randomized, patient- and assessor-blinded, two-armed trial. The study is designed to investigate the effect of imaging guided left ventricular lead positioning on a clinical composite primary endpoint comprising all-cause mortality, hospitalization for heart failure, or unchanged or worsened functional capacity (no improvement in New York Heart Association class and <10% improvement in six-minute-walk test). Imaging guided LV lead positioning is targeted to the latest activated non-scarred myocardial region by speckle tracking echocardiography, single-photon emission computed tomography, and cardiac computed tomography. Secondary endpoints include changes in LV dimensions, ejection fraction and dyssynchrony. A total of 192 patients are included in the study. Despite tremendous advances in knowledge with CRT, the proportion of patients not responding to this treatment has remained stable since the introduction of CRT. ImagingCRT is a prospective, randomized study assessing the clinical and echocardiographic effect of multimodality imaging guided LV lead placement in CRT. The results are expected to make an important contribution in the pursuit of increasing response rate to CRT. Clinicaltrials.gov identifier NCT01323686. The trial was registered March 25, 2011 and the first study subject was randomized April 11, 2011.

Correlation between tissue metabolism and cellularity assessed by standardized uptake value and apparent diffusion coefficient in peritoneal metastasis.

PubMed

Yu, Xue; Lee, Elaine Yuen Phin; Lai, Vincent; Chan, Queenie

2014-07-01

To evaluate the correlation between standardized uptake value (SUV) (tissue metabolism) and apparent diffusion coefficient (ADC) (water diffusivity) in peritoneal metastases. Patients with peritoneal dissemination detected on (18)F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) were prospectively recruited for MRI examinations with informed consent and the study was approved by the local Institutional Review Board. FDG-PET/CT, diffusion-weighted imaging (DWI), MRI, and DWI/MRI images were independently reviewed by two radiologists based on visual analysis. SUVmax/SUVmean and ADCmin/ADCmean were obtained manually by drawing ROIs over the peritoneal metastases on FDG-PET/CT and DWI, respectively. Diagnostic characteristics of each technique were evaluated. Pearson's coefficient and McNemar and Kappa tests were used for statistical analysis. Eight patients were recruited for this prospective study and 34 peritoneal metastases were evaluated. ADCmean was significantly and negatively correlated with SUVmax (r = -0.528, P = 0.001) and SUVmean (r = -0.548, P = 0.001). ADCmin had similar correlation with SUVmax (r = -0.508, P = 0.002) and SUVmean (r = -0.513, P = 0.002). DWI/MRI had high diagnostic performance (accuracy = 98%) comparable to FDG-PET/CT, in peritoneal metastasis detection. Kappa values were excellent for all techniques. There was a significant inverse correlation between SUV and ADC. © 2013 Wiley Periodicals, Inc.

Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study.

PubMed

Chang, Yoon; Koenig, Lisa J; Pruszynski, Jessica E; Bradley, Thomas G; Bosio, Jose A; Liu, Dawei

2013-04-01

The aim of this prospective study was to use cone-beam computed tomography to assess the dimensional changes of the upper airway in orthodontic patients with maxillary constriction treated by rapid maxillary expansion. Fourteen orthodontic patients (mean age, 12.9 years; range, 9.7-16 years) were recruited. The patients with posterior crossbite and constricted maxilla were treated with rapid maxillary expansion as the initial part of their comprehensive orthodontic treatments. Before and after rapid maxillary expansion cone-beam computed tomography scans were taken to measure the retropalatal and retroglossal airway changes in terms of volume, and sagittal and cross-sectional areas. The transverse expansions by rapid maxillary expansion were assessed between the midlingual alveolar bone plates at the maxillary first molar and first premolar levels. The measurements of the before and after rapid maxillary expansion scans were compared by using paired t tests with the Bonferroni adjustment for multiple comparisons. After rapid maxillary expansion, significant and equal amounts of 4.8 mm of expansion were observed at the first molar (P = 0.0000) and the first premolar (P = 0.0000) levels. The width increase at the first premolar level (20.0%) was significantly greater than that at the first molar level (15.0%) (P = 0.035). As the primary outcome variable, the cross-sectional airway measured from the posterior nasal spine to basion level was the only parameter showing a significant increase of 99.4 mm(2) (59.6%) after rapid maxillary expansion (P = 0.0004). These results confirm the findings of previous studies of the effect of rapid maxillary expansion on the maxilla. Additionally, we found that only the cross-sectional area of the upper airway at the posterior nasal spine to basion level significantly gains a moderate increase after rapid maxillary expansion. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Esophageal involvement and interstitial lung disease in mixed connective tissue disease.

PubMed

Fagundes, M N; Caleiro, M T C; Navarro-Rodriguez, T; Baldi, B G; Kavakama, J; Salge, J M; Kairalla, R; Carvalho, C R R

2009-06-01

Mixed connective tissue disease is a systemic inflammatory disorder that results in both pulmonary and esophageal manifestations. We sought to evaluate the relationship between esophageal dysfunction and interstitial lung disease in patients with mixed connective tissue disease. We correlated the pulmonary function data and the high-resolution computed tomography findings of interstitial lung disease with the results of esophageal evaluation in manometry, 24-hour intraesophageal pH measurements, and the presence of esophageal dilatation on computed tomography scan. Fifty consecutive patients with mixed connective tissue disease, according to Kasukawa's classification criteria, were included in this prospective study. High-resolution computed tomography parenchymal abnormalities were present in 39 of 50 patients. Esophageal dilatation, gastroesophageal reflux, and esophageal motor impairment were also very prevalent (28 of 50, 18 of 36, and 30 of 36, respectively). The presence of interstitial lung disease on computed tomography was significantly higher among patients with esophageal dilatation (92% vs. 45%; p<0.01) and among patients with severe motor dysfunction (90% vs. 35%; p<0.001). Although we were not able to prove a causal relationship between esophageal and pulmonary involvement, our series revealed a strong association between esophageal motor dysfunction and interstitial lung disease in patients with mixed connective tissue disease.

Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire.

PubMed

Eichfeld, Uwe; Dietrich, Arne; Ott, Rudolph; Kloeppel, Rainer

2005-01-01

Peripheral pulmonary nodules are preferably removed by minimally invasive techniques, such as video-assisted thoracoscopic (VATS) surgery. These nodules should be marked preoperatively for better intraoperative detection and removal. Twenty-two cases with a single pulmonary nodule requiring surgical removal for histologic examination were included in a prospective study. Guided by computed tomography, nodules were marked preoperatively using a laser marker system and fixed with a spiral wire. The marked nodules were removed by VATS surgery immediately after the marking. The marking wire was placed in all 22 patients without any complications. The marked nodule was completely removed by VATS surgery in 19 patients. Conversion to thoracotomy was necessary in 3 patients, twice because of thoracoscopy-related problems and once because of a marking failure. The average times for the marking procedure and operation were 24 minutes and 32 minutes, respectively. This new method of computed tomography-guided nodule marking with a spiral wire and subsequent VATS surgery is very efficient in terms of localization and stable fixation of subpleural pulmonary nodules.

Reduction of metal artifacts from alloy hip prostheses in computer tomography.

PubMed

Wang, Fengdan; Xue, Huadan; Yang, Xianda; Han, Wei; Qi, Bing; Fan, Yu; Qian, Wenwei; Wu, Zhihong; Zhang, Yan; Jin, Zhengyu

2014-01-01

The objective of this study was to evaluate the feasibility of reducing artifacts from large metal implants with gemstone spectral imaging (GSI) and metal artifact reduction software (MARS). Twenty-three in-vivo cobalt-chromium-molybdenum alloy total hip prostheses were prospectively scanned by fast kV-switching GSI between 80 and 140 kVp. The computed tomography images were reconstructed with monochromatic energy and with/without MARS. Both subjective and objective measurements were performed to assess the severity of metal artifacts. Increasing photon energy was associated with reduced metal artifacts in GSI images (P < 0.001). Combination of GSI with MARS further diminished the metal artifacts (P < 0.001). Artifact reduction at 3 anatomical levels (femoral head, neck, and shaft) were evaluated, with data showing that GSI and MARS could reduce metal artifacts at all 3 levels (P = 0.011, P < 0.001, and P = 0.003, respectively). Nevertheless, in certain cases, GSI without MARS produced more realistic images for the clinical situation. Proper usage of GSI with/without MARS could reduce the computed tomography artifacts of large metal parts and improve the radiological evaluation of postarthroplasty patients.

Comparison of conventional ultrasonography and ultrasonography-computed tomography fusion imaging for target identification using digital/real hybrid phantoms: a preliminary study.

PubMed

Soyama, Takeshi; Sakuhara, Yusuke; Kudo, Kohsuke; Abo, Daisuke; Wang, Jeff; Ito, Yoichi M; Hasegawa, Yu; Shirato, Hiroki

2016-07-01

This preliminary study compared ultrasonography-computed tomography (US-CT) fusion imaging and conventional ultrasonography (US) for accuracy and time required for target identification using a combination of real phantoms and sets of digitally modified computed tomography (CT) images (digital/real hybrid phantoms). In this randomized prospective study, 27 spheres visible on B-mode US were placed at depths of 3.5, 8.5, and 13.5 cm (nine spheres each). All 27 spheres were digitally erased from the CT images, and a radiopaque sphere was digitally placed at each of the 27 locations to create 27 different sets of CT images. Twenty clinicians were instructed to identify the sphere target using US alone and fusion imaging. The accuracy of target identification of the two methods was compared using McNemar's test. The mean time required for target identification and error distances were compared using paired t tests. At all three depths, target identification was more accurate and the mean time required for target identification was significantly less with US-CT fusion imaging than with US alone, and the mean error distances were also shorter with US-CT fusion imaging. US-CT fusion imaging was superior to US alone in terms of accurate and rapid identification of target lesions.

Finasteride for chronic central serous chorioretinopathy.

PubMed

Forooghian, Farzin; Meleth, Annal D; Cukras, Catherine; Chew, Emily Y; Wong, Wai T; Meyerle, Catherine B

2011-04-01

To evaluate the safety and efficacy of finasteride, an inhibitor of dihydrotestosterone synthesis, in the treatment of chronic central serous chorioretinopathy. Five patients with chronic central serous chorioretinopathy were prospectively enrolled in this pilot study. Patients were administered finasteride (5 mg) daily for 3 months, after which study medication was withheld and patients were observed for 3 months. Main outcome measures included best-corrected visual acuity, central subfield macular thickness, and subretinal fluid volume as assessed by optical coherence tomography. Serum dihydrotestosterone, serum testosterone, and urinary cortisol were also measured. There was no change in mean best-corrected visual acuity. Mean center-subfield macular thickness and subretinal fluid volume reached a nadir at 3 months and rose to levels that were below baseline by 6 months. The changes in both optical coherence tomography parameters paralleled those in serum dihydrotestosterone level. In four patients, center-subfield macular thickness and/or subretinal fluid volume increased after discontinuation of finasteride. In the remaining patient, both optical coherence tomography parameters normalized with finasteride and remained stable when the study medication was discontinued. Finasteride may represent a novel medical treatment for chronic central serous chorioretinopathy. Larger controlled clinical trials are needed to further assess the efficacy of finasteride for the treatment of central serous chorioretinopathy.

SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVEALS INTERNAL LIMITING MEMBRANE PEELING ALTERS DEEP RETINAL VASCULATURE.

PubMed

Michalewska, Zofia; Nawrocki, Jerzy

2018-04-30

To describe morphology of retinal and choroidal vessels in swept-source optical coherence tomography angiography before and after vitrectomy with the temporal inverted internal limiting membrane (ILM) flap technique for full-thickness macular holes. Prospective, observational study of 36 eyes of 33 patients with full-thickness macular holes swept-source optical coherence tomography angiography was performed in patients before and 1 month after vitrectomy. Vitrectomy with the temporal inverted ILM flap technique was performed. In this method, ILM is peeled only at one side of the fovea. An ILM flap is created to cover the macular hole. Comparison of retina vasculature in the areas of ILM peeling vs. no ILM peeling at 1 and 3 months after successful vitrectomy was performed. The study demonstrated lower density of vessels in the deep retinal plexus in the area where ILM was peeled as compared to the rest of the fovea. Visual acuity and central retinal thickness 1 month after surgery correlates with fovea avascular zone diameter in deep retinal layers at the same time point (P = 0.001). This study confirmed that ILM peeling might alter blood flow in deep retinal vessels below the peeling area in the early postoperative period. The area of the fovea avascular zone corresponds to functional results at the same time point.

Multimodal airway evaluation in growing patients after rapid maxillary expansion.

PubMed

Fastuca, R; Meneghel, M; Zecca, P A; Mangano, F; Antonello, M; Nucera, R; Caprioglio, A

2015-06-01

The objective of this study was to evaluate the airway volume of growing patients combining a morphological approach using cone beam computed tomography associated with functional data obtained by polysomnography examination after rapid maxillary expansion treatment. 22 Caucasian patients (mean age 8.3±0.9 years) undergoing rapid maxillary expansion with Haas type expander banded on second deciduous upper molars were enrolled for this prospective study. Cone beam computed tomography scans and polysomnography exams were collected before placing the appliance (T0) and after 12 months (T1). Image processing with airway volume computing and analyses of oxygen saturation and apnoea/hypopnoea index were performed. Airway volume, oxygen saturation and apnea/hypopnea index underwent significant increase over time. However, no significant correlation was seen between their increases. The rapid maxillary expansion treatment induced significant increases in the total airway volume and respiratory performance. Functional respiratory parameters should be included in studies evaluating the RME treatment effects on the respiratory performance.

Computed tomography versus digital subtraction angiography for the diagnosis of obscure gastrointestinal bleeding.

PubMed

Wildgruber, Moritz; Wrede, Christian E; Zorger, Niels; Müller-Wille, René; Hamer, Okka W; Zeman, Florian; Stroszczynski, Christian; Heiss, Peter

2017-03-01

The diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB. The institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test. 24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06). Due to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB. Copyright © 2016. Published by Elsevier B.V.

Multicenter AIDS Cohort Study Quantitative Coronary Plaque Progression Study: rationale and design.

PubMed

Nakanishi, Rine; Post, Wendy S; Osawa, Kazuhiro; Jayawardena, Eranthi; Kim, Michael; Sheidaee, Nasim; Nezarat, Negin; Rahmani, Sina; Kim, Nicholas; Hathiramani, Nicolai; Susarla, Shriraj; Palella, Frank; Witt, Mallory; Blaha, Michael J; Brown, Todd T; Kingsley, Lawrence; Haberlen, Sabina A; Dailing, Christopher; Budoff, Matthew J

2018-01-01

The association of HIV with coronary atherosclerosis has been established; however, the progression of coronary atherosclerosis over time among participants with HIV is not well known. The Multicenter AIDS Cohort Study Quantitative Coronary Plaque Progression Study is a large prospective multicenter study quantifying progression of coronary plaque assessed by serial coronary computed tomography angiography (CTA). HIV-infected and uninfected men who were enrolled in the Multicenter AIDS Cohort Study Cardiovascular Substudy were eligible to complete a follow-up contrast coronary CTA 3-6 years after baseline. We measured coronary plaque volume and characteristics (calcified and noncalcified plaque including fibrous, fibrous-fatty, and low attenuation) and vulnerable plaque among HIV-infected and uninfected men using semiautomated plaque software to investigate the progression of coronary atherosclerosis over time. We describe a novel, large prospective multicenter study investigating incidence, transition of characteristics, and progression in coronary atherosclerosis quantitatively assessed by serial coronary CTAs among HIV-infected and uninfected men.

VISUALIZATION FROM INTRAOPERATIVE SWEPT-SOURCE MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY IN VITRECTOMY FOR COMPLICATIONS OF PROLIFERATIVE DIABETIC RETINOPATHY.

PubMed

Gabr, Hesham; Chen, Xi; Zevallos-Carrasco, Oscar M; Viehland, Christian; Dandrige, Alexandria; Sarin, Neeru; Mahmoud, Tamer H; Vajzovic, Lejla; Izatt, Joseph A; Toth, Cynthia A

2018-01-10

To evaluate the use of live volumetric (4D) intraoperative swept-source microscope-integrated optical coherence tomography in vitrectomy for proliferative diabetic retinopathy complications. In this prospective study, we analyzed a subgroup of patients with proliferative diabetic retinopathy complications who required vitrectomy and who were imaged by the research swept-source microscope-integrated optical coherence tomography system. In near real time, images were displayed in stereo heads-up display facilitating intraoperative surgeon feedback. Postoperative review included scoring image quality, identifying different diabetic retinopathy-associated pathologies and reviewing the intraoperatively documented surgeon feedback. Twenty eyes were included. Indications for vitrectomy were tractional retinal detachment (16 eyes), combined tractional-rhegmatogenous retinal detachment (2 eyes), and vitreous hemorrhage (2 eyes). Useful, good-quality 2D (B-scans) and 4D images were obtained in 16/20 eyes (80%). In these eyes, multiple diabetic retinopathy complications could be imaged. Swept-source microscope-integrated optical coherence tomography provided surgical guidance, e.g., in identifying dissection planes under fibrovascular membranes, and in determining residual membranes and traction that would benefit from additional peeling. In 4/20 eyes (20%), acceptable images were captured, but they were not useful due to high tractional retinal detachment elevation which was challenging for imaging. Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different complications and facilitation of intraoperative decision making.

Neuroimaging findings with MDMA/ecstasy: technical aspects, conceptual issues and future prospects.

PubMed

Reneman, Liesbeth; de Win, Maartje M L; van den Brink, Wim; Booij, Jan; den Heeten, Gerard J

2006-03-01

Users of ecstasy (3,4-methylenedioxymethamphetamine; MDMA) may be at risk of developing MDMA-induced injury to the serotonin (5-HT) system. Previously, there were no methods available for directly evaluating the neurotoxic effects of MDMA in the living human brain. However, development of in vivoneuroimaging tools have begun to provide insights into the effects of ecstasy on the human brain. Single photon emission computed tomography (SPECT), positron emission computed tomography (PET) and proton magnetic resonance spectroscopy (1H-MRS) studies which have evaluated ecstasy's neurotoxic potential will be reviewed and discussed in terms of technical aspects, conceptual issues and future prospects. Although PET and SPECT may be limited by several factors such as the low cortical uptake and the use of a non-optimal reference region (cerebellum) the few studies conducted so far provide suggestive evidence that people who heavily use ecstasy are at risk of developing subcortical, and probably also cortical reductions in serotonin transporter (SERT) densities, a marker of 5-HT neurotoxicity. There seem to be dose-dependent and transient reductions in SERT for which females may be more vulnerable than males. 1H-MRS appears to be a less sensitive technique for studying ecstasy's neurotoxic potential. Whether individuals with a relatively low ecstasy exposure also demonstrate loss of SERT needs to be determined. Because most studies have had a retrospective design, in which evidence is indirect and differs in the degree to which any causal links can be implied, longitudinal studies in human ecstasy users are needed to draw definite conclusions.

Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines.

PubMed

Smart, Luke R; Mangat, Halinder S; Issarow, Benson; McClelland, Paul; Mayaya, Gerald; Kanumba, Emmanuel; Gerber, Linda M; Wu, Xian; Peck, Robert N; Ngayomela, Isidore; Fakhar, Malik; Stieg, Philip E; Härtl, Roger

2017-09-01

Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. Prospective TBI data from sub-Saharan Africa are sparse. This study examines epidemiology and explores management of patients with severe TBI and adherence to Brain Trauma Foundation Guidelines at a tertiary care referral hospital in Tanzania. Patients with severe TBI hospitalized at Bugando Medical Centre were recorded in a prospective registry including epidemiologic, clinical, treatment, and outcome data. Between September 2013 and October 2015, 371 patients with TBI were admitted; 33% (115/371) had severe TBI. Mean age was 32.0 years ± 20.1, and most patients were male (80.0%). Vehicular injuries were the most common cause of injury (65.2%). Approximately half of the patients (47.8%) were hospitalized on the day of injury. Computed tomography of the brain was performed in 49.6% of patients, and 58.3% were admitted to the intensive care unit. Continuous arterial blood pressure monitoring and intracranial pressure monitoring were not performed in any patient. Of patients with severe TBI, 38.3% received hyperosmolar therapy, and 35.7% underwent craniotomy. The 2-week mortality was 34.8%. Mortality of patients with severe TBI at Bugando Medical Centre, Tanzania, is approximately twice that in high-income countries. Intensive care unit care, computed tomography imaging, and continuous arterial blood pressure and intracranial pressure monitoring are underused or unavailable in the tertiary referral hospital setting. Improving outcomes after severe TBI will require concerted investment in prehospital care and improvement in availability of intensive care unit resources, computed tomography, and expertise in multidisciplinary care. Copyright © 2017 Elsevier Inc. All rights reserved.

F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: Comparison with magnetic resonance imaging

PubMed Central

Gayana, Shankaramurthy; Bhattacharya, Anish; Sen, Ramesh Kumar; Singh, Paramjeet; Prakash, Mahesh; Mittal, Bhagwant Rai

2016-01-01

Objective: Femoral head avascular necrosis (FHAVN) is one of the increasingly common causes of musculoskeletal disability and poses a major diagnostic and therapeutic challenge. Although radiography, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) have been widely used in the diagnosis of FHAVN, positron emission tomography (PET) has recently been evaluated to assess vascularity of the femoral head. In this study, the authors compared F-18 fluoride PET/CT with MRI in the initial diagnosis of FHAVN. Patients and Methods: We prospectively studied 51 consecutive patients with a high clinical suspicion of FHAVN. All patients underwent MRI and F-18 fluoride PET/CT, the time interval between the two scans being 4–10 (mean 8) days. Two nuclear medicine physicians blinded to the MRI report read the PET/CT scans. Clinical assessment was also done. Final diagnoses were made by surgical pathology or clinical and radiologic follow-up. Results: A final diagnosis of avascular necrosis (AVN) was made in 40 patients. MRI was 96.5% sensitive, 100% specific, and 98.03% accurate while PET/CT was 100% sensitive, specific, and accurate in diagnosing FHAVN. The agreement between the two imaging modalities for the diagnosis of AVN was 96.07%. Conclusion: F-18 fluoride PET/CT showed good agreement with MRI in the initial diagnosis of FHAVN and can be better than MRI in detecting early disease. PMID:26917886

Fourier Domain Optical Coherence Tomography With 3D and En Face Imaging of the Punctum and Vertical Canaliculus: A Step Toward Establishing a Normative Database.

PubMed

Kamal, Saurabh; Ali, Mohammad Javed; Ali, Mohammad Hasnat; Naik, Milind N

2016-01-01

To report the features of Fourier domain optical coherence tomography imaging of the normal punctum and vertical canaliculus. Prospective, interventional series of consecutive healthy and asymptomatic adults, who volunteered for optical coherence tomography imaging, were included in the study. Fourier domain optical coherence tomography images of the punctum and vertical canaliculus along with 3D and En face images were captured using the RTVue scanner with a corneal adaptor module and a wide-angled lens. Maximum punctal diameter, mid-canalicular diameter, and vertical canalicular height were calculated. Statistical analysis was performed using Pearson correlation test, and scatter plot matrices were analyzed. A total of 103 puncta of 52 healthy subjects were studied. Although all the images could depict the punctum and vertical canaliculus and all the desired measurements could be obtained, occasional tear debris within the canaliculus was found to be interfering with the imaging. The mean maximum punctal diameter, mid-canalicular diameter, and vertical canalicular height were recorded as 214.71 ± 73 μm, 125.04 ± 60.69 μm, and 890.41 ± 154.76 μm, respectively, with an insignificant correlation between them. The maximum recorded vertical canalicular height in all the cases was far less than the widely reported depth of 2 mm. High-resolution 3D and En face images provided a detailed topography of punctal surface and overview of vertical canaliculus. Fourier domain optical coherence tomography with 3D and En face imaging is a useful noninvasive modality to image the proximal lacrimal system with consistently reproducible high-resolution images. This is likely to help clinicians in the management of proximal lacrimal disorders.

Routine 18F-2-deoxy-2-fluoro-D-glucose (18F-FDG) myocardial tomography using a normal large field of view gamma-camera.

PubMed

Höflin, F; Ledermann, H; Noelpp, U; Weinreich, R; Rösler, H

1989-12-01

There is a recent need to study glucose metabolism of the heart in ischemic, as well as in "hibernating or stunned" myocardium, and compare it with that in perfusion studies. In non-positron emission tomography centers, positron imaging is possible with a standard Anger-type camera if proper collimation and adequate shielding of the camera crystal can be achieved. For the study with fast-decaying isotopes, seven-pinhole tomography (7PHT), a limited-angle method designed for transaxial tomography of the left ventricle using a nonrotating camera, is well suited, because projections are acquired simultaneously. Individual adjustment (patient supine) of the camera's view axis (CAx) with the left ventricular axis (LVAx) gives excellent results: sensitivity for CHD 82%, specificity 72% in a prospective 201TI study (48 patients, x-ray coronarography as reference). Good alignment of CAx with LVAx is also achieved with the patient prone in LAO in a hammock above the camera surface. In this setting additional lead shielding of the camera is possible using a table reinforced with 5 cm of lead with a central hole for the 7PH-collimator, which has a special lead inlay. This allows utilization of the 511 KeV emitter 18F-FDG, which with a half-life of 109 minutes, can be transported a reasonable distance from the production site. System sensitivity and resolution for 18F was found comparable to 201Tl, 99mTc, and 123I using a phantom. First clinical examinations after 201Tl stress/redistribution studies showed increased 18F-FDG uptake in ischemic heart segments, as well as in "hibernating" nonperfused or "stunned" myocardium.

Pilot study utilizing Fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography for glycolytic phenotyping of canine mast cell tumors.

PubMed

Griffin, Lynn R; Thamm, Doug H; Selmic, Laura E; Ehrhart, E J; Randall, Elissa

2018-03-23

The goal of this prospective pilot study was to use naturally occurring canine mast cell tumors of various grades and stages as a model for attempting to determine how glucose uptake and markers of biologic behavior are correlated. It was hypothesized that enhanced glucose uptake, as measured by 2-[fluorine-18]fluoro-d-glucose-positron emission tomography/computed tomography (F18 FDG PET-CT), would correlate with histologic grade. Dogs were recruited for this study from a population referred for treatment of cytologically or histologically confirmed mast cell tumors. Patients were staged utilizing standard of care methods (abdominal ultrasound and three view thoracic radiographs), followed by a whole body F18 FDG PET-CT. Results of the F18 FDG PET-CT were analyzed for possible metastasis and standard uptake value maximum (SUV max ) of identified lesions. Incisional or excisional biopsies of the accessible mast cell tumors were obtained and histology performed. Results were then analyzed to look for a possible correlation between the grade of mast cell tumors and SUV max . A total of nine animals were included in the sample. Findings indicated that there was a correlation between grade of mast cell tumors and SUV max as determined by F18 FDG PET-CT (p-value = 0.073, significance ≤ 0.1). Based on the limited power of this study, it is felt that further research to examine the relationship between glucose utilization and biologic aggressiveness in canine mast cell tumors is warranted. This study was unable to show that F18 FDG PET-CT was a better staging tool than standard of care methods. © 2018 American College of Veterinary Radiology.

Possible role for fundus autofluorescence as a predictive factor for visual acuity recovery after epiretinal membrane surgery.

PubMed

Brito, Pedro N; Gomes, Nuno L; Vieira, Marco P; Faria, Pedro A; Fernandes, Augusto V; Rocha-Sousa, Amândio; Falcão-Reis, Fernando

2014-02-01

To study the potential association between fundus autofluorescence, spectral-domain optical coherence tomography, and visual acuity in patients undergoing surgery because of epiretinal membranes. Prospective, interventional case series including 26 patients submitted to vitrectomy because of symptomatic epiretinal membranes. Preoperative evaluation consisted of a complete ophthalmologic examination, autofluorescence, and spectral-domain optical coherence tomography. Studied variables included foveal autofluorescence (fov.AF), photoreceptor inner segment/outer segment (IS/OS) junction line integrity, external limiting membrane integrity, central foveal thickness, and foveal morphology. All examinations were repeated at the first, third, and sixth postoperative months. The main outcome measures were logarithm of minimal angle resolution visual acuity, fov.AF integrity, and IS/OS integrity. All cases showing a continuous IS/OS line had an intact fov.AF, whereas patients with IS/OS disruption could have either an increased area of foveal hypoautofluorescence or an intact fov.AF, with the latter being associated with IS/OS integrity recovery in follow-up spectral-domain optical coherence tomography imaging. The only preoperative variables presenting a significant correlation with final visual acuity were baseline visual acuity (P = 0.047) and fov.AF grade (P = 0.023). Recovery of IS/OS line integrity after surgery, in patients with preoperative IS/OS disruption and normal fov.AF, can be explained by the presence of a functional retinal pigment epithelium-photoreceptor complex, supporting normal photoreceptor activity. Autofluorescence imaging provides a functional component to the study of epiretinal membranes, complementing the structural information obtained with optical coherence tomography.

Stress Computed Tomography Myocardial Perfusion Imaging: A New Topic in Cardiology.

PubMed

Seitun, Sara; Castiglione Morelli, Margherita; Budaj, Irilda; Boccalini, Sara; Galletto Pregliasco, Athena; Valbusa, Alberto; Cademartiri, Filippo; Ferro, Carlo

2016-02-01

Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Axial Plane Deformity of the Shoulder in Adolescent Idiopathic Scoliosis.

PubMed

Menon, Venugopal K; Tahasildar, Naveen; Pillay, Haroon M; M, Anbuselvam

2017-05-01

Prospective observational study. To study axial plane deformation of the shoulder in adolescent idiopathic scoliosis (AIS) and try to correlate it with curve type and surgical correction. It is established that AIS is a 3-dimensional deformity. The rib hump is the most common manifestation of axial plane deformations; the least common manifestation seems to be upper trunk and shoulder rotation, which has been hitherto undescribed. Fourteen consecutive, operated cases of AIS were analyzed prospectively. Preoperative and postoperative x-rays of the spine and clinical photographs were studied. Clinical photographs (top view) were taken with patients in the sitting position, to show shoulder level in relation to the axis of the head and pelvis. Chest computed tomography scans were also studied to determine the direction of apical vertebra and trunk torsion. All 14 patients in this series had their right shoulders anteriorly rotated preoperatively (anticlockwise). The direction of rotation seemed unrelated to the curve type and shoulder elevation, although most had rib humps on the right. This shoulder rotation was corrected postoperatively by routine maneuvers done for scoliosis correction. Minor residual rotation was seen in 6 patients who also had minimal persisting rib hump. In 1 case the axial plane rotation worsened, although the shoulder level and trunk symmetry improved significantly. The apical vertebral rotation on computed tomography had little bearing on the direction of shoulder rotation. Axial plane rotation of the shoulder is a hitherto un-described dimension of AIS deformity complex. Much of it corrects spontaneously with correction of the thoracic spinal deformity.

Recent Update on Radiation Dose Assessment for the State-of-the-Art Coronary Computed Tomography Angiography Protocols.

PubMed

Tan, Sock Keow; Yeong, Chai Hong; Ng, Kwan Hoong; Abdul Aziz, Yang Faridah; Sun, Zhonghua

2016-01-01

This study aimed to measure the absorbed doses in selected organs for prospectively ECG-triggered coronary computed tomography angiography (CCTA) using five different generations CT scanners in a female adult anthropomorphic phantom and to estimate the effective dose (HE). Prospectively ECG-triggered CCTA was performed using five commercially available CT scanners: 64-detector-row single source CT (SSCT), 2 × 32-detector-row-dual source CT (DSCT), 2 × 64-detector-row DSCT and 320-detector-row SSCT scanners. Absorbed doses were measured in 34 organs using pre-calibrated optically stimulated luminescence dosimeters (OSLDs) placed inside a standard female adult anthropomorphic phantom. HE was calculated from the measured organ doses and compared to the HE derived from the air kerma-length product (PKL) using the conversion coefficient of 0.014 mSv∙mGy-1∙cm-1 for the chest region. Both breasts and lungs received the highest radiation dose during CCTA examination. The highest HE was received from 2 × 32-detector-row DSCT scanner (6.06 ± 0.72 mSv), followed by 64-detector-row SSCT (5.60 ± 0.68 and 5.02 ± 0.73 mSv), 2 × 64-detector-row DSCT (1.88 ± 0.25 mSv) and 320-detector-row SSCT (1.34 ± 0.48 mSv) scanners. HE calculated from the measured organ doses were about 38 to 53% higher than the HE derived from the PKL-to-HE conversion factor. The radiation doses received from a prospectively ECG-triggered CCTA are relatively small and are depending on the scanner technology and imaging protocols. HE as low as 1.34 and 1.88 mSv can be achieved in prospectively ECG-triggered CCTA using 320-detector-row SSCT and 2 × 64-detector-row DSCT scanners.

Recent Update on Radiation Dose Assessment for the State-of-the-Art Coronary Computed Tomography Angiography Protocols

PubMed Central

Tan, Sock Keow; Yeong, Chai Hong; Ng, Kwan Hoong; Abdul Aziz, Yang Faridah; Sun, Zhonghua

2016-01-01

Objectives This study aimed to measure the absorbed doses in selected organs for prospectively ECG-triggered coronary computed tomography angiography (CCTA) using five different generations CT scanners in a female adult anthropomorphic phantom and to estimate the effective dose (HE). Materials and Methods Prospectively ECG-triggered CCTA was performed using five commercially available CT scanners: 64-detector-row single source CT (SSCT), 2 × 32-detector-row-dual source CT (DSCT), 2 × 64-detector-row DSCT and 320-detector-row SSCT scanners. Absorbed doses were measured in 34 organs using pre-calibrated optically stimulated luminescence dosimeters (OSLDs) placed inside a standard female adult anthropomorphic phantom. HE was calculated from the measured organ doses and compared to the HE derived from the air kerma-length product (PKL) using the conversion coefficient of 0.014 mSv∙mGy-1∙cm-1 for the chest region. Results Both breasts and lungs received the highest radiation dose during CCTA examination. The highest HE was received from 2 × 32-detector-row DSCT scanner (6.06 ± 0.72 mSv), followed by 64-detector-row SSCT (5.60 ± 0.68 and 5.02 ± 0.73 mSv), 2 × 64-detector-row DSCT (1.88 ± 0.25 mSv) and 320-detector-row SSCT (1.34 ± 0.48 mSv) scanners. HE calculated from the measured organ doses were about 38 to 53% higher than the HE derived from the PKL-to-HE conversion factor. Conclusion The radiation doses received from a prospectively ECG-triggered CCTA are relatively small and are depending on the scanner technology and imaging protocols. HE as low as 1.34 and 1.88 mSv can be achieved in prospectively ECG-triggered CCTA using 320-detector-row SSCT and 2 × 64-detector-row DSCT scanners. PMID:27552224

Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A Prospective Study.

PubMed

Gimber, Lana Hirai; Travis, R Ing; Takahashi, Jayme M; Goodman, Torrey L; Yoon, Hyo-Chun

2009-01-01

Pulmonary computed tomography angiography (CTA) and the Wells criteria both have interobserver variability in the assessment of pulmonary embolism (PE). Quantitative D-dimer assay findings have been shown to have a high negative predictive value in patients with low pretest probability of PE. Evaluate roles for clinical probability and CTA in Emergency Department (ED) patients suspected of acute PE but having a low serum D-dimer level. Prospective observational study of ED patients with possible PE who underwent pulmonary CTA and had D-dimer levels

Predictive Accuracy of the Liverpool Lung Project Risk Model for Stratifying Patients for Computed Tomography Screening for Lung Cancer

PubMed Central

Raji, Olaide Y.; Duffy, Stephen W.; Agbaje, Olorunshola F.; Baker, Stuart G.; Christiani, David C.; Cassidy, Adrian; Field, John K.

2013-01-01

Background External validation of existing lung cancer risk prediction models is limited. Using such models in clinical practice to guide the referral of patients for computed tomography (CT) screening for lung cancer depends on external validation and evidence of predicted clinical benefit. Objective To evaluate the discrimination of the Liverpool Lung Project (LLP) risk model and demonstrate its predicted benefit for stratifying patients for CT screening by using data from 3 independent studies from Europe and North America. Design Case–control and prospective cohort study. Setting Europe and North America. Patients Participants in the European Early Lung Cancer (EUELC) and Harvard case–control studies and the LLP population-based prospective cohort (LLPC) study. Measurements 5-year absolute risks for lung cancer predicted by the LLP model. Results The LLP risk model had good discrimination in both the Harvard (area under the receiver-operating characteristic curve [AUC], 0.76 [95% CI, 0.75 to 0.78]) and the LLPC (AUC, 0.82 [CI, 0.80 to 0.85]) studies and modest discrimination in the EUELC (AUC, 0.67 [CI, 0.64 to 0.69]) study. The decision utility analysis, which incorporates the harms and benefit of using a risk model to make clinical decisions, indicates that the LLP risk model performed better than smoking duration or family history alone in stratifying high-risk patients for lung cancer CT screening. Limitations The model cannot assess whether including other risk factors, such as lung function or genetic markers, would improve accuracy. Lack of information on asbestos exposure in the LLPC limited the ability to validate the complete LLP risk model. Conclusion Validation of the LLP risk model in 3 independent external data sets demonstrated good discrimination and evidence of predicted benefits for stratifying patients for lung cancer CT screening. Further studies are needed to prospectively evaluate model performance and evaluate the optimal population risk thresholds for initiating lung cancer screening. Primary Funding Source Roy Castle Lung Cancer Foundation. PMID:22910935

The value of dynamic infrared thermography (DIRT) in perforatorselection and planning of free DIEP flaps.

PubMed

de Weerd, Louis; Weum, Sven; Mercer, James B

2009-09-01

The aim of this paper is to evaluate dynamic infrared thermography (DIRT) as a technique to assist in preoperative perforator selection and planning of free deep inferior epigastric perforator (DIEP) flaps. Twenty-seven patients, scheduled for secondary autologous breast reconstruction with either a free DIEP flap or superficial inferior epigastric artery flap, were included in this prospective clinical study. Preoperative mapping of perforators was performed with a hand-held Doppler and DIRT. A multidetector computer tomography scan was additionally carried out in the last 8 patients. In 23 patients a DIEP flap was used. The perforator as selected from DIRT was a suitable perforator in all DIEP flaps. The location and quality of the selected perforator from DIRT corresponded well with the multidetector computer tomography scan results. Preoperative perforator selection and planning of DIEP flaps is facilitated with the use of DIRT. The technique is noninvasive and easy to use.

Decreased Lung Perfusion After Breast/Chest Wall Irradiation: Quantitative Results From a Prospective Clinical Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liss, Adam L., E-mail: adamliss68@gmail.com; Marsh, Robin B.; Kapadia, Nirav S.

Purpose: To quantify lung perfusion changes after breast/chest wall radiation therapy (RT) using pre- and post-RT single photon emission computed tomography/computed tomography (SPECT/CT) attenuation-corrected perfusion scans; and correlate decreased perfusion with adjuvant RT dose for breast cancer in a prospective clinical trial. Methods and Materials: As part of an institutional review board–approved trial studying the impact of RT technique on lung function in node-positive breast cancer, patients received breast/chest wall and regional nodal irradiation including superior internal mammary node RT to 50 to 52.2 Gy with a boost to the tumor bed/mastectomy scar. All patients underwent quantitative SPECT/CT lung perfusion scanningmore » before RT and 1 year after RT. The SPECT/CT scans were co-registered, and the ratio of decreased perfusion after RT relative to the pre-RT perfusion scan was calculated to allow for direct comparison of SPECT/CT perfusion changes with delivered RT dose. The average ratio of decreased perfusion was calculated in 10-Gy dose increments from 0 to 60 Gy. Results: Fifty patients had complete lung SPECT/CT perfusion data available. No patient developed symptoms consistent with pulmonary toxicity. Nearly all patients demonstrated decreased perfusion in the left lung according to voxel-based analyses. The average ratio of lung perfusion deficits increased for each 10-Gy increment in radiation dose to the lung, with the largest changes in regions of lung that received 50 to 60 Gy (ratio 0.72 [95% confidence interval 0.64-0.79], P<.001) compared with the 0- to 10-Gy region. For each increase in 10 Gy to the left lung, the lung perfusion ratio decreased by 0.06 (P<.001). Conclusions: In the assessment of 50 patients with node-positive breast cancer treated with RT in a prospective clinical trial, decreased lung perfusion by SPECT/CT was demonstrated. Our study allowed for quantification of lung perfusion defects in a prospective cohort of breast cancer patients for whom attenuation-corrected SPECT/CT scans could be registered directly to RT treatment fields for precise dose estimates.« less

The success of opening single chronic total occlusion lesions to improve myocardialviabilitytrial (SOS-COMEDY)

PubMed Central

Huang, Rongchong; Song, Xiantao; Zhang, Haishan; Tian, Wen; Huang, Zheng; Zhang, Xingwei; Yang, Junqing; Zhang, Dongfeng; Wu, Jian; Zhong, Lei; Ting, Henry H.

2018-01-01

Abstract Aims: Success of opening single (SOS)-comedy is a prospective multicenter study to compare the improvement in the decrease of myocardial viability by percutaneous coronary intervention (PCI) with that by optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. Methods and results: The risks and the benefits of both options (PCI and OMT) were listed in a CTO decision aid (DA). Eligible participants detected by invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) were divided into PCI or OMT groups according to patients’ choice after shared-decision making process with DA. Participants will undergo positron emission tomography/computed tomography (PET/CT), cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE), and proceed to ICA and revascularization if possible. Blinded core laboratory interpretation will be performed for ICA, CCTA, PET/CT, CMR, and TTE. All participants will be followed up for 12 months. The primary endpoint is the improvement to the decrease of myocardial viability from baseline assessed with the use of PET/CT after 12-month follow-up. Conclusions: All of the patients are appropriately consented before enrolling in this study, which has been approved by the Ethics Committee. Results of SOS-COMEDY will be helpful to develop a strategy for single CTO patients. PMID:29668609

Multicenter study of quantitative computed tomography analysis using a computer-aided three-dimensional system in patients with idiopathic pulmonary fibrosis.

PubMed

Iwasawa, Tae; Kanauchi, Tetsu; Hoshi, Toshiko; Ogura, Takashi; Baba, Tomohisa; Gotoh, Toshiyuki; Oba, Mari S

2016-01-01

To evaluate the feasibility of automated quantitative analysis with a three-dimensional (3D) computer-aided system (i.e., Gaussian histogram normalized correlation, GHNC) of computed tomography (CT) images from different scanners. Each institution's review board approved the research protocol. Informed patient consent was not required. The participants in this multicenter prospective study were 80 patients (65 men, 15 women) with idiopathic pulmonary fibrosis. Their mean age was 70.6 years. Computed tomography (CT) images were obtained by four different scanners set at different exposures. We measured the extent of fibrosis using GHNC, and used Pearson's correlation analysis, Bland-Altman plots, and kappa analysis to directly compare the GHNC results with manual scoring by radiologists. Multiple linear regression analysis was performed to determine the association between the CT data and forced vital capacity (FVC). For each scanner, the extent of fibrosis as determined by GHNC was significantly correlated with the radiologists' score. In multivariate analysis, the extent of fibrosis as determined by GHNC was significantly correlated with FVC (p < 0.001). There was no significant difference between the results obtained using different CT scanners. Gaussian histogram normalized correlation was feasible, irrespective of the type of CT scanner used.

Clinical application of optical coherence tomography in combination with functional diagnostics: advantages and limitations for diagnosis and assessment of therapy outcome in central serous chorioretinopathy.

PubMed

Schliesser, Joshua A; Gallimore, Gary; Kunjukunju, Nancy; Sabates, Nelson R; Koulen, Peter; Sabates, Felix N

2014-01-01

While identifying functional and structural parameters of the retina in central serous chorioretinopathy (CSCR) patients, this study investigated how an optical coherence tomography (OCT)-based diagnosis can be significantly supplemented with functional diagnostic tools and to what degree the determination of disease severity and therapy outcome can benefit from diagnostics complementary to OCT. CSCR patients were evaluated prospectively with microperimetry (MP) and spectral domain optical coherence tomography (SD-OCT) to determine retinal sensitivity function and retinal thickness as outcome measures along with measures of visual acuity (VA). Patients received clinical care that involved focal laser photocoagulation or pharmacotherapy targeting inflammation and neovascularization. Correlation of clinical parameters with a focus on functional parameters, VA, and mean retinal sensitivity, as well as on the structural parameter mean retinal thickness, showed that functional measures were similar in diagnostic power. A moderate correlation was found between OCT data and the standard functional assessment of VA; however, a strong correlation between OCT and MP data showed that diagnostic measures cannot always be used interchangeably, but that complementary use is of higher clinical value. The study indicates that integrating SD-OCT with MP provides a more complete diagnosis with high clinical relevance for complex, difficult to quantify diseases such as CSCR.

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin.

PubMed

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT.

Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE).

PubMed

Morris, Michael J; Dodson, Darrel W; Lucero, Pedro F; Haislip, Georgette D; Gallup, Roger A; Nicholson, Karin L; Zacher, Lisa L

2014-07-01

Because of increased levels of airborne particulate matter in Southwest Asia, deployed military personnel are at risk for developing acute and chronic lung diseases. Increased respiratory symptoms are reported, but limited data exist on reported lung diseases. To evaluate new respiratory complaints in military personnel returning from Southwest Asia to determine potential etiologies for symptoms. Returning military personnel underwent a prospective standardized evaluation for deployment-related respiratory symptoms within 6 months of returning to their duty station. Prospective standardized evaluation included full pulmonary function testing, high-resolution chest tomography, methacholine challenge testing, and fiberoptic bronchoscopy with bronchoalveolar lavage. Other procedures including lung biopsy were performed if clinically indicated. Fifty patients completed the study procedures. A large percentage (42%) remained undiagnosed, including 12% with normal testing and an isolated increase in lavage neutrophils or lymphocytes. Twenty (40%) patients demonstrated some evidence of airway hyperreactivity to include eight who met asthma criteria and two with findings secondary to gastroesophageal reflux. Four (8%) additional patients had isolated reduced diffusing capacity and the remaining six had other miscellaneous airway disorders. No patients were identified with diffuse parenchymal disease on the basis of computed tomography imaging. A significant number (66%) of this cohort had underlying mental health and sleep disorders. Evaluation of new respiratory symptoms in military personnel after service in Southwest Asia should focus on airway hyperreactivity from exposures to higher levels of ambient particulate matter. These patients may be difficult to diagnose and require close follow-up.

Is computed tomography volumetric assessment of the liver reliable in patients with cirrhosis?

PubMed Central

Goumard, Claire; Perdigao, Fabiano; Cazejust, Julien; Zalinski, Stéphane; Soubrane, Olivier; Scatton, Olivier

2014-01-01

Objectives: The estimation of liver volume (LV) has been widely studied in normal liver, the density of which is considered to be equivalent to 1 kg/l. In cirrhosis, volumetric evaluation and its correlation to liver mass remain unclear. The aim of this study was to evaluate the accuracy of computed tomography (CT) scanning to assess LV in patients with cirrhosis. Methods: Liver volume was evaluated by CT (CTLV) and correlated to the explanted liver weight (LW) in 49 patients. Liver density (LD) and its association with clinical features were analysed. Commonly used formulae for estimating LV were also evaluated. The real density of cirrhotic liver was prospectively measured in explant specimens. Results: Wide variations between CTLV (in ml) and LW (in g) were found (range: 3–748). Cirrhotic livers in patients with hepatitis B virus infection presented significantly increased LD (P = 0.001) with lower CTLV (P = 0.005). Liver volume as measured by CT was also decreased in patients with Model for End-stage Liver Disease scores of >15 (P = 0.023). Formulae estimating LV correlated poorly with CTLV and LW. The density of cirrhotic liver measured prospectively in 15 patients was 1.1 kg/l. Conclusions: In cirrhotic liver, LV assessed by CT did not correspond to real LW. Liver density changed according to the aetiology and severity of liver disease. Commonly used formulae did not accurately assess LV. PMID:23679861

Diagnosis of peritoneal mesothelioma: computed tomography, sonography, and fine-needle aspiration biopsy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reuter, K.; Raptopoulos, V.; Reale, F.

1983-06-01

The diagnosis of peritoneal mesothelioma was made prospectively and noninvasively in four patients with the use of sonography, computed tomography, and sonographically guided fine-needle aspiration biopsy. The imaging methods revealed information similar to the operative findings, with clear superiority of computed tomography over sonography. These noninvasive methods may be used as screening tools, especially among groups or in regional areas with a high risk for asbestos exposure. The findings included soft-tissue masses with invariable involvement of the omentum; small intraperitoneal nodules; thickened peritoneum, mesentery, and bowel wall; pleural plaques; and usually minimal, if any, ascites. Since the differential diagnosis frommore » peritoneal carcinomatosis may be difficult, sonographically (or CT) guided aspiration biopsy is needed to produce diagnostic cytologic specimens. The use of this type of biopsy should obviate surgical exploration.« less

Correlation between Preoperative High Resolution Computed Tomography (CT) Findings with Surgical Findings in Chronic Otitis Media (COM) Squamosal Type.

PubMed

Karki, S; Pokharel, M; Suwal, S; Poudel, R

Background The exact role of High resolution computed tomography (HRCT) temporal bone in preoperative assessment of Chronic suppurative otitis media atticoantral disease still remains controversial. Objective To evaluate the role of high resolution computed tomography temporal bone in Chronic suppurative otitis media atticoantral disease and to compare preoperative computed tomographic findings with intra-operative findings. Method Prospective, analytical study conducted among 65 patients with chronic suppurative otitis media atticoantral disease in Department of Radiodiagnosis, Kathmandu University Dhulikhel Hospital between January 2015 to July 2016. The operative findings were compared with results of imaging. The parameters of comparison were erosion of ossicles, scutum, facial canal, lateral semicircular canal, sigmoid and tegmen plate along with extension of disease to sinus tympani and facial recess. Sensitivity, specificity, negative predictive value, positive predictive values were calculated. Result High resolution computed tomography temporal bone offered sensitivity (Se) and specificity (Sp) of 100% for visualization of sigmoid and tegmen plate erosion. The performance of HRCT in detecting malleus (Se=100%, Sp=95.23%), incus (Se=100%,Sp=80.48%) and stapes (Se=96.55%, Sp=71.42%) erosion was excellent. It offered precise information about facial canal erosion (Se=100%, Sp=75%), scutum erosion (Se=100%, Sp=96.87%) and extension of disease to facial recess and sinus tympani (Se=83.33%,Sp=100%). high resolution computed tomography showed specificity of 100% for lateral semicircular canal erosion (Sp=100%) but with low sensitivity (Se=53.84%). Conclusion The findings of high resolution computed tomography and intra-operative findings were well comparable except for lateral semicircular canal erosion. high resolution computed tomography temporal bone acts as a road map for surgeon to identify the extent of disease, plan for appropriate procedure that is required and prepare for potential complications that can be encountered during surgery.

Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography.

PubMed

Matsumoto, Shokei; Sekine, Kazuhiko; Funabiki, Tomohiro; Orita, Tomohiko; Shimizu, Masayuki; Hayashida, Kei; Kazamaki, Taku; Suzuki, Tatsuya; Kishikawa, Masanobu; Yamazaki, Motoyasu; Kitano, Mitsuhide

2016-01-01

An occult pneumothorax is a pneumothorax that is not seen on a supine chest X-ray but is detected by computed tomography scanning. However, critical patients are difficult to transport to the computed tomography suite. We previously reported a method to detect occult pneumothorax using oblique chest radiography (OXR). Several authors have also reported that ultrasonography is an effective technique for detecting occult pneumothorax. The aim of this study was to evaluate the usefulness of OXR in the diagnosis of the occult pneumothorax and to compare OXR with ultrasonography. All consecutive blunt chest trauma patients with clinically suspected pneumothorax on arrival at the emergency department were prospectively included at our tertiary-care center. The patients underwent OXR and ultrasonography, and underwent computed tomography scans as the gold standard. Occult pneumothorax size on computed tomography was classified as minuscule, anterior, or anterolateral. One hundred and fifty-nine patients were enrolled. Of the 70 occult pneumothoraces found in the 318 thoraces, 19 were minuscule, 32 were anterior, and 19 were anterolateral. The sensitivity and specificity of OXR for detecting occult pneumothorax was 61.4 % and 99.2 %, respectively. The sensitivity and specificity of lung ultrasonography was 62.9 % and 98.8 %, respectively. Among 27 occult pneumothoraces that could not be detected by OXR, 16 were minuscule and 21 could be conservatively managed without thoracostomy. OXR appears to be as good method as lung ultrasonography in the detection of large occult pneumothorax. In trauma patients who are difficult to transfer to computed tomography scan, OXR may be effective at detecting occult pneumothorax with a risk of progression.

Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement.

PubMed

Ghobrial, Fady Emil Ibrahim; Eldin, Manal Salah; Razek, Ahmed Abdel Khalek Abdel; Atwan, Nadia Ibrahim; Shamaa, Sameh Sayed Ahmed

2017-01-01

To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good ( k =0.793, percent agreement of 89.29%). We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).

Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography

NASA Astrophysics Data System (ADS)

Efstathopoulos, E. P.; Kelekis, N. L.; Pantos, I.; Brountzos, E.; Argentos, S.; Grebáč, J.; Ziaka, D.; Katritsis, D. G.; Seimenis, I.

2009-09-01

Computed tomography (CT) coronary angiography has been widely used since the introduction of 64-slice scanners and dual-source CT technology, but high radiation doses have been reported. Prospective ECG-gating using a 'step-and-shoot' axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. Radiation doses were estimated for 25 patients scanned with either prospective or retrospective ECG-gating. Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring. It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECG-gating (3.2 ± 0.6 mSv versus 13.4 ± 2.7 mSv). Consequently, the radiogenic fatal cancer risk for the patient is much lower with prospective gating (0.0176% versus 0.0737%). No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments. Therefore, prospective ECG-gating using a 'step-and-shoot' protocol that covers the cardiac anatomy in two axial acquisitions effectively reduces radiation doses in 256-slice CT coronary angiography without compromising image quality.

In vivo noninvasive measurement of preprandial and postprandial blood glucose using optical coherence tomography

NASA Astrophysics Data System (ADS)

Zhang, Ying; Zhang, Xiyang; Li, Zhifang; Li, Hui

2016-10-01

Blood glucose concentration measurement is essential for the diagnosis and treatment of diabetes. However, conventional glucose measurement methods are invasive and not suitable for real-time monitoring. This study demonstrated a noninvasive blood glucose measurement method using optical coherence tomography to image human lip in vivo. Optical coherence tomography (OCT) is a noninvasive and depth-resolved technique capable of acquiring tissue structure images in real time. Human lip has very thin skin and is full of blood vessels, which is appropriate for noninvasive glucose measurement. To verify the feasibility of OCT for glucose concentration monitoring, two groups of OCT imaging data were obtained from human lips of normal people. In one group, OCT images of lip were acquired from people on an empty stomach. In the other group, the same sites of lip were observed by OCT 2 hours after breakfast. Evident differences were found from two groups of OCT images that correspond to preprandial glucose and 2- hour postprandial glucose, respectively. The relationship between OCT image and blood glucose concentration was investigated. The result indicates that OCT possesses considerable prospects in terms of noninvasive blood glucose measurement.

Assessing the effects of ketorolac and acetazolamide on macular thickness by optical coherence tomography following cataract surgery.

PubMed

Turan-Vural, Ece; Halili, Elvin; Serin, Didem

2014-06-01

We aimed to evaluate the efficacy of topical ketorolac 0.5 % solution and oral acetazolamide 250 mg/day delivery during the first month after uneventful phacoemulsification surgery by measuring the macular thickness using optical coherence tomography. Our nonmasked randomized prospective study comprised 87 eyes of 80 patients. Complete follow-up was achieved on 84 eyes of 77 eligible patients. Postoperatively, the patients were divided into three groups. One group received ketorolac 0.5 %, the other group received acetazolamide 250 mg/day, and the control group was given no agent. Macular thickness and volume were measured at 1 week and 1 month after surgery by optical coherence tomography. Foveal thickness, parafoveal thickness, and perifoveal thickness were determined to be significantly elevated at postoperative 1 week and 1 month in the control group. Foveal, perifoveal, and parafoveal volumes were also significantly high at postoperative week 1 and month 1 in the control group. There was no significant difference between the ketorolac and acetazolamide groups. The correlation analysis between best-corrected visual acuity, and volume and thickness revealed a negative correlation in the acetazolamide group. Use of acetazolamide after cataract surgery is as effective as ketorolac on macular thickness and volume.

Evaluation of a High Concentrated Contrast Media Injection Protocol in Combination with Low Tube Current for Dose Reduction in Coronary Computed Tomography Angiography: A Randomized, Two-center Prospective Study.

PubMed

Sun, Yibo; Hua, Yanqing; Wang, Mingpeng; Mao, Dingbiao; Jin, Xiu; Li, Cheng; Shi, Kailei; Xu, Jianrong

2017-12-01

The study aimed to prospectively evaluate the radiation dose reduction potential and image quality (IQ) of a high-concentration contrast media (HCCM) injection protocol in combination with a low tube current (mAs) in coronary computed tomography angiography. Eighty-one consecutive patients (mean age: 62 years; 34 females; body mass index: 18-31) were included and randomized-assigned into two groups. All computed tomography (CT) examinations were performed in two groups with the same tube voltage (100 kV), flow rate of contrast medium (5.0 mL/s), and iodine dose (22.8 g). An automatic mAs and low concentration contrast medium (300 mgI/mL) were used in group A, whereas effective mAs was reduced by a factor 0.6 along with HCCM (400 mgI/mL) in group B. Radiation dose was assessed (CT dose index [CTDI vol ] and dose length product), and vessel-based objective IQ for various regions of interest (enhancement, noise, signal-to-noise ratio, and contrast-to-noise ratio), subjective IQ, noise, and motion artifacts were analyzed overall and vessel-based with a 5-point Likert scale. The CT attenuation of coronary arteries and image noise in group B were significantly higher than those in group A (ranges: 507.5-548.1 Hounsfield units vs 407.5-444.5 Hounsfield units; and 20.3 ± 8.6 vs 17.7 ± 8.0) (P ≤ 0.0166). There was no significant difference between the two groups in signal-to-noise ratio, contrast-to-noise ratio, and subjective IQ of coronary arteries (29.4-31.7, 30.0-37.0, and medium score of 5 in group A vs 29.4-32.4, 27.7-36.3, and medium score of 5 in group B, respectively, P ≥ 0.1859). Both mean CTDI vol and dose length product in group B were 58% of those of group A. HCCM combined with low tube current allows dose reduction in coronary computed tomography angiography and does not compromise IQ. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients.

PubMed

Pidgeon, T E; Shariff, U; Devine, F; Menon, V

2016-09-01

Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. Methods Data were recorded prospectively for all patients attending the clinic during 2013 and 2014. The primary outcome was patient destination (whether there was follow-up/admission) after clinic attendance. Results The ASC reviewed patients with a wide age range and array of general surgical complaints. In 2013, 186 patients attended the ASC. After the introduction of the ultrasonography service in 2014, 304 patients attended. In 2014, there was a reduction in the proportion of patients admitted to hospital from the clinic (18.3% vs 8.9%, p=0.002). However, the proportion of patients discharged after ASC review remained comparable with 2013 (30.1% in 2013 vs 38.8% in 2014, p=0.051). The proportion of patients undergoing computed tomography (CT) scans also fell (14.0% vs 4.9%, p<0.001). Conclusions The ASC assessed a wide array of general surgical complaints. Only a small proportion required hospital admission. The introduction of an ultrasonography service was associated with a further reduction in admission rates and computed tomography.

Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP.

PubMed

Buscail, L; Escourrou, J; Moreau, J; Delvaux, M; Louvel, D; Lapeyre, F; Tregant, P; Frexinos, J

1995-04-01

The usefulness and accuracy rate of endoscopic ultrasonography (EUS) in the diagnosis of chronic pancreatitis (CP) were prospectively evaluated in 81 patients with suspected pancreatic disease. All underwent EUS, abdominal ultrasonography (AUS), and computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 55 of the cases. The diagnosis of CP was established in 44 patients (CP group) including 24 with a calcified form. No pancreatic disease was observed in 18 patients (control group), and 19 patients had a pancreatic tumor. In the CP group AUS was less accurate than EUS in visualizing the pancreas, performances of CT scan being identical to EUS in this respect. A good correlation was observed between EUS and ERCP for visualization and measurement of the Wirsung duct. The most significant changes observed by EUS in the CP group were dilatation of the main pancreatic duct, heterogeneous echogenicity of the pancreatic parenchyma, and cysts < 20 mm in size even in noncalcified CP or with normal pancreatograms. Sensitivity of EUS for diagnosis of CP was 88% (AUS, 58%; ERCP, 74%; CT scan, 75%), the specificity being 100% for ERCP and EUS, 95% for CT scan, and 75% for AUS. The good performances of EUS allow early diagnosis of CP in symptomatic patients since heterogeneous echogenicity of the pancreatic parenchyma seems to be almost specifically associated with the disease.

Detection of incidental colorectal pathology on positron emission tomography/computed tomography.

PubMed

Mui, Milton; Akhurst, Timothy; Warrier, Satish K; Lynch, A Craig; Heriot, Alexander G

2018-03-01

Positron emission tomography/computed tomography (PET/CT) is an important modality in cancer imaging. With its increasing availability and use, it is not uncommon to detect incidental focal colorectal 18 F-FDG uptake which poses a diagnostic challenge, as they may be associated with malignant or pre-malignant colorectal lesions. The aim of our study is to determine the proportion of these findings which represents true pathology. Patients with incidental focal colorectal 18 F-FDG uptake on PET/CT who subsequently underwent colonoscopy between January 2002 to September 2013 were identified from a prospective database in a tertiary referral centre. PET/CT results were correlated with colonoscopy and pathology results in these patients. Positive predictive values (PPVs) and 95% confidence intervals (CIs) of PET/CT in the detection of incidental colorectal pathology were calculated. A total of 148 patients (92 men and 56 women), with a mean age 73 years (range of 36 to 93 years) were included in the study. A total of 170 foci of colorectal 18 F-FDG uptake were detected on PET/CT. Of these, 101 foci corresponded to a malignant or pre-malignant lesion (PPV 59%; 95% CI: 52-67%). On a per-patient analysis, 93 patients had at least one focus of colorectal 18 F-FDG uptake which corresponded to a pre-malignant or malignant lesion (PPV 63%; 95% CI: 54-71%). Focal colorectal 18 F-FDG uptake on PET/CT is associated with a significant proportion of malignant or pre-malignant lesions. Further evaluation with colonoscopy is recommended. © 2016 Royal Australasian College of Surgeons.

OPTICAL COHERENCE TOMOGRAPHY BASELINE PREDICTORS FOR INITIAL BEST-CORRECTED VISUAL ACUITY RESPONSE TO INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN EYES WITH DIABETIC MACULAR EDEMA: The CHARTRES Study.

PubMed

Santos, Ana R; Costa, Miguel Â; Schwartz, Christian; Alves, Dalila; Figueira, João; Silva, Rufino; Cunha-Vaz, Jose G

2018-06-01

To identify baseline optical coherence tomography morphologic characteristics predicting the visual response to anti-vascular endothelial growth factor therapy in diabetic macular edema. Sixty-seven patients with diabetic macular edema completed a prospective, observational study (NCT01947881-CHARTRES). All patients received monthly intravitreal injections of Lucentis for 3 months followed by PRN treatment and underwent best-corrected visual acuity measurements and spectral domain optical coherence tomography at Baseline, Months 1, 2, 3, and 6. Visual treatment response was characterized as good (≥10 letters), moderate (5-10 letters), and poor (<5 or letters loss). Spectral domain optical coherence tomography images were graded before and after treatment by a certified Reading Center. One month after loading dose, 26 patients (38.80%) were identified as good responders, 19 (28.35%) as Moderate and 22 (32.83%) as poor responders. There were no significant best-corrected visual acuity and central retinal thickness differences at baseline (P = 0.176; P = 0.573, respectively). Ellipsoid zone disruption and disorganization of retinal inner layers were good predictors for treatment response, representing a significant risk for poor visual recovery to anti-vascular endothelial growth factor therapy (odds ratio = 10.96; P < 0.001 for ellipsoid zone disruption and odds ratio = 7.05; P = 0.034 for disorganization of retinal inner layers). Damage of ellipsoid zone, higher values of disorganization of retinal inner layers, and central retinal thickness decrease are good predictors of best-corrected visual acuity response to anti-vascular endothelial growth factor therapy.

Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: A large contemporary prospective cohort study.

PubMed

Mery, Carlos M; De León, Luis E; Molossi, Silvana; Sexson-Tejtel, S Kristen; Agrawal, Hitesh; Krishnamurthy, Rajesh; Masand, Prakash; Qureshi, Athar M; McKenzie, E Dean; Fraser, Charles D

2018-01-01

The purpose of this study was to prospectively analyze the outcomes of patients with anomalous aortic origin of a coronary artery undergoing surgical intervention according to a standardized management algorithm. All patients aged 2 to 18 years undergoing surgical intervention for anomalous aortic origin of a coronary artery between December 2012 and April 2017 were prospectively included. Patients underwent stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and retrospectively electrocardiogram-gated computed tomography angiography preoperatively. Patients were cleared for exercise at 3 months postoperatively if asymptomatic and repeat stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and computed tomography angiography showed normal results. A total of 44 patients, with a median age of 14 years (8-18 years), underwent surgical intervention: 9 (20%) for the anomalous left coronary artery and 35 (80%) for the anomalous right coronary artery. Surgical procedures included unroofing in 35 patients (80%), translocation in 7 patients (16%), ostioplasty in 1 patient (2%), and side-side-anastomosis in 1 patient (2%). One patient who presented with aborted sudden cardiac death from an anomalous left coronary and underwent unroofing presented 1 year later with a recurrent episode and was found to have an unrecognized myocardial bridge and persistent compression of the coronary requiring reintervention. At last follow-up, 40 patients (91%) are asymptomatic and 4 patients have nonspecific chest pain; 42 patients (95%) have returned to full activity, and 2 patients are awaiting clearance. Surgical treatment for anomalous aortic origin of a coronary artery is safe and should aim to associate the coronary ostium with the correct sinus, away from the intercoronary pillar. After surgery, the majority of patients are cleared for exercise and remain asymptomatic. Longer follow-up is needed to assess the true efficacy of surgery in the prevention of sudden cardiac death. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Birt-Hogg-Dube syndrome prospectively detected by review of chest computed tomography scans.

PubMed

Park, Hye Jung; Park, Chul Hwan; Lee, Sang Eun; Lee, Geun Dong; Byun, Min Kwang; Lee, Sungsoo; Lee, Kyung-A; Kim, Tae Hoon; Kim, Seong Han; Yang, Seo Yeon; Kim, Hyung Jung; Ahn, Chul Min

2017-01-01

Birt-Hogg-Dube syndrome (BHD) is a rare disorder caused by mutations in the gene that encodes folliculin (FLCN) and is inherited in an autosomal dominant manner. BHD is commonly accompanied by fibrofolliculomas, renal tumors, multiple pulmonary cysts, and spontaneous pneumothorax. The aim of this study was to detect BHD prospectively in patients undergoing chest computed tomography (CT) scans and to evaluate further the characteristics of BHD in Korea. We prospectively checked and reviewed the chest CT scans obtained for 10,883 patients at Gangnam Severance Hospital, Seoul, Korea, from June 1, 2015 to May 31, 2016. Seventeen patients met the study inclusion criteria and underwent screening for FLCN mutation to confirm BHD. We analyzed the characteristics of the patients confirmed to have BHD and those for a further 6 patients who had previously been described in Korea. Six (0.06%) of the 10,883 patients reviewed were diagnosed with BHD. There was no difference in demographic or clinical features between the patients with BHD (n = 6) and those without BHD (n = 11). Pneumothorax was present in 50% of the patients with BHD but typical skin and renal lesions were absent. The maximum size of the cysts in the BHD group (median 39.4 mm; interquartile range [IQR] 11.4 mm) was significantly larger than that in the non-BHD group (median 15.8 mm; IQR 7.8 mm; P = 0.001). Variable morphology was seen in 100.0% of the cysts in the BHD group but in only 18.2% of the cysts in the non-BHD group (P = 0.002). Nine (95%) of the total of 12 Korean patients with BHD had experienced pneumothorax. Typical skin and renal lesions were present in 20.0% of patients with BHD. Our findings suggest that BHD can be detected if chest CT scans are read in detail.

A Prospective Phase II Study of Cisplatin and Cremophor EL-Free Paclitaxel (Genexol-PM) in Patients with Unresectable Thymic Epithelial Tumors.

PubMed

Kim, Hae Su; Lee, Ji Yun; Lim, Sung Hee; Sun, Jong-Mu; Lee, Se Hoon; Ahn, Jin Seok; Park, Keunchil; Moon, Seung Hwan; Ahn, Myung-Ju

2015-12-01

We conducted a prospective phase II study of cisplatin plus cremophor EL-free paclitaxel (Genexol-PM) in patients with unresectable thymic epithelial tumors to determine the efficacy and tolerability of the combination therapy. Patients were treated with cisplatin (70 mg/m) and Genexol-PM (230 mg/m) on day 1 of a 3-week cycle as first-line palliative chemotherapy. The primary end point of this study was objective response rate, and the secondary end points included toxicity, progression-free survival (PFS), overall survival, correlation between early 18F-fluorodeoxyglucose positron emission tomography/computed tomography response and PFS, and correlation between baseline flurododeoxyglucose uptake and histology. Forty-two patients with unresectable thymoma (n = 14) or thymic carcinoma (n = 28) were enrolled between May 2012 and October 2014. The median age was 59 years (range: 25-77) and 30 patients (71%) were male, and 39 patients (93%) had an ECOG PS of 1. The median number of treatment cycles was six (range: 1-6). For 40 assessable patients, the objective response rate was 62.5% (95% confidence interval [CI]: 47.6-77.4) with rates of 46% (95% CI: 23.3-76.9) for advanced thymoma (n = 13) and 70% (95% CI: 52.0-82.1) for thymic carcinoma (n = 27). With a median follow-up of 15.5 months, the median PFS for all 42 patients was 9.8 months (11.4 months for thymoma versus 8.1 months for thymic carcinoma). The 2-year overall survival was 77.9% for thymoma and 65.9% for thymic carcinoma. There were no treatment-related deaths. The most common grade 3 and 4 treatment-related adverse event was neutropenia in 11 patients (26%). Eight patients (19%) experienced grade 2 hypersensitivity reactions. There was no correlation between early positron emission tomography response and PFS, but tumor histology (thymoma versus thymic carcinoma) was correlated with SUVmax before chemotherapy. These data suggest that combination of cisplatin and Genexol-PM is highly effective and tolerable for the treatment of unresectable thymic epithelial tumors.

Diagnosis and evaluation of gastric cancer by positron emission tomography

PubMed Central

Wu, Chen-Xi; Zhu, Zhao-Hui

2014-01-01

Gastric cancer is the second leading cause of cancer mortality worldwide. The diagnosis of gastric cancer has been significantly improved with the broad availability of gastrointestinal endoscopy. Effective technologies for accurate staging and quantitative evaluation are still in demand to merit reasonable treatment and better prognosis for the patients presented with advanced disease. Preoperative staging using conventional imaging tools, such as computed tomography (CT) and endoscopic ultrasonography, is inadequate. Positron emission tomography (PET), using 18F-fluorodeoxyglucose (FDG) as a tracer and integrating CT for anatomic localization, holds a promise to detect unsuspected metastasis and has been extensively used in a variety of malignancies. However, the value of FDG PET/CT in diagnosis and evaluation of gastric cancer is still controversial. This article reviews the current literature in diagnosis, staging, response evaluation, and relapse monitoring of gastric cancer, and discusses the current understanding, improvement, and future prospects in this area. PMID:24782610

Progress and challenges in global mantle attenuation tomography (Invited)

NASA Astrophysics Data System (ADS)

Romanowicz, B. A.

2009-12-01

Global anelastic tomography has lagged behind elastic tomography, because of the difficulty to separate elastic and anelastic effects accumulated in the amplitudes of seismic waves as they propagate long distances through the heterogeneous mantle. Specifically, amplitudes are very sensitive to scattering and lateral gradients in elastic structure. Until now, these gradients - or the short wavelength features of elastic models - have not been tightly enough constrained due to a combination of (1) use of approximate wave propagation theories; (2) necessary damping due to incomplete coverage and bandwidth. Different schemes have been designed to circumvent these shortcomings in attenuation tomography, which limit resolution to long wavelengths and introduce large uncertainties in the estimation of the strength of lateral variations in attenuation. We review the robust information on anelastic structure available so far from first and second generation global upper mantle models. We discuss improvements that can be expected with, in particular, the availability of accurate numerical schemes for wave propagation in a 3D elastic earth, as well as the associated challenges, and prospects for unraveling the 3D attenuation structure of the lower mantle.

Greater physician involvement improves coding outcomes in endobronchial ultrasound-guided transbronchial needle aspiration procedures.

PubMed

Pillai, Anilkumar; Medford, Andrew R L

2013-01-01

Correct coding is essential for accurate reimbursement for clinical activity. Published data confirm that significant aberrations in coding occur, leading to considerable financial inaccuracies especially in interventional procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Previous data reported a 15% coding error for EBUS-TBNA in a U.K. service. We hypothesised that greater physician involvement with coders would reduce EBUS-TBNA coding errors and financial disparity. The study was done as a prospective cohort study in the tertiary EBUS-TBNA service in Bristol. 165 consecutive patients between October 2009 and March 2012 underwent EBUS-TBNA for evaluation of unexplained mediastinal adenopathy on computed tomography. The chief coder was prospectively electronically informed of all procedures and cross-checked on a prospective database and by Trust Informatics. Cost and coding analysis was performed using the 2010-2011 tariffs. All 165 procedures (100%) were coded correctly as verified by Trust Informatics. This compares favourably with the 14.4% coding inaccuracy rate for EBUS-TBNA in a previous U.K. prospective cohort study [odds ratio 201.1 (1.1-357.5), p = 0.006]. Projected income loss was GBP 40,000 per year in the previous study, compared to a GBP 492,195 income here with no coding-attributable loss in revenue. Greater physician engagement with coders prevents coding errors and financial losses which can be significant especially in interventional specialties. The intervention can be as cheap, quick and simple as a prospective email to the coding team with cross-checks by Trust Informatics and against a procedural database. We suggest that all specialties should engage more with their coders using such a simple intervention to prevent revenue losses. Copyright © 2013 S. Karger AG, Basel.

Dose profiles for lung and breast regions at prospective and retrospective CT coronary angiography using optically stimulated luminescence dosimeters on a 64-detector CT scanner.

PubMed

Funama, Yoshinori; Taguchi, Katsuyuki; Utsunomiya, Daisuke; Oda, Seitaro; Murasaki, Hiroo; Yamashita, Yasuyuki; Awai, Kazuo

2012-01-01

The purpose of our study was to acquire dose profiles at critical organs of lung and breast regions using optically stimulated luminescence (OSL) dosimeters; assess the actual radiation dose delivered at retrospective and prospective computed tomography coronary angiography (CTCA). Using a chest CT phantom we applied a prospectively-gated step-and-shoot- and a retrospectively-gated helical mode on a 64-detector row CT scanner. Retrospective scan mode was used with and without electrocardiogram (ECG) based tube current modulation. OSL dosimeters were used to measure dose profiles. In the both scan modes we acquired dose profiles and determined the mean and maximum dose in left lung and in left breast regions. In prospective mode, the mean dose was 21.53 mGy in left lung- and 23.59 mGy in left breast region. With respect to the retrospective mode, the mean dose with tube current modulation was 38.63 mGy for left lung- and 46.02 mGy for left breast region, i.e. 0.56 and 0.55 times lower than the mean dose without modulation. The OSL dosimeter is useful for measurement of the actual radiation dose along z-axis at lung and breast regions in the prospective and the retrospective CTCA. Copyright © 2011 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Spectral Domain Optical Coherence Tomography Allows the Unification of Clinical Decision Making for the Evaluation of Choroidal Neovascularization Activity.

PubMed

Volz, Cornelia; Grassmann, Felix; Greslechner, Roman; Märker, David Arthur; Peters, Patrick; Helbig, Horst; Gamulescu, Maria-Andreea

2018-06-21

This prospective observational clinical study investigated the benefits of spectral domain optical coherence tomography for specialists and residents in the management of neovascular age-related macular degeneration (AMD). The study involved 49 eyes of 44 patients. Patients were advised to present for reevaluation 4 weeks after the administration of the loading dose of vascular endothelial growth factor (VEGF)-inhibitors (3 intravitreal injections every 4 weeks after diagnosis). They were examined by residents (3-4 years' experience in ophthalmology) and specialists (> 5 years' experience). Each examiner evaluated the clinical situation and the spectral domain optical coherence tomography (SD-OCT) scan. After each evaluation, the examiners independently stated if further anti-VEGF treatment was recommended. The "true outcome" was defined as the specialist decision based on clinical evaluation and SD-OCT. Specialists and residents did not significantly differ in their accuracy in deciding on the correct treatment (p = 0.705 and p = 1), with or without the aid of SD-OCT. Both groups benefited from using SD-OCT to support their recommendations (p = 0.001 and p = 0.0002) and achieved a similar level of accuracy (p = 1 for difference). Residents benefited more than specialists by using SD-OCT to substantiate their recommendation on how to manage exudative AMD after the administration of the loading dose. © 2018 S. Karger AG, Basel.

PET scanning in head and neck oncology: a review.

PubMed

McGuirt, W F; Greven, K; Williams, D; Keyes, J W; Watson, N; Cappellari, J O; Geisinger, K R

1998-05-01

The objective of this study was to review and describe the usage of fluorine-labeled deoxyglucose (FDG) and positron emission tomography (PET) in the diagnosis and management of head and neck cancer. Several prospective series,-including 159 newly diagnosed and previously untreated and 23 previously irradiated head and neck squamous cell carcinoma patients initially seen at the Wake Forest University Medical Center and evaluated by clinical examination, conventional computed tomography/ magnetic resonance imaging (CT/MRI) scans, PET scans, and histopathologic studies,-were reviewed and the findings summarized for comparison of the correct differentiation of primary and metastatic cancers and for postirradiation tumor clearance in a subsegment of those cases. Positron emission tomography scanning using a fluorine-labeled deoxyglucose (FDG) radiotracer proved as reliable as conventional scanning for primary and metastatic tumor identification. Compared with clinical examination, PET was better for identification of nodal metastatic tumors but poorer for small primary tumors. For previously irradiated patients treated at least 4 months before the test, PET scanning was clearly superior to clinical examination and conventional imaging in differentiating tumor recurrence from soft-tissue irradiation effects. Fluorine-labeled deoxyglucose-PET scanning is comparable to conventional imaging of head and neck cancers in detecting primary and metastatic carcinoma. Lack of anatomic detail remains its major drawback. Currently, its greatest role is in the evaluation of the postradiotherapy patient.

DETECTION OF MICROVASCULAR CHANGES IN EYES OF PATIENTS WITH DIABETES BUT NOT CLINICAL DIABETIC RETINOPATHY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PubMed

de Carlo, Talisa E; Chin, Adam T; Bonini Filho, Marco A; Adhi, Mehreen; Branchini, Lauren; Salz, David A; Baumal, Caroline R; Crawford, Courtney; Reichel, Elias; Witkin, Andre J; Duker, Jay S; Waheed, Nadia K

2015-11-01

To evaluate the ability of optical coherence tomography angiography to detect early microvascular changes in eyes of diabetic individuals without clinical retinopathy. Prospective observational study of 61 eyes of 39 patients with diabetes mellitus and 28 control eyes of 22 age-matched healthy subjects that received imaging using optical coherence tomography angiography between August 2014 and March 2015. Eyes with concomitant retinal, optic nerve, and vitreoretinal interface diseases and/or poor-quality images were excluded. Foveal avascular zone size and irregularity, vessel beading and tortuosity, capillary nonperfusion, and microaneurysm were evaluated. Foveal avascular zone size measured 0.348 mm² (0.1085-0.671) in diabetic eyes and 0.288 mm² (0.07-0.434) in control eyes (P = 0.04). Foveal avascular zone remodeling was seen more often in diabetic than control eyes (36% and 11%, respectively; P = 0.01). Capillary nonperfusion was noted in 21% of diabetic eyes and 4% of control eyes (P = 0.03). Microaneurysms and venous beading were noted in less than 10% of both diabetic and control eyes. Both diabetic and healthy control eyes demonstrated tortuous vessels in 21% and 25% of eyes, respectively. Optical coherence tomography angiography was able to image foveal microvascular changes that were not detected by clinical examination in diabetic eyes. Changes to the foveal avascular zone and capillary nonperfusion were more prevalent in diabetic eyes, whereas vessel tortuosity was observed with a similar frequency in normal and diabetic eyes. Optical coherence tomography angiography may be able to detect diabetic eyes at risk of developing retinopathy and to screen for diabetes quickly and noninvasively before the systemic diagnosis is made.

Hip Resurfacing Using Highly Cross-linked Polyethylene: Prospective Study Results at 8.5 Years.

PubMed

Pritchett, James W

2016-10-01

Hip resurfacing is an option to consider when treating younger, more active patients. Advantages over total hip arthroplasty include a more normal gait and a lower incidence of thigh pain. In this prospective study, 190 hip resurfacing procedures (164 participants) were performed using a cobalt-chromium femoral component and a cementless acetabular cup with a 3.8-mm highly cross-linked polyethylene acetabular liner. The mean follow-up was 8.5 (range, 7-10) years. Two participants were lost to follow-up and 2 died. One participant underwent successful revision surgery for acetabular loosening. Four participants underwent successful revision to a total hip arthroplasty because of femoral neck fracture (2), femoral loosening, or infection. The Kaplan-Meier survivorship was 97%. Acetabular bone conservation was assessed using computed tomography by measuring the medial acetabular wall. The mean thickness was 9 mm. Femoral bone was well preserved with a mean head:neck ratio of 1.37. There were 4 (2%) osteolytic defects up to 0.9 cm(3) on computed tomography and no instances of impending polyethylene wear-through. Seven polyethylene retrievals had a measured wear rate of 0.05 mm/y. Hip resurfacing using a highly cross-linked polyethylene acetabular component is a reliable procedure. Both femoral and acetabular bones are reasonably preserved compared with prior resurfacing methods. The low incidence of osteolysis and the low rate of wear found on retrievals suggest that many years of use in highly active patients is possible. Copyright © 2016 Elsevier Inc. All rights reserved.

The use of computed tomography for the estimation of DIEP flap weights in breast reconstruction: a simple mathematical formula.

PubMed

Nanidis, Theodore G; Ridha, Hyder; Jallali, Navid

2014-10-01

Estimation of the volume of abdominal tissue is desirable when planning autologous abdominal based breast reconstruction. However, this can be difficult clinically. The aim of this study was to develop a simple, yet reliable method of calculating the deep inferior epigastric artery perforator flap weight using the routine preoperative computed tomography angiogram (CTA) scan. Our mathematical formula is based on the shape of a DIEP flap resembling that of an isosceles triangular prism. Thus its volume can be calculated with a standard mathematical formula. Using bony landmarks three measurements were acquired from the CTA scan to calculate the flap weight. This was then compared to the actual flap weight harvested in both a retrospective feasibility and prospective study. In the retrospective group 17 DIEP flaps in 17 patients were analyzed. Average predicted flap weight was 667 g (range 293-1254). The average actual flap weight was 657 g (range 300-1290) giving an average percentage error of 6.8% (p-value for weight difference 0.53). In the prospective group 15 DIEP flaps in 15 patients were analyzed. Average predicted flap weight was 618 g (range 320-925). The average actual flap weight was 624 g (range 356-970) giving an average percentage error of 6.38% (p-value for weight difference 0.57). This formula is a quick, reliable and accurate way of estimating the volume of abdominal tissue using the preoperative CTA scan. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Dosage optimization in positron emission tomography: state-of-the-art methods and future prospects

PubMed Central

Karakatsanis, Nicolas A; Fokou, Eleni; Tsoumpas, Charalampos

2015-01-01

Positron emission tomography (PET) is widely used nowadays for tumor staging and therapy response in the clinic. However, average PET radiation exposure has increased due to higher PET utilization. This study aims to review state-of-the-art PET tracer dosage optimization methods after accounting for the effects of human body attenuation and scan protocol parameters on the counting rate. In particular, the relationship between the noise equivalent count rate (NECR) and the dosage (NECR-dosage curve) for a range of clinical PET systems and body attenuation sizes will be systematically studied to prospectively estimate the minimum dosage required for sufficiently high NECR. The optimization criterion can be determined either as a function of the peak of the NECR-dosage curve or as a fixed NECR score when NECR uniformity across a patient population is important. In addition, the systematic NECR assessments within a controllable environment of realistic simulations and phantom experiments can lead to a NECR-dosage response model, capable of predicting the optimal dosage for every individual PET scan. Unlike conventional guidelines suggesting considerably large dosage levels for obese patients, NECR-based optimization recommends: i) moderate dosage to achieve 90% of peak NECR for obese patients, ii) considerable dosage reduction for slimmer patients such that uniform NECR is attained across the patient population, and iii) prolongation of scans for PET/MR protocols, where longer PET acquisitions are affordable due to lengthy MR sequences, with motion compensation becoming important then. Finally, the need for continuous adaptation of dosage optimization to emerging technologies will be discussed. PMID:26550543

Area at risk can be assessed by iodine-123-meta-iodobenzylguanidine single-photon emission computed tomography after myocardial infarction: a prospective study.

PubMed

Hedon, Christophe; Huet, Fabien; Ben Bouallegue, Fayçal; Vernhet, Hélène; Macia, Jean-Christophe; Cung, Thien-Tri; Leclercq, Florence; Cade, Stéphane; Cransac, Frédéric; Lattuca, Benoit; Vandenberghe, D'Arcy; Bourdon, Aurélie; Benkiran, Meriem; Vauchot, Fabien; Gervasoni, Richard; D'estanque, Emmanuel; Mariano-Goulart, Denis; Roubille, François

2018-02-01

Myocardial salvage is an important surrogate endpoint to estimate the impact of treatments in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the correlation between cardiac sympathetic denervation area assessed by single-photon emission computed tomography (SPECT) using iodine-123-meta-iodobenzylguanidine (I-MIBG) and myocardial area at risk (AAR) assessed by cardiac magnetic resonance (CMR) (gold standard). A total of 35 postprimary reperfusion STEMI patients were enrolled prospectively to undergo SPECT using I-MIBG (evaluates cardiac sympathetic denervation) and thallium-201 (evaluates myocardial necrosis), and to undergo CMR imaging using T2-weighted spin-echo turbo inversion recovery for AAR and postgadolinium T1-weighted phase sensitive inversion recovery for scar assessment. I-MIBG imaging showed a wider denervated area (51.1±16.0% of left ventricular area) in comparison with the necrosis area on thallium-201 imaging (16.1±14.4% of left ventricular area, P<0.0001). CMR and SPECT provided similar evaluation of the transmural necrosis (P=0.10) with a good correlation (R=0.86, P<0.0001). AAR on CMR was not different compared with the denervated area (P=0.23) and was adequately correlated (R=0.56, P=0.0002). Myocardial salvage evaluated by SPECT imaging (mismatch denervated but viable myocardium) was significantly higher than by CMR (P=0.02). In patients with STEMI, I-MIBG SPECT, assessing cardiac sympathetic denervation may precisely evaluate the AAR, providing an alternative to CMR for AAR assessment.

Evaluation of white-to-white distance and anterior chamber depth measurements using the IOL Master, slit-lamp adapted optical coherence tomography and digital photographs in phakic eyes.

PubMed

Wilczyński, Michał; Pośpiech-Zabierek, Aleksandra

2015-01-01

The accurate measurement of the anterior chamber internal diameter and depth is important in ophthalmic diagnosis and before some eye surgery procedures. The purpose of the study was to compare the white-to-white distance measurements performed using the IOL-Master and photography with internal anterior chamber diameter determined using slit lamp adapted optical coherence tomography in healthy eyes, and to compare anterior chamber depth measurements by IOL-Master and slit lamp adapted optical coherence tomography. The data were gathered prospectively from a non-randomized consecutive series of patients. The examined group consisted of 46 eyes of 39 patients. White-to-white was measured using IOL-Master and photographs of the eye were taken with a digital camera. Internal anterior chamber diameter was measured with slit-lamp adapted optical coherence tomography. Anterior chamber depth was measured using the IOL Master and slit-lamp adapted optical coherence tomography. Statistical analysis was performed using parametric tests. A Bland-Altman plot was drawn. White-to-white distance by the IOL Master was 11.8 +/- 0.40 mm, on photographs it was 11.29 +/- 0.58 mm and internal anterior chamber diameter by slit-lamp adapted optical coherence tomography was 11.34?0.54 mm. A significant difference was found between IOL-Master and slit-lamp adapted optical coherence tomography (p<0.01), as well as between IOL Master and digital photographs (p<0.01). There was no difference between SL-OCT and digital photographs (p>0.05). All measurements were correlated (Spearman p<0.001). Mean anterior chamber depth determined using the IOL-Master was 2.99 +/- 0.50 mm and by slit-lamp adapted optical coherence tomography was 2.56 +/- 0.46 mm. The difference was statistically significant (p<0.001). The correlation between the values was also statistically significant (Spearman, p<0.001). Automated measurements using IOL-Master yield constantly higher values than measurements based on direct eye visualization slit-lamp adapted optical coherence tomography and digital photographs. In order to obtain accurate measurements of the internal anterior chamber diameter and anterior chamber depth, a method involving direct visualization of intraocular structures should be used.

Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

PubMed

Error, Marc; Ashby, Shaelene; Orlandi, Richard R; Alt, Jeremiah A

2018-01-01

Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P < .001). All residents, junior and senior, demonstrated significant improvement in identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

Role of FDG-PET in the Implementation of Involved-Node Radiation Therapy for Hodgkin Lymphoma Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Girinsky, Théodore; Aupérin, Anne; Ribrag, Vincent

2014-08-01

Purpose: This study examines the role of {sup 18}F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL). Methods and Material: Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) weremore » first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results. Results: From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients. Conclusions: Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.« less

Liver Function Assessment Using Technetium 99m-Galactosyl Single-Photon Emission Computed Tomography/CT Fusion Imaging: A Prospective Trial.

PubMed

Okabayashi, Takehiro; Shima, Yasuo; Morita, Sojiro; Shimada, Yasuhiro; Sumiyoshi, Tatsuaki; Sui, Kenta; Iwata, Jun; Iiyama, Tatsuo

2017-12-01

The prediction of postoperative liver function remains a largely subjective practice based on CT volumetric analysis. However, future liver volume after a hepatectomy is not the only factor that contributes to postoperative liver function and outcomes. In this prospective trial, 185 consecutive patients who underwent liver operations between 2014 and 2015 were studied. Volumetric and functional rates of remnant liver were measured using technetium 99m-galactosyl human serum albumin single-photon emission computed tomography/CT fusion imaging to evaluate post-hepatectomy remnant liver function. Remnant indocyanine green clearance rate using galactosyl (KGSA) (KGSA × functional rate) was used to predict future remnant liver function. Hepatectomy was considered safe for patients with remnant KGSA values ≥0.05, and the primary end point was to determine the accuracy and reliability of this criteria. The prediction of the 90-day major complication and mortality rates was assessed. Median hospital stay was 9 days and median ICU stay was 1 day, with only 1 in-hospital death (90-day mortality rate 0.5%). Overall morbidity rate evaluated according to the Clavien-Dindo classification was 9%. For post-hepatectomy liver failure definitions, the International Study Group of Liver Surgery definition was fulfilled in 14 patients (8%), with the majority being grade B (50%), compared with 2 patients (1%) fulfilling the "50-50" criteria, and 0 patients (0%) fulfilling the Peak Bili >7 criteria. Results of this study showed that remnant KGSA provided information that allowed us to predict remnant liver function. This information will be important for surgeons when deciding on a treatment plan for patients with liver diseases. (ClinicalTrials.gov ID: NCT02013895). Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Optical Coherence Tomography Substudy of A Prospective Multicenter Randomized Post-Market Trial to Assess the Safety and Effectiveness of the Firehawk™ Rapamycin Target Eluting Cobalt Chromium Coronary Stent System for the Treatment of Atherosclerotic Lesions: TARGET All Comers.

PubMed

Baumbach, Andreas; Lansky, Alexandra J; Onuma, Yoshi; Asano, Taku; Johnson, Thomas; Anderson, Richard; Kiemeneij, Ferdinand; Zheng, Ming; Van Royen, Niels; Slagboom, Ton; Vlachojannis, Georg; Xu, Bo; Serruys, Patrick; Wijns, William

2018-06-12

Durable polymer drug-eluting stents (DP DES) may contribute to persistent inflammation, delayed endothelial healing and subsequent late DES thrombosis. The aim of this Optical Coherence Tomography (OCT) sub-study was to compare healing and neointimal coverage of a novel bioabsorbable polymer sirolimus-eluting stent (FIREHAWK®) (BP DES) versus the DP DES (XIENCE) at 90 days in an all comers patient population. The TARGET All Comers study is a prospective multicenter randomised post-market trial of 1656 patients randomised 1:1 to FIREHAWK or XIENCE at 21 centers in 10 European countries. The TARGET OCT sub-study enrolled 36 consecutive patients with 52 lesions at 6 centers proficient in OCT. Follow-up OCT was performed at 3 months or prior to revascularisation when occurring before the 3-month window. The substudy was designed for non-inferiority of the primary endpoint of neointimal thickness. At follow-up, the mean neointimal thickness by OCT (52 lesions, Firehawk, n=24; Xience, n=28), was not significantly different between groups (Firehawk 75.5μm vs Xience V 82.3 μm) meeting the primary endpoint of non-inferiority (Pnoninferiority<0.001). The percentage of stent strut coverage was high in both groups (strut level: 99.9% ± 0.3 vs 100% ± 0.1, p=0.26), and the proportion of malapposed struts (1.0±1.6% vs. 1.2±2.0%, p=0.51) was low in both groups. Based on OCT, the FIREHAWK BP DES has a similar healing response 3 months after implantation compared to the DP DES, with near complete strut coverage, moderate neointima formation and minimal strut malapposition.

PROSPECTIVE COMPARISON OF TUMOR STAGING USING COMPUTED TOMOGRAPHY VERSUS MAGNETIC RESONANCE IMAGING FINDINGS IN DOGS WITH NASAL NEOPLASIA: A PILOT STUDY.

PubMed

Lux, Cassie N; Culp, William T N; Johnson, Lynelle R; Kent, Michael; Mayhew, Philipp; Daniaux, Lise A; Carr, Alaina; Puchalski, Sarah

2017-05-01

Identification of nasal neoplasia extension and tumor staging in dogs is most commonly performed using computed tomography (CT), however magnetic resonance imaging (MRI) is routinely used in human medicine. A prospective pilot study enrolling six dogs with nasal neoplasia was performed with CT and MRI studies acquired under the same anesthetic episode. Interobserver comparison and comparison between the two imaging modalities with regard to bidimensional measurements of the nasal tumors, tumor staging using historical schemes, and assignment of an ordinal scale of tumor margin clarity at the tumor-soft tissue interface were performed. The hypotheses included that MRI would have greater tumor measurements, result in higher tumor staging, and more clearly define the tumor soft tissue interface when compared to CT. Evaluation of bone involvement of the nasal cavity and head showed a high level of agreement between CT and MRI. Estimation of tumor volume using bidimensional measurements was higher on MRI imaging in 5/6 dogs, and resulted in a median tumor volume which was 18.4% higher than CT imaging. Disagreement between CT and MRI was noted with meningeal enhancement, in which two dogs were positive for meningeal enhancement on MRI and negative on CT. One of six dogs had a higher tumor stage on MRI compared to CT, while the remaining five agreed. Magnetic resonance imaging resulted in larger bidimensional measurements and tumor volume estimates, along with a higher likelihood of identifying meningeal enhancement when compared to CT imaging. Magnetic resonance imaging may provide integral information for tumor staging, prognosis, and treatment planning. © 2017 American College of Veterinary Radiology.

Who Explicitly Requests the Ordering of Computed Tomography for Emergency Department Patients? A Multicenter Prospective Study

PubMed Central

Broder, Joshua Seth; Bhat, Rahul; Boyd, Joshua P.; Ogloblin, Ivan A.; Limkakeng, Alexander; Hocker, Michael Brian; Drake, Weiying Gao; Miller, Taylor; Harringa, John Brian; Repplinger, Michael Dean

2016-01-01

Background Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. Objective To determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. Methods Prospective, observational study at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Results Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0%, 95% CI 79.4–84.3), resident physicians (28.6%, 95%CI 25.8–31.6), consulting physicians (24.4%, 95%CI 21.7–27.2), and admitting physicians (3.9%, 95%CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2%, 95%CI 43.7–58.6), resident physicians in the ED (39.9%, 95%CI, 32.8–47.4), and admitting physicians (8.9%, 95%CI, 5.5–14.2). EPs were the sole party requesting CT in 46.2% of cases while multiple parties were involved in 39.0%. Patients, families, and radiologists were uncommon sources of such requests. Conclusions Emergency physicians requested the majority of CTs, though nearly 20% were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization. PMID:26873604

Dose reduction in whole-body computed tomography of multiple injuries (DoReMI): protocol for a prospective cohort study

PubMed Central

2014-01-01

Background Single-pass, contrast-enhanced whole body multidetector computed tomography (MDCT) emerged as the diagnostic standard for evaluating patients with major trauma. Modern iterative image algorithms showed high image quality at a much lower radiation dose in the non-trauma setting. This study aims at investigating whether the radiation dose can safely be reduced in trauma patients without compromising the diagnostic accuracy and image quality. Methods/Design Prospective observational study with two consecutive cohorts of patients. Setting: A high-volume, academic, supra-regional trauma centre in Germany. Study population: Consecutive male and female patients who 1. had been exposed to a high-velocity trauma mechanism, 2. present with clinical evidence or high suspicion of multiple trauma (predicted Injury Severity Score [ISS] ≥16) and 3. are scheduled for primary MDCT based on the decision of the trauma leader on call. Imaging protocols: In a before/after design, a consecutive series of 500 patients will undergo single-pass, whole-body 128-row multi-detector computed tomography (MDCT) with a standard, as low as possible radiation dose. This will be followed by a consecutive series of 500 patients undergoing an approved ultra-low dose MDCT protocol using an image processing algorithm. Data: Routine administrative data and electronic patient records, as well as digital images stored in a picture archiving and communications system will serve as the primary data source. The protocol was approved by the institutional review board. Main outcomes: (1) incidence of delayed diagnoses, (2) diagnostic accuracy, as correlated to the reference standard of a synopsis of all subsequent clinical, imaging, surgical and autopsy findings, (3) patients’ safety, (4) radiation exposure (e.g. effective dose), (5) subjective image quality (assessed independently radiologists and trauma surgeons on a 100-mm visual analogue scale), (6) objective image quality (e.g., contrast-to-noise ratio). Analysis: Multivariate regression will be employed to adjust and correct the findings for time and cohort effects. An exploratory interim analysis halfway after introduction of low-dose MDCT will be conducted to assess whether this protocol is clearly inferior or superior to the current standard. Discussion Although non-experimental, this study will generate first large-scale data on the utility of imaging-enhancing algorithms in whole-body MDCT for major blunt trauma. Trial registration Current Controlled Trials ISRCTN74557102. PMID:24589310

Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?

PubMed

Hajalioghli, Parisa; Nemati, Masoud; Dinparast Saleh, Leila; Fouladi, Daniel F

2016-07-01

The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.

Impact of B-Scan Averaging on Spectralis Optical Coherence Tomography Image Quality before and after Cataract Surgery

PubMed Central

Podkowinski, Dominika; Sharian Varnousfaderani, Ehsan; Simader, Christian; Bogunovic, Hrvoje; Philip, Ana-Maria; Gerendas, Bianca S.

2017-01-01

Background and Objective To determine optimal image averaging settings for Spectralis optical coherence tomography (OCT) in patients with and without cataract. Study Design/Material and Methods In a prospective study, the eyes were imaged before and after cataract surgery using seven different image averaging settings. Image quality was quantitatively evaluated using signal-to-noise ratio, distinction between retinal layer image intensity distributions, and retinal layer segmentation performance. Measures were compared pre- and postoperatively across different degrees of averaging. Results 13 eyes of 13 patients were included and 1092 layer boundaries analyzed. Preoperatively, increasing image averaging led to a logarithmic growth in all image quality measures up to 96 frames. Postoperatively, increasing averaging beyond 16 images resulted in a plateau without further benefits to image quality. Averaging 16 frames postoperatively provided comparable image quality to 96 frames preoperatively. Conclusion In patients with clear media, averaging 16 images provided optimal signal quality. A further increase in averaging was only beneficial in the eyes with senile cataract. However, prolonged acquisition time and possible loss of details have to be taken into account. PMID:28630764

Pilot study assessment of dynamic vascular changes in breast cancer with near-infrared tomography from prospectively targeted manipulations of inspired end-tidal partial pressure of oxygen and carbon dioxide.

PubMed

Jiang, Shudong; Pogue, Brian W; Michaelsen, Kelly E; Jermyn, Michael; Mastanduno, Michael A; Frazee, Tracy E; Kaufman, Peter A; Paulsen, Keith D

2013-07-01

The dynamic vascular changes in the breast resulting from manipulation of both inspired end-tidal partial pressure of oxygen and carbon dioxide were imaged using a 30 s per frame frequency-domain near-infrared spectral (NIRS) tomography system. By analyzing the images from five subjects with asymptomatic mammography under different inspired gas stimulation sequences, the mixture that maximized tissue vascular and oxygenation changes was established. These results indicate maximum changes in deoxy-hemoglobin, oxygen saturation, and total hemoglobin of 21, 9, and 3%, respectively. Using this inspired gas manipulation sequence, an individual case study of a subject with locally advanced breast cancer undergoing neoadjuvant chemotherapy (NAC) was analyzed. Dynamic NIRS imaging was performed at different time points during treatment. The maximum tumor dynamic changes in deoxy-hemoglobin increased from less than 7% at cycle 1, day 5 (C1, D5) to 17% at (C1, D28), which indicated a complete response to NAC early during treatment and was subsequently confirmed pathologically at the time of surgery.

Pulmonary Nodule Volumetry at Different Low Computed Tomography Radiation Dose Levels With Hybrid and Model-Based Iterative Reconstruction: A Within Patient Analysis.

PubMed

den Harder, Annemarie M; Willemink, Martin J; van Hamersvelt, Robbert W; Vonken, Evertjan P A; Schilham, Arnold M R; Lammers, Jan-Willem J; Luijk, Bart; Budde, Ricardo P J; Leiner, Tim; de Jong, Pim A

2016-01-01

The aim of the study was to determine the effects of dose reduction and iterative reconstruction (IR) on pulmonary nodule volumetry. In this prospective study, 25 patients scheduled for follow-up of pulmonary nodules were included. Computed tomography acquisitions were acquired at 4 dose levels with a median of 2.1, 1.2, 0.8, and 0.6 mSv. Data were reconstructed with filtered back projection (FBP), hybrid IR, and model-based IR. Volumetry was performed using semiautomatic software. At the highest dose level, more than 91% (34/37) of the nodules could be segmented, and at the lowest dose level, this was more than 83%. Thirty-three nodules were included for further analysis. Filtered back projection and hybrid IR did not lead to significant differences, whereas model-based IR resulted in lower volume measurements with a maximum difference of -11% compared with FBP at routine dose. Pulmonary nodule volumetry can be accurately performed at a submillisievert dose with both FBP and hybrid IR.

End-of-Treatment Positron Emission Tomography After Uniform First-Line Therapy of B-Cell Posttransplant Lymphoproliferative Disorder Identifies Patients at Low Risk of Relapse in the Prospective German PTLD Registry.

PubMed

Zimmermann, Heiner; Denecke, Timm; Dreyling, Martin H; Franzius, Christiane; Reinke, Petra; Subklewe, Marion; Amthauer, Holger; Kneba, Michael; Riess, Hanno; Trappe, Ralf U

2018-05-01

Fluorine-18 fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) is a recommended standard in the staging and response assessment of 18F-FDG-avid lymphoma. Posttransplant lymphoproliferative disorder (PTLD) can be detected by 18F-FDG-PET at diagnosis with high sensitivity and specificity. However, the role of response assessment by end-of-treatment (EOT) PET has only been addressed in small case series. We performed a retrospective, multicenter study of 37 patients with CD20-positive PTLD after solid organ transplantation treated with uniform, up-to-date, first-line protocols in the prospective German PTLD registry who had received EOT 18F-FDG-PET between 2006 and 2014. Median follow-up was 5.0 years. Any nonphysiological 18F-FDG uptake (Deauville score greater 2) was interpreted as PET-positive. By computed tomography (CT) final staging, 18 of 37 patients had a complete response, 18 had a partial response and 1 patient had stable disease. EOT PET was negative in 24 of 37 patients and positive in 13 of 37 patients. The positive predictive value of EOT PET for PTLD relapse was 38%, and the negative predictive value was 92%. Time to progression (TTP) and progression-free-survival were significantly longer in the PET negative group (P = 0.019 and P = 0.013). In the 18 patients in a partial response by CT staging, we noted highly significant differences in overall survival (P = 0.001), time to progression (P = 0.007), and progression-free survival (P < 0.001) by EOT PET. Even without baseline imaging, EOT PET in PTLD identifies patients at low risk of relapse and offers clinically relevant information, particularly in patients in a partial remission by CT staging.

Inter-ethnic variation of ocular traits-design and methodology of comparison study among American Caucasians, American Chinese and mainland Chinese.

PubMed

Wang, Dan Dan; Huang, Guo Fu; He, Ming Guang; Wu, Ling Ling; Lin, Shan

2011-03-01

To summarize the design and methodology of a multi-center study. With the existed ethnic differences of glaucoma, this survey will explore the differences with regard to anterior and posterior ocular segment parameters between Caucasians and Chinese. In this study, four cohorts including American Caucasians and American Chinese from San Francisco, southern mainland Chinese from Guangzhou, and northern mainland Chinese from Beijing were prospectively enrolled for a series of eye examinations and tests from May 2008 to December 2010. A total of 120 subjects including 15 of each gender in each age decade from 40s to 70s were recruited for each group. Data of the following tests were collected: a questionnaire eliciting systemic and ocular disease history, blood pressure, presenting and best corrected visual acuity, auto-refraction, Goldmann applanation tonometry, gonioscopy, A-scan, anterior segment optical coherence tomography (ASOCT), ultrasound biomicroscopy (UBM), visual field (VF), Heidelberg retinal tomography (HRT), OCT for optic nerve, and digital fundus photography. this study will provide insights to the etiologies of glaucoma especially PACG through inter-ethnic comparisons of relevant ocular anatomic and functional parameters.

Contrast improvement of continuous wave diffuse optical tomography reconstruction by hybrid approach using least square and genetic algorithm

NASA Astrophysics Data System (ADS)

Patra, Rusha; Dutta, Pranab K.

2015-07-01

Reconstruction of the absorption coefficient of tissue with good contrast is of key importance in functional diffuse optical imaging. A hybrid approach using model-based iterative image reconstruction and a genetic algorithm is proposed to enhance the contrast of the reconstructed image. The proposed method yields an observed contrast of 98.4%, mean square error of 0.638×10-3, and object centroid error of (0.001 to 0.22) mm. Experimental validation of the proposed method has also been provided with tissue-like phantoms which shows a significant improvement in image quality and thus establishes the potential of the method for functional diffuse optical tomography reconstruction with continuous wave setup. A case study of finger joint imaging is illustrated as well to show the prospect of the proposed method in clinical diagnosis. The method can also be applied to the concentration measurement of a region of interest in a turbid medium.

Ultrasound and computed tomography of the iliosacral lymphatic centre in dogs with anal sac gland carcinoma.

PubMed

Pollard, R E; Fuller, M C; Steffey, M A

2017-06-01

In this prospective study, we hypothesized that computed tomography (CT) would identify more normal and abnormal iliosacral lymph nodes (LNs) than abdominal ultrasound in dogs with anal sac gland carcinoma (ASGC). Twelve client-owned dogs with ASGC but without distant metastasis were enrolled. Abdominal ultrasound and contrast-enhanced CT scans of the abdomen were obtained. Iliosacral LNs were counted and assessed for location, laterality and size. Significantly (P < 0.00001) more iliosacral LNs were identified with CT (61) than ultrasound (30), including significantly (P = 0.00012) more medial iliac LNs with CT (33) than ultrasound (19). There was no difference in number of internal iliac LNs identified with CT versus ultrasound. Significantly (P = 0.000061) more sacral LNs were identified with CT (15) than ultrasound (0). Ultrasound identified slightly more (7) abnormal iliosacral LNs than CT (5). Contrast CT was able to identify more normal but not more abnormal LNs than ultrasound. © 2015 John Wiley & Sons Ltd.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Massuger, L.F.; Kenemans, P.; Claessens, R.A.

The safety and diagnostic accuracy of immunoscintigraphy with the indium-111-labeled monoclonal antibody OV-TL 3 F(ab')2({sup 111}In-OV-TL 3 F(ab')2) for diagnosis and follow-up of ovarian cancer was prospectively studied in 31 patients. Planar and SPECT scintigraphy were performed up to 4 days after i.v. injection of 140 MBq {sup 111}In-OV-TL 3 F(ab')2. Surgical evaluation was possible in 22 out of 31 patients. Imaging results were compared with X-ray computed tomography, ultrasound, and CA 125 serum level using the histologically confirmed surgical findings as a gold standard. Apart from a transient rash observed in two patients, no other immediate or delayed adversemore » reactions were observed. Within the surgically evaluated group, ovarian cancer lesions were detected in 16 out of 17 patients (94%). Of 45 distinct tumor deposits found at operation, 67% were detected and localized with immunoscintigraphy while X-ray computed tomography and ultrasound visualized 53% and 23%, respectively.« less

Immunoscintigraphy of ovarian cancer with indium-111-labeled OV-TL 3 F(ab')2 monoclonal antibody.

PubMed

Massuger, L F; Kenemans, P; Claessens, R A; Verheijen, R H; Schijf, C P; Strijk, S P; Poels, L G; van Hoesel, R G; Corstens, F H

1990-11-01

The safety and diagnostic accuracy of immunoscintigraphy with the indium-111-labeled monoclonal antibody OV-TL 3 F(ab')2(111In-OV-TL 3 F(ab')2) for diagnosis and follow-up of ovarian cancer was prospectively studied in 31 patients. Planar and SPECT scintigraphy were performed up to 4 days after i.v. injection of 140 MBq 111In-OV-TL 3 F(ab')2. Surgical evaluation was possible in 22 out of 31 patients. Imaging results were compared with X-ray computed tomography, ultrasound, and CA 125 serum level using the histologically confirmed surgical findings as a "gold standard." Apart from a transient rash observed in two patients, no other immediate or delayed adverse reactions were observed. Within the surgically evaluated group, ovarian cancer lesions were detected in 16 out of 17 patients (94%). Of 45 distinct tumor deposits found at operation, 67% were detected and localized with immunoscintigraphy while X-ray computed tomography and ultrasound visualized 53% and 23%, respectively.

Correlative studies of structural and functional imaging in primary progressive aphasia.

PubMed

Panegyres, P K; McCarthy, M; Campbell, A; Lenzo, N; Fallon, M; Thompson, J

2008-01-01

To compare and contrast structural and functional imaging in primary progressive aphasia (PPA). A cohort of 8 patients diagnosed with PPA presenting with nonfluency were prospectively evaluated. All patients had structural imaging in the form of MRI and in 1 patient CAT scanning on account of a cardiac pacemaker. All patients had single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging. SPECT and PET imaging had 100% correlation. Anatomical imaging was abnormal in only 6 of the 8 patients. Wernicke's area showed greater peak Z score reduction and extent of area affected than Broca's area (McNemar paired test: P = .008 for Z score reduction; P = .0003 for extent). PET scanning revealed significant involvement of the anterior cingulum. Functional imaging in PPA: (a) identified more patients correctly than anatomic imaging highlighting the importance of SPECT and PET in the diagnosis; and (b) demonstrated the heterogeneous involvement of disordered linguistic networks in PPA suggesting its syndromic nature.

The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: Data From the Dutch Lung Surgery Audit.

PubMed

Heineman, David Jonathan; Ten Berge, Martijn Geert; Daniels, Johannes Marlene; Versteegh, Michaël Ignatius; Marang-van de Mheen, Perla Jacqueline; Wouters, Michael Wilhelmus; Schreurs, Wilhelmina Hendrika

2016-11-01

Clinical staging of non-small cell lung cancer (NSCLC) determines the initial treatment offered to a patient. The similarity between clinical and pathologic staging in some studies is as low as 50%, and others publish results as high as 91%. The Dutch Lung Surgery Audit is a clinical database that registers the clinical and pathologic TNM of almost all NSCLC patients who undergo operations in the Netherlands. The objective of this study was to determine the accuracy of clinical staging of NSCLC. Prospective data were derived from the Dutch Lung Surgery Audit in 2013 and 2014. Patients were included if they had undergone a surgical resection for stage IA to IIIB NSCLC without neoadjuvant treatment and had a positron emission tomography-computed tomography scan as part of the clinical workup. Clinical (c)TNM and pathologic (p)TNM were compared, and whether discrepancy was based on tumor or nodal staging was determined. From 2,834 patients identified, 2,336 (82.4%) fulfilled the inclusion criteria and had complete data. Of these 2,336, 1,276 (54.6%) were staged accurately, 707 (30.3%) were clinically understaged, and 353 (15.1%) were clinically overstaged. In the understaged group, 346 patients had a higher pN stage (14.8%), of which 148 patients had unforeseen N2 disease (6.3%). In the overstaged group, 133 patients had a cN that was higher than the pN (5.7%). Accuracy of NSCLC staging in the Netherlands is low (54.6%), even in the era of positron emission tomography-computed tomography. Especially accurate nodal staging remains challenging. Future efforts should include the identification of specific pitfalls in NSCLC staging. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Diagnostic capability of spectral-domain optical coherence tomography for glaucoma.

PubMed

Wu, Huijuan; de Boer, Johannes F; Chen, Teresa C

2012-05-01

To determine the diagnostic capability of spectral-domain optical coherence tomography in glaucoma patients with visual field defects. Prospective, cross-sectional study. Participants were recruited from a university hospital clinic. One eye of 85 normal subjects and 61 glaucoma patients with average visual field mean deviation of -9.61 ± 8.76 dB was selected randomly for the study. A subgroup of the glaucoma patients with early visual field defects was calculated separately. Spectralis optical coherence tomography (Heidelberg Engineering, Inc) circular scans were performed to obtain peripapillary retinal nerve fiber layer (RNFL) thicknesses. The RNFL diagnostic parameters based on the normative database were used alone or in combination for identifying glaucomatous RNFL thinning. To evaluate diagnostic performance, calculations included areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Overall RNFL thickness had the highest area under the receiver operating characteristic curve values: 0.952 for all patients and 0.895 for the early glaucoma subgroup. For all patients, the highest sensitivity (98.4%; 95% confidence interval, 96.3% to 100%) was achieved by using 2 criteria: ≥ 1 RNFL sectors being abnormal at the < 5% level and overall classification of borderline or outside normal limits, with specificities of 88.9% (95% confidence interval, 84.0% to 94.0%) and 87.1% (95% confidence interval, 81.6% to 92.5%), respectively, for these 2 criteria. Statistical parameters for evaluating the diagnostic performance of the Spectralis spectral-domain optical coherence tomography were good for early perimetric glaucoma and were excellent for moderately advanced perimetric glaucoma. Copyright © 2012 Elsevier Inc. All rights reserved.

Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain: Design of the CArdiac cT in the treatment of acute CHest pain (CATCH)-2 randomized controlled trial.

PubMed

Sørgaard, Mathias; Linde, Jesper J; Hove, Jens D; Petersen, Jan R; Jørgensen, Tem B S; Abdulla, Jawdat; Heitmann, Merete; Kragelund, Charlotte; Hansen, Thomas Fritz; Udholm, Patricia M; Pihl, Christian; Kühl, J Tobias; Engstrøm, Thomas; Jensen, Jan Skov; Høfsten, Dan E; Kelbæk, Henning; Kofoed, Klaus F

2016-09-01

Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain. Copyright © 2015 Elsevier Inc. All rights reserved.

The Rate and Clinical Significance of Incidental Thyroid Uptake as Detected by Gallium-68 DOTATATE Positron Emission Tomography/Computed Tomography

PubMed Central

Nockel, Pavel; Millo, Corina; Keutgen, Xavier; Klubo-Gwiezdzinska, Joanna; Shell, Jasmine; Patel, Dhaval; Nilubol, Naris; Herscovitch, Peter; Sadowski, Samira M.

2016-01-01

Background: Gallium-68 (Ga-68) DOTATATE is a radiolabeled peptide–imaging modality that targets the somatostatin receptor (SSTR), especially subtype 2 (SSTR2). Benign and malignant thyroid tumors have been observed to express SSTR. The aim of this study was to evaluate the frequency and clinical significance of incidental atypical thyroid uptake as detected by Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT). Methods: A retrospective analysis was conducted of a prospective study in which 237 patients underwent Ga-68 DOTATATE PET/CT as part of a work-up for metastatic and unknown primary neuroendocrine tumors. The types of uptake in the thyroid gland (focal/diffuse) and maximum standardized uptake value (SUVmax) levels were evaluated and compared with the background uptake in the liver and salivary glands. Results: Of 237 patients, 26 (11%) had atypical thyroid uptake as detected by Ga-68 DOTATATE PET/CT. There were no significant clinical or biochemical variables associated with atypical thyroid uptake. Fourteen (54%) patients had positive focal uptake, and 12 (46%) patients had diffuse uptake. Of the 14 patients with atypical focal uptake, 10 (71%) had thyroid nodules on the corresponding side, as detected by anatomic imaging. Three of 10 patients (21%) were found to have papillary thyroid cancer, and seven (70%) had adenomatoid nodules. Of the 12 patients with diffuse increased uptake, six (50%) had a history of hypothyroidism, five (42%) had chronic lymphocytic thyroiditis, and one (8%) had nontoxic multinodular goiter. Conclusions: Patients with an incidental focal abnormal thyroid uptake on Ga-68 DOTATATE PET/CT scan should have further clinical evaluation to exclude a diagnosis of thyroid cancer. PMID:27094616

AMISH EYE STUDY: Baseline Spectral Domain Optical Coherence Tomography Characteristics of Age-Related Macular Degeneration.

PubMed

Nittala, Muneeswar G; Song, Yeunjoo E; Sardell, Rebecca; Adams, Larry D; Pan, Samuel; Velaga, Swetha B; Horst, Violet; Dana, Debra; Caywood, Laura; Laux, Renee; Fuzzell, Denise; Fuzzell, Sarada; Scott, William K; Cooke Bailey, Jessica N; Igo, Robert P; Haines, Jonathan; Pericak-Vance, Margaret A; Sadda, SriniVas R; Stambolian, Dwight

2018-05-09

To describe spectral domain optical coherence tomography (SD-OCT) findings in an Amish cohort to assess SD-OCT markers for early age-related macular degeneration (AMD). The authors performed a family-based prospective cohort study of 1,146 elderly Amish subjects (age range 50-99 years) (2,292 eyes) who had a family history of at least 1 individual with AMD. All subjects underwent complete ophthalmic examinations, SD-OCT using both Cirrus and Spectralis (20 × 20° scan area) instruments, fundus autofluorescence, infrared imaging, and color fundus photography. Spectral domain optical coherence tomography characteristics were analyzed in subjects with AMD (with and without subretinal drusenoid deposits [SDDs]) and normal healthy cohorts. Participants' mean age was 65.2 years (SD ± 11). Color fundus photographic findings in 596 (53%) subjects (1,009 eyes) were consistent with AMD; the remaining 478 (43%) subjects showed no signs of AMD. The choroid was significantly thinner on OCT (242 ± 76 µm, P < 0.001) in those with AMD compared with those without (263 ± 63 µm). Subretinal drusenoid deposits were found in 143 eyes (7%); 11 of the 143 eyes (8%) had no other manifestations of AMD. Drusen volume (P < 0.001) and area of geographic atrophy (P < 0.001) were significantly greater, and choroid was significantly (P < 0.001) thinner in subjects with SDDs versus those without SDDs. The authors describe spectral domain optical coherence tomography characteristics in an elderly Amish population with and without AMD, including the frequency of SDD. Although relatively uncommon in this population, the authors confirmed that SDDs can be found in the absence of other features of AMD and that eyes with SDDs have thinner choroids.

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST).

PubMed

Babl, Franz E; Lyttle, Mark D; Bressan, Silvia; Borland, Meredith; Phillips, Natalie; Kochar, Amit; Dalziel, Stuart R; Dalton, Sarah; Cheek, John A; Furyk, Jeremy; Gilhotra, Yuri; Neutze, Jocelyn; Ward, Brenton; Donath, Susan; Jachno, Kim; Crowe, Louise; Williams, Amanda; Oakley, Ed

2014-06-13

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014).

Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer.

PubMed

Linz, C; Müller-Richter, U D A; Buck, A K; Mottok, A; Ritter, C; Schneider, P; Metzen, D; Heuschmann, P; Malzahn, U; Kübler, A C; Herrmann, K; Bluemel, C

2015-01-01

Detecting bone invasion in oral cancer is crucial for therapy planning and the prognosis. The present study evaluated cone beam computed tomography (CBCT) for detecting bone invasion in comparison to standard imaging techniques. A total of 197 patients with diagnoses of oral cancer underwent CBCT as part of preoperative staging between January 2007 and April 2013. The sensitivity, specificity, and accuracy of CBCT were compared with panoramic radiography (PR), multi-slice computed tomography (CT) or magnetic resonance imaging (MRI), and bone scintigraphy (BS) using McNemar's test. Histopathology and clinical follow-up served as references for the presence of bone invasion. CBCT and BS (84.8% and 89.3%, respectively), as well as CBCT and CT/MRI (83.2%), showed comparable accuracy (P = 0.188 and P = 0.771). CBCT was significantly superior to PR, which was reconstructed based on a CBCT dataset (74.1%, P = 0.002). In detecting bone invasion, CBCT was significantly more accurate than PR and was comparable to BS and CT/MRI. However, each method has certain advantages, and the best combination of imaging methods must be evaluated in prospective clinic trials. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A New Dual-purpose Quality Control Dosimetry Protocol for Diagnostic Reference-level Determination in Computed Tomography.

PubMed

Sohrabi, Mehdi; Parsi, Masoumeh; Sina, Sedigheh

2018-05-17

A diagnostic reference level is an advisory dose level set by a regulatory authority in a country as an efficient criterion for protection of patients from unwanted medical exposure. In computed tomography, the direct dose measurement and data collection methods are commonly applied for determination of diagnostic reference levels. Recently, a new quality-control-based dose survey method was proposed by the authors to simplify the diagnostic reference-level determination using a retrospective quality control database usually available at a regulatory authority in a country. In line with such a development, a prospective dual-purpose quality control dosimetry protocol is proposed for determination of diagnostic reference levels in a country, which can be simply applied by quality control service providers. This new proposed method was applied to five computed tomography scanners in Shiraz, Iran, and diagnostic reference levels for head, abdomen/pelvis, sinus, chest, and lumbar spine examinations were determined. The results were compared to those obtained by the data collection and quality-control-based dose survey methods, carried out in parallel in this study, and were found to agree well within approximately 6%. This is highly acceptable for quality-control-based methods according to International Atomic Energy Agency tolerance levels (±20%).

Quantitative X-ray computed tomography peritoneography in malignant peritoneal mesothelioma patients receiving intraperitoneal chemotherapy.

PubMed

Leinwand, Joshua C; Zhao, Binsheng; Guo, Xiaotao; Krishnamoorthy, Saravanan; Qi, Jing; Graziano, Joseph H; Slavkovic, Vesna N; Bates, Gleneara E; Lewin, Sharyn N; Allendorf, John D; Chabot, John A; Schwartz, Lawrence H; Taub, Robert N

2013-12-01

Intraperitoneal chemotherapy is used to treat peritoneal surface-spreading malignancies. We sought to determine whether volume and surface area of the intraperitoneal chemotherapy compartments are associated with overall survival and posttreatment glomerular filtration rate (GFR) in malignant peritoneal mesothelioma (MPM) patients. Thirty-eight MPM patients underwent X-ray computed tomography peritoneograms during outpatient intraperitoneal chemotherapy. We calculated volume and surface area of contrast-filled compartments by semiautomated computer algorithm. We tested whether these were associated with overall survival and posttreatment GFR. Decreased likelihood of mortality was associated with larger surface areas (p = 0.0201) and smaller contrast-filled compartment volumes (p = 0.0341), controlling for age, sex, histologic subtype, and presence of residual disease >0.5 cm postoperatively. Larger volumes were associated with higher posttreatment GFR, controlling for pretreatment GFR, body surface area, surface area, and the interaction between body surface area and volume (p = 0.0167). Computed tomography peritoneography is an appropriate modality to assess for maldistribution of intraperitoneal chemotherapy. In addition to identifying catheter failure and frank loculation, quantitative analysis of the contrast-filled compartment's surface area and volume may predict overall survival and cisplatin-induced nephrotoxicity. Prospective studies should be undertaken to confirm and extend these findings to other diseases, including advanced ovarian carcinoma.

Computed tomography in the evaluation of penetrating neck trauma: a preliminary study.

PubMed

Gracias, V H; Reilly, P M; Philpott, J; Klein, W P; Lee, S Y; Singer, M; Schwab, C W

2001-11-01

Penetrating neck trauma has traditionally been evaluated by surgical exploration and/or invasive diagnostic studies. We hypothesized that computed tomography (CT), used as an early diagnostic tool to accurately determine trajectory, would direct or eliminate further studies or procedures in stable patients with penetrating neck trauma. Retrospective case series. Academic, urban, level I trauma center. Hemodynamically stable patients without hard signs of vascular injury or aerodigestive violation who had sustained penetrating trauma to the neck. Patients underwent a spiral CT as an initial diagnostic study after initial evaluation in the trauma bay. Further invasive studies were directed by CT findings. Number of invasive studies performed. Twenty-three patients were identified during the 30-month period. Nineteen patients sustained gunshot wounds; 3, shotgun wounds; and 1, a stab wound. One patient died of a cranial gunshot wound. Three isolated zone I, 1 isolated zone II, 9 isolated zone III, and 10 multiple neck zone trajectories were evaluated. Thirteen patients were identified by CT to have trajectories remote from vital structures and required no further evaluation. Ten patients underwent angiography. Only 2 underwent bronchoscopy and esophagoscopy. Four patients were discharged from the emergency department; 7 other patients were discharged within 24 hours. No adverse patient events occurred before, during, or after CT scan. Computed tomography in stable selected patients with penetrating neck trauma appears safe. Invasive studies can often be eliminated from the diagnostic algorithm when CT demonstrates trajectories remote from vital structures. As a result, efficient evaluation and early discharge from the trauma bay or emergency department can be realized. Further prospective study of CT scan after penetrating neck trauma is needed.

Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A Prospective Study

PubMed Central

Gimber, Lana Hirai; Travis, R Ing; Takahashi, Jayme M; Goodman, Torrey L; Yoon, Hyo-Chun

2009-01-01

Context: Pulmonary computed tomography angiography (CTA) and the Wells criteria both have interobserver variability in the assessment of pulmonary embolism (PE). Quantitative D-dimer assay findings have been shown to have a high negative predictive value in patients with low pretest probability of PE. Objective: Evaluate roles for clinical probability and CTA in Emergency Department (ED) patients suspected of acute PE but having a low serum D-dimer level. Design: Prospective observational study of ED patients with possible PE who underwent pulmonary CTA and had D-dimer levels ≤1.0 μg/mL. Main Outcome: Clinical probability of PE determined by ED physicians using standard published criteria; pulmonary CTAs read by initial and study radiologists kept unaware of D-dimer results. Results: In 16 months, 744 patients underwent pulmonary CTA, with 347 study participants who had a D-dimer level ≤ 1.0 μg/mL. In one participant, CTA showed a PE that was agreed on by both the initial and study radiologists. In six participants, the initial findings were reported as positive for PE but were not interpreted as positive by the study radiologist. In none of these participants was PE diagnosed on the basis of clinical probability, of findings on ancillary studies and three-month follow-up examination, or by another radiologist, unaware of findings, acting as a tiebreaker. Conclusion: Pulmonary CTA findings positive for acute embolism should be viewed with caution, especially if the suspected PE is in a distal segmental or subsegmental artery in a patient with a serum D-dimer level of ≤1.0 μg/mL. Furthermore, the Wells criteria may be of limited additional value in this group of patients with low D-dimer levels because most will have low or intermediate clinical probability of PE. PMID:20740096

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin

PubMed Central

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

Background: To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). Materials and Methods: A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. Results: PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. Conclusions: F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT. PMID:26170563

Metabolic imaging biomarkers of postradiotherapy xerostomia.

PubMed

Cannon, Blake; Schwartz, David L; Dong, Lei

2012-08-01

Xerostomia is a major complication of head and neck radiotherapy (RT). Available xerostomia measures remain flawed. [(18)F]fluorodeoxyglucose-labeled positron emission tomography-computed tomography (FDG-PET-CT) is routinely used for staging and response assessment of head and neck cancer. We investigated quantitative measurement of parotid gland FDG uptake as a potential biomarker for post-RT xerostomia. Ninety-eight locally advanced head and neck cancer patients receiving definitive RT underwent baseline and post-RT FDG-PET-CT on a prospective imaging trial. A separate validation cohort of 14 patients underwent identical imaging while prospectively enrolled in a second trial collecting sialometry and patient-reported outcomes. Radiation dose and pre- and post-RT standard uptake values (SUVs) for all voxels contained within parotid gland ROI were deformably registered. Average whole-gland or voxel-by-voxel models incorporating parotid D(Met) (defined as the pretreatment parotid SUV weighted by dose) accurately predicted posttreatment changes in parotid FDG uptake (e.g., fractional parotid SUV). Fractional loss of parotid FDG uptake closely paralleled early parotid toxicity defined by posttreatment salivary output (p < 0.01) and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer xerostomia scores (p < 0.01). In this pilot series, loss of parotid FDG uptake was strongly associated with acute clinical post-RT parotid toxicity. D(Met) may potentially be used to guide function-sparing treatment planning. Prospective validation of FDG-PET-CT as a convenient, quantifiable imaging biomarker of parotid function is warranted and ongoing. Copyright © 2012 Elsevier Inc. All rights reserved.

Optical Coherence Tomography Reflective Drusen Substructures Predict Progression to Geographic Atrophy in Age-related Macular Degeneration.

PubMed

Veerappan, Malini; El-Hage-Sleiman, Abdul-Karim M; Tai, Vincent; Chiu, Stephanie J; Winter, Katrina P; Stinnett, Sandra S; Hwang, Thomas S; Hubbard, G Baker; Michelson, Michelle; Gunther, Randall; Wong, Wai T; Chew, Emily Y; Toth, Cynthia A

2016-12-01

Structural and compositional heterogeneity within drusen comprising lipids, carbohydrates, and proteins have been previously described. We sought to detect and define phenotypic patterns of drusen heterogeneity in the form of optical coherence tomography-reflective drusen substructures (ODS) and examine their associations with age-related macular degeneration (AMD)-related features and AMD progression. Retrospective analysis in a prospective study. Patients with intermediate AMD (n = 349) enrolled in the multicenter Age-Related Eye Disease Study 2 (AREDS2) ancillary spectral-domain optical coherence tomography (SD OCT) study. Baseline SD OCT scans of 1 eye per patient were analyzed for the presence of ODS. Cross-sectional and longitudinal associations of ODS presence with AMD-related features visible on SD OCT and color photographs, including drusen volume, geographic atrophy (GA), and preatrophic features, were evaluated for the entire macular region. Similar associations were also made locally within a 0.5-mm-diameter region around individual ODS and corresponding control region without ODS in the same eye. Preatrophy SD OCT changes and GA, central GA, and choroidal neovascularization (CNV) from color photographs. Four phenotypic subtypes of ODS were defined: low reflective cores, high reflective cores, conical debris, and split drusen. Among the 349 participants, there were 307 eligible eyes and 74 (24%) had at least 1 ODS. The ODS at baseline were associated with (1) greater macular drusen volume at baseline (P < 0.001), (2) development of preatrophic changes at year 2 (P = 0.001-0.01), and (3) development of macular GA (P = 0.005) and preatrophic changes at year 3 (P = 0.002-0.008), but not development of CNV. The ODS at baseline in a local region were associated with (1) presence of preatrophy changes at baseline (P = 0.02-0.03) and (2) development of preatrophy changes at years 2 and 3 within the region (P = 0.008-0.05). Optical coherence tomography-reflective drusen substructures are optical coherence tomography-based biomarkers of progression to GA, but not to CNV, in eyes with intermediate AMD. Optical coherence tomography-reflective drusen substructures may be a clinical entity helpful in monitoring AMD progression and informing mechanisms in GA pathogenesis. Copyright © 2016 American Academy of Ophthalmology. All rights reserved.

The significance of routine thoracic computed tomography in patients with blunt chest trauma.

PubMed

Çorbacıoğlu, Seref Kerem; Er, Erhan; Aslan, Sahin; Seviner, Meltem; Aksel, Gökhan; Doğan, Nurettin Özgür; Güler, Sertaç; Bitir, Aysen

2015-05-01

The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

7-year follow-up after stereotactic ablative radiotherapy for patients with stage I non-small cell lung cancer: Results of a phase 2 clinical trial.

PubMed

Sun, Bing; Brooks, Eric D; Komaki, Ritsuko U; Liao, Zhongxing; Jeter, Melenda D; McAleer, Mary F; Allen, Pamela K; Balter, Peter A; Welsh, James D; O'Reilly, Michael S; Gomez, Daniel; Hahn, Stephen M; Roth, Jack A; Mehran, Reza J; Heymach, John V; Chang, Joe Y

2017-08-15

The authors evaluated the efficacy, patterns of failure, and toxicity of stereotactic ablative radiotherapy (SABR) for patients with medically inoperable, clinical stage I non-small cell lung cancer (NSCLC) in a prospective clinical trial with 7 years of follow-up. Clinical staging was performed according to the seventh edition of the American Joint Committee on Cancer TNM staging system. Eligible patients with histologically confirmed NSCLC of clinical stage I as determined using positron emission tomography staging were treated with SABR (50 grays in 4 fractions). The primary endpoint was progression-free survival. Patients were followed with computed tomography and/or positron emission tomography/computed tomography every 3 months for the first 2 years, every 6 months for the next 3 years, and then annually thereafter. A total of 65 patients were eligible for analysis. The median age of the patients was 71 years, and the median follow-up was 7.2 years. A total of 18 patients (27.7%) developed disease recurrence at a median of 14.5 months (range, 4.3-71.5 months) after SABR. Estimated incidences of local, regional, and distant disease recurrence using competing risk analysis were 8.1%, 10.9%, and 11.0%, respectively, at 5 years and 8.1%, 13.6%, and 13.8%, respectively, at 7 years. A second primary lung carcinoma developed in 12 patients (18.5%) at a median of 35 months (range, 5-67 months) after SABR. Estimated 5-year and 7-year progression-free survival rates were 49.5% and 38.2%, respectively; the corresponding overall survival rates were 55.7% and 47.5%, respectively. Three patients (4.6%) experienced grade 3 treatment-related adverse events. No patients developed grade 4 or 5 adverse events (toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 3.0]). With long-term follow-up, the results of the current prospective study demonstrated outstanding local control and low toxicity after SABR in patients with clinical stage I NSCLC. Regional disease recurrence and distant metastases were the dominant manifestations of failure. Surveillance for second primary lung carcinoma is recommended. Cancer 2017;123:3031-39. © 2017 American Cancer Society. © 2017 American Cancer Society.

Value of 18fluorodeoxyglucose-positron-emission tomography in amyotrophic lateral sclerosis: a prospective study.

PubMed

Van Laere, Koen; Vanhee, Annelies; Verschueren, Jolien; De Coster, Liesbeth; Driesen, An; Dupont, Patrick; Robberecht, Wim; Van Damme, Philip

2014-05-01

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder primarily affecting the motor system, with extramotor involvement to a variable extent. Biomarkers for early differential diagnosis and prognosis are needed. An autosomal dominant hexanucleotide (GGGGCC) expansion in the noncoding region of the chromosome 9 open reading frame 72 (C9orf72) gene is the most frequent genetic cause of ALS, but its metabolic pattern has not been studied systematically. To evaluate the use of 18fluorodeoxyglucose-positron-emission tomography as a marker of ALS pathology and investigate whether a specific metabolic signature is present in patients with C9orf72 mutations. In total, 81 patients with a suspected diagnosis of ALS at University Hospital Leuven were prospectively investigated. All underwent detailed neurological examination and electrodiagnostic and genetic testing for the major known genetic causes of ALS (C9orf72, SOD1, TARDBP, and FUS). A diagnosis of ALS was made in 70 of 81 patients. Of these, 11 were C9orf72 positive and 59 were C9orf72 negative. In 7 patients, the diagnosis of primary lateral sclerosis was made; 4 patients had progressive muscular atrophy. A screened healthy control population was used for comparison. Positron-emission tomographic data were spatially normalized and analyzed using a predefined volume of interest and a voxel-based analysis (SPM8). Discriminant analysis was done both volume of interest based and voxel based using a support vector machine approach. Compared with control participants, 18fluorodeoxyglucose-positron-emission tomography showed perirolandic and variable prefrontal hypometabolism in most patients. Patients with primary lateral sclerosis showed a similar pattern. Patients with C9orf72-positive ALS had discrete relative hypometabolism in the thalamus and posterior cingulate compared with those with C9orf72-negative ALS. A posteriori-corrected discriminant analysis was able to correctly classify 95% of ALS cases and 71% of primary lateral sclerosis cases. Prefrontal hypometabolism was associated with reduced clinical functioning (ALS Functional Rating Scale). Extensive hypometabolism in the prefrontal or anterior temporal areas was present in 10% of patients and associated with significantly shorter survival as an independent factor (n = 63, P < .001). Patients who were C9orf72 positive did not differ in survival compared with those who were C9orf72 negative. 18Fluorodeoxyglucose-positron-emission tomography is a useful early diagnostic and prognostic marker for ALS. Amyotrophic lateral sclerosis that is positive for C9orf72 is characterized by only mild cerebral metabolic differences that show no prognostic difference.

Macular Ganglion Cell Imaging Study: Covariate Effects on the Spectral Domain Optical Coherence Tomography for Glaucoma Diagnosis.

PubMed

Jeong, Jae Hoon; Choi, Yun Jeong; Park, Ki Ho; Kim, Dong Myung; Jeoung, Jin Wook

2016-01-01

To evaluate the effect of multiple covariates on the diagnostic performance of the Cirrus high-definition optical coherence tomography (HD-OCT) for glaucoma detection. A prospective case-control study was performed and included 173 recently diagnosed glaucoma patients and 63 unaffected individuals from the Macular Ganglion Cell Imaging Study. Regression analysis of receiver operating characteristic were conducted to evaluate the influence of age, spherical equivalent, axial length, optic disc size, and visual field index on the macular ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) measurements. Disease severity, as measured by visual field index, had a significant effect on the diagnostic performance of all Cirrus HD-OCT parameters. Age, axial length and optic disc size were significantly associated with diagnostic accuracy of average peripapillary RNFL thickness, whereas axial length had a significant effect on the diagnostic accuracy of average GCIPL thickness. Diagnostic performance of the Cirrus HD-OCT may be more accurate in the advanced stages of glaucoma than at earlier stages. A smaller optic disc size was significantly associated with improved the diagnostic ability of average RNFL thickness measurements; however, GCIPL thickness may be less affected by age and optic disc size.

Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial

PubMed Central

2012-01-01

Background Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic. Methods/design The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014. Discussion This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease. Trial registration ClinicalTrials.gov Identifier: NCT01149590 PMID:23036114

Helical prospective ECG-gating in cardiac computed tomography: radiation dose and image quality.

PubMed

DeFrance, Tony; Dubois, Eric; Gebow, Dan; Ramirez, Alex; Wolf, Florian; Feuchtner, Gudrun M

2010-01-01

Helical prospective ECG-gating (pECG) may reduce radiation dose while maintaining the advantages of helical image acquisition for coronary computed tomography angiography (CCTA). Aim of this study was to evaluate helical pECG-gating in CCTA in regards to radiation dose and image quality. 86 patients undergoing 64-multislice CCTA were enrolled. pECG-gating was performed in patients with regular heart rates (HR) < 65 bpm; with the gating window set at 70-85% of the cardiac cycle. All patients received oral and some received additional IV beta-blockers to achieve HR < 65 bpm. In patients with higher or irregular HR, or for functional evaluation, retrospective ECG-gating (rECG) was performed. The average X-ray dose was estimated from the dose length product. Each arterial segment (modified AHA/ACC 17-segment-model) was evaluated on a 4-point image quality scale (4 = excellent; 3 = good, mild artefact; 2 = acceptable, some artefact, 1 = uninterpretable). pECG-gating was applied in 57 patients, rECG-gating in 29 patients. There was no difference in age, gender, body mass index, scan length or tube output settings between both groups. HR in the pECG-group was 54.7 bpm (range, 43-64). The effective radiation dose was significantly lower for patients scanned with pECG-gating with mean 6.9 mSv +/- 1.9 (range, 2.9-10.7) compared to rECG with 16.9 mSv +/- 4.1 (P < 0.001), resulting in a mean dose reduction of 59.2%. For pECG-gating, out of 969 coronary segments, 99.3% were interpretable. Image quality was excellent in 90.2%, good in 7.8%, acceptable in 1.3% and non-interpretable in 0.7% (n = 7 segments). For patients with steady heart rates <65 bpm, helical prospective ECG-gating can significantly lower the radiation dose while maintaining high image quality.

Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy.

PubMed

Rapp, Martin; Ley, Charles J; Hansson, Kerstin; Sjöström, Lennart

2017-03-20

To describe postoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy and partial discectomy. Prospective clinical case study of dogs diagnosed with and treated for DLSS. Surgical and clinical findings were described. Computed tomography and low field MRI findings pre- and postoperatively were described and graded. Clinical, CT and MRI examinations were performed four to 18 months after surgery. Eleven of 13 dogs were clinically improved and two dogs had unchanged clinical status postoperatively despite imaging signs of neural compression. Vacuum phenomenon, spondylosis, sclerosis of the seventh lumbar (L7) and first sacral (S1) vertebrae endplates and lumbosacral intervertebral joint osteoarthritis became more frequent in postoperative CT images. Postoperative MRI showed mild disc extrusions in five cases, and in all cases contrast enhancing non-discal tissue was present. All cases showed contrast enhancement of the L7 spinal nerves both pre- and postoperatively and seven had contrast enhancement of the lumbosacral intervertebral joints and paraspinal tissue postoperatively. Articular process fractures or fissures were noted in four dogs. The study indicates that imaging signs of neural compression are common after DLSS surgery, even in dogs that have clinical improvement. Contrast enhancement of spinal nerves and soft tissues around the region of disc herniation is common both pre- and postoperatively and thus are unreliable criteria for identifying complications of the DLSS surgery.

Physical properties of root cementum: Part 26. Effects of micro-osteoperforations on orthodontic root resorption: A microcomputed tomography study.

PubMed

Chan, Emmanuel; Dalci, Oyku; Petocz, Peter; Papadopoulou, Alexandra K; Darendeliler, M Ali

2018-02-01

Studies have demonstrated the potential efficacy of micro-osteoperforations in accelerating tooth movement by amplifying the expression of inflammatory markers. The aim of this investigation was to examine the effects of micro-osteoperforations on orthodontic root resorption with microcomputed tomography. This prospective controlled clinical trial involved 20 subjects requiring extraction of the maxillary first premolars as part of their orthodontic treatment. A buccal tipping force of 150 g was applied to both premolars. Using the Propel appliance (Propel Orthodontics, San Jose, Calif), micro-osteoperforations were applied at a depth of 5 mm on the mesial and distal aspects in the midroot region of the experimental side of the first premolar root; the contralateral side served as the control. After 28 days, both premolars were extracted. The teeth were scanned under microcomputed tomography, and the volumes of root resorption craters were calculated and compared. Premolars treated with micro-osteoperforation exhibited significantly greater average total amounts of root resorption than did the control teeth (0.576 vs 0.406 mm 3 ). The total average volumetric root loss of premolars treated with micro-osteoperforation was 42% greater than that of the control teeth. This 28-day trial showed that micro-osteoperforations resulted in greater orthodontic root resorption. However, these results should be verified in patients who are undergoing full-length orthodontic treatment. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Imaging work-up for screening of paraganglioma and pheochromocytoma in SDHx mutation carriers: a multicenter prospective study from the PGL.EVA Investigators.

PubMed

Gimenez-Roqueplo, Anne-Paule; Caumont-Prim, Aurore; Houzard, Claire; Hignette, Chantal; Hernigou, Anne; Halimi, Philippe; Niccoli, Patricia; Leboulleux, Sophie; Amar, Laurence; Borson-Chazot, Françoise; Cardot-Bauters, Catherine; Delemer, Brigitte; Chabolle, Frédéric; Coupier, Isabelle; Libé, Rossella; Peitzsch, Mirko; Peyrard, Séverine; Tenenbaum, Florence; Plouin, Pierre-François; Chatellier, Gilles; Rohmer, Vincent

2013-01-01

Recommendations have not been established concerning imaging to screen SDHx mutation carriers for paraganglioma and pheochromocytoma. Our objective was to compare the performance of gadolinium-enhanced magnetic resonance angiography, contrast-enhanced computed tomography, and [(123)I]metaiodo-benzylguanidine and somatostatin receptor scintigraphies for detecting head and neck and thoracic-abdominal-pelvic paragangliomas in SDHx mutation carriers. We conducted a prospective, multicenter study from June 2005 to December 2009 at 23 French medical centers. A total of 238 index cases or relatives carrying mutations in SDHD, SDHB, or SDHC genes were included. Images obtained by each technique were analyzed blind, without knowledge of results from other tests, first in each local center and then centrally. We evaluated sensitivity, specificity, and likelihood ratios for individual and combinations of tests, the gold standard being the consensus of an expert committee. Two hundred two tumors were diagnosed in 96 subjects. At local assessment, the sensitivity of anatomical imaging for detecting all tumors was higher (85.7%) than that of both scintigraphic techniques (42.7% for [(123)I]metaiodo-benzylguanidine and 69.5% for somatostatin receptor scintigraphy), except for thoracic localizations where somatostatin receptor scintigraphy was more sensitive (61.5 vs. 46.2% for anatomical imaging and 30.8% for [(123)I]metaiodo-benzylguanidine scintigraphy). The best diagnostic performance during local assessment was obtained by combining anatomical imaging tests and somatostatin receptor scintigraphy (sensitivity 91.7%). Central assessment significantly increased the sensitivity (98.6%) of tests in combination. In routine practice, the imaging work-up for screening SDHx mutation carriers should include thoraco-abdomino-pelvic computed tomography, head and neck magnetic angiography, and somatostatin receptor scintigraphy. Expert centralized image assessment is recommended.

Relation of Coronary Flow Reserve to Other Findings on Positron Emission Tomography Myocardial Perfusion Imaging and Left Heart Catheterization in Patients With End-stage Renal Disease Being Evaluated for Kidney Transplant.

PubMed

Paz, Yehuda; Morgenstern, Rachelle; Weinberg, Richard; Chiles, Mariana; Bhatti, Navdeep; Ali, Ziad; Mohan, Sumit; Bokhari, Sabahat

2017-12-01

Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD) and often goes undetected. Abnormal coronary flow reserve (CFR), which predicts increased risk of cardiac death, may be present in patients with ESRD without other evidence of coronary artery disease (CAD). We prospectively studied 131 patients who had rest and dipyridamole pharmacologic stress N 13 -ammonia positron emission tomography myocardial perfusion imaging (PET MPI) for kidney transplant evaluation. Thirty-four patients also had left heart catheterization. Abnormal PET MPI was defined as qualitative ischemia or infarct, stress electrocardiogram ischemia, or transient ischemic dilation. CFR was calculated as the ratio of stress to rest coronary blood flow. Global CFR < 2 was defined as abnormal. Of 131 patients who had PET MPI (66% male, 55.6 ± 12.1 years), 30% (39 of 131) had abnormal PET MPI and 59% (77 of 131) had abnormal CFR. In a subset of 34 patients who had left heart catheterization (66% male, 61.0 ± 12.1 years), 68% (23 of 34) had abnormal CFR on PET MPI, and 68% (23 of 34) had ≥70% obstruction on left heart catheterization. Abnormal CFR was not significantly associated with abnormal PET MPI (p = 0.13) or obstructive CAD on left heart catheterization (p = 0.26). In conclusion, in the first prospective study of PET MPI in patients with ESRD, abnormal CFR is highly prevalent and is independent of abnormal findings on PET MPI or obstructive CAD on left heart catheterization. Copyright © 2017 Elsevier Inc. All rights reserved.

Structural and functional photoacoustic molecular tomography aided by emerging contrast agents

PubMed Central

Nie, Liming

2015-01-01

Photoacoustic tomography (PAT) can offer structural, functional and molecular contrasts at scalable observation level. By ultrasonically overcoming the strong optical scattering, this imaging technology can reach centimeters penetration depth while retaining high spatial resolution in biological tissue. Recent extensive research has been focused on developing new contrast agents to improve the imaging sensitivity, specificity and efficiency. These emerging materials have substantially accelerated PAT applications in signal sensing, functional imaging, biomarker labeling and therapy monitoring etc. Here, the potentials of different optical probes as PAT contrast agents were elucidated. We first describe the instrumental embodiments and the measured functional parameters, then focus on emerging contrast agent-based PAT applications, and finally discuss the challenges and prospects. PMID:24967718

Microwave tomography enhanced GPR surveys in Centaur’s Domus, Regio VI of Pompeii, Italy

NASA Astrophysics Data System (ADS)

Catapano, I.; Crocco, L.; Di Napoli, R.; Soldovieri, F.; Brancaccio, A.; Pesando, F.; Aiello, A.

2012-08-01

The archaeological area of Pompeii (Naples, Italy) is known worldwide as one of the most remarkable examples of a Roman Empire town, but its origins are prior to the Roman age and there is a huge archeological interest in discovering the history of the forma urbis. With respect to this framework, the paper presents results from microwave tomography enhanced ground penetrating radar (GPR) surveys carried out in the Centaur’s Domus, Regio VI, one of the most ancient housing areas of Pompeii. The GPR prospections aimed at addressing and driving the archeological excavation campaign performed in this area in October 2010. The results of stratigraphic assays are used to assess the reliability of the tomographic images obtained.

Effects of a radiation dose reduction strategy for computed tomography in severely injured trauma patients in the emergency department: an observational study.

PubMed

Kim, Soo Hyun; Jung, Seung Eun; Oh, Sang Hoon; Park, Kyu Nam; Youn, Chun Song

2011-11-03

Severely injured trauma patients are exposed to clinically significant radiation doses from computed tomography (CT) imaging in the emergency department. Moreover, this radiation exposure is associated with an increased risk of cancer. The purpose of this study was to determine some effects of a radiation dose reduction strategy for CT in severely injured trauma patients in the emergency department. We implemented the radiation dose reduction strategy in May 2009. A prospective observational study design was used to collect data from patients who met the inclusion criteria during this one year study (intervention group) from May 2009 to April 2010. The prospective data were compared with data collected retrospectively for one year prior to the implementation of the radiation dose reduction strategy (control group). By comparison of the cumulative effective dose and the number of CT examinations in the two groups, we evaluated effects of a radiation dose reduction strategy. All the patients met the institutional adult trauma team activation criteria. The radiation doses calculated by the CT scanner were converted to effective doses by multiplication by a conversion coefficient. A total of 118 patients were included in this study. Among them, 33 were admitted before May 2009 (control group), and 85 were admitted after May 2009 (intervention group). There were no significant differences between the two groups regarding baseline characteristics, such as injury severity and mortality. Additionally, there was no difference between the two groups in the mean number of total CT examinations per patient (4.8 vs. 4.5, respectively; p = 0.227). However, the mean effective dose of the total CT examinations per patient significantly decreased from 78.71 mSv to 29.50 mSv (p < 0.001). The radiation dose reduction strategy for CT in severely injured trauma patients effectively decreased the cumulative effective dose of the total CT examinations in the emergency department. But not effectively decreased the number of CT examinations.

Prognostic Value of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Suspected Coronary Heart Disease: Long-Term Follow-up of a Prospective, Diagnostic Accuracy Cohort Study.

PubMed

Greenwood, John P; Herzog, Bernhard A; Brown, Julia M; Everett, Colin C; Nixon, Jane; Bijsterveld, Petra; Maredia, Neil; Motwani, Manish; Dickinson, Catherine J; Ball, Stephen G; Plein, Sven

2016-05-10

There are no prospective, prognostic data comparing cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) in the same population of patients with suspected coronary heart disease (CHD). To establish the ability of CMR and SPECT to predict major adverse cardiovascular events (MACEs). Annual follow-up of the CE-MARC (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) study for a minimum of 5 years for MACEs (cardiovascular death, acute coronary syndrome, unscheduled revascularization or hospital admission for cardiovascular cause). (Current Controlled Trials registration: ISRCTN77246133). Secondary and tertiary care cardiology services. 752 patients from the CE-MARC study who were being investigated for suspected CHD. Prediction of time to MACE was assessed by using univariable (log-rank test) and multivariable (Cox proportional hazards regression) analysis. 744 (99%) of the 752 recruited patients had complete follow-up. Of 628 who underwent CMR, SPECT, and the reference standard test of X-ray angiography, 104 (16.6%) had at least 1 MACE. Abnormal findings on CMR (hazard ratio, 2.77 [95% CI, 1.85 to 4.16]; P < 0.001) and SPECT (hazard ratio, 1.62 [CI, 1.11 to 2.38; P = 0.014) were both strong and independent predictors of MACE. Only CMR remained a significant predictor after adjustment for other cardiovascular risk factors, angiography result, or stratification for initial patient treatment. Data are from a single-center observational study (albeit conducted in a high-volume institution for both CMR and SPECT). Five-year follow-up of the CE-MARC study indicates that compared with SPECT, CMR is a stronger predictor of risk for MACEs, independent of cardiovascular risk factors, angiography result, or initial patient treatment. This further supports the role of CMR as an alternative to SPECT for the diagnosis and management of patients with suspected CHD. British Heart Foundation.

Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review.

PubMed

Turan, Nefize; Heider, Robert A; Roy, Anil K; Miller, Brandon A; Mullins, Mark E; Barrow, Daniel L; Grossberg, Jonathan; Pradilla, Gustavo

2018-05-01

Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging," "ferumoxytol," and "myeloperoxidase". Only studies in English were cited. Since the development and improvement of noninvasive diagnostic imaging (computed tomography angiography and magnetic resonance angiography), many prospective studies and meta-analyses have compared these tests with gold standard digital subtraction angiography (DSA). Although computed tomography angiography and magnetic resonance angiography have lower detection rates for UIAs, they are vital in the treatment and follow-up of UIAs. The reduction in ionizing radiation and lack of endovascular instrumentation with these modalities provide benefits compared with DSA. Novel molecular imaging techniques to detect inflammation within the aneurysmal wall with the goal of stratifying risk based on level of inflammation are under investigation. DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care. Copyright © 2018 Elsevier Inc. All rights reserved.

[18F]-Fluoromisonidazole Positron Emission Tomography/Computed Tomography Visualization of Tumor Hypoxia in Patients With Chordoma of the Mobile and Sacrococcygeal Spine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheney, Matthew D., E-mail: mcheney@lroc.harvard.edu; Chen, Yen-Lin; Lim, Ruth

2014-12-01

Purpose: To investigate [18F]-fluoromisonidazole positron emission tomography/computed tomography (FMISO-PET/CT) detection of targetable hypoxic subvolumes (HSVs) in chordoma of the mobile or sacrococcygeal spine. Methods and Materials: A prospective, pilot study of 20 patients with primary or locally recurrent chordoma of the mobile or sacrococcygeal spine treated with proton or combined proton/photon radiation therapy (RT) with or without surgery was completed. The FMISO-PET/CT was performed before RT and after 19.8-34.2 GyRBE (relative biologic effectiveness). Gross tumor volumes were delineated and HSVs defined including voxels with standardized uptake values ≥1.4 times the muscle mean. Clinical characteristics and treatments received were compared betweenmore » patients with and without HSVs. Results: The FMISO-PET/CT detected HSVs in 12 of 20 patients (60%). Baseline and interval HSV spatial concordance varied (0%-94%). Eight HSVs were sufficiently large (≥5 cm{sup 3}) to potentially allow an intensity modulated proton therapy boost. Patients with HSVs had significantly larger gross tumor volumes (median 410.0 cm{sup 3} vs 63.4 cm{sup 3}; P=.02) and were significantly more likely to have stage T2 tumors (5 of 12 vs 0 of 8; P=.04). After a median follow-up of 1.8 years (range, 0.2-4.4 years), a local recurrence has yet to be observed. Three patients developed metastatic disease, 2 with HSVs. Conclusions: Detection of targetable HSVs by FMISO-PET/CT within patients undergoing RT with or without surgery for treatment of chordoma of the mobile and sacrococcygeal spine is feasible. The study's inability to attribute interval HSV changes to treatment, rapidly changing hypoxic physiology, or imaging inconsistencies is a limitation. Further study of double-baseline FMISO-PET/CT and hypoxia-directed RT dose escalation, particularly in patients at high risk for local recurrence, is warranted.« less

Diagnostic Accuracy of 64Copper Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging of Intermediate- to High-risk Prostate Cancer: Our Preliminary Experience.

PubMed

Cantiello, Francesco; Gangemi, Vincenzo; Cascini, Giuseppe Lucio; Calabria, Ferdinando; Moschini, Marco; Ferro, Matteo; Musi, Gennaro; Butticè, Salvatore; Salonia, Andrea; Briganti, Alberto; Damiano, Rocco

2017-08-01

To assess the diagnostic accuracy of 64 Copper prostate-specific membrane antigen ( 64 Cu-PSMA) positron emission tomography/computed tomography (PET/CT) in the primary lymph node (LN) staging of a selected cohort of intermediate- to high-risk prostate cancer (PCa) patients. An observational prospective study was performed in 23 patients with intermediate- to high-risk PCa, who underwent 64 Cu-PSMA PET/CT for local and lymph nodal staging before laparoscopic radical prostatectomy with an extended pelvic LN dissection. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for LN status of 64 Cu-PSMA PET/CT were calculated using the final pathological findings as reference. Furthermore, we evaluated the correlation of intraprostatic tumor extent and grading with 64 Cu-PSMA intraprostatic distribution. Pathological analysis of LN involvement in 413 LNs harvested from our study cohort identified a total of 22 LN metastases in 8 (5%) of the 23 (35%) PCa patients. Imaging-based LN staging in a per-patient analysis showed that 64 Cu-PSMA PET/CT was positive in 7 of 8 LN-positive patients (22%) with a sensitivity of 87.5%, specificity of 100%, PPV of 100%, and NPV of 93.7%, considering the maximum standardized uptake value (SUV max ) at 4 hours as our reference. Receiver operating characteristic curve was characterized by an area under the curve of 0.938. A significant positive association was observed between SUV max at 4 hours with Gleason score, index, and cumulative tumor volume. In our intermediate- to high-risk PCa patients study cohort, we showed the high diagnostic accuracy of 64 Cu-PSMA PET/CT for primary LN staging before radical prostatectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis.

PubMed

Treglia, Giorgio; Bertagna, Francesco; Sadeghi, Ramin; Muoio, Barbara; Giovanella, Luca

2015-12-01

This study aimed at performing a meta-analysis on the prevalence and risk of malignancy of focal parotid incidental uptake (FPIU) detected by hybrid fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) or (18)F-FDG PET alone. A comprehensive literature search of studies published up to July 2014 was performed. Records reporting at least 5 FPIUs were selected. Pooled prevalence and malignancy risk of FPIU were calculated including 95 % confidence intervals (95 % CI). Twelve records were selected for our meta-analysis. Pooled prevalence of FPIU detected by (18)F-FDG PET or PET/CT was 0.6 % (95 % CI 0.4-0.7 %), collecting data of 220 patients with FPIU. Overall, 181 FPIUs underwent further evaluation and 165 FPIUs were pathologically proven. Pooled risk of malignancy was 9.6 % (95 % CI 5.4-14.8 %), 10.9 % (95 % CI 5.8-17.3 %) and 20.4 % (95 % CI 12.3-30 %), considering all FPIUs detected, only those which underwent further evaluation and only those pathologically proven, respectively. Selection bias in the included studies, the heterogeneity among studies and the publication bias are limitations of our meta-analysis. Overall FPIUs are observed in about 1 % of (18)F-FDG PET or PET/CT scans and they are benign in most of the cases. Nevertheless, further evaluation is needed whenever FPIUs are detected by (18)F-FDG-PET or PET/CT to exclude malignant lesions or with possible malignant degeneration. Prospective studies are needed to confirm the findings reported by our meta-analysis.

Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

PubMed

Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

2010-06-01

Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior, anterolateral, and lateral head/neck junctions demonstrated that 74% of the joints had an aspherical femoral head. The study demonstrated substantial prevalence of bony characteristics predisposing to femoroacetabular impingement in asymptomatic individuals according to the established measurement parameters in current literature.

Isolated prospective confabulation in Wernicke-Korsakoff syndrome: a case for reality filtering.

PubMed

Schnider, Armin; Nahum, Louis; Pignat, Jean-Michel; Leemann, Béatrice; Lövblad, Karl-Olof; Wissmeyer, Michael; Ptak, Radek

2013-01-01

A 57-year-old man suffered severe amnesia and disorientation, accompanied by content-specific confabulation, due to an alcoholic Wernicke-Korsakoff syndrome. For months, he was deeply concerned about a single obligation that he thought he had to respond to, but which he had already assumed 20 years previously. This monothematic, prospective confabulation was associated with failures of reality filtering as previously documented in behaviorally spontaneous confabulation and disorientation: the patient failed to suppress the interference of currently irrelevant memories and to abandon anticipations that were no longer valid (impaired extinction capacity). Magnetic resonance imaging showed damage to the mamillary bodies and the dorsomedial thalamic nucleus. Positron emission tomography (FDG-PET) showed extended orbitofrontal hypometabolism. We suggest that isolated prospective confabulation shares the core feature (acts and thoughts based on currently irrelevant memory), mechanism (failure of reality filtering), and anatomical basis (orbitofrontal dysfunction) with behaviorally spontaneous confabulations.

Non-invasive coronary angiography for patients with acute atypical chest pain discharged after negative screening including maximal negative treadmill stress test. A prospective study.

PubMed

Bonello, L; Armero, S; Jacquier, A; Com, O; Sarran, A; Sbragia, P; Panuel, M; Arques, S; Paganelli, F

2009-05-01

Among patients admitted in the emergency department for acute atypical chest pain those with an acute coronary syndrome (ACS) who are mistakenly discharged home have high mortality. A recent retrospective study has demonstrated that multislice computed tomography (MSCT) coronary angiography could improve triage of these patients. We aimed to prospectively confirm these data on patients with a negative screening including maximal treadmill stress. 30 patients discharged from the emergency department after negative screening for an ACS were included. All patients underwent MSCT angiography of the coronary artery. Patients with coronary atheroma on MSCT had an invasive coronary angiography to confirm these findings. Seven patients (23%) had obstructive coronary artery disease on MSCT. Invasive coronary angiography (ICA) confirmed the diagnosis in all patients. In patients with no previously known coronary artery disease admitted to the emergency department with atypical acute chest pain and discharged after negative screening, including maximal treadmill stress test, MSCT coronary angiography is useful for the diagnosis of obstructive coronary artery disease.

Sinkhole risk assessment by ERT: The case study of Sirino Lake (Basilicata, Italy)

NASA Astrophysics Data System (ADS)

Giampaolo, V.; Capozzoli, L.; Grimaldi, S.; Rizzo, E.

2016-01-01

The presence of natural or artificial lakes and reservoirs that can drain because of natural phenomena can generate catastrophic events affecting urban and agricultural areas next to the source area. Therefore, geophysical prospecting techniques have been applied in the study of Sirino Lake, which, during the last century, was affected by the sudden opening of small sinkholes, resulting in the almost total draining of the lake and in the sudden increase of water flow rates of distal springs. Two electrical resistivity tomographies (ERTs) were carried out across the lake, using electrode arrays located on land and across the water body. Self-potential (SP) data were acquired around the lake shore and the surrounding area. The geophysical prospecting contributed significant data toward explaining the unique hydrogeological characteristics of the lake. Integration of geophysical, geological, hydrogeological, and geomorphological data allowed us to estimate the thickness of the lacustrine deposits beneath the lake, to describe the main patterns of the subsurface fluid flows in the area, and to identify possible water escape routes causing the piping phenomena.

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64.

PubMed

Miller, Julie M; Dewey, Marc; Vavere, Andrea L; Rochitte, Carlos E; Niinuma, Hiroyuki; Arbab-Zadeh, Armin; Paul, Narinder; Hoe, John; de Roos, Albert; Yoshioka, Kunihiro; Lemos, Pedro A; Bush, David E; Lardo, Albert C; Texter, John; Brinker, Jeffery; Cox, Christopher; Clouse, Melvin E; Lima, João A C

2009-04-01

Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective "CORE-64" trial ("Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors"). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.

Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study.

PubMed

Ciura, Viesha A; Brouwers, H Bart; Pizzolato, Raffaella; Ortiz, Claudia J; Rosand, Jonathan; Goldstein, Joshua N; Greenberg, Steven M; Pomerantz, Stuart R; Gonzalez, R Gilberto; Romero, Javier M

2014-11-01

The computed tomography angiography (CTA) spot sign is a validated biomarker for poor outcome and hematoma expansion in intracerebral hemorrhage. The spot sign has proven to be a dynamic entity, with multimodal imaging proving to be of additional value. We investigated whether the addition of a 90-second delayed CTA acquisition would capture additional intracerebral hemorrhage patients with the spot sign and increase the sensitivity of the spot sign. We prospectively enrolled consecutive intracerebral hemorrhage patients undergoing first pass and 90-second delayed CTA for 18 months at a single academic center. Univariate and multivariate logistic regression were performed to assess clinical and neuroimaging covariates for relationship with hematoma expansion and mortality. Sensitivity of the spot sign for hematoma expansion on first pass CTA was 55%, which increased to 64% if the spot sign was present on either CTA acquisition. In multivariate analysis the spot sign presence was associated with significant hematoma expansion: odds ratio, 17.7 (95% confidence interval, 3.7-84.2; P=0.0004), 8.3 (95% confidence interval, 2.0-33.4; P=0.004), and 12.0 (95% confidence interval, 2.9-50.5; P=0.0008) if present on first pass, delayed, or either CTA acquisition, respectively. Spot sign presence on either acquisitions was also significant for mortality. We demonstrate improved sensitivity for predicting hematoma expansion and poor outcome by adding a 90-second delayed CTA, which may enhance selection of patients who may benefit from hemostatic therapy. © 2014 American Heart Association, Inc.

Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients.

PubMed

Brasil, Ivelise Regina Canito; de Araujo, Igor Farias; Lima, Adriana Augusta Lopes de Araujo; Melo, Ernesto Lima Araujo; Esmeraldo, Ronaldo de Matos

2018-01-01

To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. The celiac trunk was "normal" (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta) in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries) was seen in 82 patients. We observed six types of variations of the hepatic artery. We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications.

128-slice Dual-source Computed Tomography Coronary Angiography in Patients with Atrial Fibrillation: Image Quality and Radiation Dose of Prospectively Electrocardiogram-triggered Sequential Scan Compared with Retrospectively Electrocardiogram-gated Spiral Scan.

PubMed

Lin, Lu; Wang, Yi-Ning; Kong, Ling-Yan; Jin, Zheng-Yu; Lu, Guang-Ming; Zhang, Zhao-Qi; Cao, Jian; Li, Shuo; Song, Lan; Wang, Zhi-Wei; Zhou, Kang; Wang, Ming

2013-01-01

Objective To evaluate the image quality (IQ) and radiation dose of 128-slice dual-source computed tomography (DSCT) coronary angiography using prospectively electrocardiogram (ECG)-triggered sequential scan mode compared with ECG-gated spiral scan mode in a population with atrial fibrillation. Methods Thirty-two patients with suspected coronary artery disease and permanent atrial fibrillation referred for a second-generation 128-slice DSCT coronary angiography were included in the prospective study. Of them, 17 patients (sequential group) were randomly selected to use a prospectively ECG-triggered sequential scan, while the other 15 patients (spiral group) used a retrospectively ECG-gated spiral scan. The IQ was assessed by two readers independently, using a four-point grading scale from excel-lent (grade 1) to non-assessable (grade 4), based on the American Heart Association 15-segment model. IQ of each segment and effective dose of each patient were compared between the two groups. Results The mean heart rate (HR) of the sequential group was 96±27 beats per minute (bpm) with a variation range of 73±25 bpm, while the mean HR of the spiral group was 86±22 bpm with a variationrange of 65±24 bpm. Both of the mean HR (t=1.91, P=0.243) and HR variation range (t=0.950, P=0.350) had no significant difference between the two groups. In per-segment analysis, IQ of the sequential group vs. spiral group was rated as excellent (grade 1) in 190/244 (78%) vs. 177/217 (82%) by reader1 and 197/245 (80%) vs. 174/214 (81%) by reader2, as non-assessable (grade 4) in 4/244 (2%) vs. 2/217 (1%) by reader1 and 6/245 (2%) vs. 4/214 (2%) by reader2. Overall averaged IQ per-patient in the sequential and spiral group showed equally good (1.27±0.19 vs. 1.25±0.22, Z=-0.834, P=0.404). The effective radiation dose of the sequential group reduced significantly compared with the spiral group (4.88±1.77 mSv vs. 10.20±3.64 mSv; t=-5.372, P=0.000). Conclusion Compared with retrospectively ECG-gated spiral scan, prospectively ECG-triggered sequential DSCT coronary angiography provides similarly diagnostically valuable images in patients with atrial fibrillation and significantly reduces radiation dose.

Evaluation of the Diagnostic Accuracy of Conventional 2-Dimensional and 3-Dimensional Computed Tomography for Assessing Canine Sacral and Pelvic Fractures by Radiologists, Orthopedic Surgeons, and Veterinary Medical Students.

PubMed

Stieger-Vanegas, Susanne M; Senthirajah, Sri Kumar Jamie; Nemanic, Sarah; Baltzer, Wendy; Warnock, Jennifer; Hollars, Katelyn; Lee, Scott S; Bobe, Gerd

2015-08-01

To determine, using 3 groups of evaluators of varying experience reading orthopedic CT studies, if 3-dimensional computed tomography (3D-CT) provides a more accurate and time efficient method for diagnosis of canine sacral and pelvic fractures, and displacements of the sacroiliac and coxofemoral joints compared with 2-dimensional computed tomography (2D-CT). Retrospective clinical and prospective study. Dogs (n = 23): 12 dogs with traumatic pelvic fractures, 11 canine cadavers with pelvic trauma induced by a lateral impactor. All dogs had a 2D-CT exam of the pelvis and subsequent 3D-CT reconstructions from the 2D-CT images. Both 2D-CT and 3D-CT studies were anonymized and randomly presented to 2 veterinary radiologists, 2 veterinary orthopedic surgeons, and 2 veterinary medical students. Evaluators classified fractures using a confidence scale and recorded the duration of evaluation for each modality and case. 3D-CT was a more time-efficient technique for evaluation of traumatic sacral and pelvic injuries compared with 2D-CT in all evaluator groups irrespective of experience level reading orthopedic CT studies. However, for radiologists and surgeons, 2D-CT was the more accurate technique for evaluating sacral and pelvic fractures. 3D-CT improves sacral and pelvic fracture diagnosis when added to 2D-CT; however, 3D-CT has a reduced accuracy for evaluation of sacral and pelvic fractures if used without concurrent evaluation of 2D-CT images. © Copyright 2014 by The American College of Veterinary Surgeons.

Stent coverage and neointimal proliferation in bare metal stents postdilated with a Paclitaxel-eluting balloon versus everolimus-eluting stents: prospective randomized study using optical coherence tomography at 6-month follow-up.

PubMed

Poerner, Tudor C; Otto, Sylvia; Gassdorf, Johannes; Nitsche, Kristina; Janiak, Florian; Scheller, Bruno; Goebel, Björn; Jung, Christian; Figulla, Hans R

2014-12-01

In this randomized trial, strut coverage and neointimal proliferation of a therapy of bare metal stents (BMSs) postdilated with the paclitaxel drug-eluting balloon (DEB) was compared with everolimus drug-eluting stents (DESs) at 6-month follow-up using optical coherence tomography. We hypothesized sufficient stent coverage at follow-up. A total of 105 lesions in 90 patients were treated with either XIENCE V DES (n=51) or BMS postdilated with the SeQuent Please DEB (n=54). At follow-up, comparable results on the primary optical coherence tomography end point (percentage uncovered struts 5.64±9.65% in BMS+DEB versus 4.93±9.29% in DES; P=0.366) were found. Thus, BMS+DEB achieved the prespecified noninferiority margin of 5% uncovered struts versus DES (difference between treatment means, 0.71%; one-sided upper 95% confidence interval, 4.14%; noninferiority P=0.04). Optical coherence tomography analysis showed significantly more global neointimal proliferation in the BMS+DEB group (15.7±7.8 versus 11.0±5.2 mm(3) proliferation volume/cm stent length; P=0.002). No significant focal in-stent stenosis analyzed with angiography (percentage diameter stenosis at follow-up, 22.8±11.9 versus 16.9±10.4; P=0.014) and optical coherence tomography (peak local area stenosis, 39.5±13.8% versus 36.8±15.6%; P=0.409) was found. Good stent strut coverage of >94% was found in both therapy groups. Despite greater suppression of global neointimal growth in DES, both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up. http://www.clinicaltrials.gov. Unique identifier: NCT01056744. © 2014 American Heart Association, Inc.

Neurological Outcomes Following Suicidal Hanging: A Prospective Study of 101 Patients

PubMed Central

Jawaid, Mohammed Turab; Amalnath, S. Deepak; Subrahmanyam, D. K. S.

2017-01-01

Context: Survivors of suicidal hanging can have variable neurological outcomes – from complete recovery to irreversible brain damage. Literature on the neurological outcomes in these patients is confined to retrospective studies and case series. Hence, this prospective study was carried out. Aims: The aim is to study the neurological outcomes in suicidal hanging. Settings and Design: This was a prospective observational study carried out from July 2014 to July 2016. Subjects and Methods: Consecutive patients admitted to the emergency and medicine wards were included in the study. Details of the clinical and radiological findings, course in hospital and at 1 month postdischarge were analyzed. Statistical Analysis Used: Statistical analysis was performed using IBM SPSS advanced statistics 20.0 (SPSS Inc., Chicago, USA). Univariate analysis was performed using Chi-square test for significance and Odd's ratio was calculated. Results: Of the 101 patients, 6 died and 4 had residual neuro deficits. Cervical spine injury was seen in 3 patients. Interestingly, 39 patients could not remember the act of hanging (retrograde amnesia). Hypotension, pulmonary edema, Glasgow coma scale (GCS) score <8 at admission, need for mechanical ventilation, and cerebral edema on plain computed tomography were more in those with amnesia as compared to those with normal memory and these findings were statistically significant. Conclusions: Majority of patients recovered without any sequelae. Routine imaging of cervical spine may not be warranted in all patients, even in those with poor GCS. Retrograde amnesia might be more common than previously believed and further studies are needed to analyze this peculiar feature. PMID:28584409

[Possibilities of follow-up imaging after implantation of a carbon fiber-reinforced hip prosthesis].

PubMed

Krüger, T; Alter, C; Reichel, H; Birke, A; Hein, W; Spielmann, R P

1998-03-01

There are many problems in the radiological diagnosis of aseptic loosening in total hip arthroplasty. Computed tomography (CT) and magnetic resonance tomography (MRT) are not usable for metallic implants (stainless steel, cobalt alloy, titanium alloy). From April 1993 to December 1993 15 CFRP non-cemented hip prostheses have been implanted. In a prospective clinical study plane radiographs, CT and MRT have been analysed. Three stems were revised (1 femoral fracture, 1 severe thigh pain, 1 aseptic loosening). CFRP are not visible in plane radiographs. There was a complete (two-third of the cases) or nearly complete (one-third of the cases) small sclerotic interface between the prosthesis and the bone, these were apparent in CT and MRT in stable implant cases and did not have any clinical correlations. The small sclerotic interface is quite different in comparison to so called "Reactive Lines". In one case of aseptic loosening there was an interposition of soft tissue between prosthesis and bone in MRT and CT. CFRP inaugurates new diagnostic possibilities in aseptic loosening of hip prosthesis and in tumour surgery too.

Optical coherence tomography in anterior segment imaging

PubMed Central

Kalev-Landoy, Maya; Day, Alexander C.; Cordeiro, M. Francesca; Migdal, Clive

2008-01-01

Purpose To evaluate the ability of optical coherence tomography (OCT), designed primarily to image the posterior segment, to visualize the anterior chamber angle (ACA) in patients with different angle configurations. Methods In a prospective observational study, the anterior segments of 26 eyes of 26 patients were imaged using the Zeiss Stratus OCT, model 3000. Imaging of the anterior segment was achieved by adjusting the focusing control on the Stratus OCT. A total of 16 patients had abnormal angle configurations including narrow or closed angles and plateau irides, and 10 had normal angle configurations as determined by prior full ophthalmic examination, including slit-lamp biomicroscopy and gonioscopy. Results In all cases, OCT provided high-resolution information regarding iris configuration. The ACA itself was clearly visualized in patients with narrow or closed angles, but not in patients with open angles. Conclusions Stratus OCT offers a non-contact, convenient and rapid method of assessing the configuration of the anterior chamber. Despite its limitations, it may be of help during the routine clinical assessment and treatment of patients with glaucoma, particularly when gonioscopy is not possible or difficult to interpret. PMID:17355288

Blood flow to the promontory in cochlear otosclerosis.

PubMed

Nakashima, T; Sone, M; Fujii, H; Teranishi, M; Yamamoto, H; Otake, H; Sugiura, M; Naganawa, S

2006-04-01

To investigate Schwartze sign with measurements of blood flow to the promontory in patients with cochlear otosclerosis. Prospective clinical study. Tertiary referral centre. Five patients with cochlear otosclerosis and five control subjects. Significant decalcification around the cochlea was observed by computed tomography (CT) in patients with cochlear otosclerosis. However, no recognizable lesion was observed at the oval window in two patients. One patient had mixed hearing loss and four patients had sensorineural hearing loss without an air-bone gap. The relationship between CT findings and the presence or absence of Schwartze sign was investigated. Blood flow to the promontory was measured through the tympanic membrane using laser speckle flowgraphy and laser Doppler flowmetry. The Schwartze sign correlated significantly with otosclerotic lesions invading the promontory. Patients with otosclerosis exhibited elevated and pulsating blood flow to the promontory with the Schwartze sign. Computed tomography demonstrated that cochlear otosclerosis can exist without the oval window lesion. Schwartze sign can be used as a sign of the otosclerotic invasion to the promontory. The reddening of the Schwartze sign is likely due to increased blood flow.

Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury.

PubMed

Inaba, Kenji; Okoye, Obi T; Browder, Timothy; Best, Charles; Branco, Bernardino C; Teixeira, Pedro G; Barmparas, Galinos; Reddy, Sravanthi; Demetriades, Demetrios

2013-12-01

The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury. All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram. A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed. In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal. Diagnostic study, level II.

MACULAR ATROPHY FINDINGS BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY COMPARED WITH FUNDUS AUTOFLUORESCENCE IN TREATED EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

PubMed

Takasago, Yukari; Shiragami, Chieko; Kobayashi, Mamoru; Osaka, Rie; Ono, Aoi; Yamashita, Ayana; Tsujikawa, Akitaka; Hirooka, Kazuyuki

2017-11-28

To compare the areas of choriocapillaris (CC) nonperfusion and macular atrophy (MA) in treated exudative age-related macular degeneration. This was a prospective, observational, cross-sectional study. Forty-four eyes exhibiting MA (42 patients with age-related macular degeneration), with a dry macula, underwent fundus autofluorescence and optical coherence tomography angiography. The area of MA detected by fundus autofluorescence and CC nonperfusion detected by optical coherence tomography angiography was measured using image analysis software. The rates of concordance between the MA and CC nonperfusion areas were calculated. We qualitatively and quantitatively compared the areas of MA and CC nonperfusion in age-related macular degeneration eyes. The mean areas of MA and CC nonperfusion were 5.95 ± 4.50 mm and 10.66 ± 7.05 mm, respectively (paired t-test, P < 0.001). In 39 eyes (88.6%), the CC nonperfusion area was larger than the MA area, and the mean CC nonperfusion area was significantly larger than the mean MA area. Fundus autofluorescence matching optical coherence tomography angiography showed that the CC nonperfusion area was almost included in the MA area. The mean concordance rate for the MA area inside the CC nonperfusion area was 87.7 ± 13.9%. The MA and CC nonperfusion areas markedly overlapped. The area of CC nonperfusion correlated with the MA area. Choroidal ischemia might be involved in the pathogenesis of MA in treated age-related macular degeneration.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison of the sensitivity and specificity of 5 image sets of dual-energy computed tomography for detecting first-pass myocardial perfusion defects compared with positron emission tomography.

PubMed

Li, Wenhuan; Zhu, Xiaolian; Li, Jing; Peng, Cheng; Chen, Nan; Qi, Zhigang; Yang, Qi; Gao, Yan; Zhao, Yang; Sun, Kai; Li, Kuncheng

2014-12-01

The sensitivity and specificity of 5 different image sets of dual-energy computed tomography (DECT) for the detection of first-pass myocardial perfusion defects have not systematically been compared using positron emission tomography (PET) as a reference standard. Forty-nine consecutive patients, with known or strongly suspected of coronary artery disease, were prospectively enrolled in our study. Cardiac DECT was performed at rest state using a second-generation 128-slice dual-source CT. The DECT data were reconstructed to iodine maps, monoenergetic images, 100 kV images, nonlinearly blended images, and linearly blended images by different postprocessing techniques. The myocardial perfusion defects on DECT images were visually assessed by 5 observers, using standard 17-segment model. Diagnostic accuracy of 5 image sets was assessed using nitrogen-13 ammonia PET as the gold standard. Discrimination was quantified using the area under the receiver operating characteristic curve (AUC), and AUCs were compared using the method of DeLong. The DECT and PET examinations were successfully completed in 30 patients and a total of 90 territories and 510 segments were analyzed. Cardiac PET revealed myocardial perfusion defects in 56 territories (62%) and 209 segments (41%). The AUC of iodine maps, monoenergetic images, 100 kV images, nonlinearly blended images, and linearly blended images were 0.986, 0.934, 0.913, 0.881, and 0.871, respectively, on a per-territory basis. These values were 0.922, 0.813, 0.779, 0.763, and 0.728, respectively, on a per-segment basis. DECT iodine maps shows high sensitivity and specificity, and is superior to other DECT image sets for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.

Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study.

PubMed

Eisner, Brian H; Kambadakone, Avinash; Monga, Manoj; Anderson, James K; Thoreson, Andrew A; Lee, Hang; Dretler, Stephen P; Sahani, Dushyant V

2009-04-01

We determined the most accurate method of measuring urinary stones on computerized tomography. For the in vitro portion of the study 24 calculi, including 12 calcium oxalate monohydrate and 12 uric acid stones, that had been previously collected at our clinic were measured manually with hand calipers as the gold standard measurement. The calculi were then embedded into human kidney-sized potatoes and scanned using 64-slice multidetector computerized tomography. Computerized tomography measurements were performed at 4 window settings, including standard soft tissue windows (window width-320 and window length-50), standard bone windows (window width-1120 and window length-300), 5.13x magnified soft tissue windows and 5.13x magnified bone windows. Maximum stone dimensions were recorded. For the in vivo portion of the study 41 patients with distal ureteral stones who underwent noncontrast computerized tomography and subsequently spontaneously passed the stones were analyzed. All analyzed stones were 100% calcium oxalate monohydrate or mixed, calcium based stones. Stones were prospectively collected at the clinic and the largest diameter was measured with digital calipers as the gold standard. This was compared to computerized tomography measurements using 4.0x magnified soft tissue windows and 4.0x magnified bone windows. Statistical comparisons were performed using Pearson's correlation and paired t test. In the in vitro portion of the study the most accurate measurements were obtained using 5.13x magnified bone windows with a mean 0.13 mm difference from caliper measurement (p = 0.6). Measurements performed in the soft tissue window with and without magnification, and in the bone window without magnification were significantly different from hand caliper measurements (mean difference 1.2, 1.9 and 1.4 mm, p = 0.003, <0.001 and 0.0002, respectively). When comparing measurement errors between stones of different composition in vitro, the error for calcium oxalate calculi was significantly different from the gold standard for all methods except bone window settings with magnification. For uric acid calculi the measurement error was observed only in standard soft tissue window settings. In vivo 4.0x magnified bone windows was superior to 4.0x magnified soft tissue windows in measurement accuracy. Magnified bone window measurements were not statistically different from digital caliper measurements (mean underestimation vs digital caliper 0.3 mm, p = 0.4), while magnified soft tissue windows were statistically distinct (mean underestimation 1.4 mm, p = 0.001). In this study magnified bone windows were the most accurate method of stone measurements in vitro and in vivo. Therefore, we recommend the routine use of magnified bone windows for computerized tomography measurement of stones. In vitro the measurement error in calcium oxalate stones was greater than that in uric acid stones, suggesting that stone composition may be responsible for measurement inaccuracies.

Can (18)F-FDG PET/CT scan change treatment planning and be prognostic in recurrent colorectal carcinoma? A prospective and follow-up study.

PubMed

Artiko, Vera; Odalovic, Strahinja; Sobic-Saranovic, Dragana; Petrovic, Milorad; Stojiljkovic, Milica; Petrovic, Nebojsa; Kozarevic, Nebojsa; Grozdic-Milojevic, Isidora; Obradovic, Vladimir

2015-01-01

To prospectively study whether in patients with resected primary colorectal cancer fluorine- 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) examination could diagnose the stage, specify treatment procedure and be prognostic. This prospective study included 75 patients with resected primary colorectal adenocarcinoma referred for (18)F-FDG PET/CT to the National PET Center, at the Clinical Center of Serbia, Belgrade, from January 2010 to May 2013. Findings of (18)F-FDG PET/CT were compared to findings of subsequent histopathological examinations or with results of clinical and imaging follow-up. Patients were followed after PET/CT examination for a mean follow-up time of 16.7±5.9 months. In the detection of recurrent disease (18)F-FDG PET/CT showed overall sensitivity, specificity, PPV, NPV and accuracy of 96.6%, 82.4%, 94.9%, 87.5% and 93.3%, respectively. In the detection of stages I and II sensitivity, specificity and accuracy of (18)F-FDG PET/CT were: 88%, 96.6% and 94.7%, respectively, and in the detection of stages III and IV sensitivity, specificity and accuracy were 94.9%, 87.5% and 93.3%, respectively. These findings prevented or changed intended surgical treatment in 12/32 cases. Univariate and multivariate Cox proportional regression analyses revealed that metastatic recurrence (stages III and IV) was the only and independent prognostic factor of disease progression during follow-up (P=0.012 and P=0.023, respectively). Although, survival seemed better in patients with local recurrence compared to metastatic recurrent disease, this difference did not reach significance (Log-rank test; P=0.324). In addition, progression-free survival time was significantly longer in patients in whom (18)F-FDG PET/CT scan led to treatment changes (Log-rank test; P=0.037). (18)F-FDG PET/CT was sensitive and accurate for the detection and staging of local and metastatic recurrent colorectal carcinoma, with higher specificity in the detection of local recurrences. The (18)F-FDG PET/CT scan induced treatment changes in 30/75 patients, including 12/32 patients in which surgical treatment was previously planned, and progression free survival time was significantly longer in these patients.

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases.

PubMed

Simon, P; Goldzak, M; Eschler, A; Mittlmeier, T

2015-10-01

The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method. This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH). Articular congruity and global reduction of the calcaneus was assessed in all patients by computed tomography (CT) scan three months postoperatively. Functional results were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and all complications recorded. For the 63 fracture nails, the average AOFAS score was 85.9 at a mean final follow-up of 12 months. Only three secondary fusions were performed. For the six comminuted fractures requiring primary fusion, the average AOFAS score was 75.9 at the last follow-up. The posterior intrafocal approach for both reduction and locked nailing of intra-articular calcaneal fractures has been proven as an effective and reliable procedure.

Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience.

PubMed

Krishnan, Ullas Chandrika; Byanyima, Rosemary Kusaba; Faith, Ameda; Kamulegeya, Adriane

2017-01-01

The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital. CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries. A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18-80) years and 18-27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03). Good matched case-control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures.

The Effect of Heart Rate on Exposure Window and Best Phase for Stress Perfusion Computed Tomography: Lessons From the CORE320 Study.

PubMed

Steveson, Chloe; Schuijf, Joanne D; Vavere, Andrea L; Mather, Richard T; Caton, Teresa; Mehra, Vishal; Betoko, Aisha; Cox, Christopher; Lima, Joao Ac; George, Richard T

The aim of this study is to evaluate the effect of heart rate on exposure window, best phase, and image quality for stress computed tomography perfusion (CTP) in the CORE320 study. The CTP data sets were analyzed to determine the best phase for perfusion analysis. A predefined exposure window covering 75% to 95% of the R-R cycle was used. Of the 368 patients included in the analysis, 93% received oral β blockade before the rest scan. The median heart rate during the stress acquisition was 69 bpm (interquartile range [IQR], 60-77). The median best phase was 81% (IQR, 76-90), and length of exposure window was 22% (IQR, 19-24). The best phase was significantly later in the cardiac cycle with higher heart rates (P < 0.001), and higher heart rates resulted in a small, but higher number of poor quality scans (6%, P < 0.001). The median effective dose of the stress scan was 5.3 mSv (IQR, 3.8-6.1). Stress myocardial CTP imaging can be performed using prospective electrocardiography triggering, an exposure window of 75% to 95%, and β-blockade resulting in good or excellent image quality in the majority (80%) of patients while maintaining a low effective radiation dose.

Macular Ganglion Cell Imaging Study: Covariate Effects on the Spectral Domain Optical Coherence Tomography for Glaucoma Diagnosis

PubMed Central

Jeong, Jae Hoon; Choi, Yun Jeong; Park, Ki Ho; Kim, Dong Myung

2016-01-01

Purpose To evaluate the effect of multiple covariates on the diagnostic performance of the Cirrus high-definition optical coherence tomography (HD-OCT) for glaucoma detection. Methods A prospective case-control study was performed and included 173 recently diagnosed glaucoma patients and 63 unaffected individuals from the Macular Ganglion Cell Imaging Study. Regression analysis of receiver operating characteristic were conducted to evaluate the influence of age, spherical equivalent, axial length, optic disc size, and visual field index on the macular ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) measurements. Results Disease severity, as measured by visual field index, had a significant effect on the diagnostic performance of all Cirrus HD-OCT parameters. Age, axial length and optic disc size were significantly associated with diagnostic accuracy of average peripapillary RNFL thickness, whereas axial length had a significant effect on the diagnostic accuracy of average GCIPL thickness. Conclusions Diagnostic performance of the Cirrus HD-OCT may be more accurate in the advanced stages of glaucoma than at earlier stages. A smaller optic disc size was significantly associated with improved the diagnostic ability of average RNFL thickness measurements; however, GCIPL thickness may be less affected by age and optic disc size. PMID:27490718

Clinical Relevance of 18F-Sodium Fluoride Positron-Emission Tomography in Noninvasive Identification of High-Risk Plaque in Patients With Coronary Artery Disease.

PubMed

Lee, Joo Myung; Bang, Ji-In; Koo, Bon-Kwon; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Yaliang, Tong; Suh, Minseok; Paeng, Jin Chul; Shiono, Yasutsugu; Kubo, Takashi; Akasaka, Takashi

2017-11-01

18 F-sodium fluoride ( 18 F-NaF) positron-emission tomography has been introduced as a potential noninvasive imaging tool to identify plaques with high-risk characteristics in patients with coronary artery disease. We sought to evaluate the clinical relevance of 18 F-NaF uptake using optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography in patients with coronary artery disease. The target population consisted of 51 prospectively enrolled patients (93 stenoses) who underwent 18 F-NaF positron-emission tomography before invasive coronary angiography. 18 F-NaF uptake was compared with IVUS- and OCT-derived plaque characteristics. In the coronary computed tomography angiography subgroup (46 lesions), qualitative lesion characteristics were compared between 18 F-NaF-positive and 18 F-NaF-negative plaques using adverse plaque characteristics. The plaques with 18 F-NaF uptake showed significantly higher plaque burden, more frequent posterior attenuation and positive remodeling in IVUS, and significantly higher maximum lipid arc and more frequent microvessels in OCT (all P <0.05). There were no differences in minimum lumen area and area of calcium between 18 F-NaF-positive and 18 F-NaF-negative lesions. Among 51 lesions with 18 F-NaF-positive uptake, 48 lesions (94.1%) had at least one of high-risk characteristics. The 18 F-NaF tissue-to-background ratio in plaques with high-risk characteristics was significantly higher than in those without (1.09 [95% confidence interval, 0.85-1.34] versus 0.62 [95% confidence interval, 0.42-0.82], P <0.001 for IVUS definition; 0.76 [95% confidence interval, 0.54-0.98] versus 0.42 [95% confidence interval, 0.21-0.62], P =0.014 for OCT definition). Among the 15 lesions that met both IVUS- and OCT-defined criteria for high-risk plaque, 14 (93.3%) showed 18 F-NaF-positive uptake. There was no difference in the prevalence of plaques with any adverse plaque characteristics between 18 F-NaF-positive and 18 F-NaF-negative plaques in the coronary computed tomography angiography subgroup (85.2% versus 78.9%; P =0.583). This study's results suggest that 18 F-NaF positron-emission tomography can be a useful noninvasive diagnostic tool to identify and localize plaque with high-risk characteristics. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02388412. © 2017 American Heart Association, Inc.

Alternating R-CHOP and R-cytarabine is a safe and effective regimen for transplant-ineligible patients with a newly diagnosed mantle cell lymphoma.

PubMed

Klener, Pavel; Fronkova, Eva; Belada, David; Forsterova, Kristina; Pytlik, Robert; Kalinova, Marketa; Simkovic, Martin; Salek, David; Mocikova, Heidi; Prochazka, Vit; Blahovcova, Petra; Janikova, Andrea; Markova, Jana; Obr, Ales; Berkova, Adela; Kubinyi, Jozef; Vaskova, Martina; Mejstrikova, Ester; Campr, Vit; Jaksa, Radek; Kodet, Roman; Michalova, Kyra; Trka, Jan; Trneny, Marek

2018-02-01

Implementation of cytarabine into induction therapy became standard of care for younger patients with mantle cell lymphoma (MCL). On the basis of its beneficial impact, many centers incorporated cytarabine at lower doses also into first-line treatments of elderly patients. We conducted a multicenter observational study that prospectively analyzed safety and efficacy of alternating 3 + 3 cycles of R-CHOP and R-cytarabine for newly diagnosed transplant-ineligible MCL patients. A total of 73 patients were enrolled with median age 70 years. Most patients had intermediate (39.7%) and high-risk (50.7%) disease according to MCL international prognostic index. Rituximab maintenance was initiated in 58 patients. Overall response rate reached 89% by positron emission tomography-computed tomography, including 75.3% complete remissions. Two patients (2.7%) did not complete the induction therapy because of toxicity. Three patients (4.1%) were considered nonresponders, which led to therapy change before completion of induction. Estimated progression-free survival and overall survival were 51.3% and 68.6% at 4 years, respectively. Mantle cell lymphoma international prognostic index, bulky disease (≥ 5 cm), and achievement of positron emission tomography-negativity independently correlated with progression-free survival. Grade 3 to 4 hematologic and nonhematologic toxicity was documented in 48% and 20.5% patients, respectively. Alternation of R-CHOP and R-cytarabine represents feasible and very effective regimen for elderly/comorbid MCL patients. This study was registered at GovTrial (clinicaltrials.gov) NCT03054883. Copyright © 2017 John Wiley & Sons, Ltd.

Ocular biometry by computed tomography in different dog breeds.

PubMed

Chiwitt, Carolin L H; Baines, Stephen J; Mahoney, Paul; Tanner, Andrew; Heinrich, Christine L; Rhodes, Michael; Featherstone, Heidi J

2017-09-01

To (i) correlate B-mode ocular ultrasound (US) and computed tomography (CT) (prospective pilot study), (ii) establish a reliable method to measure the normal canine eye using CT, (iii) establish a reference guide for some dog breeds, (iv) compare eye size between different breeds and breed groups, and (v) investigate the correlation between eye dimensions and body weight, gender, and skull type (retrospective study). B-mode US and CT were performed on ten sheep cadaveric eyes. CT biometry involved 100 adult pure-bred dogs with nonocular and nonorbital disease, representing eleven breeds. Eye length, width, and height were each measured in two of three planes (horizontal, sagittal, and equatorial). B-mode US and CT measurements of sheep cadaveric eyes correlated well (0.70-0.71). The shape of the canine eye was found to be akin to an oblate spheroid (a flattened sphere). A reference guide was established for eleven breeds. Eyes of large breed dogs were significantly larger than those of medium and small breed dogs (P < 0.01), and eyes of medium breed dogs were significantly larger than those of small breed dogs (P < 0.01). Eye size correlated with body weight (0.74-0.82) but not gender or skull type. Computed tomography is a suitable method for biometry of the canine eye, and a reference guide was established for eleven breeds. Eye size correlated with breed size and body weight. Because correlation between B-mode US and CT was shown, the obtained values can be applied in the clinical setting, for example, for the diagnosis of microphthalmos and buphthalmos. © 2016 American College of Veterinary Ophthalmologists.

Blunt trauma of bone structures of the chest--computed tomography vs multidetector computed tomography.

PubMed

Petrović, Kosta; Turkalj, Ivan; Stojanović, Sanja; Vucaj-Cirilović, Viktorija; Nikolić, Olivera; Stojiljković, Dragana

2013-08-01

Computerized tomography (CT), especially multidetector CT (MDCT), has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT) examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR). This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists inde pendently and separately described the findings for 5-mm-thick axial CT slices (5 mm CT) as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thin-slice examination together which was ultimately considered as a real, true finding. No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05). Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p < 0.05) in favor of better display of injury by MDCT examination. MDCT is a powerful diagnostic tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

The effect of internal fixation lamp on anterior chamber angle width measured by anterior segment optical coherence tomography.

PubMed

Nakamine, Sakari; Sakai, Hiroshi; Arakaki, Yoshikuni; Yonahara, Michiko; Kaiya, Tadayoshi

2018-01-01

To study the effect of the internal fixation lamp on anterior chamber width measured by anterior segment optical coherence tomography. In a prospective cross sectional observational study, consecutive 22 right eyes of 22 patients (4 men and 18 women) with suspected primary angle closure underwent swept source domain anterior segment optical coherence tomography (AS-OCT), (CASIA SS-1000, Tomey, Nagoya, Japan). Anterior chamber parameters of angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) at 500 or 750 µm from scleral spur and pupil diameter were measured by AS-OCT in a three-dimensional mode in 4 quadrants (superior, inferior, temporal and nasal) in dark room setting both with and without internal fixation lamp. Anterior segment parameters of AOD 500 in superior, inferior and temporal quadrants, AOD 750 at superior and nasal, TIA 500 at superior, and inferior and TIA 750 at superior and nasal, and ARA 500 or 750 at superior and inferior with internal fixation lamp were greater and the pupil diameter was significantly (all P < 0.05, paired t test) smaller than when measured without fixation lamp. Internal fixation lamp of the anterior segment OCT makes the pupil constrict and angle wider. When using AS-OCT with usual setting with internal fixation lamp on with eyes in which the anterior chamber angle is narrow but open, it is recommended that the internal fixation lamp be turned off to ensure a clear indication as to whether the angle is open or closed in the dark.

Effectiveness of diagnostic strategies in suspected delayed cerebral ischemia: a decision analysis.

PubMed

Rawal, Sapna; Barnett, Carolina; John-Baptiste, Ava; Thein, Hla-Hla; Krings, Timo; Rinkel, Gabriel J E

2015-01-01

Delayed cerebral ischemia (DCI) is a serious complication after aneurysmal subarachnoid hemorrhage. If DCI is suspected clinically, imaging methods designed to detect angiographic vasospasm or regional hypoperfusion are often used before instituting therapy. Uncertainty in the strength of the relationship between imaged vasospasm or perfusion deficits and DCI-related outcomes raises the question of whether imaging to select patients for therapy improves outcomes in clinical DCI. Decision analysis was performed using Markov models. Strategies were either to treat all patients immediately or to first undergo diagnostic testing by digital subtraction angiography or computed tomography angiography to assess for angiographic vasospasm, or computed tomography perfusion to assess for perfusion deficits. According to current practice guidelines, treatment consisted of induced hypertension. Outcomes were survival in terms of life-years and quality-adjusted life-years. When treatment was assumed to be ineffective in nonvasospasm patients, Treat All and digital subtraction angiography were equivalent strategies; when a moderate treatment effect was assumed in nonvasospasm patients, Treat All became the superior strategy. Treating all patients was also superior to selecting patients for treatment via computed tomography perfusion. One-way sensitivity analyses demonstrated that the models were robust; 2- and 3-way sensitivity analyses with variation of disease and treatment parameters reinforced dominance of the Treat All strategy. Imaging studies to test for the presence of angiographic vasospasm or perfusion deficits in patients with clinical DCI do not seem helpful in selecting which patients should undergo treatment and may not improve outcomes. Future directions include validating these results in prospective cohort studies. © 2014 American Heart Association, Inc.

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

PubMed

Selcuk, Adin; Ozer, Tulay; Esen, Erkan; Ozdogan, Fatih; Ozel, Halil Erdem; Yuce, Turgut; Caliskan, Sebla; Dasli, Sinem; Bilal, Nagihan; Genc, Gulden; Genc, Selahattin

2017-05-01

To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm 3 before treatment to 6.57 ± 2.03 cm 3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Image quality assessment of automatic three-segment MR attenuation correction vs. CT attenuation correction.

PubMed

Partovi, Sasan; Kohan, Andres; Gaeta, Chiara; Rubbert, Christian; Vercher-Conejero, Jose L; Jones, Robert S; O'Donnell, James K; Wojtylak, Patrick; Faulhaber, Peter

2013-01-01

The purpose of this study is to systematically evaluate the usefulness of Positron emission tomography/Magnetic resonance imaging (PET/MRI) images in a clinical setting by assessing the image quality of Positron emission tomography (PET) images using a three-segment MR attenuation correction (MRAC) versus the standard CT attenuation correction (CTAC). We prospectively studied 48 patients who had their clinically scheduled FDG-PET/CT followed by an FDG-PET/MRI. Three nuclear radiologists evaluated the image quality of CTAC vs. MRAC using a Likert scale (five-point scale). A two-sided, paired t-test was performed for comparison purposes. The image quality was further assessed by categorizing it as acceptable (equal to 4 and 5 on the five-point Likert scale) or unacceptable (equal to 1, 2, and 3 on the five-point Likert scale) quality using the McNemar test. When assessing the image quality using the Likert scale, one reader observed a significant difference between CTAC and MRAC (p=0.0015), whereas the other readers did not observe a difference (p=0.8924 and p=0.1880, respectively). When performing the grouping analysis, no significant difference was found between CTAC vs. MRAC for any of the readers (p=0.6137 for reader 1, p=1 for reader 2, and p=0.8137 for reader 3). All three readers more often reported artifacts on the MRAC images than on the CTAC images. There was no clinically significant difference in quality between PET images generated on a PET/MRI system and those from a Positron emission tomography/Computed tomography (PET/CT) system. PET images using the automatic three-segmented MR attenuation method provided diagnostic image quality. However, future research regarding the image quality obtained using different MR attenuation based methods is warranted before PET/MRI can be used clinically.

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

PubMed

Mark, Daniel B; Federspiel, Jerome J; Cowper, Patricia A; Anstrom, Kevin J; Hoffmann, Udo; Patel, Manesh R; Davidson-Ray, Linda; Daniels, Melanie R; Cooper, Lawton S; Knight, J David; Lee, Kerry L; Douglas, Pamela S

2016-07-19

PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. To conduct an economic analysis for PROMISE (a major secondary aim of the study). Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550). 190 U.S. centers. 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Cost weights for test strategies were obtained from sources outside PROMISE. Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up. National Heart, Lung, and Blood Institute.

Computed tomography-based evaluation of template (NobelGuide™)-guided implant positions: a prospective radiological study.

PubMed

Vasak, Christoph; Watzak, Georg; Gahleitner, André; Strbac, Georg; Schemper, Michael; Zechner, Werner

2011-10-01

This prospective study was intended to evaluate the overall deviation in a clinical treatment setting to provide for quantification of the potential impairment of treatment safety and reliability with computer-assisted, template-guided transgingival implantation. The patient population enrolled (male/female=10/8) presented with partially dentate and edentulous maxillae and mandibles. Overall, 86 implants were placed by two experienced dental surgeons strictly following the NobelGuide™ protocol for template-guided implantation. All patients had a postoperative computed tomography (CT) with identical settings to the preoperative examination. Using the triple scan technique, pre- and postoperative CT data were merged in the Procera planning software, a newly developed procedure - initially presented in 2007 allowing measurement of the deviations at implant shoulder and apex. The deviations measured were an average of 0.43 mm (bucco-lingual), 0.46 mm (mesio-distal) and 0.53 mm (depth) at the level of the implant shoulder and slightly higher at the implant apex with an average of 0.7 mm (bucco-lingual), 0.63 mm (mesio-distal) and 0.52 mm (depth). The maximum deviation of 2.02 mm was encountered in the corono-apical direction. Significantly lower deviations were seen for implants in the anterior region vs. the posterior tooth region (P<0.01, 0.31 vs. 0.5 mm), and deviations were also significantly lower in the mandible than in the maxilla (P=0.04, 0.36 vs. 0.45 mm) in the mesio-distal direction. Moreover, a significant correlation between deviation and mucosal thickness was seen and a learning effect was found over the time period of performance of the surgical procedures. Template-guided implantation will ensure reliable transfer of preoperative computer-assisted planning into surgical practice. With regard to the required verification of treatment reliability of an implantation system with flapless access, all maximum deviations measured in this clinical study were within the safety margins recommended by the planning software. © 2011 John Wiley & Sons A/S.

Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada.

PubMed

Cressman, Sonya; Lam, Stephen; Tammemagi, Martin C; Evans, William K; Leighl, Natasha B; Regier, Dean A; Bolbocean, Corneliu; Shepherd, Frances A; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R; Mayo, John R; McWilliams, Annette; Couture, Christian; English, John C; Goffin, John; Hwang, David M; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J; Goss, Glenwood D; Nicholas, Garth; Seely, Jean M; Sekhon, Harmanjatinder S; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J

2014-10-01

It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061). In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.

Application of electrical resistivity tomography techniques for mapping man-made sinkholes

NASA Astrophysics Data System (ADS)

Rey, J.; Martínez, J.; Hidalgo, C.; Dueñas, J.

2012-04-01

The suitability of the geophysical prospecting by electrical resistivity tomography to detect and map man-made subsurface cavities and related sinkholes has been studied in the Linares abandoned mining district (Spain). We have selected for this study four mined sectors constituted of different lithologies: granite and phyllites of Paleozoic age, and Triassic shales and sandstones. In three of these sectors, detail underground topographic surveys were carried out to chart the position and dimensions of the mining voids (galleries and chamber), in order to analyze the resolution of this methodology to characterize these cavities by using different electrode arrays. The results are variable, depending on the depth and diameter of the void, the selected electrode array, the spacing between electrodes, geological complexity and data density. These results also indicate that when the cavity is empty, an anomaly with a steep gradient and high resistivity values is registered, because the air that fills the mining void is dielectric, while when the cavities are filled with fine grain sediments, frequently saturated in water, the electrical resistance is lower. In relation with the three different multi-electrode arrays tested, the Wenner-Schlumberger array has resulted to offer the maximum resolution in all these cases, with lower and more stable values for the RMS than the other arrays. Therefore, this electrode array has been applied in the fourth studied sector, a former mine near the city centre of Linares, in an area of urban expansion in which there are problems of subsidence. Two sets of four electrical tomography profiles have been carried out, perpendicular to each other, and which have allowed reaching depths of research between 30-35 m. This net-array allowed the identification of two shallow anomalies of low resistivity values, interpreted as old mining galleries filled with fine material saturated in water. It also allows detecting two fractures, correlated in the profiles and which can be mapped to more than 25 m in depth. As showed by this case study, electrical resistivity tomography can be a suitable tool in sub-surface cavities detection and man-made sinkhole investigations.

Imaging Cellular Proliferation During Chemo-Radiotherapy: A Pilot Study of Serial {sup 18}F-FLT Positron Emission Tomography/Computed Tomography Imaging for Non-Small-Cell Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Everitt, Sarah, E-mail: Sarah.Everitt@petermac.or; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria; Hicks, Rodney J.

2009-11-15

Purpose: To establish whether {sup 18}F-3'-deoxy-3'-fluoro-L-thymidine ({sup 18}F-FLT) can monitor changes in cellular proliferation of non-small-cell lung cancer (NSCLC) during radical chemo-radiotherapy (chemo-RT). Methods and Materials: As part of a prospective pilot study, 5 patients with locally advanced NSCLC underwent serial {sup 18}F-FLT positron emission tomography (PET)/computed tomography (CT) scans during treatment. Baseline {sup 18}F-FLT PET/CT scans were compared with routine staging {sup 18}F-FDG PET/CT scans. Two on-treatment {sup 18}F-FLT scans were performed for each patient on Days 2, 8, 15 or 29, providing a range of time points for response assessment. Results: In all 5 patients, baseline lesional uptakemore » of {sup 18}F-FLT on PET/CT corresponded to staging {sup 18}F-FDG PET/CT abnormalities. {sup 18}F-FLT uptake in tumor was observed on five of nine (55%) on-treatment scans, on Days 2, 8 and 29, but not Day 15. A 'flare' of {sup 18}F-FLT uptake in the primary tumor of one case was observed after 2 Gy of radiation (1.22 x baseline). The remaining eight on-treatment scans demonstrated a mean reduction in {sup 18}F-FLT tumor uptake of 0.58 x baseline. A marked reduction of {sup 18}F-FLT uptake in irradiated bone marrow was observed for all cases. This reduction was observed even after only 2 Gy, and all patients demonstrated a complete absence of proliferating marrow after 10 Gy. Conclusions: This proof of concept study indicates that {sup 18}F-FLT uptake can monitor the distinctive biologic responses of epithelial cancers and highly radiosensitive normal tissue changes during radical chemo-RT. Further studies of {sup 18}F-FLT PET/CT imaging during therapy may suggest that this tracer is useful in developing response-adapted RT for NSCLC.« less

Magnetic resonance imaging versus computed tomography to plan hemilaminectomies in chondrodystrophic dogs with intervertebral disc extrusion.

PubMed

Noyes, Julie A; Thomovsky, Stephanie A; Chen, Annie V; Owen, Tina J; Fransson, Boel A; Carbonneau, Kira J; Matthew, Susan M

2017-10-01

To determine the influence of preoperative computed tomography (CT) versus magnetic resonance (MR) on hemilaminectomies planned to treat thoracolumbar (TL) intervertebral disc (IVD) extrusions in chondrodystrophic dogs. Prospective clinical study. Forty chondrodystrophic dogs with TL IVD extrusion and preoperative CT and MR studies. MR and CT images were randomized and reviewed by 4 observers masked to the dog's identity and corresponding imaging studies. Observers planned the location along the spine, side, and extent (number of articular facets to be removed) based on individual reviews of CT and MR studies. Intra-observer agreement was determined between overall surgical plan, location, side, and size of the hemilaminectomy planned on CT versus MR of the same dog. Similar surgical plans were developed based on MR versus CT in 43.5%-66.6% of dogs, depending on the observer. Intra-observer agreement in location, side, and size of the planned hemilaminectomy based on CT versus MR ranged between 48.7%-66.6%, 87%-92%, and 51.2%-71.7% of dogs, respectively. Observers tended to plan larger laminectomy defects based on MR versus CT of the same dog. Findings from this study indicated considerable differences in hemilaminectomies planned on preoperative MR versus CT imaging. Surgical location and size varied the most; the side of planned hemilaminectomies was most consistent between imaging modalities. © 2017 The American College of Veterinary Surgeons.

Medial tibial stress syndrome: a critical review.

PubMed

Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

2009-01-01

Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

A Prospective Quasi-Randomized Comparison of Intraoperatively Built Custom-Linked Seeds Versus Loose Seeds for Prostate Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ishiyama, Hiromichi, E-mail: hishiyam@kitasato-u.ac.jp; Satoh, Takefumi; Kawakami, Shogo

Purpose: To compare dosimetric parameters, seed migration rates, operation times, and acute toxicities of intraoperatively built custom-linked (IBCL) seeds with those of loose seeds for prostate brachytherapy. Methods and Materials: Participants were 140 patients with low or intermediate prostate cancer prospectively allocated to an IBCL seed group (n=74) or a loose seed group (n=66), using quasirandomization (allocated by week of the month). All patients underwent prostate brachytherapy using an interactive plan technique. Computed tomography and plain radiography were performed the next day and 1 month after brachytherapy. The primary endpoint was detection of a 5% difference in dose to 90% ofmore » prostate volume on postimplant computed tomography 1 month after treatment. Seed migration was defined as a seed position >1 cm from the cluster of other seeds on radiography. A seed dropped into the seminal vesicle was also defined as a migrated seed. Results: Dosimetric parameters including the primary endpoint did not differ significantly between groups, but seed migration rate was significantly lower in the IBCL seed group (0%) than in the loose seed group (55%; P<.001). Mean operation time was slightly but significantly longer in the IBCL seed group (57 min) than in the loose seed group (50 min; P<.001). No significant differences in acute toxicities were seen between groups (median follow-up, 9 months). Conclusions: This prospective quasirandomized control trial showed no dosimetric differences between IBCL seed and loose seed groups. However, a strong trend toward decreased postimplant seed migration was shown in the IBCL seed group.« less

Interstitial Lung Disease in India. Results of a Prospective Registry.

PubMed

Singh, Sheetu; Collins, Bridget F; Sharma, Bharat B; Joshi, Jyotsna M; Talwar, Deepak; Katiyar, Sandeep; Singh, Nishtha; Ho, Lawrence; Samaria, Jai Kumar; Bhattacharya, Parthasarathi; Gupta, Rakesh; Chaudhari, Sudhir; Singh, Tejraj; Moond, Vijay; Pipavath, Sudhakar; Ahuja, Jitesh; Chetambath, Ravindran; Ghoshal, Aloke G; Jain, Nirmal K; Devi, H J Gayathri; Kant, Surya; Koul, Parvaiz; Dhar, Raja; Swarnakar, Rajesh; Sharma, Surendra K; Roy, Dhrubajyoti J; Sarmah, Kripesh R; Jankharia, Bhavin; Schmidt, Rodney; Katiyar, Santosh K; Jindal, Arpita; Mangal, Daya K; Singh, Virendra; Raghu, Ganesh

2017-03-15

Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.

Prospective evaluation of Doppler sonography to detect the twinkling artifact versus unenhanced computed tomography for identifying urinary tract calculi.

PubMed

Kielar, Ania Z; Shabana, Wael; Vakili, Maryam; Rubin, Jonathan

2012-10-01

The twinkling artifact is an emerging tool for identifying urinary tract calculi. The purpose of this prospective study was to evaluate the diagnostic accuracy of the twinkling artifact compared to unenhanced computed tomography in detecting urolithasis. After Research Ethics Board approval, 51 patients with flank pain from the emergency department were enrolled between November 2009 and September 2010. Patients received an unenhanced computed tomographic scan with 1.25-mm raw data and reformatted 5-mm axial and 2-mm coronal images. Blinded assessment of the urinary tract was performed with gray-scale and color Doppler interrogation. The number of calculi, location, size, kidney distance from the skin, body mass index of the patient, and sonographic image parameters were recorded. There were 35 right-sided and 38 left-sided renal calculi, 14 right-sided and 21 left-sided ureteric calculi, and 6 bladder calculi (total, 114 calculi). Thirteen patients had no calculi. The average calculus size was 2.6 mm (range, 1-9 mm). There were 6 false-positive and 22 false-negative instances of twinkling artifacts. On gray-scale evaluation looking for an echogenic focus with shadowing, there were 8 false-positive and 40 false-negative findings. The positive predictive value (PPV) of the twinkling artifact for identifying calculi was 94%, and the sensitivity was 83%. The PPV of gray-scale sonographic shadowing was only 64.9%, and the sensitivity was 80.2%. The twinkling artifact has a high PPV for detecting renal and urinary tract calculi. Evaluation for the twinkling artifact is a complementary technique to standard gray-scale shadowing of calculi and improves detection of urolithiasis on sonography.

Prospective flutemetamol positron emission tomography and histopathology in normal pressure hydrocephalus.

PubMed

Rinne, Juha O; Frantzen, Janek; Leinonen, Ville; Lonnrot, Kimmo; Laakso, Aki; Virtanen, Kirsi A; Solin, Olof; Kotkansalo, Anna; Koivisto, Anne; Sajanti, Juha; Karppinen, Atte; Lehto, Hanna; Rummukainen, Jaana; Buckley, Chris; Smith, Adrian; Jones, Paul A; Sherwin, Paul; Farrar, Gill; McLain, Richard; Kailajarvi, Marita; Grachev, Igor D

2014-01-01

BACKGOUND/OBJECTIVE: To determine the level of association between uptake of the amyloid positron emission tomography (PET) imaging agent [(18)F]flutemetamol and the level of amyloid-β measured by immunohistochemical and histochemical staining in a frontal cortical region biopsy site. Seventeen patients with probable normal pressure hydrocephalus (NPH) underwent prospective [(18)F]flutemetamol PET and subsequent frontal cortical brain biopsy during ventriculoperitoneal shunting. Tissue amyloid-β was evaluated using the monoclonal antibody 4G8, thioflavin S and Bielschowsky silver stain. Four of the 17 patients (23.5%) had amyloid-β pathology based on the overall pathology read and also showed increased [(18)F]flutemetamol uptake. [(18)F]Flutemetamol standardized uptake values from the biopsy site were significantly associated with biopsy specimen amyloid-β levels (Pearson's r = 0.67; p = 0.006). There was also good correlation between the biopsy specimen amyloid-β level and uptake of [(18)F]flutemetamol in the region contralateral to the biopsy site (r = 0.67; p = 0.006), as well as with composite cortical [(18)F]flutemetamol uptake (r = 0.65; p = 0.008). The blinded visual read showed a high level of agreement between all readers (κ = 0.88). Two of 3 readers were in full agreement on all images; 1 reader disagreed on 1 of the 17 NPH cases. Blinded visual assessments of PET images by 1 reader were associated with 100% sensitivity to the overall pathology read, and assessments by the 2 others were associated with 75% sensitivity (overall sensitivity by majority read was 75%); specificity of all readers was 100%. [(18)F]Flutemetamol detects brain amyloid-β in vivo and shows promise as a valuable tool to study and possibly facilitate diagnosis of Alzheimer's disease both in patients with suspected NPH and among the wider population.

Deep Retinal Capillary Nonperfusion Is Associated With Photoreceptor Disruption in Diabetic Macular Ischemia.

PubMed

Scarinci, Fabio; Nesper, Peter L; Fawzi, Amani A

2016-08-01

To report outer retinal structural changes associated with macular capillary nonperfusion at the level of deep capillary plexus (DCP) in diabetic patients. Prospective observational cross-sectional study. The study included 14 eyes of 10 patients who were diagnosed as having diabetic retinopathy. To study the outer retina and localize areas of capillary nonperfusion at the superficial (SCP) or DCP, we used the spectral-domain optical coherence tomography (SDOCT) device (RTVue-XR Avanti; Optovue Inc, Fremont, California, USA) with split-spectrum amplitude-decorrelation angiography (SSADA) software for optical coherence tomography angiography (OCTA). Two independent masked graders (F.S. and A.A.F.) qualitatively evaluated SDOCT scans as either normal or having outer retina disruption. The angiographic images were examined to define the presence and location of capillary nonperfusion. Eight eyes showed outer retinal disruption on SDOCT that co-localized to areas of enlarged foveal avascular zone, areas of no flow between capillaries, and capillary nonperfusion of the DCP. Six eyes without outer retinal changes on SDOCT showed robust perfusion of the DCP. Using OCTA, this study shows that macular photoreceptor disruption on SDOCT in patients with diabetic retinopathy corresponds to areas of capillary nonperfusion at the level of the DCP. This is important in highlighting the contribution of the DCP to the oxygen requirements of the photoreceptors as well as the outer retina in diabetic macular ischemia. Copyright © 2016 Elsevier Inc. All rights reserved.

The Role of Computed Tomography in Blunt Abdominal Trauma.

PubMed

Karki, O B

2015-01-01

Blunt injury trauma is regularly encountered in the emergency department. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma scan, Diagnostic peritoneal lavage and Computed Tomography scan. The aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma. A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines. Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traffic accident (47.5%) was the most common mechanism of injury. Spleen (27.5%) was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% specificity 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, specificity 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed. In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan.

Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: a systematic review and a meta-analysis.

PubMed

Treglia, Giorgio; Sadeghi, Ramin; Annunziata, Salvatore; Lococo, Filippo; Cafarotti, Stefano; Prior, John O; Bertagna, Francesco; Ceriani, Luca; Giovanella, Luca

2014-01-01

To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the assessment of pleural abnormalities in cancer patients. A comprehensive literature search of studies published through June 2013 regarding the role of (18)F-FDG-PET and PET/CT in evaluating pleural abnormalities in cancer patients was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odd ratio (DOR) of (18)F-FDG-PET or PET/CT on a per patient-based analysis were calculated. The area under the summary ROC curve (AUC) was calculated to measure the accuracy of these methods in the assessment of pleural abnormalities. Sub-analyses considering (18)F-FDG-PET/CT and patients with lung cancer only were carried out. Eight studies comprising 360 cancer patients (323 with lung cancer) were included. The meta-analysis of these selected studies provided the following results: sensitivity 86% [95% confidence interval (95%CI): 80-91%], specificity 80% [95%CI: 73-85%], LR+ 3.7 [95%CI: 2.8-4.9], LR- 0.18 [95%CI: 0.09-0.34], DOR 27 [95%CI: 13-56]. The AUC was 0.907. No significant improvement considering PET/CT studies only and patients with lung cancer was found. (18)F-FDG-PET and PET/CT demonstrated to be useful diagnostic imaging methods in the assessment of pleural abnormalities in cancer patients, nevertheless possible sources of false-negative and false-positive results should be kept in mind. The literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited and prospective studies are needed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Impact of 3-dimensional-computed tomography workstation for precise planning of endovascular aneurysm repair.

PubMed

Higashiura, Wataru; Sakaguchi, Shoji; Tabayashi, Nobuoki; Taniguchi, Shigeki; Kichikawa, Kimihiko

2008-12-01

Compared with open surgery, imaging is considered to be important for planning and device selection of endovascular aneurysm repair (EVAR). The present study evaluated the usefulness of a 3-dimensional (3D)-computed tomography (CT) workstation in planning EVAR. A prospective study was conducted in 8 patients who underwent EVAR using Zenith endograft between February and August 2007. Endograft size and optimized deployment projection were decided using a 3D-CT workstation. The primary endpoint was defined as successful deployment of a same size endograft as preoperatively selected without type I or III endoleak or inadvertent arterial occlusion. The following parameters were investigated: (a) incidence of use of an alternative endograft; (b) prevalence of type I or III endoleak; and (c) distance from lowest renal artery to tip of graft. Successful deployment of endograft was achieved in all 8 patients. Use of alternative endograft or type I or III endoleak was not detected in 8 patients. Distance from the lowest renal artery to the tip of the graft was 2.8mm. Assessment using a 3D-CT workstation appears to allow accurate endograft selection and precise deployment of the Zenith endograft without type I or III endoleak, even in institutes with a small number of patients.

Optical Coherence Tomography of Fovea Before and after Laser Treatment in Retinopathy of Prematurity

PubMed Central

Narang, Subina; Singh, Amrita; Jain, Suksham; Sood, Sunandan; Chawla, Deepak

2014-01-01

Purpose: To study the fovea in preterm babies with Type I retinopathy of prematurity (ROP) before and after laser treatment using optical coherence tomography (OCT). Materials and Methods: This was a prospective observational case-control study including preterm neonates undergoing screening for ROP from May 2009 to July 2011. Group 1 included 30 eyes of 15 neonates with Type I ROP. A 532-nm laser was used for treatment in all cases for Group 1. Group 2 included 14 eyes of 7 preterm neonates without ROP that served as controls. OCT was performed under sedation in the lateral position before and after laser treatment. P <0.05 was considered statistically significant. Results: The mean initial central macular thickness (CMT) was comparable in both groups (P = 0.832) and statistically significantly correlated with gestational age (P = 0.015). No adverse effects on the anterior segment or posterior segment were observed. There was no significant difference in CMT before and after laser treatment in Group 1 (P = 0.007). There was one case of cystoid macular edema after laser treatment. Conclusion: The macula in preterm babies with Type 1 ROP was comparable to those without ROP. Gestational age was the only predictor of CMT. PMID:25371634

A new method for detecting cerebral hemorrhage in rabbits by magnetic inductive phase shift.

PubMed

Jin, Gui; Sun, Jian; Qin, Mingxin; Tang, Qinghua; Xu, Lin; Ning, Xu; Xu, Jia; Pu, Xianjie; Chen, Mingsheng

2014-02-15

Cerebral hemorrhage, which is an important clinical problem, is often monitored and studied using expensive devices, such as magnetic resonance imaging (MRI) and positron emission tomography (PET) that are unavailable in economically underdeveloped regions. Magnetic induction tomography (MIT) is a new type of non-contact, non-invasive, and low-cost detection technology, and exhibits prospects for wide application, especially for the detection of brain diseases. However, the previous studies on MIT have focused on laboratory models and rarely on in vivo applications because the induced signals produced by biological tissues are notably weak. Based on the symmetry between the two brain hemispheres and the fact that a local brain hemorrhage will not affect the contra-lateral hemisphere, a symmetric cancellation-type sensor detection system, which is characterized by one excitation coil and two receiving coils, was designed to improve the detection sensitivity of MIT. This method was subsequently used to detect the occurrence of cerebral hematomas in rabbits. The average phase drift induced by a 3-ml injection of autologous blood was 1.885°, which is a fivefold improvement compared with the traditional single excitation coil and single receiving coil method. The results indicate that this system has high sensitivity and anti-interference ability and high practical value. © 2013 Published by Elsevier B.V.

Cone-Beam Computed Tomography Evaluation of Horizontal and Vertical Dimensional Changes in Buccal Peri-Implant Alveolar Bone and Soft Tissue: A 1-Year Prospective Clinical Study.

PubMed

Kaminaka, Akihiro; Nakano, Tamaki; Ono, Shinji; Kato, Tokinori; Yatani, Hirofumi

2015-10-01

This study evaluated changes in the horizontal and vertical dimensions of the buccal alveolar bone and soft tissue over a 1-year period following implant prosthesis. Thirty-three participants with no history of guided bone regeneration or soft tissue augmentation underwent dental implant placement with different types of connections. The dimensions of the buccal alveolar bone and soft tissue were evaluated immediately and at 1 year after prosthesis from reconstructions of cross-sectional cone-beam computed tomography images. The vertical and horizontal loss of buccal bone and soft tissue around implants with conical connections were lower than around those with external or internal connections. Statistically significant negative correlations were observed between initial horizontal bone thickness and changes in vertical bone and soft tissue height (p < .05), and between initial horizontal soft tissue thickness and the change in vertical soft tissue height (p < .05). Implants with a conical connection preserve peri-implant alveolar bone and soft tissue more effectively than other connection types. Furthermore, the initial buccal alveolar bone and soft tissue thickness around the implant platform may influence their vertical dimensional changes at 1 year after implant prosthesis. © 2014 Wiley Periodicals, Inc.

Waste disposal mapping with electrical resistivity tomography case: Leuwigajah landfill

NASA Astrophysics Data System (ADS)

Aryanti, Erisha; Ardi, Ahmad Puji; Almunziri, Muaz; Xanggam, Zael Yahd; Eleazar, Adino; Widodo

2017-07-01

Leuwigajah landfill as administrative is located between district of Bandung and Cimahi citythat has an environmental and social problem that caused aquifer contamination due to the big amount of waste from Bandung city, Cimahi and Bandung regency. It is occupied in abandoned andesite mine site with an area of about 25 hectare. The aim of this research is to map the geology structure and to study the leachate towards aquifer layer below Leuwigajah landfill. Here, we present the study of Leuwigajah landfill subsurface using Electrical Resistivity Tomography (ERT). ERT is one of the most promising prospecting techniques mainly concerning its effective contribution to resolve several environmental problems, was applied for the geophysical modeling. ERT is a robust imaging method the theory and implementation of which are well documented in geophysical research literature. The geological setting comprises clayed weathered layer, fractured andesitic dike. Due to the above-mentioned geological singularity and in the light of the requirement for an environmentally safe construction of the landfill, an ERT survey was carried out with dipole-dipole array, 78 m of acquisition line and 6 m of electrode spacing. The model consists of 4 layers below the Leuwigajah landfill and andesitic fracture until depth of 18.7 m below the surface.

Comparison of choroidal thickness using swept-source and spectral-domain optical coherence tomography in normal Indian eyes.

PubMed

Narendran, Siddharth; Manayath, George; Venkatapathy, Narendran

2018-01-01

Choroidal thickness measurements are reported to differ between spectral-domain optical coherence tomography (SD-OCT) and swept-source OCT (SS-OCT). The aim of this study was to assess the comparability of choroidal thickness measurements using SS-OCT and SD-OCT devices among normal participants. This was a prospective study of 31 (62 eyes) normal participants. Choroidal imaging was performed sequentially with the Spectralis OCT (SD-OCT) and the deep range imaging OCT (DRI OCT-1) (SS-OCT) using standardized imaging protocols. The subfoveal choroidal thickness (SFChT) was measured manually by two masked retinal specialists. Paired t -tests and intraclass correlation coefficients (ICCs) were used to compare the measurements. The mean SFChT was 319.5 μm and 325.3 μm for DRI OCT-1 and Spectralis OCT, respectively ( P = 0.001), with a mean difference of 5.9 with ICC of 0.97. The mean difference in choroidal thickness between the OCT devices was larger among eyes with choroidal thickness > 350 μm compared with eyes with thinner choroids (8.0 μm vs. 4.7 μm). SFChT measurements are comparable between DRI OCT-1 and Spectralis OCT. The variability between the devices increases in thicker choroids.

The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes.

PubMed

Carlson, Eric R; Schaefferkoetter, Josh; Townsend, David; McCoy, J Michael; Campbell, Paul D; Long, Misty

2013-01-01

To determine whether the time course of 18-fluorine fluorodeoxyglucose (18F-FDG) activity in multiple consecutively obtained 18F-FDG positron emission tomography (PET)/computed tomography (CT) scans predictably identifies metastatic cervical adenopathy in patients with oral/head and neck cancer. It is hypothesized that the activity will increase significantly over time only in those lymph nodes harboring metastatic cancer. A prospective cohort study was performed whereby patients with oral/head and neck cancer underwent consecutive imaging at 9 time points with PET/CT from 60 to 115 minutes after injection with (18)F-FDG. The primary predictor variable was the status of the lymph nodes based on dynamic PET/CT imaging. Metastatic lymph nodes were defined as those that showed an increase greater than or equal to 10% over the baseline standard uptake values. The primary outcome variable was the pathologic status of the lymph node. A total of 2,237 lymph nodes were evaluated histopathologically in the 83 neck dissections that were performed in 74 patients. A total of 119 lymph nodes were noted to have hypermetabolic activity on the 90-minute (static) portion of the study and were able to be assessed by time points. When we compared the PET/CT time point (dynamic) data with the histopathologic analysis of the lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.3%, 70.5%, 66.0%, 65.2%, and 65.5%, respectively. The use of dynamic PET/CT imaging does not permit the ablative surgeon to depend only on the results of the PET/CT study to determine which patients will benefit from neck dissection. As such, we maintain that surgeons should continue to rely on clinical judgment and maintain a low threshold for executing neck dissection in patients with oral/head and neck cancer, including those patients with N0 neck designations. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women-Does This Factor Impact Upper Tract Imaging Findings?

PubMed

Wu, Yuefeng Rose; Rego, Lauren L; Christie, Alana L; Lavelle, Rebecca S; Alhalabi, Feras; Zimmern, Philippe E

2016-08-01

We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection. Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Patients with irretrievable images, absent or incomplete urine culture results for review, no imaging performed, an obvious source of recurrent urinary tract infections or a history of pyelonephritis were excluded from analysis. Of 289 women from 2006 to 2014 with symptomatic recurrent urinary tract infections 116 met study inclusion criteria. Mean ± SD age was 65.0 ± 14.4 years. Of the women 95% were white and 81% were postmenopausal. Almost a third were sexually active and none had prolapse stage 2 or greater. Of the 116 women 48 (41%) had persistent and 68 (59%) had reinfection recurrent urinary tract infection. Imaging included ultrasound in 52 patients, computerized tomography in 26, ultrasound and computerized tomography in 31, and excretory urogram with ultrasound/computerized tomography in 7. Of the total of 58 imaging findings in 55 women 57 (98%) were noncontributory. One case (0.9%) of mild hydronephrosis was noted in the persistent recurrent urinary tract infection group but it was not related to any clinical parameters. Escherichia coli was the dominant bacteria in 71% of persistent and 47% of reinfection recurrent urinary tract infections in the most recently reported urine culture. This study reaffirms that upper tract imaging is not indicated for bacterial reinfection, recurrent urinary tract infections. However, the same conclusion can be extended to recurrent urinary tract infections secondary to bacterial persistence, thus, questioning the routine practice of upper tract studies in white postmenopausal women with recurrent urinary tract infections and trigonitis. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Whole brain C-arm computed tomography parenchymal blood volume measurements

PubMed Central

Byrne, James V

2016-01-01

Introduction C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) imaging in the neuro-interventional suite is a new technique for which detailed whole brain measurements have not been previously reported. This study aims to create a catalogue of PBV measurements for various anatomical regions encompassing the whole brain, using a three-dimensional volume-of-interest (3D-VOI) analysis. Methods We acquired and analysed 30 C-arm FDCT datasets from 26 patients with aneurysmal subarachnoid haemorrhage (SAH), as part of a prospective study comparing C-arm computed tomography (CT) PBV with magnetic resonance perfusion-weighted imaging (MR-PWI). We calculated the PBV values for various brain regions with an automated analysis, using 58 pre-defined atlas-based 3D-VOIs encompassing the whole brain. VOIs partially or completely overlapping regions of magnetic resonance diffusion weighted imaging (MR-DWI) abnormality or magnetic resonance cerebral blood flow (MR-CBF) asymmetry were excluded from the analysis. Results Of the 30 C-arm CT PBV datasets, 14 (54%; 12 patients) had areas of restricted diffusion, the majority of which were focal. The PBV values for the cerebral cortex and cerebral white matter were 4.01 ± 0.47 (mean ± SD) and 3.01 ± 0.39 ml per 100 ml. Lobar PBV values were: frontal lobe 4.2 ± 0.8, temporal lobe 4.2 ± 0.9, parietal lobe 3.9 ± 0.7 and occipital lobe 4.3 ± 0.8 ml/100 ml. The basal ganglia and brainstem PBV values were 3.4 ± 0.7 and 4.6 ± 0.6 ml/100 ml, respectively. Conclusions Compared with the typical reference cerebral blood volume (CBV) values reported in the literature for Positron Emission Tomography (PET), the PBV values were relatively high for the white matter and relatively low for the cortical grey matter. The reported catalogue of PBV values for various brain regions would be useful to inform future studies and could be used in clinical practice, when interpreting PBV maps. PMID:26769737

Whole brain C-arm computed tomography parenchymal blood volume measurements.

PubMed

Kamran, Mudassar; Byrne, James V

2016-04-01

C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) imaging in the neuro-interventional suite is a new technique for which detailed whole brain measurements have not been previously reported. This study aims to create a catalogue of PBV measurements for various anatomical regions encompassing the whole brain, using a three-dimensional volume-of-interest (3D-VOI) analysis. We acquired and analysed 30 C-arm FDCT datasets from 26 patients with aneurysmal subarachnoid haemorrhage (SAH), as part of a prospective study comparing C-arm computed tomography (CT) PBV with magnetic resonance perfusion-weighted imaging (MR-PWI). We calculated the PBV values for various brain regions with an automated analysis, using 58 pre-defined atlas-based 3D-VOIs encompassing the whole brain. VOIs partially or completely overlapping regions of magnetic resonance diffusion weighted imaging (MR-DWI) abnormality or magnetic resonance cerebral blood flow (MR-CBF) asymmetry were excluded from the analysis. Of the 30 C-arm CT PBV datasets, 14 (54%; 12 patients) had areas of restricted diffusion, the majority of which were focal. The PBV values for the cerebral cortex and cerebral white matter were 4.01 ± 0.47 (mean ± SD) and 3.01 ± 0.39 ml per 100 ml. Lobar PBV values were: frontal lobe 4.2 ± 0.8, temporal lobe 4.2 ± 0.9, parietal lobe 3.9 ± 0.7 and occipital lobe 4.3 ± 0.8 ml/100 ml. The basal ganglia and brainstem PBV values were 3.4 ± 0.7 and 4.6 ± 0.6 ml/100 ml, respectively. Compared with the typical reference cerebral blood volume (CBV) values reported in the literature for Positron Emission Tomography (PET), the PBV values were relatively high for the white matter and relatively low for the cortical grey matter. The reported catalogue of PBV values for various brain regions would be useful to inform future studies and could be used in clinical practice, when interpreting PBV maps. © The Author(s) 2016.

Prospective Randomized Controlled Trial of Hindfoot and Ankle Fusions Treated With rhPDGF-BB in Combination With a β-TCP-Collagen Matrix.

PubMed

Daniels, Timothy R; Younger, Alastair S E; Penner, Murray J; Wing, Kevin J; Le, Ian L D; Russell, Iain S; Lalonde, Karl-André; Evangelista, Peter T; Quiton, Jovelyn D; Glazebrook, Mark; DiGiovanni, Christopher W

2015-07-01

Ankle and hindfoot arthrodesis is often supplemented with autograft to promote bony union. Autograft harvest can lead to increased perioperative morbidity. Purified recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) has stimulated bone formation in mandibular defects and hindfoot fusion. This randomized controlled trial evaluated the efficacy and safety of rhPDGF-BB combined with an injectable, osteoconductive beta-tricalcium phosphate (β-TCP)-collagen matrix versus autograft in ankle and hindfoot fusions. Seventy-five patients requiring ankle or hindfoot fusion were randomized 5:1 for rhPDGF-BB/β-TCP-collagen (treatment, n = 63) or autograft (control, n = 12). Prospective analysis included 142 autograft control subjects from another clinical trial with identical study protocols. Standardized operative and postoperative protocols were used. Patients underwent standard internal fixation augmented with autograft or 0.3 mg/mL rhPDGF-BB/β-TCP-collagen. Radiologic, clinical, and quality-of-life outcomes were assessed over 52 weeks. Primary outcome was joint fusion (50% or more osseous bridging on computed tomography) at 24 weeks. Secondary outcomes included radiographs, clinical healing status, visual analog scale pain score, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale score, Foot Function Index score, and Short Form-12 score. Noninferiority P values were calculated. Complete fusion of all involved joints at 24 weeks as indicated by computed tomography was achieved in 53 of 63 (84%) rhPDGF-BB/β-TCP-collagen-treated patients and 100 of 154 (65%) autograft-treated patients (P < .001). Mean time to fusion was 14.3 ± 8.9 weeks for rhPDGF-BB/β-TCP-collagen patients versus 19.7 ± 11.5 weeks for autograft patients (P < .01). Clinical success at 52 weeks was achieved in 57 of 63 (91%) rhPDGF-BB/β-TCP-collagen patients and 120 of 154 (78%) autograft patients (P < .001). Safety-related outcomes were equivalent. Autograft controls had 2 bone graft harvest infections. Application of rhPDGF-BB/β-TCP-collagen was a safe, effective alternative to autograft for ankle and hindfoot fusions, eliminating the pain and morbidity associated with autograft harvesting. Level I, prospective randomized study. © The Author(s) 2015.

Prospective randomized trial: outcomes of SF₆ versus C₃F₈ in macular hole surgery.

PubMed

Briand, Sophie; Chalifoux, Emmanuelle; Tourville, Eric; Bourgault, Serge; Caissie, Mathieu; Tardif, Yvon; Giasson, Marcelle; Boivin, Jocelyne; Blanchette, Caty; Cinq-Mars, Benoit

2015-04-01

To compare macular hole (MH) closure and visual acuity improvement after vitrectomy using SF6 versus C3F8 gas tamponade. The secondary purposes were to report the cumulative incidence of cataract development at 1 year after MH surgery and the proportion of complications. Prospective, randomized study. Thirty-one patients were prospectively randomized to the SF6 group and 28 patients to the C3F8 group. Preoperative data included MH minimum diameter, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), cataract staging, and intraocular pressure (IOP) measurement. Postoperative data included optical coherence tomography confirmation of the closure at 6 weeks and 1 year, and ETDRS BCVA and cataract development/extraction, both 1 year after the MH surgery. Primary MH closure was achieved in 93.3% in the SF6 group and 92.9% in the C3F8 group. Mean ETDRS BCVA improved by 17.7 letters in the SF6 and 16.9 letters in the C3F8 group. The difference in cumulative incidence of cataract development and extraction between both groups was not statistically significant. Regardless of the dye used, similar results were achieved. Finally, the proportion of adverse events was similar in both groups. MH surgery with SF6 gas achieves results similar to C3F8 in terms of visual acuity improvement, MH closure, cataract development/extraction, and adverse events. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT versus First-Generation 64-Slice Dual-Source CT

NASA Astrophysics Data System (ADS)

Gu, Jin; Shi, He-Shui; Han, Ping; Yu, Jie; Ma, Gui-Na; Wu, Sheng

2016-10-01

This study sought to compare the image quality and radiation dose of coronary computed tomography angiography (CCTA) from prospectively triggered 128-slice CT (128-MSCT) versus dual-source 64-slice CT (DSCT). The study was approved by the Medical Ethics Committee at Tongji Medical College of Huazhong University of Science and Technology. Eighty consecutive patients with stable heart rates lower than 70 bpm were enrolled. Forty patients were scanned with 128-MSCT, and the other 40 patients were scanned with DSCT. Two radiologists independently assessed the image quality in segments (diameter >1 mm) according to a three-point scale (1: excellent; 2: moderate; 3: insufficient). The CCTA radiation dose was calculated. Eighty patients with 526 segments in the 128-MSCT group and 544 segments in the DSCT group were evaluated. The image quality 1, 2 and 3 scores were 91.6%, 6.9% and 1.5%, respectively, for the 128-MSCT group and 97.6%, 1.7% and 0.7%, respectively, for the DSCT group, and there was a statistically significant inter-group difference (P ≤ 0.001). The effective doses were 3.0 mSv in the 128-MSCT group and 4.5 mSv in the DSCT group (P ≤ 0.001). Compared with DSCT, CCTA with prospectively triggered 128-MSCT had adequate image quality and a 33.3% lower radiation dose.

Image registration and analysis for quantitative myocardial perfusion: application to dynamic circular cardiac CT.

PubMed

Isola, A A; Schmitt, H; van Stevendaal, U; Begemann, P G; Coulon, P; Boussel, L; Grass, M

2011-09-21

Large area detector computed tomography systems with fast rotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively, ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce x-ray dose and limit motion artefacts. Even in the case of highly accurate prospective triggering and stable heart rate, spatial misalignment of the cardiac volumes acquired and reconstructed per cardiac cycle may occur due to small motion pattern variations from cycle to cycle. These misalignments reduce the accuracy of the quantitative analysis of myocardial perfusion parameters on a per voxel basis. An image-based solution to this problem is elastic 3D image registration of dynamic volume sequences with variable contrast, as it is introduced in this contribution. After circular cone-beam CT reconstruction of cardiac volumes covering large areas of the myocardial tissue, the complete series is aligned with respect to a chosen reference volume. The results of the registration process and the perfusion analysis with and without registration are evaluated quantitatively in this paper. The spatial alignment leads to improved quantification of myocardial perfusion for three different pig data sets.

Longitudinal changes in the visual field and optic disc in glaucoma.

PubMed

Artes, Paul H; Chauhan, Balwantray C

2005-05-01

The nature and mode of functional and structural progression in open-angle glaucoma is a subject of considerable debate in the literature. While there is a traditionally held viewpoint that optic disc and/or nerve fibre layer changes precede visual field changes, there is surprisingly little published evidence from well-controlled prospective studies in this area, specifically with modern perimetric and imaging techniques. In this paper, we report on clinical data from both glaucoma patients and normal controls collected prospectively over several years, to address the relationship between visual field and optic disc changes in glaucoma using standard automated perimetry (SAP), high-pass resolution perimetry (HRP) and confocal scanning laser tomography (CSLT). We use several methods of analysis of longitudinal data and describe a new technique called "evidence of change" analysis which facilitates comparison between different tests. We demonstrate that current clinical indicators of visual function (SAP and HRP) and measures of optic disc structure (CSLT) provide largely independent measures of progression. We discuss the reasons for these findings as well as several methodological issues that pose challenges to elucidating the true structure-function relationship in glaucoma.

Future prospects in dermatologic applications of lasers, nanotechnology, and other new technologies.

PubMed

Boixeda, P; Feltes, F; Santiago, J L; Paoli, J

2015-04-01

We review novel technologies with diagnostic and therapeutic applications in dermatology. Among the diagnostic techniques that promise to become part of dermatologic practice in the future are optical coherence tomography, multiphoton laser scanning microscopy, Raman spectroscopy, thermography, and 7-T magnetic resonance imaging. Advances in therapy include novel light-based treatments, such as those applying lasers to new targets and in new wavelengths. Devices for home therapy are also appearing. We comment on the therapeutic uses of plasma, ultrasound, radiofrequency energy, total reflection amplification of spontaneous emission of radiation, light stimulation, and transepidermal drug delivery. Finally, we mention some basic developments in nanotechnology with prospects for future application in dermatology. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

Prospective study of functional bone marrow-sparing intensity modulated radiation therapy with concurrent chemotherapy for pelvic malignancies.

PubMed

Liang, Yun; Bydder, Mark; Yashar, Catheryn M; Rose, Brent S; Cornell, Mariel; Hoh, Carl K; Lawson, Joshua D; Einck, John; Saenz, Cheryl; Fanta, Paul; Mundt, Arno J; Bydder, Graeme M; Mell, Loren K

2013-02-01

To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB). We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26%) were men. Twenty-one subjects completed (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) simulation and magnetic resonance imaging by use of quantitative IDEAL (IDEAL IQ; GE Healthcare, Waukesha, WI). The PET/CT and IDEAL IQ were registered, and BM subvolumes were segmented above the mean standardized uptake value and below the mean fat fraction within the pelvis and lumbar spine; their intersection was designated as functional BM for IMRT planning. Functional BM-sparing vs total BM-sparing IMRT plans were compared in 12 subjects; 10 were treated with functional BM-sparing pelvic IMRT per protocol. In gynecologic cancer patients, the mean functional BM V(10) (volume receiving ≥10 Gy) and V(20) (volume receiving ≥20 Gy) were 85% vs 94% (P<.0001) and 70% vs 82% (P<.0001), respectively, for functional BM-sparing IMRT vs total BM-sparing IMRT. In anal cancer patients, the corresponding values were 75% vs 77% (P=.06) and 62% vs 67% (P=.002), respectively. Of 10 subjects treated with functional BM-sparing pelvic IMRT, 3 (30%) had acute grade 3 hematologic toxicity or greater. IMRT can reduce dose to BM subregions identified by (18)F-fluorodeoxyglucose-PET/CT and IDEAL IQ. The efficacy of BM-sparing IMRT is being tested in a phase II trial. Copyright © 2013 Elsevier Inc. All rights reserved.

Structure-Function Relationship between Flicker-Defined Form Perimetry and Spectral-Domain Optical Coherence Tomography in Glaucoma Suspects.

PubMed

Reznicek, Lukas; Muth, Daniel; Vogel, Michaela; Hirneiß, Christoph

2017-03-01

To evaluate the relationship between functional parameters of repeated flicker-defined form perimetry (FDF) and structural parameters of spectral-domain optical coherence tomography (SD-OCT) in glaucoma suspects with normal findings in achromatic standard automated perimetry (SAP). Patients with optic nerve heads (ONH) clinically suspicious for glaucoma and normal SAP findings were enrolled in this prospective study. Each participant underwent visual field (VF) testing with FDF perimetry, using the Heidelberg Edge Perimeter (HEP, Heidelberg Engineering, Heidelberg, Germany) at two consecutive visits. Peripapillary RNFL thickness was obtained by SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany). Correlations and regression analyses of global and sectoral peripapillary RNFL thickness with corresponding global and regional VF sensitivities were investigated. A consecutive series of 65 study eyes of 36 patients were prospectively included. The second FDF test (HEP II) was used for analysis. Cluster-point based suspicious VF defects were found in 34 eyes (52%). Significant correlations were observed between mean global MD (PSD) of HEP II and SD-OCT-based global peripapillary RNFL thickness (r = 0.380, p = 0.003 for MD and r = -0.516, p < 0.001 for PSD) and RNFL classification scores (R 2 = 0.157, p = 0.002 for MD and R 2 = 0.172, p = 0.001 for PSD). Correlations between mean global MD and PSD of HEP II and sectoral peripapillary RNFL thickness and classification scores showed highest correlations between function and structure for the temporal superior and temporal inferior sectors whereas sectoral MD and PSD correlated weaker with sectoral RNFL thickness. Correlations between linear RNFL values and untransformed logarithmic MD values for each segment were less significant than correlations between logarithmic MD values and RNFL thickness. In glaucoma suspects with normal SAP, global and sectoral peripapillary RNFL thickness is correlated with sensitivity and VF defects in FDF perimetry.

Accuracy of Cup Positioning With the Computed Tomography-Based Two-dimensional to Three-Dimensional Matched Navigation System: A Prospective, Randomized Controlled Study.

PubMed

Yamada, Kazuki; Endo, Hirosuke; Tetsunaga, Tomonori; Miyake, Takamasa; Sanki, Tomoaki; Ozaki, Toshifumi

2018-01-01

The accuracy of various navigation systems used for total hip arthroplasty has been described, but no publications reported the accuracy of cup orientation in computed tomography (CT)-based 2D-3D (two-dimensional to three-dimensional) matched navigation. In a prospective, randomized controlled study, 80 hips including 44 with developmental dysplasia of the hips were divided into a CT-based 2D-3D matched navigation group (2D-3D group) and a paired-point matched navigation group (PPM group). The accuracy of cup orientation (absolute difference between the intraoperative record and the postoperative measurement) was compared between groups. Additionally, multiple logistic regression analysis was performed to evaluate patient factors affecting the accuracy of cup orientation in each navigation. The accuracy of cup inclination was 2.5° ± 2.2° in the 2D-3D group and 4.6° ± 3.3° in the PPM group (P = .0016). The accuracy of cup anteversion was 2.3° ± 1.7° in the 2D-3D group and 4.4° ± 3.3° in the PPM group (P = .0009). In the PPM group, the presence of roof osteophytes decreased the accuracy of cup inclination (odds ratio 8.27, P = .0140) and the absolute value of pelvic tilt had a negative influence on the accuracy of cup anteversion (odds ratio 1.27, P = .0222). In the 2D-3D group, patient factors had no effect on the accuracy of cup orientation. The accuracy of cup positioning in CT-based 2D-3D matched navigation was better than in paired-point matched navigation, and was not affected by patient factors. It is a useful system for even severely deformed pelvises such as developmental dysplasia of the hips. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospective Study of Functional Bone Marrow-Sparing Intensity Modulated Radiation Therapy With Concurrent Chemotherapy for Pelvic Malignancies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liang Yun; Center for Advanced Radiotherapy Technologies, University of California, San Diego, La Jolla, California; Bydder, Mark

2013-02-01

Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB). Methods and Materials: We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26%) were men. Twenty-one subjects completed {sup 18}F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computedmore » tomography (CT) simulation and magnetic resonance imaging by use of quantitative IDEAL (IDEAL IQ; GE Healthcare, Waukesha, WI). The PET/CT and IDEAL IQ were registered, and BM subvolumes were segmented above the mean standardized uptake value and below the mean fat fraction within the pelvis and lumbar spine; their intersection was designated as functional BM for IMRT planning. Functional BM-sparing vs total BM-sparing IMRT plans were compared in 12 subjects; 10 were treated with functional BM-sparing pelvic IMRT per protocol. Results: In gynecologic cancer patients, the mean functional BM V{sub 10} (volume receiving {>=}10 Gy) and V{sub 20} (volume receiving {>=}20 Gy) were 85% vs 94% (P<.0001) and 70% vs 82% (P<.0001), respectively, for functional BM-sparing IMRT vs total BM-sparing IMRT. In anal cancer patients, the corresponding values were 75% vs 77% (P=.06) and 62% vs 67% (P=.002), respectively. Of 10 subjects treated with functional BM-sparing pelvic IMRT, 3 (30%) had acute grade 3 hematologic toxicity or greater. Conclusions: IMRT can reduce dose to BM subregions identified by {sup 18}F-fluorodeoxyglucose-PET/CT and IDEAL IQ. The efficacy of BM-sparing IMRT is being tested in a phase II trial.« less

18 F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis.

PubMed

Grayson, Peter C; Alehashemi, Sara; Bagheri, Armin A; Civelek, Ali Cahid; Cupps, Thomas R; Kaplan, Mariana J; Malayeri, Ashkan A; Merkel, Peter A; Novakovich, Elaine; Bluemke, David A; Ahlman, Mark A

2018-03-01

To assess the clinical value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large vessel vasculitis (LVV) and comparator subjects. Patients with Takayasu arteritis and giant cell arteritis were studied, along with a comparator group consisting of patients with hyperlipidemia, patients with diseases that mimic LVV, and healthy controls. Participants underwent clinical evaluation and FDG-PET imaging, and patients with LVV underwent serial imaging at 6-month intervals. We calculated sensitivity and specificity of FDG-PET interpretation for distinguishing patients with clinically active LVV from comparator subjects and from patients with disease in clinical remission. A qualitative summary score based on global arterial FDG uptake, the PET Vascular Activity Score (PETVAS), was used to study associations between activity on PET scan and clinical characteristics and to predict relapse. A total of 170 FDG-PET scans were performed in 115 participants (56 patients with LVV and 59 comparator subjects). FDG-PET distinguished patients with clinically active LVV from comparator subjects with a sensitivity of 85% (95% confidence interval [95% CI] 69, 94) and a specificity of 83% (95% CI 71, 91). FDG-PET scans were interpreted as active vasculitis in most patients with LVV in clinical remission (41 of 71 [58%]). Clinical disease activity status, disease duration, body mass index, and glucocorticoid use were independently associated with activity on PET scan. Among patients who underwent PET during clinical remission, future clinical relapse was more common in patients with a high PETVAS than in those with a low PETVAS (55% versus 11%; P = 0.03) over a median follow-up period of 15 months. FDG-PET provides information about vascular inflammation that is complementary to, and distinct from, clinical assessment in LVV. FDG-PET scan activity during clinical remission was associated with future clinical relapse. © 2017, American College of Rheumatology.

Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study.

PubMed

Prescott, Gordon; Sharp, Peter; Goatman, Keith; Scotland, Graham; Fleming, Alan; Philip, Sam; Staff, Roger; Santiago, Cynthia; Borooah, Shyamanga; Broadbent, Deborah; Chong, Victor; Dodson, Paul; Harding, Simon; Leese, Graham; Megaw, Roly; Styles, Caroline; Swa, Ken; Wharton, Helen; Olson, John

2014-08-01

Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30,000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Interchangeability and reliability of macular perfusion parameter measurements using optical coherence tomography angiography

PubMed Central

Dong, Jing; Jia, Ya-ding; Wu, Qiang; Zhang, Suhua; Jia, Yali; Huang, David; Wang, Xiaogang

2018-01-01

Aim The aim of the study was to investigate the interchangeability and reliability of macular perfusion measurements using optical coherence tomography angiography. Methods A prospective cross-sectional observational study. Healthy adult Chinese subjects were recruited. Macular perfusion parameters were automatically analysed by software included in a spectral-domain optical coherence tomography system. The vessel density (VD) of the whole, parafovea, superior-hemi, inferior-hemi, fovea, temporal, superior, nasal and inferior quadrants as well as the foveal avascular zone (FAZ) and choroidal capillary VD (CCVD) were quantified. Results A total of 51 eyes in 27 subjects were included (8 men and 19 women, mean age 24±4 years). Significant differences in VD of all quadrants (all p<0.001) was detected between the 3×3 mm and 6×6 mm macular scan size. The biggest difference of VD between the two scan size was 5.14±4.03, which was not clinically meaningful. No statistically significant differences were found in FAZ or CCVD between the two different scan sizes. The mean intraclass correlation coefficient (ICC) between two measurements from the inter-rater of 20 eyes was from 0.560 to 0.893 for VD and 0.845 for FAZ. The mean ICC between two measurements from the intrarater of 20 eyes was from 0.497 to 0.870 for VD and 0.780 for FAZ. Conclusions FAZ and CCVD are interchangeable between the 3×3 mm and 6×6 mm macular scan sizes. The VD differences between the two different scan sizes are not clinically meaningful. The macular perfusion parameters presented good but not perfect reliability, which should be acknowledged in clinical practice. PMID:28336674

Refining Coats' disease by ultra-widefield imaging and optical coherence tomography angiography.

PubMed

Rabiolo, Alessandro; Marchese, Alessandro; Sacconi, Riccardo; Cicinelli, Maria Vittoria; Grosso, Andrea; Querques, Lea; Querques, Giuseppe; Bandello, Francesco

2017-10-01

The purpose of our study was to describe ultra-widefield (UWF) imaging and optical coherence tomography angiography (OCT-A) findings in affected and fellow eyes of patients with Coats' disease. Consecutive patients affected by Coats' disease were prospectively recruited at the Department of Ophthalmology, San Raffaele Hospital, Milan, Italy in this cross-sectional, observational study. Patients underwent UWF color fundus photographs, UWF green autofluorescence, UWF fluorescein angiography (FA), optical coherence tomography (OCT), with 3 × 3 mm and 6 × 6 mm OCT-A scans of the macula. Images were qualitatively evaluated by two independent operators for the presence of pathology. Eleven patients affected by Coats' disease (eight males, mean age 17.1 ± 6.7 years). Nine and two patients had a clinical diagnosis of unilateral and bilateral disease, respectively. Five eyes had macular fibrosis. All clinically affected eyes exhibited retinal pathology at UWF imaging with the temporal sector most involved followed by the inferior, nasal, superior and macula. In all eyes with macular fibrosis, OCT-A revealed replacement of the foveal avascular zone with coarse vessels suggestive of vascularized fibrosis and flow void area in the choriocapillaris due to a masking effect; type 3 neovascularization was seen in 75% of cases. Seven out of nine clinically unaffected fellow eyes showed retinal pathology at UWF FA with the temporal quadrant most involved. We demonstrated that Coats' disease is a highly asymmetric bilateral disease and that UWF imaging is able to identify more retinal pathology than standard fundus imaging, thus guiding proper retinal photocoagulation. OCT-A allowed easy identification of type 3 neovascularization in a proportion of patients with macular fibrosis.

Does Optic Nerve Head Size Variation Affect Circumpapillary Retinal Nerve Fiber Layer Thickness Measurement by Optical Coherence Tomography?

PubMed Central

Huang, David; Chopra, Vikas; Lu, Ake Tzu-Hui; Tan, Ou; Francis, Brian; Varma, Rohit

2012-01-01

Purpose. To determine the relationship between retinal nerve fiber layer (RNFL) thickness, optic disc size, and image magnification. Methods. The cohort consisted of 196 normal eyes of 101 participants in the Advanced Imaging for Glaucoma Study (AIGS), a multicenter, prospective, longitudinal study to develop advanced imaging technologies for glaucoma diagnosis. Scanning laser tomography was used to measure disc size. Optical coherence tomography (OCT) was used to perform circumpapillary RNFL thickness measurements using the standard fixed 3.46-mm nominal scan diameter. A theoretical model of magnification effects was developed to relate RNFL thickness (overall average) with axial length and magnification. Results. Multivariate regression showed no significant correlation between RNFL thickness and optic disc area (95% confidence interval [CI] = −0.9 to 4.1 μm/mm2, P = 0.21). Linear regression showed that RNFL thickness depended significantly on axial length (slope = −3.1 μm/mm, 95% CI = −4.9 to −1.3, P = 0.001) and age (slope = −0.3 μm/y, 95% CI = −0.5 to −0.2, P = 0.0002). The slope values agreed closely with the values predicted by the magnification model. Conclusions. There is no significant association between RNFL thickness and optic disc area. Previous publications that showed such an association may have been biased by the effect of axial length on fundus image magnification and, therefore, both measured RNFL thickness and apparent disc area. The true diameter of the circumpapillary OCT scan is larger for a longer eye (more myopic eye), leading to a thinner RNFL measurement. Adjustment of measured RNFL thickness by axial length, in addition to age, may lead to a tighter normative range and improve the detection of RNFL thinning due to glaucoma. PMID:22743319

Diagnostic importance of contrast enhanced 18F-fluorodeoxyglucose positron emission computed tomography in patients with tumor induced osteomalacia: Our experience

PubMed Central

Jain, Avani S.; Shelley, Simon; Muthukrishnan, Indirani; Kalal, Shilpa; Amalachandran, Jaykanth; Chandran, Sureshkumar

2016-01-01

Aims and Objectives: To assess the diagnostic utility of contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-ceCT) in localization of tumors in patients with clinical diagnosis of tumor-induced osteomalacia (TIO), in correlation with histopathological results. Materials and Methods: Eight patients (five male and three female) aged 24–60 (mean 42) years with a clinical diagnosis of TIO were included in this prospective study. They underwent whole body (head to toe) FDG PET-ceCT following a standard protocol on Philips GEMINI TF PET-CT scanner. The FDG PET-ceCT results were correlated with postoperative histology findings and clinical follow-up. Results: All the patients had an abnormal PET-ceCT study. The sensitivity of PET-ceCT was 87.5%, and positive predictive value was 100%. The tumor was located in the craniofacial region in 6/8 patients and in bone in 2/8 patients. Hemangiopericytoma was the most common reported histology. All patients underwent surgery, following which they demonstrated clinical improvement. However, one patient with atypical findings on histology did not show any clinical improvement, hence, underwent 68Gallium-DOTANOC PET-ceCT scan for relocalization of the site of the tumor. Conclusion: The tumors causing TIO are small in size and usually located in obscure sites in the body. Hence, head to toe protocol should be followed for FDG PET-ceCT scans with the inclusion of upper limbs. Once the tumor is localized, regional magnetic resonance imaging can be performed for better characterization of soft tissue lesion. Imaging with FDG PET-ceCT plays an important role in detecting the site of the tumor and thereby facilitating timely management. PMID:26917888

Diagnostic importance of contrast enhanced (18)F-fluorodeoxyglucose positron emission computed tomography in patients with tumor induced osteomalacia: Our experience.

PubMed

Jain, Avani S; Shelley, Simon; Muthukrishnan, Indirani; Kalal, Shilpa; Amalachandran, Jaykanth; Chandran, Sureshkumar

2016-01-01

To assess the diagnostic utility of contrast-enhanced (18)F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-ceCT) in localization of tumors in patients with clinical diagnosis of tumor-induced osteomalacia (TIO), in correlation with histopathological results. Eight patients (five male and three female) aged 24-60 (mean 42) years with a clinical diagnosis of TIO were included in this prospective study. They underwent whole body (head to toe) FDG PET-ceCT following a standard protocol on Philips GEMINI TF PET-CT scanner. The FDG PET-ceCT results were correlated with postoperative histology findings and clinical follow-up. All the patients had an abnormal PET-ceCT study. The sensitivity of PET-ceCT was 87.5%, and positive predictive value was 100%. The tumor was located in the craniofacial region in 6/8 patients and in bone in 2/8 patients. Hemangiopericytoma was the most common reported histology. All patients underwent surgery, following which they demonstrated clinical improvement. However, one patient with atypical findings on histology did not show any clinical improvement, hence, underwent (68)Gallium-DOTANOC PET-ceCT scan for relocalization of the site of the tumor. The tumors causing TIO are small in size and usually located in obscure sites in the body. Hence, head to toe protocol should be followed for FDG PET-ceCT scans with the inclusion of upper limbs. Once the tumor is localized, regional magnetic resonance imaging can be performed for better characterization of soft tissue lesion. Imaging with FDG PET-ceCT plays an important role in detecting the site of the tumor and thereby facilitating timely management.

Future aspects of cellular and molecular research in clinical voice treatment aspects of optical coherence tomography

NASA Astrophysics Data System (ADS)

Pedersen, Mette; Mahmood, Sanila

2015-02-01

Focus is upon our clinical experience in a prospective cohort study on cure of dystonia where the mode of treatment was fexofenadine tablets and local budesonide inhaler in the larynx, and in a randomized controlled trial of lifestyle change related to acid provocation of food and habits in laryngopharyngeal reflux (LPR). The advanced high-speed films is one new tool, another being optical coherence tomography (OCT), which should be used in the future in randomized controlled trials. We are focusing on OCT of the swallowing process in the oesophagaus and larynx as well as the vocal fold function. It can be shown on OCT how the layer of the vocal folds develop, possibly corresponding to hormonal and paediatric development. The arytenoid area in the larynx should also be focused upon with OCT in pathology. The thyroid function is related to voice and the swallowing function, both hormonally and pathoanatomically. We know too little about voice and thyroid hormones in an updated way as well as the outer anatomic supporting muscular structure of the larynx, related to thyroid immune degeneration and cysts. Also, here OCT analyses might be of value.

Spatial smoothing coherence factor for ultrasound computed tomography

NASA Astrophysics Data System (ADS)

Lou, Cuijuan; Xu, Mengling; Ding, Mingyue; Yuchi, Ming

2016-04-01

In recent years, many research studies have been carried out on ultrasound computed tomography (USCT) for its application prospect in early diagnosis of breast cancer. This paper applies four kinds of coherence-factor-like beamforming methods to improve the image quality of synthetic aperture focusing method for USCT, including the coherence-factor (CF), the phase coherence factor (PCF), the sign coherence factor (SCF) and the spatial smoothing coherence factor (SSCF) (proposed in our previous work). The performance of these methods was tested with simulated raw data which were generated by the ultrasound simulation software PZFlex 2014. The simulated phantom was set to be water of 4cm diameter with three nylon objects of different diameters inside. The ring-type transducer had 72 elements with a center frequency of 1MHz. The results show that all the methods can reveal the biggest nylon circle with the radius of 2.5mm. SSCF gets the highest SNR among the proposed methods and provides a more homogenous background. None of these methods can reveal the two smaller nylon circles with the radius of 0.75mm and 0.25mm. This may be due to the small number of elements.

Preoperative computed tomography-guided percutaneous hookwire localization of metallic marker clips in the breast with a radial approach: initial experience.

PubMed

Uematsu, T; Kasami, M; Uchida, Y; Sanuki, J; Kimura, K; Tanaka, K; Takahashi, K

2007-06-01

Hookwire localization is the current standard technique for radiological marking of nonpalpable breast lesions. Stereotactic directional vacuum-assisted breast biopsy (SVAB) is of sufficient sensitivity and specificity to replace surgical biopsy. Wire localization for metallic marker clips placed after SVAB is needed. To describe a method for performing computed tomography (CT)-guided hookwire localization using a radial approach for metallic marker clips placed percutaneously after SVAB. Nineteen women scheduled for SVAB with marker-clip placement, CT-guided wire localization of marker clips, and, eventually, surgical excision were prospectively entered into the study. CT-guided wire localization was performed with a radial approach, followed by placement of a localizing marker-clip surgical excision. Feasibility and reliability of the procedure and the incidence of complications were examined. CT-guided wire localization surgical excision was successfully performed in all 19 women without any complications. The mean total procedure time was 15 min. The median distance on CT image from marker clip to hookwire was 2 mm (range 0-3 mm). CT-guided preoperative hookwire localization with a radial approach for marker clips after SVAB is technically feasible.

Serial computed tomography scanning in acute pancreatitis: a prospective study.

PubMed Central

London, N J; Neoptolemos, J P; Lavelle, J; Bailey, I; James, D

1989-01-01

One hundred and two patients with acute pancreatitis had abdominal computed tomography (CT) scans within 72 hours of admission, at one week and at six weeks. Twenty eight attacks were clinically severe, 74 clinically mild. Ninety three (91%) admission scans, 85 (84%) one week scans, and 52 (51%) six week scans were abnormal. The aetiology of the pancreatitis could be inferred from 28 (27%) of admission scans, the CT sign of fatty liver having a sensitivity of 21% and specificity of 100% for alcoholic aetiology. The sensitivity of CT for gall stone aetiology was 34%, specificity 100%. The pancreatic size indices (max anteroposterior measurement of head x max anteroposterior measurement of body) of those patients with severe attacks were significantly greater than those with mild attacks on admission, at one week and at six weeks (p less than 0.004). Fourteen pseudocysts were detected by CT, five (36%) of which were clinically apparent. The pseudocyst size indices (max anteroposterior x max transverse measurement) of the pseudocysts which were clinically apparent were significantly greater than those which were not apparent (p less than 0.01) and only those pseudocysts with a size index greater than or equal to 15 cm2 required treatment. PMID:2651228

Clinical results of computerized tomography-based simulation with laser patient marking.

PubMed

Ragan, D P; Forman, J D; He, T; Mesina, C F

1996-02-01

Accuracy of a patient treatment portal marking device and computerized tomography (CT) simulation have been clinically tested. A CT-based simulator has been assembled based on a commercial CT scanner. This includes visualization software and a computer-controlled laser drawing device. This laser drawing device is used to transfer the setup, central axis, and/or radiation portals from the CT simulator to the patient for appropriate patient skin marking. A protocol for clinical testing is reported. Twenty-five prospectively, sequentially accessioned patients have been analyzed. The simulation process can be completed in an average time of 62 min. Under many cases, the treatment portals can be designed and the patient marked in one session. Mechanical accuracy of the system was found to be within +/- 1mm. The portal projection accuracy in clinical cases is observed to be better than +/- 1.2 mm. Operating costs are equivalent to the conventional simulation process it replaces. Computed tomography simulation is a clinical accurate substitute for conventional simulation when used with an appropriate patient marking system and digitally reconstructed radiographs. Personnel time spent in CT simulation is equivalent to time in conventional simulation.

New Ways to Detect Pediatric Sickle Cell Retinopathy: A Comprehensive Review.

PubMed

Pahl, Daniel A; Green, Nancy S; Bhatia, Monica; Chen, Royce W S

2017-11-01

Sickle retinopathy reflects disease-related vascular injury of the eye, which can potentially result in visual loss from vitreous hemorrhage or retinal detachment. Here we review sickle retinopathy among children with sickle cell disease, describe the epidemiology, pediatric risk factors, pathophysiology, ocular findings, and treatment. Newer, more sensitive ophthalmological imaging modalities are available for retinal imaging, including ultra-widefield fluorescein angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography. Optical coherence tomography angiography provides a noninvasive view of retinal vascular layers that could previously not be imaged and can be quantified for comparative or prospective analyses. Ultra-widefield fluorescein angiography provides a more comprehensive view of the peripheral retina than traditional imaging techniques. Screening for retinopathy by standard fundoscopic imaging modalities detects a prevalence of approximately 10%. In contrast, these more sensitive methods allow for more sensitive examination that includes the retina perimeter where sickle retinopathy is often first detectable. Use of these new imaging modalities may detect a higher prevalence of early sickle pathology among children than has previously been reported. Earlier detection may help in better understanding the pathogenesis of sickle retinopathy and guide future screening and treatment paradigms.

Simultaneous whole body 18F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging for evaluation of pediatric cancer: Preliminary experience and comparison with 18F-fluorodeoxyglucose positron emission tomography computed tomography

PubMed Central

Pugmire, Brian S; Guimaraes, Alexander R; Lim, Ruth; Friedmann, Alison M; Huang, Mary; Ebb, David; Weinstein, Howard; Catalano, Onofrio A; Mahmood, Umar; Catana, Ciprian; Gee, Michael S

2016-01-01

AIM: To describe our preliminary experience with simultaneous whole body 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography and magnetic resonance imaging (PET-MRI) in the evaluation of pediatric oncology patients. METHODS: This prospective, observational, single-center study was Health Insurance Portability and Accountability Act-compliant, and institutional review board approved. To be eligible, a patient was required to: (1) have a known or suspected cancer diagnosis; (2) be under the care of a pediatric hematologist/oncologist; and (3) be scheduled for clinically indicated 18F-FDG positron emission tomography-computed tomography (PET-CT) examination at our institution. Patients underwent PET-CT followed by PET-MRI on the same day. PET-CT examinations were performed using standard department protocols. PET-MRI studies were acquired with an integrated 3 Tesla PET-MRI scanner using whole body T1 Dixon, T2 HASTE, EPI diffusion-weighted imaging (DWI) and STIR sequences. No additional radiotracer was given for the PET-MRI examination. Both PET-CT and PET-MRI examinations were reviewed by consensus by two study personnel. Test performance characteristics of PET-MRI, for the detection of malignant lesions, including FDG maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin), were calculated on a per lesion basis using PET-CT as a reference standard. RESULTS: A total of 10 whole body PET-MRI exams were performed in 7 pediatric oncology patients. The mean patient age was 16.1 years (range 12-19 years) including 6 males and 1 female. A total of 20 malignant and 21 benign lesions were identified on PET-CT. PET-MRI SUVmax had excellent correlation with PET-CT SUVmax for both benign and malignant lesions (R = 0.93). PET-MRI SUVmax > 2.5 had 100% accuracy for discriminating benign from malignant lesions using PET-CT reference. Whole body DWI was also evaluated: the mean ADCmin of malignant lesions (780.2 + 326.6) was significantly lower than that of benign lesions (1246.2 + 417.3; P = 0.0003; Student’s t test). A range of ADCmin thresholds for malignancy were evaluated, from 0.5-1.5 × 10-3 mm2/s. The 1.0 × 10-3 ADCmin threshold performed best compared with PET-CT reference (68.3% accuracy). However, the accuracy of PET-MRI SUVmax was significantly better than ADCmin for detecting malignant lesions compared with PET-CT reference (P < 0.0001; two-tailed McNemar’s test). CONCLUSION: These results suggest a clinical role for simultaneous whole body PET-MRI in evaluating pediatric cancer patients. PMID:27028112

Simultaneous whole body (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging for evaluation of pediatric cancer: Preliminary experience and comparison with (18)F-fluorodeoxyglucose positron emission tomography computed tomography.

PubMed

Pugmire, Brian S; Guimaraes, Alexander R; Lim, Ruth; Friedmann, Alison M; Huang, Mary; Ebb, David; Weinstein, Howard; Catalano, Onofrio A; Mahmood, Umar; Catana, Ciprian; Gee, Michael S

2016-03-28

To describe our preliminary experience with simultaneous whole body (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography and magnetic resonance imaging (PET-MRI) in the evaluation of pediatric oncology patients. This prospective, observational, single-center study was Health Insurance Portability and Accountability Act-compliant, and institutional review board approved. To be eligible, a patient was required to: (1) have a known or suspected cancer diagnosis; (2) be under the care of a pediatric hematologist/oncologist; and (3) be scheduled for clinically indicated (18)F-FDG positron emission tomography-computed tomography (PET-CT) examination at our institution. Patients underwent PET-CT followed by PET-MRI on the same day. PET-CT examinations were performed using standard department protocols. PET-MRI studies were acquired with an integrated 3 Tesla PET-MRI scanner using whole body T1 Dixon, T2 HASTE, EPI diffusion-weighted imaging (DWI) and STIR sequences. No additional radiotracer was given for the PET-MRI examination. Both PET-CT and PET-MRI examinations were reviewed by consensus by two study personnel. Test performance characteristics of PET-MRI, for the detection of malignant lesions, including FDG maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin), were calculated on a per lesion basis using PET-CT as a reference standard. A total of 10 whole body PET-MRI exams were performed in 7 pediatric oncology patients. The mean patient age was 16.1 years (range 12-19 years) including 6 males and 1 female. A total of 20 malignant and 21 benign lesions were identified on PET-CT. PET-MRI SUVmax had excellent correlation with PET-CT SUVmax for both benign and malignant lesions (R = 0.93). PET-MRI SUVmax > 2.5 had 100% accuracy for discriminating benign from malignant lesions using PET-CT reference. Whole body DWI was also evaluated: the mean ADCmin of malignant lesions (780.2 + 326.6) was significantly lower than that of benign lesions (1246.2 + 417.3; P = 0.0003; Student's t test). A range of ADCmin thresholds for malignancy were evaluated, from 0.5-1.5 × 10(-3) mm(2)/s. The 1.0 × 10(-3) ADCmin threshold performed best compared with PET-CT reference (68.3% accuracy). However, the accuracy of PET-MRI SUVmax was significantly better than ADCmin for detecting malignant lesions compared with PET-CT reference (P < 0.0001; two-tailed McNemar's test). These results suggest a clinical role for simultaneous whole body PET-MRI in evaluating pediatric cancer patients.

Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study.

PubMed

Groenendijk, E; Staas, T A; Graauwmans, F E J; Bronkhorst, E; Verhamme, L; Maal, T; Meijer, G J

2017-12-01

This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest. After application of the bone substitute, the buccal crest increased in thickness from 0.9mm to 2.4mm (mean). At a mean of 103 weeks after IIP, late postoperative CBCT scans showed that the thickness of the buccal crest was compacted to 1.8mm. In the same period, the height of the buccal crest increased by 1.6mm (mean) to, on average, 1.2mm above the implant shoulder. The aesthetic outcome was analysed using the White and Pink Esthetic Score (WES and PES). Both scored high: 8.4 and 11.8, respectively. Within the limitations of this study, the results of this IIP protocol are promising. Long-term prospective research on this topic on a large number of patients is necessary. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience

PubMed Central

Krishnan, Ullas Chandrika; Byanyima, Rosemary Kusaba; Faith, Ameda; Kamulegeya, Adriane

2017-01-01

Aim: The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital. Methods: CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries. Results: A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18–80) years and 18–27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03). Conclusions: Good matched case–control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures. PMID:29291177

Optical coherence tomography allows for the reliable identification of laryngeal epithelial dysplasia and for precise biopsy: a clinicopathological study of 61 patients undergoing microlaryngoscopy.

PubMed

Just, Tino; Lankenau, Eva; Prall, Friedrich; Hüttmann, Gereon; Pau, Hans Wilhelm; Sommer, Konrad

2010-10-01

A newly developed microscope-based spectral-domain optical coherence tomography (SD-OCT) device and an endoscope-based time-domain OCT (TD-OCT) were used to assess the inter-rater reliability, sensitivity, specificity, and accuracy of benign and dysplastic laryngeal epithelial lesions. Prospective study. OCT during microlaryngoscopy was done on 35 patients with an endoscope-based TD-OCT, and on 26 patients by an SD-OCT system integrated into an operating microscope. Biopsies were taken from microscopically suspicious lesions allowing comparative study of OCT images and histology. Thickness of the epithelium was seen to be the main criterion for degree of dysplasia. The inter-rater reliability for two observers was found to be kappa = 0.74 (P <.001) for OCT. OCT provided test outcomes for differentiation between benign laryngeal lesions and dysplasia/CIS with sensitivity of 88%, specificity of 89%, PPV of 85%, NPV of 91%, and predictive accuracy of 88%. However, because of the limited penetration depth of the laser light primarily in hyperkeratotic lesions (thickness above 1.5 mm), the basal cell layer was no longer visible, precluding reliable assessment of such lesions. OCT allows for a fairly accurate assessment of benign and dysplastic laryngeal epithelial lesion and greatly facilitates the taking of precise biopsies. Laryngoscope, 2010.

Optical Coherence Tomography Findings in Patients With Stent Thrombosis.

PubMed

Cuesta, Javier; Rivero, Fernando; Bastante, Teresa; García-Guimaraes, Marcos; Antuña, Paula; Alvarado, Teresa; Navarrete, Gonzalo; Benedicto, Amparo; Alfonso, Fernando

2017-12-01

Stent thrombosis (ST) is a rare but potentially serious complication. Optical coherence tomography (OCT) provides high-resolution images and additional information to angiography in the study of this event. Prospective study of patients with ST undergoing reintervention with OCT imaging. The study included a total of 40 consecutive patients with ST. Mean age was 69 ± 13 years and 83% were male. Early ST (≤ 30 days) was observed in 16 patients and late ST (> 30 days) in 24 patients. Stent thrombosis occurred in 17 bare-metal stents and 23 drug-eluting stents. In 34 patients (85%), adequate OCT images were obtained at the time of the ST. The predominant mechanism in early ST was stent malapposition (39%). In late ST, high frequencies of uncovered (46%) and malapposed struts (17%) were observed, especially in patients with drug-eluting stents. Furthermore, the presence of neoatherosclerosis was very high (67%) in patients with late ST. After intervention, improvements were observed in malapposition length and the amount of residual thrombus. OCT allows identification of the underlying mechanisms potentially involved in ST. This imaging modality is helpful in guiding reintervention in these patients, which improves the area and length of malapposition, as well as the maximal residual thrombus area. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study

PubMed Central

Cirla, A.; Rondena, M.; Bertolini, G.

2016-01-01

The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single centre. A complete ophthalmic examination was always followed by orbital ultrasound and computed tomography (CT) examination of the head. All masses were sampled with the patient still on the CT table using ultrasound (US) guided automatic tru-cut device. The most suitable sampling approach to the orbit was chosen each time based on the CT image analysis. One of the following different approaches was used: trans-orbital, trans-conjunctival or trans-masseteric. In all cases, the imaging-guided biopsy provided a sufficient amount of tissue for the histopathological diagnosis, which concurred with the biopsies obtained using the excisional technique. CT examination was essential for morphological diagnosis and provided detailed topographic information that allowed us to choose the safest orbital approach for the biopsy. US guided automatic tru-cut biopsy based on CT images, performed with patient still on the CT table, resulted in a minimally invasive, relatively easy, and accurate diagnostic procedure in dogs with orbital masses. PMID:27540512

Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study.

PubMed

Sabbagh, C; Dumont, F; Fuks, D; Yzet, T; Verhaeghe, P; Regimbeau, J-M

2012-02-01

Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function. From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated. Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P  < 0.01), and the mean VAC was 9,083 cc and 11,104 cc (P < 0.01). The VAC increased by 2,021 cc (P < 0.01) and was greater than the mean VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%. PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.

Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study.

PubMed

Cirla, A; Rondena, M; Bertolini, G

2016-01-01

The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single centre. A complete ophthalmic examination was always followed by orbital ultrasound and computed tomography (CT) examination of the head. All masses were sampled with the patient still on the CT table using ultrasound (US) guided automatic tru-cut device. The most suitable sampling approach to the orbit was chosen each time based on the CT image analysis. One of the following different approaches was used: trans-orbital, trans-conjunctival or trans-masseteric. In all cases, the imaging-guided biopsy provided a sufficient amount of tissue for the histopathological diagnosis, which concurred with the biopsies obtained using the excisional technique. CT examination was essential for morphological diagnosis and provided detailed topographic information that allowed us to choose the safest orbital approach for the biopsy. US guided automatic tru-cut biopsy based on CT images, performed with patient still on the CT table, resulted in a minimally invasive, relatively easy, and accurate diagnostic procedure in dogs with orbital masses.

New method of a "point-like" neutron source creation based on sharp focusing of high-current deuteron beam onto deuterium-saturated target for neutron tomography

NASA Astrophysics Data System (ADS)

Golubev, S.; Skalyga, V.; Izotov, I.; Sidorov, A.

2017-02-01

A possibility of a compact powerful point-like neutron source creation is discussed. Neutron yield of the source based on deuterium-deuterium (D-D) reaction is estimated at the level of 1011 s-1 (1013 s-1 for deuterium-tritium reaction). The fusion takes place due to bombardment of deuterium- (or tritium) loaded target by high-current focused deuterium ion beam with energy of 100 keV. The ion beam is formed by means of high-current quasi-gasdynamic ion source of a new generation based on an electron cyclotron resonance (ECR) discharge in an open magnetic trap sustained by powerful microwave radiation. The prospects of proposed generator for neutron tomography are discussed. Suggested method is compared to the point-like neutron sources based on a spark produced by powerful femtosecond laser pulses.

Optical computed tomography in PRESAGE® three-dimensional dosimetry: Challenges and prospective.

PubMed

Khezerloo, Davood; Nedaie, Hassan Ali; Farhood, Bagher; Zirak, Alireza; Takavar, Abbas; Banaee, Nooshin; Ahmadalidokht, Isa; Kron, Tomas

2017-01-01

With the advent of new complex but precise radiotherapy techniques, the demands for an accurate, feasible three-dimensional (3D) dosimetry system have been increased. A 3D dosimeter system generally should not only have accurate and precise results but should also feasible, inexpensive, and time consuming. Recently, one of the new candidates for 3D dosimetry is optical computed tomography (CT) with a radiochromic dosimeter such as PRESAGE®. Several generations of optical CT have been developed since the 90s. At the same time, a large attempt has been also done to introduce the robust dosimeters that compatible with optical CT scanners. In 2004, PRESAGE® dosimeter as a new radiochromic solid plastic dosimeters was introduced. In this decade, a large number of efforts have been carried out to enhance optical scanning methods. This article attempts to review and reflect on the results of these investigations.

Is Acute Myeloid Leukemia a Liquid Tumor?

PubMed Central

Ohanian, Maro; Faderl, Stefan; Ravandi, Farhad; Pemmaraju, Naveen; Garcia-Manero, Guillermo; Cortes, Jorge; Estrov, Zeev

2014-01-01

Extramedullary manifestations of acute myeloid leukemia (AML) were described as early as the 19th century. However, the incidence, clinical significance, and pathobiology of extramedullary AML remain ill defined. We reviewed case reports, retrospective case series, pilot studies, and imaging studies of extramedullary leukemia (EML) to determine its frequency, characteristics, clinical presentation, and significance. EML precedes or accompanies development of AML and occurs during or following treatment, even during remission. Although imaging studies are rarely conducted and the true incidence of EML has yet to be verified, authors have reported several estimates based on retrospective and autopsy studies. The incidence of EML in patients with AML of all ages is estimated to be about 9% and EML in children with AML was detected in 40% of patients at diagnosis. The combination of positron emission tomography and computed tomography were the most sensitive and reliable techniques of detecting and monitoring EML. Based on our literature review, the frequency of EML is likely underreported. The well-documented nature of EML in AML patients suggests that AML can manifest as a solid tumor. The extent to which EML accompanies AML and whether EML is derived from bone marrow are unknown. Furthermore, questions remain regarding the role of the microenvironment, which may or may not facilitate the survival and proliferation of EML, and the implications of these interactions with regard to minimal residual disease, tumor cell quiescence, and relapse. Therefore, prospective studies of detection and characterization of EML in AML patients are warranted. PMID:23280377

Is acute myeloid leukemia a liquid tumor?

PubMed

Ohanian, Maro; Faderl, Stefan; Ravandi, Farhad; Pemmaraju, Naveen; Garcia-Manero, Guillermo; Cortes, Jorge; Estrov, Zeev

2013-08-01

Extramedullary manifestations of acute myeloid leukemia (AML) were described as early as the 19th century. However, the incidence, clinical significance and pathobiology of extramedullary AML remain ill defined. We reviewed case reports, retrospective case series, pilot studies and imaging studies of extramedullary leukemia (EML) to determine its frequency, characteristics, clinical presentation and significance. EML precedes or accompanies development of AML and occurs during or following treatment, even during remission. Although imaging studies are rarely conducted and the true incidence of EML has yet to be verified, authors have reported several estimates based on retrospective and autopsy studies. The incidence of EML in patients with AML of all ages is estimated to be about 9% and EML in children with AML was detected in 40% of patients at diagnosis. The combination of positron emission tomography and computed tomography were the most sensitive and reliable techniques of detecting and monitoring EML. Based on our literature review, the frequency of EML is likely underreported. The well-documented nature of EML in patients with AML suggests that AML can manifest as a solid tumor. The extent to which EML accompanies AML and whether EML is derived from bone marrow are unknown. Furthermore, questions remain regarding the role of the microenvironment, which may or may not facilitate the survival and proliferation of EML, and the implications of these interactions with regard to minimal residual disease, tumor cell quiescence and relapse. Therefore, prospective studies of detection and characterization of EML in patients with AML are warranted. Copyright © 2013 UICC.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williamson, Casey W.; Green, Garrett; Noticewala, Sonal S.

Purpose: Validated models are needed to justify strategies to define planning target volumes (PTVs) for intact cervical cancer used in clinical practice. Our objective was to independently validate a previously published shape model, using data collected prospectively from clinical trials. Methods and Materials: We analyzed 42 patients with intact cervical cancer treated with daily fractionated pelvic intensity modulated radiation therapy and concurrent chemotherapy in one of 2 prospective clinical trials. We collected online cone beam computed tomography (CBCT) scans before each fraction. Clinical target volume (CTV) structures from the planning computed tomography scan were cast onto each CBCT scan aftermore » rigid registration and manually redrawn to account for organ motion and deformation. We applied the 95% isodose cloud from the planning computed tomography scan to each CBCT scan and computed any CTV outside the 95% isodose cloud. The primary aim was to determine the proportion of CTVs that were encompassed within the 95% isodose volume. A 1-sample t test was used to test the hypothesis that the probability of complete coverage was different from 95%. We used mixed-effects logistic regression to assess effects of time and patient variability. Results: The 95% isodose line completely encompassed 92.3% of all CTVs (95% confidence interval, 88.3%-96.4%), not significantly different from the 95% probability anticipated a priori (P=.19). The overall proportion of missed CTVs was small: the grand mean of covered CTVs was 99.9%, and 95.2% of misses were located in the anterior body of the uterus. Time did not affect coverage probability (P=.71). Conclusions: With the clinical implementation of a previously proposed PTV definition strategy based on a shape model for intact cervical cancer, the probability of CTV coverage was high and the volume of CTV missed was low. This PTV expansion strategy is acceptable for clinical trials and practice; however, we recommend daily image guidance to avoid systematic large misses in select patients.« less

RF Tomography for Tunnel Detection: Principles and Inversion Schemes

NASA Astrophysics Data System (ADS)

Lo Monte, L.; Erricolo, D.; Inan, U. S.; Wicks, M. C.

2008-12-01

We propose a novel way to detect underground tunnels based on classical seismic tomography, Ground Penetrating Radar (GPR), inverse scattering principles, and the deployment of distributed sensors, which we call "Distributed RF Tomography". Tunnel detection has been a critical problem that cannot be considered fully solved. Presently, tunnel detection is performed by methods that include seismic sensors, electrical impedance, microgravity, boreholes, and GPR. All of these methods have drawbacks that make them not applicable for use in unfriendly environments, such as battlefields. Specifically, they do not cover wide surface areas, they are generally shallow, they are limited to vertical prospecting, and require the user to be in situ, which may jeopardize one's safety. Additional application of the proposed distributed RF tomography include monitoring sensitive areas, (e.g. banks, power plants, military bases, prisons, national borders) and civil applications (e.g. environmental engineering, mine safety, search and rescue, speleology, archaeology and geophysics). The novelty of a Distributed RF tomography system consists of the following. 1) Sensors are scattered randomly above the ground, thus saving time and money compared to the use of boreholes. 2) The use of lower operating frequency (around HF), which allows for deeper penetration. 3) The use of CW diffraction tomography, which increases the resolution to sub-wavelength values, independently from the sensor displacement, and increases the SNR. 4) Use of linear inversion schemes that are suited for tunnel detection. 5) The use of modulation schemes and signal processing algorithms to mitigate interferences and noise. This presentation will cover: 1. Current physical limits of existing techniques for tunnel detection. 2. Concept of Distributed RF Tomography. 3. Inversion theories and strategies a. Proper forward model for voids buried into an homogeneous medium b. Extended matched filtering inversion c. Near field formulation : Dyadic representation d. Fourier approach: principles and techniques aimed at improving the reconstructed image. e. Theoretical Limits f. Super-Resolution : Singular Values Decomposition and MUSIC 4. Propagation Model and theoretical limitations. 5. Transmitting and Receiving design, with signal processing and modulation. 6. Numerical Simulations using FDTD tools.

Systolic hypertension and progression of aortic valve calcification in patients with aortic stenosis: results from the PROGRESSA study

PubMed Central

Tastet, Lionel; Capoulade, Romain; Clavel, Marie-Annick; Larose, Éric; Shen, Mylène; Dahou, Abdellaziz; Arsenault, Marie; Mathieu, Patrick; Bédard, Élisabeth; Dumesnil, Jean G.; Tremblay, Alexe; Bossé, Yohan; Després, Jean-Pierre; Pibarot, Philippe

2017-01-01

Aims Hypertension is highly prevalent in patients with aortic stenosis (AS) and is associated with worse outcomes. The current prospective study assessed the impact of systolic hypertension (SHPT) on the progression of aortic valve calcification (AVC) measured by multidetector computed tomography (MDCT) in patients with AS. Methods and results The present analysis includes the first series of 101 patients with AS prospectively recruited in the PROGRESSA study. Patients underwent comprehensive Doppler echocardiography and MDCT exams at baseline and after 2-year follow-up. AVC and coronary artery calcification (CAC) were measured using the Agatston method. Patients with SHPT at baseline (i.e. systolic blood pressure ≥140 mmHg; n = 37, 37%) had faster 2-year AVC progression compared with those without SHPT (i.e. systolic blood pressure <140 mmHg) (AVC median [25th percentile–75th percentile]: +370 [126–824] vs. +157 [58–303] AU; P = 0.007, respectively). Similar results were obtained with the analysis of AVC progression divided by the cross-sectional area of the aortic annulus (AVCdensity: +96 [34–218] vs. +45 [14–82] AU/cm2, P = 0.01, respectively). In multivariable analysis, SHPT remained significantly associated with faster progression of AVC or AVCdensity (all P = 0.001). There was no significant difference between groups with respect to progression of CAC (+39 [3–199] vs. +41 [0–156] AU, P = 0.88). Conclusion This prospective study shows for the first time that SHPT is associated with faster AVC progression but not with CAC progression in AS patients. These findings provide further support for the elaboration of randomized clinical trials to assess the efficacy of antihypertensive medication to slow the stenosis progression in patients with AS. PMID:26896413

Washington State Play Fairway Analysis - Passive Monitoring of St. Helens Shear Zone for Tomography and Precision Microseismic Event Detection

DOE Data Explorer

Swyer, Michael (ORCID:0000000309776975); Cladouhos, Trenton; Crosbie, Kayla; Ulberg, Carl (ORCID:000000016198809X)

2017-10-03

Data resources were derived from a passive seismic survey of the northern St. Helens Shear Zone on geothermal leases 12-24 km north of Mount St. Helens for phase 2 of the Geothermal Play-Fairway Analysis of Washington State Prospects. A 20 seismic station array of broadband seismometers was deployed with irregular spacing (1-4 km) over an area of 12 km to image seismogenic features and their damage zones in the shallow crust.

A New Volumetric Radiologic Method to Assess Indirect Decompression After Extreme Lateral Interbody Fusion Using High-Resolution Intraoperative Computed Tomography.

PubMed

Navarro-Ramirez, Rodrigo; Berlin, Connor; Lang, Gernot; Hussain, Ibrahim; Janssen, Insa; Sloan, Stephen; Askin, Gulce; Avila, Mauricio J; Zubkov, Micaella; Härtl, Roger

2018-01-01

Two-dimensional radiographic methods have been proposed to evaluate the radiographic outcome after indirect decompression through extreme lateral interbody fusion (XLIF). However, the assessment of neural decompression in a single plane may underestimate the effect of indirect decompression on central canal and foraminal volumes. The present study aimed to assess the reliability and consistency of a novel 3-dimensional radiographic method that assesses neural decompression by volumetric analysis using a new generation of intraoperative fan-beam computed tomography scanner in patients undergoing XLIF. Prospectively collected data from 7 patients (9 levels) undergoing XLIF was retrospectively analyzed. Three independent, blind raters using imaging analysis software performed volumetric measurements pre- and postoperatively to determine central canal and foraminal volumes. Intrarater and Interrater reliability tests were performed to assess the reliability of this novel volumetric method. The interrater reliability between the three raters ranged from 0.800 to 0.952, P < 0.0001. The test-retest analysis on a randomly selected subset of three patients showed good to excellent internal reliability (range of 0.78-1.00) for all 3 raters. There was a significant increase in mean volume ≈20% for right foramen, left foramen, and central canal volumes postoperatively (P = 0.0472; P = 0.0066; P = 0.0003, respectively). Here we demonstrate a new volumetric analysis technique that is feasible, reliable, and reproducible amongst independent raters for central canal and foraminal volumes in the lumbar spine using an intraoperative computed tomography scanner. Copyright © 2017. Published by Elsevier Inc.

Assessment of aortic valve calcium load by multidetector computed tomography. Anatomical validation, impact of scanner settings and incremental diagnostic value.

PubMed

Boulif, Jamila; Gerber, Bernhard; Slimani, Alisson; Lazam, Siham; de Meester, Christophe; Piérard, Sophie; Pasquet, Agnès; Pouleur, Anne-Catherine; Vancraeynest, David; El Khoury, Gébrine; de Kerchove, Laurent; Noirhomme, Philippe; Vanoverschelde, Jean-Louis

To validate aortic valve calcium (AVC) load measurements by multidetector row computed tomography (MDCT), to evaluate the impact of tube potential and slice thickness on AVC scores, to examine the accuracy of AVC load in distinguishing severe from nonsevere aortic stenosis (AS) and to investigate its effectiveness as an alternative diagnosis method when echocardiography remains inconclusive. We prospectively studied 266 consecutive patients with moderate to severe AS who underwent MDCT to measure AVC load and a comprehensive echocardiographic examination to assess AS severity. AVC load was validated against valve weight in 57 patients undergoing aortic valve replacement. The dependence of AVC scores on tube potential and slice thickness was also tested, as well as the relationship between AVC load and echocardiographic criteria of AS severity. MDCT Agatston score correlated well with valve weight (r = 0.82, p < 0.001) and hemodynamic indices of AS severity (all p < 0.001). Ex-vivo Agatston scores decreased significantly with increasing tube potential and slice thickness (repeated measures ANOVA p < 0.001). Multivariate analysis identified mean gradient, the indexed effective orifice area, male gender and left ventricular outflow tract cross-sectional area as independent correlates of the in-vivo AVC load. MDCT-derived AVC load correlated well with valve weight and hemodynamic indices of AS severity. It also depends on tube potential and slice thickness, thus suggesting that these parameters should be standardized to optimize reproducibility and accuracy. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Tumor Response and Survival Predicted by Post-Therapy FDG-PET/CT in Anal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwarz, Julie K.; Siegel, Barry A.; Dehdashti, Farrokh

2008-05-01

Purpose: To evaluate the response to therapy for anal carcinoma using post-therapy imaging with positron emission tomography (PET)/computed tomography and F-18 fluorodeoxyglucose (FDG) and to compare the metabolic response with patient outcome. Patients and Methods: This was a prospective cohort study of 53 consecutive patients with anal cancer. All patients underwent pre- and post-treatment whole-body FDG-PET/computed tomography. Patients had been treated with external beam radiotherapy and concurrent chemotherapy. Whole-body FDG-PET was performed 0.9-5.4 months (mean, 2.1) after therapy completion. Results: The post-therapy PET scan did not show any abnormal FDG uptake (complete metabolic response) in 44 patients. Persistent abnormal FDGmore » uptake (partial metabolic response) was found in the anal tumor in 9 patients. The 2-year cause-specific survival rate was 94% for patients with a complete vs. 39% for patients with a partial metabolic response in the anal tumor (p = 0.0008). The 2-year progression-free survival rate was 95% for patients with a complete vs. 22% for patients with a partial metabolic response in the anal tumor (p < 0.0001). A Cox proportional hazards model of survival outcome indicated that a complete metabolic response was the most significant predictor of progression-free survival in our patient population (p = 0.0003). Conclusions: A partial metabolic response in the anal tumor as determined by post-therapy FDG-PET is predictive of significantly decreased progression-free and cause-specific survival after chemoradiotherapy for anal cancer.« less

Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists.

PubMed

Shakespeare, Thomas P

2015-11-18

Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist's clinical practice. Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8%) or post-prostatectomy (33.3%) radiotherapy, and investigation of PSA failures following definitive (16.7%) or post-prostatectomy (33.3%) radiotherapy. In 46.3% of patients PSMA was positive after negative traditional imaging, in 9.3% PSMA was positive after equivocal imaging, and in 13.0% PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3% of cases, and hormone therapy in 33.3% of patients, with an overall change in decision-making in 53.7% of patients. PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future.

Use of multidetector computed tomography in the assessment of dogs with pericardial effusion.

PubMed

Scollan, K F; Bottorff, B; Stieger-Vanegas, S; Nemanic, S; Sisson, D

2015-01-01

Contrast-enhanced multidetector computed tomography (MDCT) allows high spatial and temporal resolution imaging of cardiac, thoracic, and abdominal structures. Accurate determination of the cause of pericardial effusion (PE) is essential to providing appropriate treatment and prognosis. Echocardiography and pericardial fluid analysis may not differentiate between causes of PE and cannot identify extracardiac metastasis. Describe the thoracic and abdominal MDCT findings and evaluate the utility of MDCT to differentiate between neoplastic and nonneoplastic causes of PE in dogs. Eleven client-owned dogs with PE diagnosed by echocardiography. Prospective observational study. Transthoracic echocardiography (TTE), 3-view thoracic radiography, and contrast-enhanced thoracic and abdominal MDCT images were evaluated for the presence of cardiac masses, pulmonary metastases, and abdominal masses. Histopathology in 5 dogs and survival analysis in all dogs were evaluated. A neoplastic cause was identified in 6/11 dogs and a nonneoplastic cause was identified in 5/11. Cardiac MDCT findings were consistent with TTE findings in all dogs with right atrial (5/5) and heart base masses (1/1). Pulmonary metastases were identified in 1/11 dogs by thoracic radiography and in 2/11 dogs by MDCT. MDCT identified splenic or hepatic lesions consistent with neoplasia in 6/11 and 5/11 dogs, respectively. Focal MDCT pericardial changes at the pericardiocentesis site were noted in 3/11 dogs. Multidetector computed tomography did not improve the detection of cardiac masses in dogs with PE over echocardiography. The benefit of MDCT was primarily in the detection of pulmonary metastases and extracardiac lesions using a single imaging modality. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography.

PubMed

Torricelli, Fabio C M; Marchini, Giovanni S; Yamauchi, Fernando I; Danilovic, Alexandre; Vicentini, Fabio C; Srougi, Miguel; Monga, Manoj; Mazzucchi, Eduardo

2015-06-01

We evaluated which variables impact fragmentation and clearance of lower pole calculi after shock wave lithotripsy. We prospectively evaluated patients undergoing shock wave lithotripsy for a solitary 5 to 20 mm lower pole kidney stone between June 2012 and August 2014. Patient body mass index and abdominal waist circumference were recorded. One radiologist blinded to shock wave lithotripsy outcomes measured stone size, area and density, stone-to-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computerized tomography. Fragmentation, success (defined as residual fragments less than 4 mm in asymptomatic patients) and the stone-free rate were evaluated by noncontrast computerized tomography 12 weeks postoperatively. Univariate and multivariate analysis was performed. A total of 100 patients were enrolled in the study. Mean stone size was 9.1 mm. Overall fragmentation, success and stone-free rates were 76%, 54% and 37%, respectively. On logistic regression body mass index (OR 1.27, 95% CI 1.11-1.49, p = 0.004) and stone density (OR 1.0026, 95% CI 1.0008-1.0046, p = 0.005) significantly impacted fragmentation. Stone size (OR 1.24, 95% CI 1.07-1.48, p = 0.039) and stone density (OR 1.0021, 95% CI 1.0007-1.0037, p = 0.012) impacted the success rate while stone size (OR 1.24, 95% CI 1.04-1.50, p = 0.029), stone density (OR 1.0015, 95% CI 1.0001-1.0032, p = 0.046) and infundibular length (OR 1.1035, 95% CI 1.015-1.217, p = 0.015) impacted the stone-free rate. The best outcomes were found in patients with a body mass index of 30 kg/m(2) or less, stones 10 mm or less and 900 HU or less, and an infundibular length of 25 mm or less. The coexistence of significant unfavorable variables led to a stone-free rate of less than 20%. Obese patients with higher than 10 mm density stones (greater than 900 HU) in the lower pole of the kidney with an infundibular length of greater than 25 mm should be discouraged from undergoing shock wave lithotripsy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ceriani, Luca, E-mail: luca.ceriani@eoc.ch; Martelli, Maurizio; Gospodarowicz, Maria K.

Purpose: To assess the predictive value of {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma. Methods and Materials: Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined bymore » a Deauville score (DS) ≤3. Results: The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence. Conclusions: All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual {sup 18}F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.« less

Prospective evaluation of changes in computed cranial tomography in patients with small cell lung carcinoma treated with chemotherapy and prophylactic cranial irradiation.

PubMed

Craig, J B; Jackson, D V; Moody, D; Cruz, J M; Pope, E K; Powell, B L; Spurr, C L; Capizzi, R L

1984-10-01

Computed cranial tomographic scans were performed as part of the pretreatment evaluation and at six- to nine-month intervals posttreatment in 13 patients with small cell lung carcinoma. All patients received 3,000 rad of prophylactic cranial irradiation delivered over two weeks in ten treatment fractions in conjunction with multiagent chemotherapy. Posttreatment scans documented an extraordinarily high frequency of abnormalities including cerebral atrophy (100%), ventricular dilatation (70%), and decreased coefficient of absorption in the white matter (15%). Unexplained neurologic abnormalities developed in four of six patients living at least 15 months after institution of therapy. As the number of long-term survivors of this type of lung cancer increases, the need for prospective comprehensive neuropsychologic assessment to determine the clinical significance of these changes is needed.

Geophysical and geomorphological investigations of a Quaternary karstic paleolake and its underground marine connection in Cassis (Bestouan, Cassis, SE France)

NASA Astrophysics Data System (ADS)

Romey, Carole; Rochette, Pierre; Vella, Claude; Arfib, Bruno; Andrieu-Ponel, Valérie; Braucher, Régis; Champollion, Cédric; Douchet, Marc; Dussouillez, Philippe; Hermitte, Daniel; Mattioli, Emanuela; Parisot, Jean-Claude; Schwenninger, Jean-Luc

2014-06-01

An original karstic system in a coastal alluvial plain located in a carbonate environment (Cassis, Provence - SE France) was studied using a multi-method approach (electrical resistivity tomography, gravimetric, passive seismic survey), combined with geomorphologic methods, surface observations and drilling. Limestone dissolution and/or cavity collapse led to the development of a polje, which was filled rapidly by erosion of Aptian marls. The combination of several dating and paleoenvironmental proxies indicates that the polje was filled during a glacial period (MIS 6, 8 or 10, i.e. in the 130-360 ka age range). This discovery has implications for the understanding of karst processes. The connection between the polje and the three km-long Bestouan underwater karstic conduit with submarine outlet is strongly suggested by sedimentological studies and geophysical prospections.

Prospects for DVCS measurements using the COMPASS spectrometer at CERN

NASA Astrophysics Data System (ADS)

Kouznetsov, O.

2011-07-01

The study of exclusive reactions like Deeply Virtual Compton Scattering (DVCS) and Deeply Virtual Meson Production (DVMP) is one major part of the future COMPASS program to investigate nucleon structure through Generalized Parton Distributions (GPD). The high energy of the muon beam allows to measure the xBj-dependence of the t-slope of the DVCS cross section and to study nucleon tomography. The use of positive and negative polarized muon beams allows to determine the Beam Charge and Spin Difference of the DVCS cross sections to access the real part of the Compton form factor related to the dominant GPD H. As a second phase a transversely polarized proton target will be used to collect data to constrain the GPD E. In preparation of the future measurements two DVCS test runs were performed in 2008 and 2009.

Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

PubMed Central

Dhasmana, Renu; Nagpal, Ramesh Chander

2016-01-01

Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus height on slit lamp and Optical coherence based tear meniscus area were similar in both sexes (p=0.5 and p=0.1). However, tear meniscus height on optical coherence tomography was significantly higher in females (p=0.04). Value of Schirmer’s and tear film break up time (r =0.2; p= 0.001) and Schirmer’s and tear meniscus height on slit lamp (r=0.6; p<0.001) had positive correlation. Tear meniscus height and tear meniscus area on optical coherence tomography had positive correlation (r =.9; p<0.001). Conclusion On optical coherence tomography tear meniscus height and area significantly correlated. Despite higher values of Schirmer’s, tear film break up time, Slit lamp based tear meniscus height in younger age group the tear meniscus height and tear meniscus area with optical coherence tomography were lower. PMID:27437253

Initial experience with gamma knife surgery for endocrine ophthalmopathy.

PubMed

Antico, Julio C; Crovetto, Luis; Tenca, Eduardo; Artes, Carlos

2005-01-01

The aim of this study was to evaluate both the effectiveness and safety of the treatment of endocrine ophthalmopathy with gamma knife surgery (GKS). Five patients were included in a prospective study designed to assess the results of GKS of endocrine ophthalmopathy secondary to Graves disease. All the patients completed a 2-year follow-up period. During this period, the patients were evaluated both clinically and by means of additional methods, including computerized tomography and magnetic resonance imaging studies. The minimum dose delivered to the 50% isodose line was 6.5 Gy in all the patients. In all cases, a clinical improvement was observed. The best effect was seen in symptom regression related to soft-tissue involvement. No treatment-related side effects were detected. In light of the results obtained the authors consider that GKS may be a safe and effective way to treat endocrine ophthalmopathy.

A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas.

PubMed

Grover, Amelia C; Skarulis, Monica; Alexander, H Richard; Pingpank, James F; Javor, Edward D; Chang, Richard; Shawker, Thomas; Gorden, Phil; Cochran, Craig; Libutti, Steven K

2005-12-01

Preoperative imaging studies localize insulinomas in less than 50% of patients. Arteriography with calcium stimulation and venous sampling (ASVS) regionalizes greater than 90% of insulinomas but requires specialized expertise and an invasive procedure. This prospective study evaluated laparoscopic exploration with IOUS compared with the other localization procedures in patients with a sporadic insulinoma. Between March 2001 and October 2004, 14 patients (7 women and 7 men; mean age, 53) with an insulinoma were enrolled in an IRB-approved protocol. Computed tomography, magnetic resonance imaging, ultrasound scan, and arteriography with calcium stimulation and venous sampling were performed preoperatively. A surgeon, blinded to the results of the localizing studies, performed a laparoscopic exploration with intraoperative ultrasound (IOUS). At the completion of the exploration, the success of laparoscopy for localization was scored, and the tumor was resected. Twelve of 14 tumors were localized successfully before laparoscopy (noninvasive, 7 of 14; invasive, 11 of 14). Laparoscopic IOUS localized successfully 12 of 14 tumors. All lesions were resected, and all patients were cured (median follow-up, 36 months). Laparoscopic IOUS identified 86% of tumors. The authors consider laparoscopic IOUS to be equivalent to ASVS in localizing insulinomas. Further study is therefore warranted to determine the role of laparoscopy with IOUS in the localization and treatment algorithm for patients with sporadic insulinoma.

Tranexamic Acid for Treatment of Residual Subdural Hematoma After Bedside Twist-Drill Evacuation.

PubMed

Tanweer, Omar; Frisoli, Fabio A; Bravate, Crystal; Harrison, Gillian; Pacione, Donato; Kondziolka, Douglas; Huang, Paul P

2016-07-01

Management of nonemergent, nonacute subdural hematomas (SDHs) ranges from observation to burr-hole evacuation or craniotomy, but recurrence rates are high. We evaluated the safety and efficacy of tranexamic acid (TXA) for the treatment of residual SDHs after bedside twist-drill evacuation. We performed a retrospective analysis of a prospectively maintained database from November 2013 to November 2014 for all patients who underwent placement of a bedside subdural evacuating port system (SEPS) followed by treatment with oral TXA (650 mg daily). All demographics, evidence of venous thromboembolism, and volumes of pertinent computed tomography were obtained. Twenty subdural hematomas in 14 patients met the inclusion criteria for this study. Most SDHs were mixed density. Mean SDH volume on presentation was 145.96 ± 40.22 cm(3) with a mean midline shift of 9.44 ± 4.84 mm. Mean volumes decreased to 80.00 ± 31.96 cm(3) and midline shift improved to 4.44 ± 3.29 mm after SEPS placement (P < 0.0001 and P = 0.0046). All patients were placed on TXA after their procedure. Mean follow-up with computed tomography was 92.1 ± 27.5 days, and mean SDH volume at last follow-up was 7.41 ± 15.54 cm(3) with a mean midline shift of 0.19 ± 0.69 mm (P < 0.0001 and P = 0.0002). Percent volume reduction was significantly higher after TXA than after SEPS (91.31% vs. 40.74%; P < 0.0001). No increase or delayed recurrence of the SDH was noted during TXA treatment. All but 1 clinical presenting symptom improved at follow-up. No venous thromboembolisms were noted among the patients. In our pilot study, chronic SDH volumes were reduced by 40.74% after SEPS drainage. The residual volume was reduced by an additional 91.31% during oral TXA treatment. No patients developed delayed recurrence or expansion of their SDHs. Further prospective studies are needed to evaluate the role of TXA for adjunctive treatment of chronic SDHs. Copyright © 2016 Elsevier Inc. All rights reserved.

Computed tomography identifies patients at high risk for stroke after transient ischemic attack/nondisabling stroke: prospective, multicenter cohort study.

PubMed

Wasserman, Jason K; Perry, Jeffrey J; Sivilotti, Marco L A; Sutherland, Jane; Worster, Andrew; Émond, Marcel; Jin, Albert Y; Oczkowski, Wieslaw J; Sahlas, Demetrios J; Murray, Heather; MacKey, Ariane; Verreault, Steve; Wells, George A; Dowlatshahi, Dar; Stotts, Grant; Stiell, Ian G; Sharma, Mukul

2015-01-01

Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack. This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression. A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P=0.002), acute+chronic ischemia (17.4%; P=0.007), acute ischemia+microangiopathy (17.6%; P=0.019), or acute+chronic ischemia+microangiopathy (25.0%; P=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22-5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71-16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33-18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52-42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93-36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90-41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34-129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01-7.18; P=0.047) was associated with a greater risk at >2 days. In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days. © 2014 American Heart Association, Inc.

Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study.

PubMed

Wu, Meng-Huang; Dubey, Navneet Kumar; Li, Yen-Yao; Lee, Ching-Yu; Cheng, Chin-Chang; Shi, Chung-Sheng; Huang, Tsung-Jen

2017-08-01

To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable. This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis. This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis. One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited. The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation. All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed. MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p<.01). Operation time was significantly lower in the MISS-iCT and OS groups compared with the MISS-FS group (p=.002). Postoperatively, VAS scores at 1 year and 2 years were significantly improved in the MISS-iCT and MISS-FS groups compared with the OS groups. No significant difference in the number of pedicle screw breach (>2 mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049). MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

Computed tomography scan diagnosis of occult groin hernia.

PubMed

Garvey, J F W

2012-06-01

The value of computed tomography (CT) for the diagnosis of clinically occult (hidden) groin hernia was assessed in a series of patients presenting with undiagnosed groin pain. A total of 158 consecutive patients presenting over a period of 5 years with undiagnosed groin pain or lower abdominal pain and negative or equivocal clinical findings were radiologically assessed with non-contrast CT. The decision to manage operatively or conservatively was then based on a combination of the clinical and CT findings. Outcomes were assessed at 10 years follow-up. The study cohort comprised 158 patients presenting with groin or lower abdominal pain and/or swelling, and was studied prospectively. Seven of these patients were re-investigated at a later date after developing new pain on either the ipsilateral or contralateral side, giving a total of 165 CT examinations. One-third of cases (54) had clinically occult groin hernias and most of the remaining cases had diagnoses that could be managed non-operatively. Of those who came to surgery, the pre-operative CT diagnosis of hernia had a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 96% (overall accuracy 94%). Lipoma of the spermatic cord was responsible for three of five false-positive CT results. The concept of sports hernia/groin disruption injury (GDI) was encountered, and this entity is discussed in this paper. In the group of patients without hernia findings on CT, the most common diagnoses were rectus abdominis and/or pyramidalis muscle injury which could be treated by physiotherapy (22%), GDI (16%), post-surgical problems (14%), miscellaneous (20%) and 'no abnormality' was identified in 15%. Overall, there were 111 patients with a 'non-hernia' CT diagnosis, of which urological, gynaecological, gastrointestinal and neuralgia contributed to the non-musculoskeletal diagnosis. This prospective non-contrast CT study of patients with undiagnosed chronic groin pain detected the majority of occult hernias requiring surgical intervention. These results suggest that CT can be a useful adjunct to the evaluation of patients presenting with chronic undiagnosed groin pain, but that experienced clinical judgment remains a critical element in the diagnostic pathway.

Multimodal Retinal Imaging in Incontinentia Pigmenti Including Optical Coherence Tomography Angiography: Findings From an Older Cohort With Mild Phenotype.

PubMed

Liu, Tin Yan Alvin; Han, Ian C; Goldberg, Morton F; Linz, Marguerite O; Chen, Connie J; Scott, Adrienne W

2018-05-01

Incontinentia pigmenti (IP) is a rare, X-linked dominant disease with potentially severe ocular complications that predominantly affect the peripheral retina. However, little is known about its effects on the macula. To describe the structural and vascular abnormalities observed in the maculas of patients with IP and to correlate these findings with peripheral pathologies. Prospective, cross-sectional study at Wilmer Eye Institute, Johns Hopkins University. Five participants with a clinical diagnosis of IP were included and underwent multimodal imaging with ultra-wide-field fluorescein angiography (FA), spectral-domain optical coherence tomography (OCT), and OCT angiography. The structural and vascular abnormalities observed on spectral-domain OCT and OCT angiography and their correlation with peripheral pathologies seen on ultra-wide-field FA. A total of 9 eyes from 5 patients (median age, 20.5 years; range, 8.4-54.2 years) were included. Median Snellen visual acuity was 20/32 (range, 20/16 to 20/63). ultra-wide-field FA-identified retinal vascular abnormalities in all 7 eyes in which FA was obtained. These abnormalities included microaneurysms, areas of nonperfusion, and vascular anastomoses, most of which were peripheral to the standard view of 30° FA with peripheral sweeps. Structural abnormalities were observed in 6 eyes on spectral-domain OCT, including inner retinal thinning and irregularities in the outer plexiform layer. Optical coherence tomography angiography abnormalities were noted in all 9 eyes, including decreased vascular density, abnormal vascular loops, and flow loss in the superficial and deep plexuses, which corresponded to areas of retinal thinning on spectral-domain OCT. Although our study is limited by the small sample size, the findings suggest that multimodal imaging is useful for detecting structural and vascular abnormalities that may not be apparent on ophthalmoscopy in patients with IP. Macular pathologies, especially a decrease in vascular density on OCT angiography, are common. Further studies are needed to characterize further the association between macular and peripheral abnormalities in patients with IP.

Resource Utilization and Costs during the Initial Years of Lung Cancer Screening with Computed Tomography in Canada

PubMed Central

Lam, Stephen; Tammemagi, Martin C.; Evans, William K.; Leighl, Natasha B.; Regier, Dean A.; Bolbocean, Corneliu; Shepherd, Frances A.; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R.; Mayo, John R.; McWilliams, Annette; Couture, Christian; English, John C.; Goffin, John; Hwang, David M.; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J.; Goss, Glenwood D.; Nicholas, Garth; Seely, Jean M.; Sekhon, Harmanjatinder S.; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N.; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D.; Tan, Wan C.; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J.

2014-01-01

Background: It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Methods: Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer’s perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. Results: The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400–$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553–$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254–$52,200; p = 0.061). Conclusion: In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure. PMID:25105438

Three-Dimensional Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2/Demineralized Bone Matrix versus Iliac Crest Bone Graft for Alveolar Cleft Reconstruction.

PubMed

Liang, Fan; Yen, Stephen L-K; Imahiyerobo, Thomas; Sanborn, Luke; Yen, Leia; Yen, Daniel; Nazarian, Sheila; Jedrzejewski, Breanna; Urata, Mark; Hammoudeh, Jeffrey

2017-10-01

Recent studies indicate that recombinant human bone morphogenetic protein-2 (rhBMP-2) in a demineralized bone matrix scaffold is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/demineralized bone matrix (DBM) scaffold is used but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities. A prospective study was conducted with 31 patients and 36 repairs of the alveolar cleft over a 2-year period. Twenty-one repairs used rhBMP-2/DBM scaffold and 14 repairs used iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; cone beam computed tomographic images were obtained at 6 to 9 months to compare volumetric and density data. At 3 months, postoperative occlusal radiographs demonstrated that 67 percent of patients receiving rhBMP-2/DBM scaffold had complete bone fill of the alveolus, versus 56 percent of patients in the autologous group. In contrast, cone beam computed tomographic data showed 31.6 percent (95 percent CI, 24.2 to 38.5 percent) fill in the rhBMP-2 group compared with 32.5 percent (95 percent CI, 22.1 to 42.9 percent) in the autologous population. Density analysis demonstrated identical average values between the groups (1.38 g/cc). These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/DBM scaffold versus autologous iliac bone graft. Cone beam computed tomography provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone. Therapeutic, II.

Integration of geotechnical and geophysical techniques for the characterization of a small earth-filled canal dyke and the localization of water leakage

NASA Astrophysics Data System (ADS)

Bièvre, Grégory; Lacroix, Pascal; Oxarango, Laurent; Goutaland, David; Monnot, Guy; Fargier, Yannick

2017-04-01

This paper investigates the combined use of extensive geotechnical, hydrogeological and geophysical techniques to assess a small earth dyke with a permanent hydraulic head, namely a canal embankment. The experimental site was chosen because of known issues regarding internal erosion and piping phenomena. Two leakages were visually located following the emptying of the canal prior to remediation works. The results showed a good agreement between the geophysical imaging techniques (Electrical Resistivity Tomography, P- and SH-waves Tomography) and the geotechnical data to detect the depth to the bedrock and its lateral variations. It appeared that surface waves might not be fully adapted for dyke investigation because of the particular geometry of the studied dyke, non-respectful of the 1D assumption, and which induced depth and velocity discrepancies retrieved from Rayleigh and Love waves inversion. The use of these classical prospecting techniques however did not allow to directly locate the two leakages within the studied earth dyke. The analysis of ambient vibration time series with a modified beam-forming algorithm allowed to localize the most energetic water flow prior to remediation works. It was not possible to detect the leakage after remediation works, suggesting that they efficiently contributed to significantly reduce the water flow. The second leakage was not detected probably because of a non-turbulent water flow, generating few energetic vibrations.

Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia.

PubMed

Gong, Liang; Zhang, Chong-Lin; Zhen, Qing

2016-04-01

Pneumonia is an infectious disease of the lung causing mortality. Mycoplasma pneumonia (MP) is an atypical bacterial pneumonia that damages several organs. Lung computed tomography (CT) has been utilized in its identification. The aim of the present study was to examine the value of computed tomography diagnosis for pediatric MP. The present study prospectively analyzed the clinical and imaging data of 1,280 cases of pediatric MP in the out- and inpatient departments from March, 2010 to March, 2014; analyzed the morphology and distribution of the pneumonic lesion in the lungs; and summarized the value of CT diagnosis for pediatric MP. In the included children, there were 688 cases of lesions in the unilateral lobe, 592 cases of lesions in the bilateral lobes, 1,101 cases of extensive patchy opacity, 496 cases of mottled opacity, 432 cases of increased lung marking, 256 cases of streak opacity, 192 cases of ground-glass opacity, 992 cases of thickened bronchial wall in the lesions, 128 cases of lymphadenopathy in the hilar lymph nodes and mediastinal lymph nodes, and the lung CT showed 32 cases of pulmonary cavity and 144 cases of pleural effusion. In conclusion, the CT signals of pediatric MP had several types with some children exhibiting complicated changes. The child's clinical manifestation and symptoms should thus be considered in the diagnosis to improve the diagnostic rate.

Study of the Radial Peripapillary Capillary Network in Congenital Optic Disc Anomalies With Optical Coherence Tomography Angiography.

PubMed

Cennamo, Gilda; Rossi, Claudia; Ruggiero, Pasquale; de Crecchio, Giuseppe; Cennamo, Giovanni

2017-04-01

To evaluate the radial peripapillary capillary network with optical coherence tomography angiography (angio-OCT) in morning glory syndrome (MGS), optic disc colobomas, and optic disc pits, and to explore possible correlations between the neural vascular structure and the pathogenesis of congenital optic disc anomalies. Prospective observational comparative case series. Fifteen eyes of 15 patients with congenital optic disc anomalies were enrolled in this study. All patients underwent angio-OCT. The scans were centered on optic discs. The mean age at presentation was 33 years (range: 19-50 years). Congenital optic disc anomalies were identified in all 15 eyes. Three eyes had the characteristic funduscopic signs of MGS, and angio-OCT scans of the peripapillary retina revealed a dense microvascular network. Optic disc colobomas were found in 5 eyes, and the characteristic funduscopic signs of optic pits were found in 7 eyes. Angio-OCT showed the absence of a radial peripapillary microvascular network in these 12 eyes. The finding that angio-OCT scans confirmed the presence of a peripapillary microvascular network only in MGS cases supports the hypothesis that a primary neuroectodermal abnormality and a secondary mesenchymal abnormality leads to MGS. Angio-OCT is a safe, rapid imaging technique that could shed light on the pathogenesis of rare diseases of the optic disc. Copyright © 2016 Elsevier Inc. All rights reserved.

Sensitivity and specificity of cone beam computed tomography in thin bony structures in maxillofacial surgery – A clinical trial.

PubMed

Thönissen, P; Ermer, M A; Schmelzeisen, R; Gutwald, R; Metzger, M C; Bittermann, G

2015-09-01

Cone-Beam Computed Tomography (CBCT) has become widely used in dentistry and maxillofacial surgery. Accuracy, sensitivity and specificity of thin bony structures below 0.5 mm have been subject of some in vitro studies. This prospective in vivo study investigates the correlation between preoperative CBCT-imaging and intraoperative clinical examination of thin bony structures. We hereby present results from daily clinical routine. A total number of 80 sites in 64 patients has been examined to differentiate between preoperative 3D imaging and clinical measurements on cystic lesions in maxilla and mandible. Different CBCT-devices with a voxel size ranging from 0.08 mm to 0.4 mm were used. Overall-specificity found for detecting thin bony structures of the human jaw is 13.89%, overall sensitivity is 100%, positive predictive value (PPV) is 58.67% and negative predictive value (NPV) is 100%. Image quality is the key to make use of additional information CBCT provides and depends on spatial, temporal and contrast resolution. CBCT does not depict reliably thin bony structures of the jaw, even if high voxel resolution is used. In selected cases using high resolution protocols should be considered despite affecting the patient with higher doses of radiation. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Reconstructing former urban environments by combining geophysical electrical methods and geotechnical investigations—an example from Chania, Greece

NASA Astrophysics Data System (ADS)

Soupios, P. M.; Loupasakis, C.; Vallianatos, F.

2008-06-01

Nowadays, geophysical prospecting is implemented in order to resolve a diversity of geological, hydrogeological, environmental and geotechnical problems. Although plenty of applications and a lot of research have been conducted in the countryside, only a few cases have been reported in the literature concerning urban areas, mainly due to high levels of noise present that aggravate most of the geophysical methods or due to spatial limitations that hinder normal method implementation. Among all geophysical methods, electrical resistivity tomography has proven to be a rapid technique and the most robust with regard to urban noise. This work presents a case study in the urban area of Chania (Crete Island, Greece), where electrical resistivity tomography (ERT) has been applied for the detection and identification of possible buried ancient ruins or other man-made structures, prior to the construction of a building. The results of the detailed geophysical survey indicated eight areas of interest providing resistivity anomalies. Those anomalies were analysed and interpreted combining the resistivity readings with the geotechnical borehole data and the historical bibliographic reports—referring to the 1940s (Xalkiadakis 1997 Industrial Archaeology in Chania Territory pp 51-62). The collected ERT-data were processed by applying advanced algorithms in order to obtain a 3D-model of the study area that depicts the interesting subsurface structures more clearly and accurately.

Do Clinical and Radiological Assessments Contribute to the Understanding of Biomaterials? Results From a Prospective Randomized Sinus Augmentation Split-Mouth Trial.

PubMed

Lorenz, Jonas; Korzinskas, Tadas; Chia, Poju; Maawi, Sarah Al; Eichler, Katrin; Sader, Robert A; Ghanaati, Shahram

2018-02-01

The present prospective randomized split-mouth trial reports on the 3-year clinical and radiological follow-up investigation of implants placed 7 months after sinus augmentation with 2 different bone substitute materials. The aim of the study was to complete the histologic observation of cellular reactions by analyses of the implants and the volumetric changes of the augmented bone substitute materials. A sinus augmentation split-mouth trial was performed in 14 patients with the synthetic bone substitute material Nanobone (NB) and the xenogeneic Bio-Oss (BO). Changes in volume and density of the augmented biomaterials were investigated by analysis of computed tomography scans, taken immediately after augmentation and after 7 months. Clinical implant parameters were assessed after 3 years of loading. Both bone substitute materials underwent nonsignificant volume reduction and significant increase in bone density over an integration period of 7 months. No significant differences concerning volume and bone density were observed between the groups. Three years after loading, 51 of 53 implants were in situ with no peri-implant infections, and only a few soft-tissue variations were present. The present prospective randomized study showed that no differences could be observed clinically and radiologically. Accordingly, it seems that both biomaterials, independent of their physicochemical composition, enable clinical success and long-time stability for dental implants. Interestingly, the histological results showed distinct differences in cellular reactions: While the xenogeneic BO induced a mild tissue reaction with only few multinucleated giant cells and comparably low vascularization, the synthetic NB induced a multinucleated giant cell-triggered tissue reaction with an increase of vascularization. Thus, the present study showed that a combination analysis-histological, clinical, and radiological-is necessary for a detailed assessment of a biomaterial's quality for clinical application.

Pulmonary Venous Anatomy Imaging with Low-Dose, Prospectively ECG-Triggered, High-Pitch 128-Slice Dual Source Computed Tomography

PubMed Central

Thai, Wai-ee; Wai, Bryan; Lin, Kaity; Cheng, Teresa; Heist, E. Kevin; Hoffmann, Udo; Singh, Jagmeet; Truong, Quynh A.

2012-01-01

Background Efforts to reduce radiation from cardiac computed tomography (CT) are essential. Using a prospectively triggered, high-pitch dual source CT (DSCT) protocol, we aim to determine the radiation dose and image quality (IQ) in patients undergoing pulmonary vein (PV) imaging. Methods and Results In 94 patients (61±9 years, 71% male) who underwent 128-slice DSCT (pitch 3.4), radiation dose and IQ were assessed and compared between 69 patients in sinus rhythm (SR) and 25 in atrial fibrillation (AF). Radiation dose was compared in a subset of 19 patients with prior retrospective or prospectively triggered CT PV scans without high-pitch. In a subset of 18 patients with prior magnetic resonance imaging (MRI) for PV assessment, PV anatomy and scan duration were compared to high-pitch CT. Using the high-pitch protocol, total effective radiation dose was 1.4 [1.3, 1.9] mSv, with no difference between SR and AF (1.4 vs 1.5 mSv, p=0.22). No high-pitch CT scans were non-diagnostic or had poor IQ. Radiation dose was reduced with high-pitch (1.6 mSv) compared to standard protocols (19.3 mSv, p<0.0001). This radiation dose reduction was seen with SR (1.5 vs 16.7 mSv, p<0.0001) but was more profound with AF (1.9 vs 27.7 mSv, p=0.039). There was excellent agreement of PV anatomy (kappa 0.84, p<0.0001), and a shorter CT scan duration (6 minutes) compared to MRI (41 minutes, p<0.0001). Conclusions Using a high-pitch DSCT protocol, PV imaging can be performed with minimal radiation dose, short scan acquisition, and excellent IQ in patients with SR or AF. This protocol highlights the success of new cardiac CT technology to minimize radiation exposure, giving clinicians a new low-dose imaging alternative to assess PV anatomy. PMID:22586259

Choroidal thickness measurement in children using optical coherence tomography.

PubMed

Bidaut-Garnier, Mélanie; Schwartz, Claire; Puyraveau, Marc; Montard, Michel; Delbosc, Bernard; Saleh, Maher

2014-04-01

To measure choroidal thickness (CT) in children of various ages by using spectral optical coherence tomography with enhanced depth imaging and to investigate the association between subfoveal CT and ocular axial length, age, gender, weight, and height in children. Healthy children were prospectively included between May and August 2012. Optical coherence tomography with the enhanced depth imaging system (Spectralis, Heidelberg, Germany) was used for choroidal imaging at nine defined points of the macula of both eyes. Axial length was measured using IOLMaster (Carl Zeiss Meditec, Dublin, CA). Height, weight, and refraction were recorded. Interobserver agreement in readings was also assessed by the Bland-Altman Method. Three hundred and forty-eight eyes from 174 children aged 3.5 years to 14.9 years were imaged. The mean subfoveal CT in right eyes was 341.96 ± 74.7 µm. Choroidal thickness increased with age (r = 0.24, P = 0.017), height, and weight but not with gender (P > 0.05). It was also inversely correlated to the axial length (r = 0.24, P = 0.001). The nasal choroid appeared thinner than in the temporal area (analysis of variance, P < 0.0001). In children, CT increases with age and is inversely correlated to axial length. There is a significant variation of CT between children of the same age.

[Intraoperative Optical Coherence Tomography (MI-OCT) for the Treatment of Corneal Dystrophies].

PubMed

Siebelmann, Sebastian; Matthaei, Mario; Heindl, Ludwig M; Bachmann, Björn O; Cursiefen, Claus

2018-06-01

The surgical treatment of corneal dystrophies develops rapidly as the use of lamellar corneal grafting techniques continue. While penetrating keratoplasty was the gold standard for treating a variety of dystrophies a few years ago, the affected layers of the cornea can, nowadays, be selectively replaced or ablated using laser technology. Of particular importance for these methods is optical coherence tomography, which has recently been integrated into surgical microscopes (MI-OCT). Literature overview from PubMed and Google.scholar.de supplemented with own imaging data. The MI-OCT enables the intraoperative real-time monitoring of different ophthalmic surgical procedures, such as deep anterior lamellar keratoplasty, Descemet's membrane endothelial keratoplasty, as well as minimally-invasive procedures, such as phototherapeutic keratectomy. In addition, it enables an evaluation of the cornea, but also of structures of the anterior chamber, in situations in which the cornea, for example, is clouded by an edema. Microscope-integrated, intraoperative optical coherence tomography (MI-OCT) represents a useful supplement to the normal surgical microscope. It is superior to the sole surgical microscope, especially in already severely clouded corneas, and represents a sensible supplement, especially for novel lamellar transplantation procedures. Prospective randomized trials are necessary to increase safety and efficacy when using MI-OCT for different indications. Georg Thieme Verlag KG Stuttgart · New York.

Utility of computed tomography in assessment of pulmonary hypertension secondary to biomass smoke exposure

PubMed Central

Sertogullarindan, Bunyamin; Bora, Aydin; Yavuz, Alpaslan; Ekin, Selami; Gunbatar, Hulya; Arisoy, Ahmet; Avcu, Serhat; Ozbay, Bulent

2014-01-01

Background The aim of this study was to investigate the feasibility of main pulmonary artery diameter quantification by thoracic computerized tomography (CT) in the diagnosis of pulmonary hypertension seconder to biomass smoke exposure. Material/Methods One hundred and four women subjects with biomass smoke exposure and 20 healthy women subjects were enrolled in the prospective study. The correlation between echocardiographic estimation of systolic pulmonary artery pressure and the main pulmonary artery diameter of the cases were studied. Results The main pulmonary artery diameter was 26.9±5.1 in the control subjects and 37.1±6.4 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). The systolic pulmonary artery pressure was 22.7±12.4 in the control subjects and 57.3±22 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). Systolic pulmonary artery pressure was significantly correlated with the main pulmonary artery diameter (r=0.614, p<0.01). A receiver operating characteristic (ROC) curve analysis showed that a value of 29 mm of the main pulmonary artery diameter differentiated between pulmonary hypertension and non-pulmonary hypertension patients. The sensitivity of the measurement to diagnose pulmonary hypertension was 91% and specificity was 80%. Conclusions Our results indicate that main pulmonary artery diameter measurements by SCT may suggest presence of pulmonary hypertension in biomass smoke exposed women. PMID:24618994

Diagnostic utility of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) in asymptomatic subjects at increased risk for Alzheimer's disease.

PubMed

Drzezga, Alexander; Altomare, Daniele; Festari, Cristina; Arbizu, Javier; Orini, Stefania; Herholz, Karl; Nestor, Peter; Agosta, Federica; Bouwman, Femke; Nobili, Flavio; Walker, Zuzana; Frisoni, Giovanni Battista; Boccardi, Marina

2018-05-13

To assess the clinical utility of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of early signs of neurodegeneration in conditions of increased risk for Alzheimer's disease (AD) as defined by: subjective cognitive decline (SCD), evidence of cerebral amyloid-pathology, apolipoprotein E (APOE) ε4-positive genotype, or autosomal dominant forms of AD (ADAD) in asymptomatic stages. A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted using the Delphi method on three different diagnostic scenarios. The level of empirical study evidence for the use of FDG-PET to detect meaningful early signs of neurodegeneration was considered to be poor for ADAD and lacking for SCD and asymptomatic persons at risk, based on APOE ε4-positive genotype or cerebral amyloid pathology. Consequently, and consistent with current diagnostic criteria, panelists decided not to recommend routine clinical use of FDG-PET in these situations and to currently mainly reserve it for research purposes. Currently, there is limited evidence on which to base recommendations regarding the clinical routine use of FDG-PET to detect diagnostically meaningful early signs of neurodegeneration in asymptomatic subjects with ADAD, with APOE ε4-positive genotype, or with cerebral amyloid pathology, and in subjects with SCD. Future prospective studies are warranted and in part already ongoing, aiming to assess the added value of FDG-PET in this context beyond research applications.

To Find a Better Dosimetric Parameter in the Predicting of Radiation-Induced Lung Toxicity Individually: Ventilation, Perfusion or CT based.

PubMed

Xiao, Lin-Lin; Yang, Guoren; Chen, Jinhu; Wang, Xiaohui; Wu, Qingwei; Huo, Zongwei; Yu, Qingxi; Yu, Jinming; Yuan, Shuanghu

2017-03-15

This study aimed to find a better dosimetric parameter in predicting of radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) individually: ventilation(V), perfusion (Q) or computerized tomography (CT) based. V/Q single-photon emission computerized tomography (SPECT) was performed within 1 week prior to radiotherapy (RT). All V/Q imaging data was integrated into RT planning system, generating functional parameters based on V/Q SPECT. Fifty-seven NSCLC patients were enrolled in this prospective study. Fifteen (26.3%) patients underwent grade ≥2 RILT, the remaining forty-two (73.7%) patients didn't. Q-MLD, Q-V20, V-MLD, V-V20 of functional parameters correlated more significantly with the occurrence of RILT compared to V20, MLD of anatomical parameters (r = 0.630; r = 0.644; r = 0.617; r = 0.651 vs. r = 0.424; r = 0.520 p < 0.05, respectively). In patients with chronic obstructive pulmonary diseases (COPD), V functional parameters reflected significant advantage in predicting RILT; while in patients without COPD, Q functional parameters reflected significant advantage. Analogous results were existed in fractimal analysis of global pulmonary function test (PFT). In patients with central-type NSCLC, V parameters were better than Q parameters; while in patients with peripheral-type NSCLC, the results were inverse. Therefore, this study demonstrated that choosing a suitable dosimetric parameter individually can help us predict RILT accurately.

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography.

PubMed

Chew, Cindy; O'Dwyer, Patrick J

2016-06-01

Accurate staging of patients with pancreatic cancer is important to avoid unnecessary operations. The aim of this study was to prospectively assess the impact of magnetic resonance (MR) imaging on preoperative staging of liver in patients with findings of resectable pancreatic cancer on computed tomography (CT). All patients who presented to a tertiary referral centre with pancreatic cancer between April 2012 and December 2013 were included in the study. Patients with findings of resectable disease on CT underwent further liver diffusion-weighted MR imaging, using a hepatocyte-specific contrast agent. A total of 583 patients with pancreatic cancer were referred. 69 (11.8%) had resectable disease on CT. Of these 69 patients, 16 (23.2%) had liver metastases on MR imaging, while 6 (8.7%) had indeterminate lesions. Of the 16 patients with positive MR imaging findings of liver metastases, 11 died of pancreatic cancer, with a mean survival time of nine months (95% confidence interval [CI] 5.22-14.05). The mean survival time of the 47 patients with negative MR imaging findings was 16 months (95% CI 14.33-18.10; p = 0.001). Subsequently, 22 of these patients underwent surgery, and only 1 (4.5%) patient was found to have liver metastasis at surgery. The results of the present study indicate that MR imaging improves the staging of disease in patients with resectable pancreatic cancer. Copyright: © Singapore Medical Association.

Can 3'-Deoxy-3'-((18)F) Fluorothymidine Out Perform 2-Deoxy-2-((18)F) Fluoro-D-Glucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Cervical Lymphadenopathy in Patients With Oral/Head and Neck Cancer?

PubMed

Schaefferkoetter, Joshua D; Carlson, Eric R; Heidel, Robert E

2015-07-01

The present study investigated the performance of cellular metabolism imaging with 2-deoxy-2-((18)F) fluoro-D-glucose (FDG) versus cellular proliferation imaging with 3'-deoxy-3'-((18)F) fluorothymidine (FLT) in the detection of cervical lymph node metastases in oral/head and neck cancer. We conducted a prospective cohort study to assess a head-to-head performance of FLT imaging and clinical FDG imaging for characterizing cervical lymph node metastases in patients with squamous cell carcinoma (SCC) of the oral/head and neck region. The primary predictor variable of the study was the presence of FDG or FLT avidity within the cervical lymph nodes. The primary outcome variable was the histologic presence of metastatic SCC in the cervical lymph nodes. The performance was reported in terms of the sensitivity, specificity, accuracy, and positive and negative predictive values. The overall accuracy for discriminating positive from negative lymph nodes was evaluated as a function of the positron emission tomography (PET) standardized uptake value (SUV). Receiver operating characteristic (ROC) analyses were performed for both tracers. Eleven patients undergoing surgical resection of SCC of the oral/head and neck region underwent preoperative FDG and FLT PET-computed tomography (CT) scans on separate days. The interpretation of the FDG PET-CT imaging resulted in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 43.2, 99.5, 94.4, 88.9, and 94.7%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for FLT PET-CT imaging was 75.7, 99.2, 97.1, 90.3, and 97.7%, respectively. The areas under the curve for the ROC curves were 0.9 and 0.84 for FDG and FLT, respectively. Poor correlation was observed between the SUV for FDG and FLT within the lymph nodes and tumors. FLT showed better overall performance for detecting lymphadenopathy on qualitative assessment within the total nodal population. This notwithstanding, FDG SUV performed better for pathologic discrimination within the visible lymph nodes. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) vs choline-positron emission tomography-computed tomography (choline-PET/CT) for selecting treatments in recurrent prostate cancer.

PubMed

Conde-Moreno, A J; Herrando-Parreño, G; Muelas-Soria, R; Ferrer-Rebolleda, J; Broseta-Torres, R; Cozar-Santiago, M P; García-Piñón, F; Ferrer-Albiach, C

2017-05-01

To determine the effectiveness of whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) in detecting metastases by comparing the results with those from choline-positron emission tomography-computed tomography (choline-PET/CT) in patients with biochemical relapse after primary treatment, and no metastases in bone scintigraphy, CT and/or pelvic MRI, or metastatic/oligometastatic prostate cancer (PCa). Patients with this disease profile who could benefit from treatment with stereotactic body radiation therapy (SBRT) were selected and their responses to these techniques were rated. This was a prospective, controlled, unicentric study, involving 46 consecutive patients from our centre who presented biochemical relapse after adjuvant, salvage or radical treatment with external beam radiotherapy, or brachytherapy. After initial tests (bone scintigraphy, CT, pelvic MRI), 35 patients with oligometastases or without them were selected. 11 patients with multiple metastases were excluded from the study. WB-DW-MRI and choline-PET/CT was then performed on each patient within 1 week. The results were interpreted by specialists in nuclear medicine and MRI. If they were candidates for treatment with ablative SBRT (SABR), they were then evaluated every three months with both tests. Choline-PET/CT detected lesions in 16 patients that were not observable using WB-DW-MRI. The results were consistent in seven patients and in three cases, a lesion was observed using WB-DW-MRI that was not detected with choline-PET/CT. The Kappa value obtained was 0.133 (p = 0.089); the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DW-MRI were estimated at 44.93, 64.29, 86.11, and 19.15%, respectively. For choline-PET/CT patients, the sensitivity, specificity, PPV, and NPV were 97.10, 58.33, 93.06, and 77.78%, respectively. Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT. Trial registration number NCT02858128.

Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe).

PubMed

Nanni, Cristina; Versari, Annibale; Chauvie, Stephane; Bertone, Elisa; Bianchi, Andrea; Rensi, Marco; Bellò, Marilena; Gallamini, Andrea; Patriarca, Francesca; Gay, Francesca; Gamberi, Barbara; Ghedini, Pietro; Cavo, Michele; Fanti, Stefano; Zamagni, Elena

2018-05-01

ᅟ: FDG PET/CT ( 18 F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients. Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff's alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease). Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35-66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff's alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4. IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.

High contrast microstructural visualization of natural acellular matrices by means of phase-based x-ray tomography

NASA Astrophysics Data System (ADS)

Hagen, Charlotte K.; Maghsoudlou, Panagiotis; Totonelli, Giorgia; Diemoz, Paul C.; Endrizzi, Marco; Rigon, Luigi; Menk, Ralf-Hendrik; Arfelli, Fulvia; Dreossi, Diego; Brun, Emmanuel; Coan, Paola; Bravin, Alberto; de Coppi, Paolo; Olivo, Alessandro

2015-12-01

Acellular scaffolds obtained via decellularization are a key instrument in regenerative medicine both per se and to drive the development of future-generation synthetic scaffolds that could become available off-the-shelf. In this framework, imaging is key to the understanding of the scaffolds’ internal structure as well as their interaction with cells and other organs, including ideally post-implantation. Scaffolds of a wide range of intricate organs (esophagus, lung, liver and small intestine) were imaged with x-ray phase contrast computed tomography (PC-CT). Image quality was sufficiently high to visualize scaffold microarchitecture and to detect major anatomical features, such as the esophageal mucosal-submucosal separation, pulmonary alveoli and intestinal villi. These results are a long-sought step for the field of regenerative medicine; until now, histology and scanning electron microscopy have been the gold standard to study the scaffold structure. However, they are both destructive: hence, they are not suitable for imaging scaffolds prior to transplantation, and have no prospect for post-transplantation use. PC-CT, on the other hand, is non-destructive, 3D and fully quantitative. Importantly, not only do we demonstrate achievement of high image quality at two different synchrotron facilities, but also with commercial x-ray equipment, which makes the method available to any research laboratory.

Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury.

PubMed

Hershkovitz, Yehuda; Zoarets, Itai; Stepansky, Albert; Kozer, Eran; Shapira, Zahar; Klin, Baruch; Halevy, Ariel; Jeroukhimov, Igor

2014-07-01

Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. Forty-two pediatric patients up to 15 years old were prospectively enrolled. All patients presented with a suspicious mechanism of blunt trauma and multisystem injury. They were neurologically intact and had no signs of injury to the abdomen or chest. Patients underwent CT imaging of the chest and abdomen as part of the initial evaluation. Thirty-one patients (74%) had a normal CT scan. Two patients of 11 with an abnormal CT scan required a change in management and were referred for observation in the Intensive Care Unit. None of the patients required surgical intervention. The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified. Copyright © 2014 Elsevier Inc. All rights reserved.

Evaluation of in vivo behavior of ameroid ring constrictors in dogs with congenital extrahepatic portosystemic shunts using computed tomography.

PubMed

Hunt, Geraldine B; Culp, William T N; Mayhew, Kelli N; Mayhew, Philipp; Steffey, Michele A; Zwingenberger, Allison

2014-10-01

To evaluate the in vivo pattern of ameroid constrictor closure of congenital extrahepatic portosystemic shunts in dogs. Prospective study. Dogs (n = 22) with congenital extrahepatic portosystemic shunts. Contrast-enhanced computed tomography was performed immediately before, and at least 8 weeks after placement of ameroid ring constrictors. Plastic-encased ameroid constrictors were used in 17 dogs and metal constrictors in 5 dogs. Presence of residual flow through the portosystemic shunt, additional anomalous vessels, acquired shunts and soft tissue associated with the ameroid constrictor was recorded. Postoperative internal diameter was recorded for the 17 plastic constrictors. Correlations between internal diameter and pre- and postoperative serum protein concentration were analyzed. No ameroid constrictor closed completely: shunt occlusion was always dependent on soft tissue within the ameroid ring. Residual flow through the shunt was present in 4 dogs (18%), although this caused persistent elevation of shunt fraction in only 1 dog (dog 8). The change in ameroid constrictor internal diameter was not significantly correlated with serum protein concentration. Complete shunt occlusion after AC placement is usually dependent on soft tissue reaction. Ameroid constrictors ≥5 mm diameter may not promote complete shunt occlusion. © Copyright 2014 by The American College of Veterinary Surgeons.

Clinical spectrum of lamellar macular defects including pseudoholes and pseudocysts defined by optical coherence tomography

PubMed Central

Chen, J C; Lee, L R

2008-01-01

Objective: To present the clinical spectrum of lamellar macular defects and describe the different subtypes based on their optical coherence tomography (OCT) configuration and visual prognosis. Methods: The retrospective observational case series reviewed OCT scans of 92 eyes with lamellar macular defects. Lamellar macular defects were categorised into subtypes of macular pseudohole (MPH), lamellar macular hole (LMH) and foveal pseudocyst (FP) according to their OCT morphology. The defects were quantitatively characterised in terms of base diameter, depth and central foveal thickness, and examined for the presence of associated epiretinal membranes (ERM). Results: Visual acuity (VA) was significantly correlated with the central foveal thickness and depth of the lamellar defect. MPH was associated with better VA compared with LMH and FP. MPH was of a smaller base diameter and had a greater central foveal thickness than that of LMH and FP. Fifty-per cent of all lamellar defects had an associated ERM. Conclusions: Different profiles of lamellar macular defects were characterised and quantified by OCT. Deeper and wider lamellar defects were associated with poorer visual outcome. Such objective parameters lamellar macular defects are of value when explaining to patients regarding their decreased acuity. Future prospective investigations are required to study the natural history of lamellar defects of different aetiology and surgical indications. PMID:18684752

The Use of Laser Guidance Reduces Fluoroscopy Time for C-Arm Cone-Beam Computed Tomography-Guided Biopsies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kroes, Maarten W., E-mail: Maarten.Kroes@radboudumc.nl; Strijen, Marco J. L. van, E-mail: m.van.strijen@antoniusziekenhuis.nl; Braak, Sicco J., E-mail: sjbraak@gmail.com

2016-09-15

PurposeWhen using laser guidance for cone-beam computed tomography (CBCT)-guided needle interventions, planned needle paths are visualized to the operator without the need to switch between entry- and progress-view during needle placement. The current study assesses the effect of laser guidance during CBCT-guided biopsies on fluoroscopy and procedure times.Materials and MethodsProspective data from 15 CBCT-guided biopsies of 8–65 mm thoracic and abdominal lesions assisted by a ceiling-mounted laser guidance technique were compared to retrospective data of 36 performed CBCT-guided biopsies of lesions >20 mm using the freehand technique. Fluoroscopy time, procedure time, and number of CBCT-scans were recorded. All data are presented asmore » median (ranges).ResultsFor biopsies using the freehand technique, more fluoroscopy time was necessary to guide the needle onto the target, 165 s (83–333 s) compared to 87 s (44–190 s) for laser guidance (p < 0.001). Procedure times were shorter for freehand-guided biopsies, 24 min versus 30 min for laser guidance (p < 0.001).ConclusionThe use of laser guidance during CBCT-guided biopsies significantly reduces fluoroscopy time.« less

Optical tomography as adjunct to x-ray mammography: methods and results

NASA Astrophysics Data System (ADS)

Khayat, Mario; Ichalalene, Zahia; Mincu, Niculae; Leblond, Fredéric; Guilman, Olga; Djeziri, Salim

2007-02-01

Recent years have seen significant efforts deployed to apply optical imaging techniques in clinical indications. Optical mammography as an adjunct to X-ray mammography is one such application. 3D optical mammography relies on the sensitivity of near-infrared light to endogenous breast chromophores in order to generate in vivo functional views of the breast. This work presents prospective tissue characterization results from a multi-site clinical study targeting optical tomography as an adjunct to conventional mammography. A 2 nd -generation multi-wavelength time-domain acquisition system was used to scan a wide population of women presenting normal or suspicious X-ray mammograms. Application specific algorithms based on a diffusive model of light transport were used to quantify the breast's optical properties and derive 3D images of physiological indices. Using histopathological findings as a gold standard, results confirm that optically derived parameters provide statistically significant discrimination between malignant and benign tissue in wide population of subjects. The methodology developed for case reviews, lesion delineation and characterization allows for better translation of the optical data to the more traditional x-ray paradigm while maintaining efficacy. They also point to the need for guidelines that facilitate correlation of optical data if those results are to be confirmed in a clinical setting.

Noninvasive in vivo optical coherence tomography tracking of chronic otitis media in pediatric subjects after surgical intervention

NASA Astrophysics Data System (ADS)

Monroy, Guillermo L.; Pande, Paritosh; Nolan, Ryan M.; Shelton, Ryan L.; Porter, Ryan G.; Novak, Michael A.; Spillman, Darold R.; Chaney, Eric J.; McCormick, Daniel T.; Boppart, Stephen A.

2017-12-01

In an institutional review board-approved study, 25 pediatric subjects diagnosed with chronic or recurrent otitis media were observed over a period of six months with optical coherence tomography (OCT). Subjects were followed throughout their treatment at the initial patient evaluation and preoperative consultation, surgery (intraoperative imaging), and postoperative follow-up, followed by an additional six months of records-based observation. At each time point, the tympanic membrane (at the light reflex region) and directly adjacent middle-ear cavity were observed in vivo with a handheld OCT probe and portable system. Imaging results were compared with clinical outcomes to correlate the clearance of symptoms in relation to changes in the image-based features of infection. OCT images of most all participants showed the presence of additional infection-related biofilm structures during their initial consultation visit and similarly for subjects imaged intraoperatively before myringotomy. Subjects with successful treatment (no recurrence of infectious symptoms) had no additional structures visible in OCT images during the postoperative visit. OCT image findings suggest surgical intervention consisting of myringotomy and tympanostomy tube placement provides a means to clear the middle ear of infection-related components, including middle-ear fluid and biofilms. Furthermore, OCT was demonstrated as a rapid diagnostic tool to prospectively monitor patients in both outpatient and surgical settings.

Inspiratory and expiratory high-resolution computed tomography (HRCT) in patients with chemical warfare agents exposure.

PubMed

Bakhtavar, Khadijeh; Sedighi, Nahid; Moradi, Zahra

2008-03-01

Chemical warfare agents (CWA) including sulfur mustard (SM) were commonly used in Iran-Iraq war. Respiratory problems are the greatest cause of long-term disability among people who had combat exposure to SM. High-resolution computed tomography (HRCT) has been accepted as the imaging modality of choice in these patients. We used expiratory HRCT findings in comparison to inspiratory HRCT for demonstration of pulmonary damage in these patients. HRCT in deep inspiration as well as full expiration was performed in 473 patients with a history of chemical gas exposure during the war and the results were compared. The study was prospective during 1 yr. Of 473 patients, 366 (77.38%) showed normal HRCT in deep inspiration; however, on corresponding expiratory cuts, 263 (71.86%) had abnormalities. The most frequent abnormal finding in expiration was patchy air trapping (77.77%). We conclude that exposure to SM causes pulmonary complications resulting in disability in the affected patients; however, HRCT in inspiration is normal in most of the affected patients. Expiratory HRCT showed patchy air trapping as the most common finding, which is suggestive of small air way diseases such as bronchiolitis obliterans; therefore it is recommended to do HRCT both in deep inspiration and full expiration in patients with a history of CWA exposure.

CT perfusion imaging of the stomach: a quantitative analysis according to different degrees of adenocarcinoma cell differentiation.

PubMed

Zongqiong, Sun; Xiaohong, Li; Wei, Cai; Jiangfeng, Zhou; Yuxi, Ge; Zhihui, Xie; Linfang, Jin; Yong, Pu; Gen, Yan

2016-01-01

To evaluate clinical usefulness of computed tomography perfusion imaging (CTPI) in gastric cancer. Twenty subjects without gastric diseases (control group) and fifty patients with gastric cancer were studied prospectively using CTPI examinations. Four perfusion parameter values, i.e., blood flow (BF), blood volume (BV), mean transit time, and permeability surface (PS), were calculated. The gastric cancer group was divided into three groups: well differentiated, moderately differentiated, and poorly differentiated gastric adenocarcinoma. Comparing the three groups, differences between the well-differentiated group and the moderately differentiated group or the poorly differentiated group were all statistically significant for BF, BV, and PS. The BF, BV, and PS values could serve as indicators of the degree of malignancy of gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Space flight-associated neuro-ocular syndrome (SANS).

PubMed

Lee, Andrew G; Mader, Thomas H; Gibson, C Robert; Brunstetter, Tyson J; Tarver, William J

2018-03-12

Interesting novel and somewhat perplexing physiologic and pathologic neuro-ocular findings have been documented in astronauts during and after long duration space flight (LDSF). These findings collectively have been termed the "space flight-associated neuro-ocular syndrome" (SANS). The National Aeronautics and Space Administration (NASA) in the United States has meticulously and prospectively documented the clinical, ultrasound, optical coherence tomography imaging, and radiographic findings of SANS including unilateral and bilateral optic disc edema, globe flattening, choroidal and retinal folds, hyperopic refractive error shifts, and nerve fiber layer infarcts (i.e., cotton wool spots). NASA and collaborating researchers continue to study SANS in preparation for future manned missions to space, including continued trips to the ISS, a return to the moon, or perhaps new voyages to the asteroid belt, or the planet, Mars.

Detector-unit-dependent calibration for polychromatic projections of rock core CT.

PubMed

Li, Mengfei; Zhao, Yunsong; Zhang, Peng

2017-01-01

Computed tomography (CT) plays an important role in digital rock analysis, which is a new prospective technique for oil and gas industry. But the artifacts in CT images will influence the accuracy of the digital rock model. In this study, we proposed and demonstrated a novel method to restore detector-unit-dependent functions for polychromatic projection calibration by scanning some simple shaped reference samples. As long as the attenuation coefficients of the reference samples are similar to the scanned object, the size or position is not needed to be exactly known. Both simulated and real data were used to verify the proposed method. The results showed that the new method reduced both beam hardening artifacts and ring artifacts effectively. Moreover, the method appeared to be quite robust.

Prediction of Treatment Outcome in Patients with Obsessive-Compulsive Disorder with Low-Resolution Brain Electromagnetic Tomography: A Prospective EEG Study.

PubMed

Krause, Daniela; Folkerts, Malte; Karch, Susanne; Keeser, Daniel; Chrobok, Agnieszka I; Zaudig, Michael; Hegerl, Ulrich; Juckel, Georg; Pogarell, Oliver

2015-01-01

The issue of predicting treatment response and identifying, in advance, which patient will profit from treating obsessive-compulsive disorder (OCD) seems to be an elusive goal. This prospective study investigated brain electric activity [using Low-Resolution Brain Electromagnetic Tomography (LORETA)] for the purpose of predicting response to treatment. Forty-one unmedicated patients with a DSM-IV diagnosis of OCD were included. A resting 32-channel EEG was obtained from each participant before and after 10 weeks of standardized treatment with sertraline and behavioral therapy. LORETA was used to localize the sources of brain electrical activity. At week 10, patients were divided into responders and non-responders (according to a reduction of symptom severity >50% on the Y-BOCS). LORETA analysis revealed that at baseline responders showed compared to non-responders a significantly lower brain electric activity within the beta 1 (t = 2.86, p < 0.05), 2 (t = 2.81, p < 0.05), and 3 (t = 2.76, p < 0.05) frequency bands and ROI analysis confirmed a reduced activity in alpha 2 (t = 2.06, p < 0.05) in the anterior cingulate cortex (ACC). When baseline LORETA data were compared to follow-up data, the analysis showed in the responder group a significantly lower brain electrical resting activity in the beta 1 (t = 3.17. p < 0.05) and beta 3 (t = 3.11. p < 0.05) frequency bands and equally for the ROI analysis of the orbitofrontal cortex (OFC) in the alpha 2 (t = 2.15. p < 0.05) frequency band. In the group of non-responders the opposite results were found. In addition, a positive correlation between frequency alpha 2 (rho = 0.40, p = 0.010), beta 3 (rho = 0.42, p = 0.006), delta (rho = 0.33, p = 0.038), theta (rho = 0.34, p = 0.031), alpha 1 (rho = 0.38, p = 0.015), and beta1 (rho = 0.34, p = 0.028) of the OFC and the bands delta (rho = 0.33, p = 0.035), alpha 1 (rho = 0.36, p = 0.019), alpha 2 (rho = 0.34, p = 0.031), and beta 3 (rho = 0.38, p = 0.015) of the ACC with a reduction of the Y-BOCS scores was identified. Our results suggest that measuring brain activity with LORETA could be an efficient and applicable technique to prospectively identify treatment responders in OCD.

Prediction of Treatment Outcome in Patients with Obsessive-Compulsive Disorder with Low-Resolution Brain Electromagnetic Tomography: A Prospective EEG Study

PubMed Central

Krause, Daniela; Folkerts, Malte; Karch, Susanne; Keeser, Daniel; Chrobok, Agnieszka I.; Zaudig, Michael; Hegerl, Ulrich; Juckel, Georg; Pogarell, Oliver

2016-01-01

The issue of predicting treatment response and identifying, in advance, which patient will profit from treating obsessive-compulsive disorder (OCD) seems to be an elusive goal. This prospective study investigated brain electric activity [using Low-Resolution Brain Electromagnetic Tomography (LORETA)] for the purpose of predicting response to treatment. Forty-one unmedicated patients with a DSM-IV diagnosis of OCD were included. A resting 32-channel EEG was obtained from each participant before and after 10 weeks of standardized treatment with sertraline and behavioral therapy. LORETA was used to localize the sources of brain electrical activity. At week 10, patients were divided into responders and non-responders (according to a reduction of symptom severity >50% on the Y-BOCS). LORETA analysis revealed that at baseline responders showed compared to non-responders a significantly lower brain electric activity within the beta 1 (t = 2.86, p < 0.05), 2 (t = 2.81, p < 0.05), and 3 (t = 2.76, p < 0.05) frequency bands and ROI analysis confirmed a reduced activity in alpha 2 (t = 2.06, p < 0.05) in the anterior cingulate cortex (ACC). When baseline LORETA data were compared to follow-up data, the analysis showed in the responder group a significantly lower brain electrical resting activity in the beta 1 (t = 3.17. p < 0.05) and beta 3 (t = 3.11. p < 0.05) frequency bands and equally for the ROI analysis of the orbitofrontal cortex (OFC) in the alpha 2 (t = 2.15. p < 0.05) frequency band. In the group of non-responders the opposite results were found. In addition, a positive correlation between frequency alpha 2 (rho = 0.40, p = 0.010), beta 3 (rho = 0.42, p = 0.006), delta (rho = 0.33, p = 0.038), theta (rho = 0.34, p = 0.031), alpha 1 (rho = 0.38, p = 0.015), and beta1 (rho = 0.34, p = 0.028) of the OFC and the bands delta (rho = 0.33, p = 0.035), alpha 1 (rho = 0.36, p = 0.019), alpha 2 (rho = 0.34, p = 0.031), and beta 3 (rho = 0.38, p = 0.015) of the ACC with a reduction of the Y-BOCS scores was identified. Our results suggest that measuring brain activity with LORETA could be an efficient and applicable technique to prospectively identify treatment responders in OCD. PMID:26834658

Prospective randomized comparison of rotational angiography with three-dimensional reconstruction and computed tomography merged with electro-anatomical mapping: a two center atrial fibrillation ablation study.

PubMed

Anand, Rishi; Gorev, Maxim V; Poghosyan, Hermine; Pothier, Lindsay; Matkins, John; Kotler, Gregory; Moroz, Sarah; Armstrong, James; Nemtsov, Sergei V; Orlov, Michael V

2016-08-01

To compare the efficacy and accuracy of rotational angiography with three-dimensional reconstruction (3DATG) image merged with electro-anatomical mapping (EAM) vs. CT-EAM. A prospective, randomized, parallel, two-center study conducted in 36 patients (25 men, age 65 ± 10 years) undergoing AF ablation (33 % paroxysmal, 67 % persistent) guided by 3DATG (group 1) vs. CT (group 2) image fusion with EAM. 3DATG was performed on the Philips Allura Xper FD 10 system. Procedural characteristics including time, radiation exposure, outcome, and navigation accuracy were compared between two groups. There was no significant difference between the groups in total procedure duration or time spent for various procedural steps. Minor differences in procedural characteristics were present between two centers. Segmentation and fusion time for 3DATG or CT-EAM was short and similar between both centers. Accuracy of navigation guided by either method was high and did not depend on left atrial size. Maintenance of sinus rhythm between the two groups was no different up to 24 months of follow-up. This study did not find superiority of 3DATG-EAM image merge to guide AF ablation when compared to CT-EAM fusion. Both merging techniques result in similar navigation accuracy.

Prospective cohort study of cancer patients diagnosed with incidental venous thromboembolism on routine computed tomography scans.

PubMed

Escalante, Carmen P; Gladish, Gregory W; Qiao, Wei; Zalpour, Ali; Assylbekova, Binara; Gao, Shuwei; Olejeme, Kelechi A; Richardson, Marsha N; Suarez-Almazor, Maria E

2017-05-01

Venous thromboembolism (VTE) is a major complication of cancer with recent increasing reports of incidental VTE. The objectives are to estimate the prevalence of incidental VTE in cancer patients on staging CT scans, identify common symptoms, and determine VTE recurrence in a prospective study. One thousand ninety patients were studied. Adult cancer patients scheduled for outpatient staging CT scans were eligible. VTE cases were followed for 6 months. Fisher's exact test for group comparisons of categorical variables and generalized linear modeling to estimate the prevalence of incidental VTE was used. The mean age was 58 years (range 18-87 years); 50% were male. The prevalence of incidental VTE was 1.8% (CI 1.15-2.87%). Significant symptoms in patients with VTE included fatigue (p = 0.004), stress (p = 0.0195), depression (p = 0.019), poorer quality of life (p = 0.0194), and poorer physical well-being (p = 0.0007). All the patients with VTE had at least one comorbidity (p = 0.03). No patient had recurrence within 6 months. The prevalence of incidental VTE on staging CT scans is lower than previously reported. Symptoms were associated with VTE; however, further work is needed to understand whether these are clinically relevant. No VTE recurrences were noted following 6 months.

[Prospective economic evaluation of image-guided radiation therapy for prostate cancer in the framework of the national programme for innovative and costly therapies assessment].

PubMed

Pommier, P; Morelle, M; Perrier, L; de Crevoisier, R; Laplanche, A; Dudouet, P; Mahé, M-A; Chauvet, B; Nguyen, T-D; Créhange, G; Zawadi, A; Chapet, O; Latorzeff, I; Bossi, A; Beckendorf, V; Touboul, E; Muracciole, X; Bachaud, J-M; Supiot, S; Lagrange, J-L

2012-09-01

The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Low-Contrast and Low-Radiation Dose Protocol in Cardiac Computed Tomography: Usefulness of Low Tube Voltage and Knowledge-Based Iterative Model Reconstruction Algorithm.

PubMed

Iyama, Yuji; Nakaura, Takeshi; Yokoyama, Koichi; Kidoh, Masafumi; Harada, Kazunori; Oda, Seitaro; Tokuyasu, Shinichi; Yamashita, Yasuyuki

This study aimed to evaluate the feasibility of a low contrast, low-radiation dose protocol of 80-peak kilovoltage (kVp) with prospective electrocardiography-gated cardiac computed tomography (CT) using knowledge-based iterative model reconstruction (IMR). Thirty patients underwent an 80-kVp prospective electrocardiography-gated cardiac CT with low-contrast agent (222-mg iodine per kilogram of body weight) dose. We also enrolled 30 consecutive patients who were scanned with a 120-kVp cardiac CT with filtered back projection using the standard contrast agent dose (370-mg iodine per kilogram of body weight) as a historical control group. We evaluated the radiation dose for the 2 groups. The 80-kVp images were reconstructed with filtered back projection (protocol A), hybrid iterative reconstruction (HIR, protocol B), and IMR (protocol C). We compared CT numbers, image noise, and contrast-to-noise ratio among 120-kVp protocol, protocol A, protocol B, and protocol C. In addition, we compared the noise reduction rate between HIR and IMR. Two independent readers compared image contrast, image noise, image sharpness, unfamiliar image texture, and overall image quality among the 4 protocols. The estimated effective dose (ED) of the 80-kVp protocol was 74% lower than that of the 120-kVp protocol (1.4 vs 5.4 mSv). The contrast-to-noise ratio of protocol C was significantly higher than that of protocol A. The noise reduction rate of IMR was significantly higher than that of HIR (P < 0.01). There was no significant difference in almost all qualitative image quality between 120-kVp protocol and protocol C except for image contrast. A 80-kVp protocol with IMR yields higher image quality with 74% decreased radiation dose and 40% decreased contrast agent dose as compared with a 120-kVp protocol, while decreasing more image noise compared with the 80-kVp protocol with HIR.

Solitary pulmonary nodules: Comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT, dynamic first-pass contrast-enhanced MR imaging, and FDG PET/CT.

PubMed

Ohno, Yoshiharu; Nishio, Mizuho; Koyama, Hisanobu; Seki, Shinichiro; Tsubakimoto, Maho; Fujisawa, Yasuko; Yoshikawa, Takeshi; Matsumoto, Sumiaki; Sugimura, Kazuro

2015-02-01

To prospectively compare the capabilities of dynamic perfusion area-detector computed tomography (CT), dynamic magnetic resonance (MR) imaging, and positron emission tomography (PET) combined with CT (PET/CT) with use of fluorine 18 fluorodeoxyglucose (FDG) for the diagnosis of solitary pulmonary nodules. The institutional review board approved this study, and written informed consent was obtained from each subject. A total of 198 consecutive patients with 218 nodules prospectively underwent dynamic perfusion area-detector CT, dynamic MR imaging, FDG PET/CT, and microbacterial and/or pathologic examinations. Nodules were classified into three groups: malignant nodules (n = 133) and benign nodules with low (n = 53) or high (n = 32) biologic activity. Total perfusion was determined with dual-input maximum slope models at area-detector CT, maximum and slope of enhancement ratio at MR imaging, and maximum standardized uptake value (SUVmax) at PET/CT. Next, all indexes for malignant and benign nodules were compared with the Tukey honest significant difference test. Then, receiver operating characteristic analysis was performed for each index. Finally, sensitivity, specificity, and accuracy were compared with the McNemar test. All indexes showed significant differences between malignant nodules and benign nodules with low biologic activity (P < .0001). The area under the receiver operating characteristic curve for total perfusion was significantly larger than that for other indexes (.0006 ≤ P ≤ .04). The specificity and accuracy of total perfusion were significantly higher than those of maximum relative enhancement ratio (specificity, P < .0001; accuracy, P < .0001), slope of enhancement ratio (specificity, P < .0001; accuracy, P < .0001), and SUVmax (specificity, P < .0001; accuracy, P < .0001). Dynamic perfusion area-detector CT is more specific and accurate than dynamic MR imaging and FDG PET/CT in the diagnosis of solitary pulmonary nodules in routine clinical practice. © RSNA, 2014.

Stereotactic Body Radiotherapy for Medically Inoperable Lung Cancer: Prospective, Single-Center Study of 108 Consecutive Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taremi, Mojgan, E-mail: mojgan.taremi@rmp.uhn.on.ca; Department of Radiation Oncology, University Health Network, Toronto, ON; Department of Radiation Oncology, VU University Medical Center, Amsterdam

2012-02-01

Purpose: To present the results of stereotactic body radiotherapy (SBRT) for medically inoperable patients with Stage I non-small-cell lung cancer (NSCLC) and contrast outcomes in patients with and without a pathologic diagnosis. Methods and Materials: Between December 2004 and October 2008, 108 patients (114 tumors) underwent treatment according to the prospective research ethics board-approved SBRT protocols at our cancer center. Of the 108 patients, 88 (81.5%) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. A pathologic diagnosis was unavailable for 33 (28.9%) of the 114 lesions. The SBRT schedules included 48 Gy in 4 fractions or 54-60 Gy inmore » 3 fractions for peripheral lesions and 50-60 Gy in 8-10 fractions for central lesions. Toxicity and radiologic response were assessed at the 3-6-month follow-up visits using conventional criteria. Results: The mean tumor diameter was 2.4-cm (range, 0.9-5.7). The median follow-up was 19.1 months (range, 1-55.7). The estimated local control rate at 1 and 4 years was 92% (95% confidence interval [CI], 86-97%) and 89% (95% CI, 81-96%). The cause-specific survival rate at 1 and 4 years was 92% (95% CI, 87-98%) and 77% (95% CI, 64-89%), respectively. No statistically significant difference was found in the local, regional, and distant control between patients with and without pathologically confirmed NSCLC. The most common acute toxicity was Grade 1 or 2 fatigue (53 of 108 patients). No toxicities of Grade 4 or greater were identified. Conclusions: Lung SBRT for early-stage NSCLC resulted in excellent local control and cause-specific survival with minimal toxicity. The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis. SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC.« less

Bicuspid Aortic Valve Stenosis and the Effect of Vitamin K2 on Calcification Using 18F-Sodium Fluoride Positron Emission Tomography/Magnetic Resonance: The BASIK2 Rationale and Trial Design.

PubMed

Peeters, Frederique E C M; van Mourik, Manouk J W; Meex, Steven J R; Bucerius, Jan; Schalla, Simon M; Gerretsen, Suzanne C; Mihl, Casper; Dweck, Marc R; Schurgers, Leon J; Wildberger, Joachim E; Crijns, Harry J G M; Kietselaer, Bas L J H

2018-03-21

BASIK2 is a prospective, double-blind, randomized placebo-controlled trial investigating the effect of vitamin K2 (menaquinone-7;MK7) on imaging measurements of calcification in the bicuspid aortic valve (BAV) and calcific aortic valve stenosis (CAVS). BAV is associated with early development of CAVS. Pathophysiologic mechanisms are incompletely defined, and the only treatment available is valve replacement upon progression to severe symptomatic stenosis. Matrix Gla protein (MGP) inactivity is suggested to be involved in progression. Being a vitamin K dependent protein, supplementation with MK7 is a pharmacological option for activating MGP and intervening in the progression of CAVS. Forty-four subjects with BAV and mild-moderate CAVS will be included in the study, and baseline 18 F-sodiumfluoride ( 18 F-NaF) positron emission tomography (PET)/ magnetic resonance (MR) and computed tomography (CT) assessments will be performed. Thereafter, subjects will be randomized (1:1) to MK7 (360 mcg/day) or placebo. During an 18-month follow-up period, subjects will visit the hospital every 6 months, undergoing a second 18 F-NaF PET/MR after 6 months and CT after 6 and 18 months. The primary endpoint is the change in PET/MR 18 F-NaF uptake (6 months minus baseline) compared to this delta change in the placebo arm. The main secondary endpoints are changes in calcium score (CT), progression of the left ventricularremodeling response and CAVS severity (echocardiography). We will also examine the association between early calcification activity (PET) and later changes in calcium score (CT).

Optical Coherence Tomography–Enhanced Microlaryngoscopy: Preliminary Report of a Noncontact Optical Coherence Tomography System Integrated With a Surgical Microscope

PubMed Central

Vokes, David E.; Jackson, Ryan; Guo, Shuguang; Perez, Jorge A.; Su, Jianping; Ridgway, James M.; Armstrong, William B.; Chen, Zhongping; Wong, Brian J. F.

2014-01-01

Objectives Optical coherence tomography (OCT) is a new imaging modality that uses near-infrared light to produce cross-sectional images of tissue with a resolution approaching that of light microscopy. We have previously reported use of OCT imaging of the vocal folds (VFs) during direct laryngoscopy with a probe held in contact or near-contact with the VFs. This aim of this study was to develop and evaluate a novel OCT system integrated with a surgical microscope to allow hands-free OCT imaging of the VFs, which could be performed simultaneously with microscopic visualization. Methods We performed a prospective evaluation of a new method of acquiring OCT images of the VFs. Results An OCT system was successfully integrated with a surgical microscope to permit noncontact OCT imaging of the VFs of 10 patients. With this novel device we were able to identify VF epithelium and lamina propria; however, the resolution was reduced compared to that achieved with the standard contact or near-contact OCT. Conclusions Optical coherence tomography is able to produce high-resolution images of vocal fold mucosa to a maximum depth of 1.6 mm. It may be used in the diagnosis of VF lesions, particularly early squamous cell carcinoma, in which OCT can show disruption of the basement membrane. Mounting the OCT device directly onto the operating microscope allows hands-free noncontact OCT imaging and simultaneous conventional microscopic visualization of the VFs. However, the lateral resolution of the OCT microscope system is 50 µm, in contrast to the conventional handheld probe system (10 µm). Although such images at this resolution are still useful clinically, improved resolution would enhance the system’s performance, potentially enabling real-time OCT-guided microsurgery of the larynx. PMID:18700431

Effect of ranibizumab on high-speed indocyanine green angiography and minimum intensity projection optical coherence tomography findings in neovascular age-related macular degeneration.

PubMed

Nicholson, Benjamin P; Nigam, Divya; Toy, Brian; Stetson, Paul F; Agrón, Elvira; Jacobs-El, Naima; Cunningham, Denise; Cukras, Catherine; Wong, Wai; Wiley, Henry; Chew, Emily; Ferris, Frederick; Meyerle, Catherine B

2015-01-01

The purpose of this 1-year prospective study was to investigate how induction/pro re nata ranibizumab intravitreal treatment of eyes with neovascular age-related macular degeneration affects the anatomy of choroidal neovascularization (CNV) and the overlying outer retinal tissue. High-speed indocyanine green (HS-ICG) angiography measurements provided quantification of the CNV size in 60 patients followed for 1 year. Minimum intensity projection optical coherence tomography (MinIP OCT), a novel algorithm assessing minimum optical intensity between the internal limiting membrane and retinal pigment epithelium, measured the area of outer retinal disruption overlying the CNV. Fluorescein angiography was also assessed to evaluate late retinal leakage. After 1 year, the mean area of CNV measured with indocyanine green angiography decreased by 5.8%. The mean area of MinIP OCT of outer retinal disruption overlying the CNV decreased by 4.2%. Mean area of fluorescein angiography leakage decreased by 6.3%. Both the area of outer retinal disruption measured with MinIP OCT and the area of leakage on fluorescein angiography typically exceeded the area of CNV on indocyanine green angiography at baseline and 1 year. Choroidal neovascularization treated with induction/pro re nata intravitreal ranibizumab for 1 year essentially remained static. Minimum intensity projection optical coherence tomography suggests that the area of outer retinal disruption overlying the CNV may be greater than the CNV itself and often correlates with the leakage area on fluorescein angiography. Additionally, there was minimal change in the area of outer retinal disruption on MinIP OCT even when fluid resolved. Measurements of the extent of CNV lesions based on indocyanine green angiography and MinIP OCT may provide useful outcome variables to help assess the CNV complex longitudinally and warrant further validation.

Application of segmented dental panoramic tomography among children: positive effect of continuing education in radiation protection

PubMed Central

Waltimo-Sirén, Janna; Laatikainen, Tuula; Haukka, Jari; Ekholm, Marja

2016-01-01

Objectives: Dental panoramic tomography is the most frequent examination among 7–12-year olds, according to the Radiation Safety and Nuclear Authority of Finland. At those ages, dental panoramic tomographs (DPTs) are mostly obtained for orthodontic reasons. Children's dose reduction by trimming the field size to the area of interest is important because of their high radiosensitivity. Yet, the majority of DPTs in this age group are still taken by using an adult programme and never by using a segmented programme. The purpose of the present study was to raise the awareness of dental staff with respect to children's radiation safety, to increase the application of segmented and child DPT programmes by further educating the whole dental team and to evaluate the outcome of the educational intervention. Methods: A five-step intervention programme, focusing on DPT field limitation possibilities, was carried out in community-based dental care as a part of mandatory continuing education in radiation protection. Application of segmented and child DPT programmes was thereafter prospectively followed up during a 1-year period and compared with our similar data from 2010 using a logistic regression analysis. Results: Application of the child programme increased by 9% and the segmented programme by 2%, reaching statistical significance (odds ratios 1.68; 95% confidence interval 1.23–2.30; p-value < 0.001). The number of repeated exposures remained at an acceptable level. The segmented DPTs were most frequently taken from the maxillary lateral incisor–canine area. Conclusions: The educational intervention resulted in improvement of radiological practice in respect to radiation safety of children during dental panoramic tomography. Segmented and child DPT programmes can be applied successfully in dental practice for children. PMID:27142159

Application of segmented dental panoramic tomography among children: positive effect of continuing education in radiation protection.

PubMed

Pakbaznejad Esmaeili, Elmira; Waltimo-Sirén, Janna; Laatikainen, Tuula; Haukka, Jari; Ekholm, Marja

2016-05-23

Dental panoramic tomography is the most frequent examination among 7-12-year olds, according to the Radiation Safety and Nuclear Authority of Finland. At those ages, dental panoramic tomographs (DPTs) are mostly obtained for orthodontic reasons. Children's dose reduction by trimming the field size to the area of interest is important because of their high radiosensitivity. Yet, the majority of DPTs in this age group are still taken by using an adult programme and never by using a segmented programme. The purpose of the present study was to raise the awareness of dental staff with respect to children's radiation safety, to increase the application of segmented and child DPT programmes by further educating the whole dental team and to evaluate the outcome of the educational intervention. A five-step intervention programme, focusing on DPT field limitation possibilities, was carried out in community-based dental care as a part of mandatory continuing education in radiation protection. Application of segmented and child DPT programmes was thereafter prospectively followed up during a 1-year period and compared with our similar data from 2010 using a logistic regression analysis. Application of the child programme increased by 9% and the segmented programme by 2%, reaching statistical significance (odds ratios 1.68; 95% confidence interval 1.23-2.30; p-value < 0.001). The number of repeated exposures remained at an acceptable level. The segmented DPTs were most frequently taken from the maxillary lateral incisor-canine area. The educational intervention resulted in improvement of radiological practice in respect to radiation safety of children during dental panoramic tomography. Segmented and child DPT programmes can be applied successfully in dental practice for children.

Clinical impact of 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-positron emission tomography (PET) on treatment choice in recurrent cancer of the cervix uteri.

PubMed

Bjurberg, Maria; Brun, Eva

2013-11-01

The superiority of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) over computed tomography and magnetic resonance imaging in detecting recurrent cervical cancer and determining the extent of the disease has been demonstrated in several clinical trials. However, there is a lack of data concerning the clinical impact of the extra findings. We report here a prospective clinical study aimed at investigating the clinical impact of FDG-PET findings on the treatment plans in recurrent cervical cancer. Thirty-six patients with suspected recurrent cervical cancer underwent FDG-PET. Relapses were confirmed in 26 cases, and one case of primary lung cancer was found. The clinical impact of the FDG-PET results was assessed using a systematic scoring system with a 4-grade scale. Median follow-up time after FDG-PET was 33.1 months (range, 5-83 months) for all patients and 22.4 months (range, 5-83 months) for patients with positive PET results. More sites of metastases were detected with FDG-PET in 56% of the patients compared to the findings by conventional imaging. The results of FDG-PET led to a change in treatment modality for 33% of the patients; and for 22%, a change in dose or deliverance of treatment was recorded. Treatment intention was changed in 30%, in all but one patient, from curative to palliative. In 48% of the patients, the initially planned treatment was reduced regarding dose or extent, or was withheld. In recurrent cervical cancer, FDG-PET provides clinically valuable information with a high impact on treatment decisions.

Physical properties and biocompatibility of UHMWPE-derived materials modified by synchrotron radiation.

PubMed

Bykova, Iu; Weinhardt, V; Kashkarova, A; Lebedev, S; Baumbach, T; Pichugin, V; Zaitsev, K; Khlusov, I

2014-08-01

The applications of synchrotron radiation (SR) in medical imaging have become of great use, particularly in angiography, bronchography, mammography, computed tomography, and X-ray microscopy. Thanks to recently developed phase contrast imaging techniques non-destructive preclinical testing of low absorbing materials such as polymers has become possible. The focus of the present work is characterization and examination of UHMWPE-derived materials widely used in medicine, before and after their exposure to SR during such testing. Physical properties, such as wettability, surface energy, IR-spectroscopy, roughness, optical microscopy, microhardness measurements of UHMWPE samples were studied before and after SR. The relationship between a growth of UHMWPE surface hydrophilicity after SR and surface colonization by stromal cells was studied in vitro. Obtained results demonstrate that SR may be used as prospective direction to examine bulk (porous) structure of polymer materials and/or to modify polymer surface and volume for tissue engineering.

A headache not to be sneezed at.

PubMed

Garry, D; Forrest-Hay, A

2009-05-01

A 32-year-old male patient presented to the emergency department (ED) complaining of a headache and vertigo precipitated by sneezing. He had a recent history of neck trauma. Examination revealed horizontal nystagmus and a gait that veered to the left, exacerbated by heel to toe walking. A diagnosis of vertebral artery dissection (VAD) was suspected. A bleed was ruled out in the ED by computerised tomography, after which the patient was loaded with aspirin. The diagnosis was confirmed by magnetic resonance imaging and magnetic resonance angiography. Although optimal treatment for VAD is unknown, the Cervical Artery Dissection in Stroke Study (CADISS) is an ongoing randomised multicentre prospective study comparing antiplatelet therapy with anticoagulation for patients with both carotid artery dissection and VAD. Headache is a very common presentation to the ED and a full neurological examination is essential if rarer causes are not to be missed.

Quantitative colorectal cancer perfusion measurement using dynamic contrast-enhanced multidetector-row computed tomography: effect of acquisition time and implications for protocols.

PubMed

Goh, Vicky; Halligan, Steve; Hugill, Jo-Ann; Gartner, Louise; Bartram, Clive I

2005-01-01

To determine the effect of acquisition time on quantitative colorectal cancer perfusion measurement. Dynamic contrast-enhanced computed tomography (CT) was performed prospectively in 10 patients with histologically proven colorectal cancer using 4-detector row CT (Lightspeed Plus; GE Healthcare Technologies, Waukesha, WI). Tumor blood flow, blood volume, mean transit time, and permeability were assessed for 3 acquisition times (45, 65, and 130 seconds). Mean values for all 4 perfusion parameters for each acquisition time were compared using the paired t test. Significant differences in permeability values were noted between acquisitions of 45 seconds and 65 and 130 seconds, respectively (P=0.02, P=0.007). There was no significant difference for values of blood volume, blood flow, and mean transit time between any of the acquisition times. Scan acquisitions of 45 seconds are too short for reliable permeability measurement in the abdomen. Longer acquisition times are required.

Spectral-Domain Optical Coherence Tomography Staging and Autofluorescence Imaging in Achromatopsia

PubMed Central

Greenberg, Jonathan P.; Sherman, Jerome; Zweifel, Sandrine A.; Chen, Royce W. S.; Duncker, Tobias; Kohl, Susanne; Baumann, Britta; Wissinger, Bernd; Yannuzzi, Lawrence A.; Tsang, Stephen H.

2015-01-01

Importance Evidence is mounting that achromatopsia is a progressive retinal degeneration, and treatments for this condition are on the horizon. Objectives To categorize achromatopsia into clinically identifiable stages using spectral-domain optical coherence tomography and to describe fundus autofluorescence imaging in this condition. Design, Setting, and Participants A prospective observational study was performed between 2010 and 2012 at the Edward S. Harkness Eye Institute, New York-Presbyterian Hospital. Participants included 17 patients (aged 10-62 years) with full-field electroretinography-confirmed achromatopsia. Main outcomes and Measures Spectral-domain optical coherence tomography features and staging system, fundus autofluorescence and near-infrared reflectance features and their correlation to optical coherence tomography, and genetic mutations served as the outcomes and measures. Results Achromatopsia was categorized into 5 stages on spectral-domain optical coherence tomography: stage 1 (2 patients [12%]), intact outer retina; stage 2 (2 patients [12%]), inner segment ellipsoid line disruption; stage 3 (5 patients [29%]), presence of an optically empty space; stage 4 (5 patients [29%]), optically empty space with partial retinal pigment epithelium disruption; and stage 5 (3 patients [18%]), complete retinal pigment epithelium disruption and/or loss of the outer nuclear layer. Stage 1 patients showed isolated hyperreflectivity of the external limiting membrane in the fovea, and the external limiting membrane was hyperreflective above each optically empty space. On near infrared reflectance imaging, the fovea was normal, hyporeflective, or showed both hyporeflective and hyperreflective features. All patients demonstrated autofluorescence abnormalities in the fovea and/or parafovea: 9 participants (53%) had reduced or absent autofluorescence surrounded by increased autofluorescence, 4 individuals (24%) showed only reduced or absent autofluorescence, 3 patients (18%) displayed only increased autofluorescence, and 1 individual (6%) exhibited decreased macular pigment contrast. Inner segment ellipsoid line loss generally correlated with the area of reduced autofluorescence, but hyperautofluorescence extended into this region in 2 patients (12%). Bilateral coloboma-like atrophic macular lesions were observed in 1 patient (6%). Five novel mutations were identified (4 in the CNGA3 gene and 1 in the CNGB3 gene). Conclusions and Relevance Achromatopsia often demonstrates hyperautofluorescence suggestive of progressive retinal degeneration. The proposed staging system facilitates classification of the disease into different phases of progression and may have therapeutic implications. PMID:24504161

Spectral-domain optical coherence tomography staging and autofluorescence imaging in achromatopsia.

PubMed

Greenberg, Jonathan P; Sherman, Jerome; Zweifel, Sandrine A; Chen, Royce W S; Duncker, Tobias; Kohl, Susanne; Baumann, Britta; Wissinger, Bernd; Yannuzzi, Lawrence A; Tsang, Stephen H

2014-04-01

IMPORTANCE Evidence is mounting that achromatopsia is a progressive retinal degeneration, and treatments for this condition are on the horizon. OBJECTIVES To categorize achromatopsia into clinically identifiable stages using spectral-domain optical coherence tomography and to describe fundus autofluorescence imaging in this condition. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was performed between 2010 and 2012 at the Edward S. Harkness Eye Institute, New York-Presbyterian Hospital. Participants included 17 patients (aged 10-62 years) with full-field electroretinography-confirmed achromatopsia. MAIN OUTCOMES AND MEASURES Spectral-domain optical coherence tomography features and staging system, fundus autofluorescence and near-infrared reflectance features and their correlation to optical coherence tomography, and genetic mutations served as the outcomes and measures. RESULTS Achromatopsia was categorized into 5 stages on spectral-domain optical coherence tomography: stage 1 (2 patients [12%]), intact outer retina; stage 2 (2 patients [12%]), inner segment ellipsoid line disruption; stage 3 (5 patients [29%]), presence of an optically empty space; stage 4 (5 patients [29%]), optically empty space with partial retinal pigment epithelium disruption; and stage 5 (3 patients [18%]), complete retinal pigment epithelium disruption and/or loss of the outer nuclear layer. Stage 1 patients showed isolated hyperreflectivity of the external limiting membrane in the fovea, and the external limiting membrane was hyperreflective above each optically empty space. On near infrared reflectance imaging, the fovea was normal, hyporeflective, or showed both hyporeflective and hyperreflective features. All patients demonstrated autofluorescence abnormalities in the fovea and/or parafovea: 9 participants (53%) had reduced or absent autofluorescence surrounded by increased autofluorescence, 4 individuals (24%) showed only reduced or absent autofluorescence, 3 patients (18%) displayed only increased autofluorescence, and 1 individual (6%) exhibited decreased macular pigment contrast. Inner segment ellipsoid line loss generally correlated with the area of reduced autofluorescence, but hyperautofluorescence extended into this region in 2 patients (12%). Bilateral coloboma-like atrophic macular lesions were observed in 1 patient (6%). Five novel mutations were identified (4 in the CNGA3 gene and 1 in the CNGB3 gene). CONCLUSIONS AND RELEVANCE Achromatopsia often demonstrates hyperautofluorescence suggestive of progressive retinal degeneration. The proposed staging system facilitates classification of the disease into different phases of progression and may have therapeutic implications.

Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial

PubMed Central

Pérez-Bárcena, Jon; Llompart-Pou, Juan A; Homar, Javier; Abadal, Josep M; Raurich, Joan M; Frontera, Guillem; Brell, Marta; Ibáñez, Javier; Ibáñez, Jordi

2008-01-01

Introduction Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis – undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital – thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. Trial Registration (Trial registration: US Clinical Trials registry NCT00622570.) PMID:18759980

IMAGING AND MEASUREMENT OF THE PRERETINAL SPACE IN VITREOMACULAR ADHESION AND VITREOMACULAR TRACTION BY A NEW SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANALYSIS.

PubMed

Stopa, Marcin; Marciniak, Elżbieta; Rakowicz, Piotr; Stankiewicz, Agnieszka; Marciniak, Tomasz; Dąbrowski, Adam

2017-10-01

To evaluate a new method for volumetric imaging of the preretinal space (also known as the subhyaloid, subcortical, or retrocortical space) and investigate differences in preretinal space volume in vitreomacular adhesion (VMA) and vitreomacular traction (VMT). Nine patients with VMA and 13 with VMT were prospectively evaluated. Automatic inner limiting membrane line segmentation, which exploits graph search theory implementation, and posterior cortical vitreous line segmentation were performed on 141 horizontal spectral domain optical coherence tomography B-scans per patient. Vertical distances (depths) between the posterior cortical vitreous and inner limiting membrane lines were calculated for each optical coherence tomography B-scan acquired. The derived distances were merged and visualized as a color depth map that represented the preretinal space between the posterior surface of the hyaloid and the anterior surface of the retina. The early treatment d retinopathy study macular map was overlaid onto final virtual maps, and preretinal space volumes were calculated for each early treatment diabetic retinopathy study map sector. Volumetric maps representing preretinal space volumes were created for each patient in the VMA and VMT groups. Preretinal space volumes were larger in all early treatment diabetic retinopathy study map macular regions in the VMT group compared with those in the VMA group. The differences reached statistical significance in all early treatment diabetic retinopathy study sectors, except for the superior outer macula and temporal outer macula where significance values were P = 0.05 and P = 0.08, respectively. Overall, the relative differences in preretinal space volumes between the VMT and VMA groups varied from 2.7 to 4.3 in inner regions and 1.8 to 2.9 in outer regions. Our study provides evidence of significant differences in preretinal space volume between eyes with VMA and those with VMT. This may be useful not only in the investigation of preretinal space properties in VMA and VMT, but also in other conditions, such as age-related macular degeneration, diabetic retinopathy, and central retinal vein occlusion.

TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION PATIENTS WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN EVERYDAY PRACTICE: Identification of Health Care Constraints in Germany-The PONS Study.

PubMed

Ehlken, Christoph; Wilke, Thomas; Bauer-Steinhusen, Ulrike; Agostini, Hansjürgen T; Hasanbasic, Zoran; Müller, Sabrina

2018-06-01

The PONS study was conceived to analyze the extent of nonpersistence (NP) and nonadherence (NA) in the treatment of patients with neovascular age-related macular degeneration in everyday clinical practice in Germany. Further objectives were to identify factors that can affect NP and NA and to analyze clinical outcomes under everyday conditions. Nonpersistence (no contact with doctor for at least 3 months) and NA (no treatment or follow-up for at least 6 weeks) as well as clinical data were analyzed up to 24 months retrospectively and 12 months prospectively in 480 patients with neovascular age-related macular degeneration in 23 treatment centers. Patients were interviewed for factors possibly affecting NP and NA. One third of patients fulfilled criteria of NA in the first 3 months and two thirds after 6 months. The NP was 18.8% after 12 months. Treatment exclusively at one center, a higher number of patients with neovascular age-related macular degeneration at the treating center, and fixed appointments were associated with a lower risk for NP. An initial gain in visual acuity after upload was not preserved after 12 months (mean change -0.5 Early Treatment Diabetic Retinopathy Study letters). Whereas visual acuity declined by 7.5 Early Treatment Diabetic Retinopathy Study letters in patients with good baseline visual acuity >20/40, visual acuity improved by 8.5 letters in patients with baseline visual acuity of ≤20/200. Only 7.5% of patients underwent an optical coherence tomography scan after 3 upload injections, and only 2.0 optical coherence tomographies were performed in the first 12 months. The NP and NA were high in our study population and are likely to have contributed to a suboptimal clinical outcome compared with randomized clinical trials. Shortcomings in the management of patients with neovascular age-related macular degeneration, including restrictions in the timely and adequate follow-up (including optical coherence tomography) and retreatment, appear to be constraining factors in Germany.

Organ localization: Toward prospective patient-specific organ dosimetry in computed tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Segars, W. P., E-mail: paul.segars@duke.edu; Rybicki, K.; Norris, Hannah

2014-12-15

Purpose: With increased focus on radiation dose from medical imaging, prospective radiation dose estimates are becoming increasingly desired. Using available populations of adult and pediatric patient phantoms, radiation dose calculations can be catalogued and prospectively applied to individual patients that best match certain anatomical characteristics. In doing so, the knowledge of organ size and location is a required element. Here, the authors develop a predictive model of organ locations and volumes based on an analysis of adult and pediatric computed tomography (CT) data. Methods: Fifty eight adult and 69 pediatric CT datasets were segmented and utilized in the study. Themore » maximum and minimum points of the organs were recorded with respect to the axial distance from the tip of the sacrum. The axial width, midpoint, and volume of each organ were calculated. Linear correlations between these three organ parameters and patient age, BMI, weight, and height were determined. Results: No statistically significant correlations were found in adult patients between the axial width, midpoint, and volume of the organs versus the patient age or BMI. Slight, positive linear trends were found for organ midpoint versus patient weight (max r{sup 2} = 0.382, mean r{sup 2} = 0.236). Similar trends were found for organ midpoint versus height (max r{sup 2} = 0.439, mean r{sup 2} = 0.200) and for organ volume versus height (max r{sup 2} = 0.410, mean r{sup 2} = 0.153). Gaussian fits performed on probability density functions of the adult organs resulted in r{sup 2}-values ranging from 0.96 to 0.996. The pediatric patients showed much stronger correlations overall. Strong correlations were observed between organ axial midpoint versus age, height, and weight (max r{sup 2} = 0.842, mean r{sup 2} = 0.790; max r{sup 2} = 0.949, mean r{sup 2} = 0.894; and max r{sup 2} = 0.870, mean r{sup 2} = 0.847, respectively). Moderate linear correlations were also observed for organ axial width versus height (max r{sup 2} = 0.772, mean r{sup 2} = 0.562) and for organ volume versus height (max r{sup 2} = 0.781, mean r{sup 2} = 0.601). Conclusions: Adult patients exhibited small variations in organ volume and location with respect to height and weight, but no meaningful correlation existed between these parameters and age or BMI. Once adulthood is reached, organ morphology and positioning seem to remain static. However, clear trends are evident between pediatric organ locations versus age, height, and weight. Such information can be incorporated into a matching methodology that may provide the highest probability of representing the anatomy of a patient undergoing a clinical exam to prospectively estimate the radiation dose.« less

Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study.

PubMed

Easter, Joshua S; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S

2014-08-01

We evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department. We prospectively enrolled children younger than 18 years and with minor head injury (Glasgow Coma Scale score 13 to 15), presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (Canadian Assessment of Tomography for Childhood Head Injury [CATCH], Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE], and Pediatric Emergency Care Applied Research Network [PECARN]) and 2 measures of physician judgment (estimated of <1% risk of traumatic brain injury and actual computed tomography ordering practice) to predict clinically important traumatic brain injury, as defined by death from traumatic brain injury, need for neurosurgery, intubation greater than 24 hours for traumatic brain injury, or hospital admission greater than 2 nights for traumatic brain injury. Among the 1,009 children, 21 (2%; 95% confidence interval [CI] 1% to 3%) had clinically important traumatic brain injuries. Only physician practice and PECARN identified all clinically important traumatic brain injuries, with ranked sensitivities as follows: physician practice and PECARN each 100% (95% CI 84% to 100%), physician estimates 95% (95% CI 76% to 100%), CATCH 91% (95% CI 70% to 99%), and CHALICE 84% (95% CI 60% to 97%). Ranked specificities were as follows: CHALICE 85% (95% CI 82% to 87%), physician estimates 68% (95% CI 65% to 71%), PECARN 62% (95% CI 59% to 66%), physician practice 50% (95% CI 47% to 53%), and CATCH 44% (95% CI 41% to 47%). Of the 5 modalities studied, only physician practice and PECARN identified all clinically important traumatic brain injuries, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely sensitive and had the poorest specificity of all modalities. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Coronary Artery Disease: Analysis of Diagnostic Performance of CT Perfusion and MR Perfusion Imaging in Comparison with Quantitative Coronary Angiography and SPECT-Multicenter Prospective Trial.

PubMed

Rief, Matthias; Chen, Marcus Y; Vavere, Andrea L; Kendziora, Benjamin; Miller, Julie M; Bandettini, W Patricia; Cox, Christopher; George, Richard T; Lima, João; Di Carli, Marcelo; Plotkin, Michail; Zimmermann, Elke; Laule, Michael; Schlattmann, Peter; Arai, Andrew E; Dewey, Marc

2018-02-01

Purpose To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years ± 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel-Haenszel test stratified by disease status. Results The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P < .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P < .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD. © RSNA, 2017 Online supplemental material is available for this article.

Diagnostic sensitivity of ultrasound, radiography and computed tomography for gender determination in four species of lizards.

PubMed

Di Ianni, Francesco; Volta, Antonella; Pelizzone, Igor; Manfredi, Sabrina; Gnudi, Giacomo; Parmigiani, Enrico

2015-01-01

Gender determination is frequently requested by reptile breeders, especially for species with poor or absent sexual dimorphism. The aims of the current study were to describe techniques and diagnostic sensitivities of ultrasound, radiography, and computed tomography for gender determination (identification of hemipenes) in four species of lizards. Nineteen lizards of known sex, belonging to four different species (Pogona vitticeps, Uromastyx aegyptia, Tiliqua scincoides, Gerrhosaurus major) were prospectively enrolled. With informed owner consent, ultrasound, noncontrast CT, contrast radiography, and contrast CT (with contrast medium administered into the cloaca) were performed in conscious animals. Imaging studies were reviewed by three different operators, each unaware of the gender of the animals and of the results of the other techniques. The lizard was classified as a male when hemipenes were identified. Nineteen lizards were included in the study, 10 females and nine males. The hemipenes were seen on ultrasound in only two male lizards, and appeared as oval hypoechoic structures. Radiographically, hemipenes filled with contrast medium appeared as spindle-shaped opacities. Noncontrast CT identified hemipenes in only two lizards, and these appeared as spindle-shaped kinked structures with hyperattenuating content consistent with smegma. Hemipenes were correctly identified in all nine males using contrast CT (accuracy of 100%). Accuracy of contrast radiography was excellent (94.7%). Accuracy of ultrasound and of noncontrast CT was poor (64.3% and 63.1%, respectively). Findings from the current study supported the use of contrast CT or contrast radiography for gender determination in lizards. © 2014 American College of Veterinary Radiology.

Electrocardiogram‐gated coronary CT angiography dose estimates using ImPACT

PubMed Central

Asada, Yasuki; Matsubara, Kosuke; Suzuki, Shouichi; Koshida, Kichiro; Matsunaga, Yuta; Haba, Tomonobu; Kawaguchi, Ai; Toyama, Hiroshi; Kato, Ryoichi

2016-01-01

The primary study objective was to assess radiation doses using a modified form of the Imaging Performance Assessment of Computed Tomography (CT) scanner (ImPACT) patient dosimetry for cardiac applications on an Aquilion ONE ViSION Edition scanner, including the Ca score, target computed tomography angiography (CTA), prospective CTA, continuous CTA/cardiac function analysis (CFA), and CTA/CFA modulation. Accordingly, we clarified the CT dose index (CTDI) to determine the relationship between heart rate (HR) and X‐ray exposure. As a secondary objective, we compared radiation doses using modified ImPACT, a whole‐body dosimetry phantom study, and the k‐factor method to verify the validity of the dose results obtained with modified ImPACT. The effective dose determined for the reference person (4.66 mSv at 60 beats per minute (bpm) and 33.43 mSv at 90 bpm) were approximately 10% less than those determined for the phantom study (5.28 mSv and 36.68 mSv). The effective doses according to the k‐factor (0.014 mSv·mGy−1·cm−1; 2.57 mSv and 17.10 mSv) were significantly lower than those obtained with the other two methods. In the present study, we have shown that ImPACT, when modified for cardiac applications, can assess both absorbed and effective doses. The results of our dose comparison indicate that modified ImPACT dose assessment is a promising and practical method for evaluating coronary CTA. PACS number(s): 87.57.Q‐, 87.59.Dj, 87.57.uq PMID:27455500

End Tidal Carbon Dioxide as a Screening Tool for Computed Tomography Angiogram in Postoperative Orthopaedic Patients Suspected of Pulmonary Embolism.

PubMed

Ramme, Austin J; Iturrate, Eduardo; Dweck, Ezra; Steiger, David J; Hutzler, Lorraine H; Fang, Yixin; Wang, Binhuan; Bosco, Joseph A; Sigmund, Alana E

2016-10-01

Computed tomography pulmonary angiography (CTA) is the gold standard for diagnosing pulmonary embolism (PE) but involves radiation and iodinated contrast exposure. Of orthopedic patients evaluated for PE, a minority have a positive CTA study. Herein, we evaluate end tidal carbon dioxide (ETCO2) as a method to identify patients at low risk for PE and may not require a CTA. We hypothesize that ETCO2 will be useful for predicting the absence of PE in postoperative orthopedic patients. In this prospective study, all patients older than 18 years who were admitted for orthopedic surgery and who had a CTA performed for PE were eligible. These patients underwent an ETCO2 measurement. Patients were determined to have PE if they had a positive PE-protocol CT. Between May 2014 and April 2015, 121 patients met the inclusion criteria for the study. Of these patients, 84 had a negative CTA examination, 25 had a positive examination, and 12 had a nondiagnostic examination. We found a statistically significant difference (P = .03) when comparing the average ETCO2 values for the positive and negative CTA groups. An ETCO2 cutoff value of 43 mm Hg was 100% sensitive with a negative predictive value of 100% for absence of PE on CTA. This study demonstrates a significant difference in ETCO2 measurements between postoperative orthopedic patients with and without CTA-detected PE. A cutoff value of >43 mm Hg may be useful in excluding patients from undergoing CTA. Copyright © 2016 Elsevier Inc. All rights reserved.

A Pilot Study of Augmented Reality Technology Applied to the Acetabular Cup Placement During Total Hip Arthroplasty.

PubMed

Ogawa, Hiroyuki; Hasegawa, Seiichirou; Tsukada, Sachiyuki; Matsubara, Masaaki

2018-06-01

We developed an acetabular cup placement device, the AR-HIP system, using augmented reality (AR). The AR-HIP system allows the surgeon to view an acetabular cup image superimposed in the surgical field through a smartphone. The smartphone also shows the placement angle of the acetabular cup. This preliminary study was performed to assess the accuracy of the AR-HIP system for acetabular cup placement during total hip arthroplasty (THA). We prospectively measured the placement angles using both a goniometer and AR-HIP system in 56 hips of 54 patients undergoing primary THA. We randomly determined the order of intraoperative measurement using the 2 devices. At 3 months after THA, the placement angle of the acetabular cup was measured on computed tomography images. The primary outcome was the absolute value of the difference between intraoperative and postoperative computed tomography measurements. The measurement angle using AR-HIP was significantly more accurate in terms of radiographic anteversion than that using a goniometer (2.7° vs 6.8°, respectively; mean difference 4.1°; 95% confidence interval, 3.0-5.2; P < .0001). There was no statistically significant difference in terms of radiographic inclination (2.1° vs 2.6°; mean difference 0.5°; 95% confidence interval, -1.1 to 0.1; P = .13). In this pilot study, the AR-HIP system provided more accurate information regarding acetabular cup placement angle than the conventional method. Further studies are required to confirm the utility of the AR-HIP system as a navigation tool. Copyright © 2018 Elsevier Inc. All rights reserved.

Macular thickness measurements using Copernicus Spectral Domain Optical Coherence Tomography.

PubMed

Gella, Laxmi; Raman, Rajiv; Sharma, Tarun

2015-01-01

To provide normal macular thickness measurements using Spectral Domain Optical Coherence Tomography (SDOCT, Copernicus, Optopol Technologies, Zawierci, Poland). Fifty-eight eyes of 58 healthy subjects were included in this prospective study. All subjects had comprehensive ophthalmic examination including best-corrected visual acuity (BCVA). All the subjects underwent Copernicus SDOCT. Central foveal thickness (CFT) and photoreceptor layer (PRL) thickness were measured and expressed as mean and standard deviation. Mean retinal thickness for each of the 9 regions defined in the Early Treatment Diabetic Retinopathy Study was reported. The data were compared with published literature in Indians using Stratus and Spectralis OCTs to assess variation in instrument measurements. The mean CFT in the study sample was 173.8 ± 18.16 microns (131-215 microns) and the mean PRL thickness was 65.48 ± 4.23 microns (56-74 microns). No significant difference (p = 0.148) was found between CFT measured automated (179.28 ± 22 microns) and manually (173.83 ± 18.1 microns). CFT was significantly lower in women (167.62 ± 16.36 microns) compared to men (180.03 ± 18 microns) (p = 0.008). Mean retinal thickness reported in this study was significantly different from published literature using Stratus OCT and Spectralis OCT. We report the normal mean retinal thickness in central 1 mm area to be between 138 and 242 microns in Indian population using Copernicus SDOCT. We suggest that different OCT instruments cannot be used interchangeably for the measurement of macular thickness as they vary in segmentation algorithms.

Evaluation of choroidal thickness in psoriasis using optical coherence tomography.

PubMed

Türkcü, Fatih Mehmet; Şahin, Alparslan; Yüksel, Harun; Akkurt, Meltem; Uçmak, Derya; Çınar, Yasin; Yıldırım, Adnan; Çaça, İhsan

2016-12-01

The purpose of this study was to evaluate choroidal thickness (CT) in patients with psoriasis using enhanced depth imaging optical coherence tomography (EDI-OCT) and to determine its relationship with psoriasis activity indices. In this prospective study, EDI-OCT images were obtained in consecutive patients with psoriasis and in age-gender-matched healthy individuals. Comprehensive ophthalmic examination and EDI-OCT evaluation were performed. CT was measured in the subfoveal area. Correlation analyses were performed to identify the relationship of the CT with disease duration and clinical disease activity score. In total, 65 individuals were evaluated in this study, 35 with psoriasis and 30 controls. The mean disease duration of the patients with psoriasis was 15.7 ± 8.8 years (0.3-34 years). There was no difference between groups with respect to age and gender (p = 0.695 and p = 0.628, respectively). Five of the 35 patients with psoriasis had anterior uveitis. None of the patients with psoriasis had signs of posterior uveitis. CT was significantly higher in the psoriasis group than that of control subjects (p < 0.001). The mean central foveal thickness was comparable between groups (p = 0.672). There was also no significant correlation between EDI-OCT, disease activity score, and disease duration (p < 0.05). Choroidal thickness is increased in psoriasis patients. Large serial and comparative studies are necessary to evaluate EDI-OCT, an examination that may be helpful in understanding the effects of psoriasis on the eye and its pathophysiology.

Development of seismic tomography software for hybrid supercomputers

NASA Astrophysics Data System (ADS)

Nikitin, Alexandr; Serdyukov, Alexandr; Duchkov, Anton

2015-04-01

Seismic tomography is a technique used for computing velocity model of geologic structure from first arrival travel times of seismic waves. The technique is used in processing of regional and global seismic data, in seismic exploration for prospecting and exploration of mineral and hydrocarbon deposits, and in seismic engineering for monitoring the condition of engineering structures and the surrounding host medium. As a consequence of development of seismic monitoring systems and increasing volume of seismic data, there is a growing need for new, more effective computational algorithms for use in seismic tomography applications with improved performance, accuracy and resolution. To achieve this goal, it is necessary to use modern high performance computing systems, such as supercomputers with hybrid architecture that use not only CPUs, but also accelerators and co-processors for computation. The goal of this research is the development of parallel seismic tomography algorithms and software package for such systems, to be used in processing of large volumes of seismic data (hundreds of gigabytes and more). These algorithms and software package will be optimized for the most common computing devices used in modern hybrid supercomputers, such as Intel Xeon CPUs, NVIDIA Tesla accelerators and Intel Xeon Phi co-processors. In this work, the following general scheme of seismic tomography is utilized. Using the eikonal equation solver, arrival times of seismic waves are computed based on assumed velocity model of geologic structure being analyzed. In order to solve the linearized inverse problem, tomographic matrix is computed that connects model adjustments with travel time residuals, and the resulting system of linear equations is regularized and solved to adjust the model. The effectiveness of parallel implementations of existing algorithms on target architectures is considered. During the first stage of this work, algorithms were developed for execution on supercomputers using multicore CPUs only, with preliminary performance tests showing good parallel efficiency on large numerical grids. Porting of the algorithms to hybrid supercomputers is currently ongoing.

Study to Improve Cardiovascular Outcomes in high-risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study.

PubMed

Kunadian, Vijay; Neely, R Dermot G; Sinclair, Hannah; Batty, Jonathan A; Veerasamy, Murugapathy; Ford, Gary A; Qiu, Weiliang

2016-08-23

The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool. Participants are recruited from 2 tertiary hospitals in the UK. Baseline evaluation includes frailty, comorbidity, cognition and quality-of-life measures, inflammatory status assessed by a biomarker panel, including microRNAs, senescence assessed by telomere length and telomerase activity, cardiovascular status assessed by arterial stiffness, endothelial function, carotid intima media thickness and left ventricular systolic and diastolic function, and coronary plaque assessed by virtual histology intravascular ultrasound and optical coherence tomography. The patients are followed-up at 30 days and at 1 year for primary outcome measures of death, myocardial infarction, stroke, unplanned revascularisation, bleeding and rehospitalisation. The study has been approved by the regional ethics committee (REC 12/NE/016). Findings of the study will be presented in scientific sessions and will be published in peer-reviewed journals. NCT01933581: Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Reduction of Metal Artifact in Single Photon-Counting Computed Tomography by Spectral-Driven Iterative Reconstruction Technique

PubMed Central

Nasirudin, Radin A.; Mei, Kai; Panchev, Petar; Fehringer, Andreas; Pfeiffer, Franz; Rummeny, Ernst J.; Fiebich, Martin; Noël, Peter B.

2015-01-01

Purpose The exciting prospect of Spectral CT (SCT) using photon-counting detectors (PCD) will lead to new techniques in computed tomography (CT) that take advantage of the additional spectral information provided. We introduce a method to reduce metal artifact in X-ray tomography by incorporating knowledge obtained from SCT into a statistical iterative reconstruction scheme. We call our method Spectral-driven Iterative Reconstruction (SPIR). Method The proposed algorithm consists of two main components: material decomposition and penalized maximum likelihood iterative reconstruction. In this study, the spectral data acquisitions with an energy-resolving PCD were simulated using a Monte-Carlo simulator based on EGSnrc C++ class library. A jaw phantom with a dental implant made of gold was used as an object in this study. A total of three dental implant shapes were simulated separately to test the influence of prior knowledge on the overall performance of the algorithm. The generated projection data was first decomposed into three basis functions: photoelectric absorption, Compton scattering and attenuation of gold. A pseudo-monochromatic sinogram was calculated and used as input in the reconstruction, while the spatial information of the gold implant was used as a prior. The results from the algorithm were assessed and benchmarked with state-of-the-art reconstruction methods. Results Decomposition results illustrate that gold implant of any shape can be distinguished from other components of the phantom. Additionally, the result from the penalized maximum likelihood iterative reconstruction shows that artifacts are significantly reduced in SPIR reconstructed slices in comparison to other known techniques, while at the same time details around the implant are preserved. Quantitatively, the SPIR algorithm best reflects the true attenuation value in comparison to other algorithms. Conclusion It is demonstrated that the combination of the additional information from Spectral CT and statistical reconstruction can significantly improve image quality, especially streaking artifacts caused by the presence of materials with high atomic numbers. PMID:25955019

A time and imaging cost analysis of low-risk ED observation patients: a conservative 64-section computed tomography coronary angiography "triple rule-out" compared to nuclear stress test strategy.

PubMed

Takakuwa, Kevin M; Halpern, Ethan J; Shofer, Frances S

2011-02-01

The study aimed to examine time and imaging costs of 2 different imaging strategies for low-risk emergency department (ED) observation patients with acute chest pain or symptoms suggestive of acute coronary syndrome. We compared a "triple rule-out" (TRO) 64-section multidetector computed tomography protocol with nuclear stress testing. This was a prospective observational cohort study of consecutive ED patients who were enrolled in our chest pain observation protocol during a 16-month period. Our standard observation protocol included a minimum of 2 sets of cardiac enzymes at least 6 hours apart followed by a nuclear stress test. Once a week, observation patients were offered a TRO (to evaluate for coronary artery disease, thoracic dissection, and pulmonary embolus) multidetector computed tomography with the option of further stress testing for those patients found to have evidence of coronary artery disease. We analyzed 832 consecutive observation patients including 214 patients who underwent the TRO protocol. Mean total length of stay was 16.1 hours for TRO patients, 16.3 hours for TRO plus other imaging test, 22.6 hours for nuclear stress testing, 23.3 hours for nuclear stress testing plus other imaging tests, and 23.7 hours for nuclear stress testing plus TRO (P < .0001 for TRO and TRO + other test compared to stress test ± other test). Mean imaging times were 3.6, 4.4, 5.9, 7.5, and 6.6 hours, respectively (P < .05 for TRO and TRO + other test compared to stress test ± other test). Mean imaging costs were $1307 for TRO patients vs $945 for nuclear stress testing. Triple rule-out reduced total length of stay and imaging time but incurred higher imaging costs. A per-hospital analysis would be needed to determine if patient time savings justify the higher imaging costs. Copyright © 2011 Elsevier Inc. All rights reserved.

Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI.

PubMed

Vernon, Jordyn; Andruszkiewicz, Nicole; Schneider, Laura; Schieman, Colin; Finley, Christian J; Shargall, Yaron; Fahim, Christine; Farrokhyar, Forough; Hanna, Waël C

2016-11-01

In our model of comprehensive clinical staging (CCS) for lung cancer, patients with a computerized tomography scan of the chest and upper abdomen not showing distant metastases will then routinely undergo whole body positron emission tomography/computerized tomography and magnetic resonance imaging (MRI) of the brain before any therapeutic decision. Our aim was to determine the accuracy of CCS and the value of brain MRI in this population. A retrospective analysis of a prospectively entered database was performed for all patients who underwent lung cancer resection from January 2012 to June 2014. Demographics, clinical and pathological stage (seventh edition of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, and metastasis staging manual), and costs of staging were collected. Correlation between clinical and pathological stage was determined. Of 315 patients with primary lung cancer, 55.6% were female and the mean age was 70 ± 9.6 years. When correlation was analyzed without consideration for substages A and B, 49.8% of patients (158 of 315) were staged accurately, 39.7% (125 of 315) were overstaged, and 10.5% (32 of 315) were understaged. Only 4.7% of patients (15 of 315) underwent surgery without appropriate neoadjuvant treatment. Preoperative brain MRI detected asymptomatic metastases in four of 315 patients (1.3%). At a median postoperative follow-up of 19 months (range 6-43), symptomatic brain metastases developed in seven additional patients. The total cost of CCS in Canadian dollars was $367,292 over the study period, with $117,272 (31.9%) going toward brain MRI. CCS is effective for patients with resectable lung cancer, with less than 5% of patients being denied appropriate systemic treatment before surgery. Brain MRI is a low-yield and high-cost intervention in this population, and its routine use should be questioned. Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Diagnostic accuracy of functional, imaging and biochemical tests for patients presenting with chest pain to the emergency department: A systematic review and meta-analysis.

PubMed

Iannaccone, Mario; Gili, Sebastiano; De Filippo, Ovidio; D'Amico, Salvatore; Gagliardi, Marco; Bertaina, Maurizio; Mazzilli, Silvia; Rettegno, Sara; Bongiovanni, Federica; Gatti, Paolo; Ugo, Fabrizio; Boccuzzi, Giacomo G; Colangelo, Salvatore; Prato, Silvia; Moretti, Claudio; D'Amico, Maurizio; Noussan, Patrizia; Garbo, Roberto; Hildick-Smith, David; Gaita, Fiorenzo; D'Ascenzo, Fabrizio

2018-01-01

Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79-0.94) and 0.84 (0.74-0.9) vs 0.89 (0.78-0.94) and 0.83 (0.70-0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81-0.98) and specificity 0.90 (0.93-0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77-0.91) and specificity 0.92 (0.83-0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.

Failure of nonoperative management of pediatric blunt liver and spleen injuries: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium study.

PubMed

Linnaus, Maria E; Langlais, Crystal S; Garcia, Nilda M; Alder, Adam C; Eubanks, James W; Maxson, R Todd; Letton, Robert W; Ponsky, Todd A; St Peter, Shawn D; Leys, Charles; Bhatia, Amina; Ostlie, Daniel J; Tuggle, David W; Lawson, Karla A; Raines, Alexander R; Notrica, David M

2017-04-01

Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. A prospective observational study was conducted on patients 18 years or younger presenting to any of 10 Level I pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography. Management of BLSI was based on the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium pediatric guideline. Failure of NOM was defined as needing laparoscopy or laparotomy. A total of 1008 patients met inclusion; 499 (50%) had liver injury, 410 (41%) spleen injury, and 99 (10%) had both. Most patients were male (n = 624; 62%) with a median age of 10.3 years (interquartile range, 5.9, 14.2). A total of 69 (7%) underwent laparotomy or laparoscopy, but only 34 (3%) underwent surgery for spleen or liver bleeding. Other (nonexclusive) operations were for 21 intestinal injuries; 15 hematoma evacuations, washouts, or drain placements; 9 pancreatic injuries; 5 mesenteric injuries; 3 diaphragm injuries; and 2 bladder injuries. Patients who failed were more likely to receive blood (52 of 69 vs. 162 of 939; p < 0.001) and median time from injury to first blood transfusion was 2.3 hours for those who failed versus 5.9 hours for those who did not (p = 0.002). Overall mortality rate was 24% (8 of 34) in those who failed NOM due to bleeding. NOM fails in 7% of children with BLSI, but only 3% of patients failed for bleeding due to liver or spleen injury. For children failing NOM due to bleeding, the mortality was 24%. Therapeutic study, level II.

Evaluation of intraoperative fluorescence imaging-guided surgery in cancer-bearing dogs: a prospective proof-of-concept phase II study in 9 cases.

PubMed

Cabon, Quentin; Sayag, David; Texier, Isabelle; Navarro, Fabrice; Boisgard, Raphaël; Virieux-Watrelot, Dorothée; Ponce, Frédérique; Carozzo, Claude

2016-04-01

The objective was to prospectively evaluate the application of intraoperative fluorescence imaging (IOFI) in the surgical excision of malignant masses in dogs, using a novel lipid nanoparticle contrast agent. Dogs presenting with spontaneous soft-tissue sarcoma or subcutaneous tumors were prospectively enrolled. Clinical staging and whole-body computed tomography (CT) were performed. All the dogs received an intravenous injection of dye-loaded lipid nanoparticles, LipImage 815. Wide or radical resection was realized after CT examination. Real-time IOFI was performed before skin incision and after tumor excision. In cases of radical resection, the lymph nodes (LNs) were imaged. The margin/healthy tissues fluorescence ratio or LN/healthy tissues fluorescence ratio was measured and compared with the histologic margins or LN status. Nine dogs were included. Limb amputation was performed in 3 dogs, and wide resection in 6. No adverse effect was noted. Fluorescence was observed in all 9 of the tumors. The margins were clean in 5 of 6 dogs after wide surgical resection, and the margin/healthy tissues fluorescence ratio was close to 1.0 in all these dogs. Infiltrated margins were observed in 1 case, with a margin/healthy tissues fluorescence ratio of 3.2. Metastasis was confirmed in 2 of 3 LNs, associated with LN/healthy tissues fluorescence ratios of 2.1 and 4.2, whereas nonmetastatic LN was associated with a ratio of 1.0. LipImage 815 used as a contrast agent during IOFI seemed to allow for good discrimination between tumoral and healthy tissues. Future studies are scheduled to evaluate the sensitivity and specificity of IOFI using LipImage 815 as a tracer. Copyright © 2016 Elsevier Inc. All rights reserved.

Staphylococcus aureus biofilms: Nemesis of endoscopic sinus surgery.

PubMed

Singhal, Deepti; Foreman, Andrew; Jervis-Bardy, Joshua; Bardy, Josh-Jervis; Wormald, Peter-John

2011-07-01

Chronic rhinosinusitis (CRS) patients with biofilms have persistent postoperative symptoms, ongoing mucosal inflammation, and recurrent infections. Recent evidence suggests that biofilms of differing species confer varying disease profiles in CRS patients. We aimed to prospectively investigate the effects of Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, and fungal biofilms on outcomes following endoscopic sinus surgery (ESS). Prospective blinded study. In this prospective blinded study, 39 patients undergoing ESS for CRS assessed their symptoms preoperatively using internationally accepted standardized symptom scoring systems and quality-of-life measures (10-point visual analog scale, Sino-Nasal Outcome Test-20, global severity of CRS). Their sinonasal mucosa was graded (Lund-Kennedy scale) and extent of radiologic disease on computed tomography scans scored (Lund-McKay scale). Random sinonasal tissue samples were assessed for different bacterial species forming biofilms by using fluorescent in-situ hybridization and confocal laser microscopy. For 12 months after surgery, CRS symptoms, quality of life, and objective evidence of persisting disease were assessed by using the preoperative tools. Different bacterial species combinations were found in 30 of 39 patients; 60% of these 30 biofilms were polymicrobial biofilms and 70% had S aureus biofilms. Preoperative nasendoscopy and radiologic disease severity were significantly worse in patients with multiple biofilms (P = .02 and P = .01, respectively), and they had worse postsurgery mucosal outcomes on endoscopy (P = .01) requiring significantly more postoperative visits (P = .04). Those with S aureus biofilms progressed poorly with their symptom scores and quality-of-life outcomes, with significant differences in nasendoscopy scores (P = .007). S. aureus biofilms play a dominant role in negatively affecting outcomes of ESS with persisting postoperative symptoms, ongoing mucosal inflammation, and infections. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Results of a prospective clinical study on the diagnostic performance of standard magnetic resonance imaging in comparison to a combination of 3T MRI and additional CT imaging in Kienböck's disease.

PubMed

Stahl, Stephane; Hentschel, Pascal; Ketelsen, Dominik; Grosse, Ulrich; Held, Manuel; Wahler, Theodora; Syha, Roland; Schaller, Hans-Eberhard; Nikolaou, Konstantin; Grözinger, Gerd

2017-05-01

This prospective clinical study examined standard wrist magnetic resonance imaging (MRI) examinations and the incremental value of computed tomography (CT) in the diagnosis of Kienböck's disease (KD) with regard to reliability and precision in the different diagnostic steps during diagnostic work-up. Sixty-four consecutive patients referred between January 2009 and January 2014 with positive initial suspicion of KD according to external standard wrist MRI were prospectively included (step one). Institutional review board approval was obtained. Clinical examination by two handsurgeons were followed by wrist radiographs (step two), ultrathin-section CT, and 3T contrast-enhanced MRI (step three). Final diagnosis was established in a consensus conference involving all examiners and all examinations results available from step three. In 12/64 patients, initial suspicion was discarded at step two and in 34/64 patients, the initial suspicion of KD was finally discarded at step three. The final external MRI positive predictive value was 47%. The most common differential diagnoses at step three were intraosseous cysts (n=15), lunate pseudarthrosis (n=13), and ulnar impaction syndrome (n=5). A correlation between radiograph-based diagnoses (step two) with final diagnosis (step three) showed that initial suspicion of stage I KD had the lowest sensitivity for correct diagnosis (2/11). Technical factors associated with a false positive external MRI KD diagnosis were not found. Standard wrist MRI should be complemented with thin-section CT, and interdisciplinary interpretation of images and clinical data, to increase diagnostic accuracy in patients with suspected KD. Copyright © 2017. Published by Elsevier B.V.

Determination of feasibility and utility of microscope-integrated optical coherence tomography during ophthalmic surgery: the DISCOVER Study RESCAN Results.

PubMed

Ehlers, Justis P; Goshe, Jeff; Dupps, William J; Kaiser, Peter K; Singh, Rishi P; Gans, Richard; Eisengart, Jonathan; Srivastava, Sunil K

2015-10-01

Optical coherence tomography (OCT) has transformed the clinical management of a myriad of ophthalmic conditions. Applying OCT to ophthalmic surgery may have implications for surgical decision making and patient outcomes. To assess the feasibility and effect on surgical decision making of a microscope-integrated intraoperative OCT (iOCT) system. Report highlighting the 1-year results (March 2014-February 2015) of the RESCAN 700 portion of the DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery) study, a single-site, multisurgeon, prospective consecutive case series regarding this investigational device. Participants included patients undergoing ophthalmic surgery. Data on clinical characteristics were collected, and iOCT was performed during surgical milestones, as directed by the operating surgeon. A surgeon questionnaire was issued to each surgeon and was completed after each case to evaluate the role of iOCT during surgery and its particular role in select surgical procedures. Percentage of cases with successful acquisition of iOCT (ie, feasibility). Percentage of cases in which iOCT altered surgical decision making (ie, utility). During year 1 of the DISCOVER study, a total of 227 eyes (91 anterior segment cases and 136 posterior segment cases) underwent imaging with the RESCAN 700 system. Successful imaging (eg, the ability to acquire an OCT image of the tissue of interest) was obtained for 224 of 227 eyes (99% [95% CI, 98%-100%]). During lamellar keratoplasty, the iOCT data provided information that altered the surgeon's decision making in 38% of the cases (eg, complete graft apposition when the surgeon believed there was interface fluid). In membrane peeling procedures, iOCT information was discordant with the surgeon's impression of membrane peel completeness in 19% of cases (eg, lack of residual membrane or presence of occult membrane), thus affecting additional surgical maneuvers. The DISCOVER study demonstrates the feasibility of real-time iOCT with a microscope-integrated iOCT system for ophthalmic surgery. The information gained from iOCT appears to allow surgeons to assess subtle details in a unique perspective from standard en face visualization, which can affect surgical decision making some of the time, although the effect of these changes in decision making on outcomes remains unknown. A prospective randomized masked trial is needed to confirm these results.

A Prospective Study of Pterygium Excision and Conjunctival Autograft With Human Fibrin Tissue Adhesive: Effects on Vision, Refraction, and Corneal Topography.

PubMed

Misra, Stuti; Craig, Jennifer P; McGhee, Charles N J; Patel, Dipika V

2014-01-01

This study aimed to investigate changes in visual acuity, corneal parameters, and topographic parameters after pterygium surgery. A prospective observational study was conducted. Twenty eyes of 20 participants undergoing pterygium excision with conjunctival autograft secured using human fibrin tissue adhesive were included in the study. All the participants were assessed preoperatively and 1 and 3 months postoperatively. The parameters included subjective refraction, visual acuity, and pterygium size (pterygium horizontal corneal length [PHCL]) and corneal tomography by Pentacam rotating Scheimpflug tomographer (OCULUS Optikgeräte GmbH, Wetzlar, Germany). The astigmatic changes were calculated using vector analysis. The mean age of participants was 49.3 ± 12.1 years. Mean PHCL was 2.68 ± 0.30 mm. The mean best corrected visual acuity preoperatively was 6/7.5, improving significantly to 6/6 at 1 month (P = 0.001) with this improvement remaining stable at 3 months postoperatively (P = 0.34). There was no significant change in subjective astigmatism, however, mean topographic astigmatism decreased significantly at 1 month (4.36 diopter, P < 0.01) and remained unchanged at 3 months (P < 0.01). Greater PHCL was associated with greater changes in corneal astigmatism. Significant improvements and early stabilization of visual acuity and topographic astigmatism confirm the optical benefits of pterygium excision. These data also suggest a significant advantage of performing pterygium before rather than simultaneously with or after cataract surgery by enabling the most accurate biometry.

Baseline data from a multicenter, 5-year, prospective cohort study of Japanese age-related macular degeneration: an AMD2000 report.

PubMed

Tsujikawa, Akitaka; Akagi-Kurashige, Yumiko; Yuzawa, Mitsuko; Ishibashi, Tatsuro; Nakanishi, Hideo; Nakatani, Eiji; Teramukai, Satoshi; Fukushima, Masanori; Yoshimura, Nagahisa

2018-03-01

To report research participants' baseline characteristics in the AMD2000 study, a prospective, multicenter, 5-year, observational cohort study of Japanese age-related macular degeneration (AMD). The characteristics were determined using multimodal imaging. Patients with AMD were recruited at 18 clinical sites in Japan between April 2006 and March 2009. Each patient underwent a complete ophthalmic examination, including measurement of best-corrected visual acuity (Landolt chart), indirect ophthalmoscopy, slit-lamp biomicroscopy with a contact lens, optical coherence tomography imaging, fundus photography, and fluorescein and indocyanine green angiography. Four hundred sixty participants (326 men [70.9%]) were included in the study. At enrollment, 131 eyes (28.5%) had hard drusen and 125 eyes (27.2%) had soft drusen in the macular area. A total of 455 eyes (98.9%) were diagnosed as having wet AMD, and 5 eyes (1.1%), as having dry AMD. Of the 455 eyes with wet AMD, 209 eyes (45.4%) had typical AMD, 228 eyes (49.6%) had polypoidal choroidal vasculopathy (PCV), and 18 eyes (3.9%) had retinal angiomatous proliferation. The size of choroidal neovascularization (CNV) was significantly smaller with indocyanine green angiography than with fluorescein angiography (P < 0.001). Poor baseline visual acuity was associated with cystoid macular edema, older age, scar, extrafoveal macular edema, subfoveal CNV, large branching vascular network, and hard exudates. Japanese patients with AMD are predominantly male, lack drusen, and have a high rate of PCV.

A Prospective Evaluation of Helical Tomotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bauman, Glenn; Yartsev, Slav; Rodrigues, George

2007-06-01

Purpose: To report results from two clinical trials evaluating helical tomotherapy (HT). Methods and Materials: Patients were enrolled in one of two prospective trials of HT (one for palliative and one for radical treatment). Both an HT plan and a companion three-dimensional conformal radiotherapy (3D-CRT) plan were generated. Pretreatment megavoltage computed tomography was used for daily image guidance. Results: From September 2004 to January 2006, a total of 61 sites in 60 patients were treated. In all but one case, a clinically acceptable tomotherapy plan for treatment was generated. Helical tomotherapy plans were subjectively equivalent or superior to 3D-CRT inmore » 95% of plans. Helical tomotherapy was deemed equivalent or superior in two thirds of dose-volume point comparisons. In cases of inferiority, differences were either clinically insignificant and/or reflected deliberate tradeoffs to optimize the HT plan. Overall imaging and treatment time (median) was 27 min (range, 16-91 min). According to a patient questionnaire, 78% of patients were satisfied to very satisfied with the treatment process. Conclusions: Helical tomotherapy demonstrated clear advantages over conventional 3D-CRT in this diverse patient group. The prospective trials were helpful in deploying this technology in a busy clinical setting.« less

A prospective evaluation of conventional cystography for detection of urine leakage at the vesicourethral anastomosis site after radical prostatectomy based on computed tomography.

PubMed

Han, K S; Choi, H J; Jung, D C; Park, S; Cho, K S; Joung, J Y; Seo, H K; Chung, J; Lee, K H

2011-03-01

To evaluate the diagnostic accuracy of conventional cystography for the detection of urine leakage at the vesicourethral anastomosis (VUA) site after radical prostatectomy based on computed tomography (CT) cystography. Patients who underwent radical prostatectomies at a single tertiary cancer centre were prospectively enrolled. Conventional cystography was routinely performed on postoperative day 7. Non-enhanced pelvic CT images were obtained after retrograde instillation of the same contrast material for a reference standard of urine leakage at the VUA site. Urine leakage was classified as follows: none; a plication abnormality; mild; moderate; and excessive. One hundred and twenty consecutive patients were enrolled. Conventional cystography detected 14 urine leakages, but CT cystography detected 40 urine leakages, which consisted of 28 mild and 12 moderate urine leakages. When using CT cystography as the standard measurement, conventional cystography showed a diagnostic accuracy of 17.8% (5/28) for mild urine leakage and 75% (9/12) for moderate leakage. Of nine patients diagnosed with mild leakage on conventional cystography, four (44.4%) had complicated moderate urine leakages based on CT cystography, requiring prolonged catheterization. The sensitivity, specificity, positive and negative predictive values, and accuracy of conventional cystography were 35, 100, 100, 75.4, and 78.3%, respectively. Conventional cystography is less accurate than CT cystography for diagnosing urine leakage at the VUA site after a radical prostatectomy. The present results suggest that CT cystography is a good choice for diagnostic imaging of urine leakage after radical prostatectomy. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Colorectal multidisciplinary meeting audit to determine patient benefit.

PubMed

Fernando, Chris; Frizelle, Frank; Wakeman, Chris; Frampton, Chris; Robinson, Bridget

2017-11-01

New Zealand tumour standards require discussion of all cases of colorectal cancer in a multidisciplinary meeting (MDM), but supporting evidence is lacking. The aim was to determine which patients benefit from MDM discussion. A retrospective and prospective audit was undertaken of all patients discussed in the Christchurch Hospital colorectal MDM over 12 months to November 2014, who were compared with contemporaneous patients not discussed and identified through Hospital discharge codes. In total, 641 patients were identified, with 459 (70%) discussed in the MDM, on average 7 years younger than not discussed. The proportion discussed by location was 39.2% colon, 63% rectosigmoid, 98% rectal, 96.6% anal. Discussed patients were more likely to have magnetic resonance imaging (68% cf 9.3%), fluorodeoxyglucose positron emission tomography scan (18% versus 2%) and chest computerized tomography scan (50% versus 26%). For colon cancer, American Joint Committee on Cancer (AJCC) stage I and II, 91% of 68 non-discussed patients went straight to surgery compared with 48% of 27 discussed in the MDM; for AJCC stage III uptake of adjuvant chemotherapy was the same whether discussed or not. An R0 resection was achieved for 91% of discussed patients, and 96% of not discussed. A clear referrer's plan, prospectively recorded in 94 patients, was changed after the MDM in 23%. Clinical staging was changed in 20 patients (4%), none with colon cancers. Discussion in the MDM influenced management, but was unlikely to change management for AJCC stage I/II colon cancer, who could be spared mandatory review in the MDM and be discussed selectively as treating clinicians decide. © 2015 Royal Australasian College of Surgeons.

Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography.

PubMed

Asami, Masahiko; Yamaji, Kyohei; Aoki, Jiro; Tanimoto, Shuzou; Watanabe, Mika; Horiuchi, Yu; Furui, Koichi; Kato, Nahoko; Hara, Kazuhiro; Tanabe, Kengo

2017-10-21

Previous studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.

Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

PubMed

Turkalj, Ivan; Petrović, Kosta; Stojanović, Sanja; Petrović, Djordje; Brakus, Alma; Ristić, Jelena

2014-02-01

Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates.

PubMed

Lascano, Agustina M; Perneger, Thomas; Vulliemoz, Serge; Spinelli, Laurent; Garibotto, Valentina; Korff, Christian M; Vargas, Maria I; Michel, Christoph M; Seeck, Margitta

2016-01-01

Preoperative workup aims at localizing the epileptogenic focus to achieve postoperative seizure-freedom. We studied the predictive value of non-invasive techniques, i.e. structural magnetic resonance imaging [MRI], high-density electric source imaging [HD-ESI] and metabolic imaging (positron emission tomography [PET]; single-photon emission computed tomography [SPECT]), in surgically treated patients. A prospective study of 190 epileptic operated patients, with >12 months follow-up and analyzed with state-of-the-art algorithms. 58 patients underwent all techniques. We computed sensitivity, specificity, predictive value and diagnostic odds ratio (OR) in relation to postoperative outcome. Of 190 patients, 148 (77.9%) were seizure-free at follow-up. Resection of the epileptogenic focus was associated with favorable postsurgical outcome (p<0.05). Among 58 patients who underwent all tests, only MRI and HD-ESI were favorable outcome predictors (MRI: OR 10.9, p=0.004; HD-ESI: OR 13.1, p=0.004). Patients with concordant structural MRI and HD-ESI results had 92.3% (24/26) probability of favorable outcome. When both results were negative, probability was 0% (0/5); and when they disagreed, it was 63.0% (17/27). Combination of MRI and HD-ESI offered the highest predictive value for postoperative seizure-freedom. This finding highlights the added value of HD-ESI in the presurgical workup, in particular in combination with an informative MRI. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Macular thickness after glaucoma filtration surgery.

PubMed

Sesar, Antonio; Cavar, Ivan; Sesar, Anita Pusić; Geber, Mia Zorić; Sesar, Irena; Laus, Katia Novak; Vatavuk, Zoran; Mandić, Zdravko

2013-09-01

The aim of present study was to analyze early postoperative changes in the macular area using optical coherence tomography (OCT) after uncomplicated glaucoma filtration surgery. This prospective study included 32 patients (34 eyes) with open-angle glaucoma, which underwent trabeculectomy with or without use of mitomycin C. Exclusion criteria were macular edema, uveitis, age-related macular degeneration, blurred optical media, secondary glaucoma and angle-closure glaucoma. All standard clinical examinations were made before surgery, at the 2nd day, 1 week and 1 month after surgery. Tomography of the macula was performed during every examination using Cirrus HD OCT for the analysis of central subfield thickness. Results show that thickening of the macula was slightly higher 1 week and 1 month after operation in comparison with baseline end 2nd day postoperativelly. There was no significant difference in the change of macular thickness in patients who have used topical prostaglandins compared with those who have used other topical medications. Also, there was no difference in macular changes between patients treated with or without mitomycin C. In conclusion, we found a slight subclinical increase in macular thickness after uncomplicated trabeculectomy, for which we considered that was the result in reduction of intraocular pressure after glaucoma surgery. Macular thickening after glaucoma filtering surgery could be a physiological reaction to the stress of the retina caused by a sudden reduction of intraocular pressure and it is the consequence of altered relationship between capillary pressure and interstitial fluid pressure.

[Computed tomography as a tool to detect potential brain-dead donors].

PubMed

Revuelto-Rey, Jaume; Aldabó-Pallás, Teresa; Egea-Guerrero, Juan José; Vilches-Arenas, Ángel; Lara, Enrique Javier; Gordillo-Escobar, Elena

2015-06-22

To assess the ability of urgent head computed tomography (CT) scan screening to detect patients who can evolve to brain death (BD). Patients who underwent urgent head CT scan and meet the following criteria: midline shift greater than 5mm and/or decrease or absence of basal cisterns. A follow-up for 28 days of each patient was made. Epidemiological data (sex, age, cause of brain injury), clinical data (level of consciousness, severity index in the CT) and patient outcomes (death, BD, discharge or transfer) were recorded. This was a prospective observational study. One hundred and sixty-six patients were selected for study, with mean age 60.08 (SD 21.8) years. A percentage of 49.4 were men and the rest women. In the follow-up, 20,5% (n=34) had BD. In univariate analysis, intracerebral hemorrhage, Glasgow Coma Scale score less than 8 and alteration of basal cisterns were statistically significant in predicting BD (P<.05). Multivariate analysis showed that patients with compression of basal cisterns were 20 (95% confidence interval [95% CI] 2.61 to 153.78; P=.004] times more likely to progress to brain death, while the absence there of 62.6 (95% CI 13.1 to 738.8; P<.001] times more. Our work shows that data as easy to interpret as compression/absence of basal cisterns can be a powerful tool for screening patients at risk for progression to BD. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Full 3D Microwave Tomography enhanced GPR surveys: a case study

NASA Astrophysics Data System (ADS)

Catapano, Ilaria; Soldovieri, Francesco; Affinito, Antonio; Hugenschmidt, Johannes

2014-05-01

Ground Penetrating Radar (GPR) systems are well assessed non-invasive diagnostic tools capable of providing high resolution images of the inner structure of the probed spatial region. Owing to this capability, GPR systems are nowadays more and more considered in the frame of civil engineering surveys since they may give information on constructive details as well as on the aging and risk factors affecting the healthiness of an infrastructure. In this frame, accurate, reliable and easily interpretable images of the probed scenarios are mandatory in order to support the management of maintenance works and assure the safety of structures. Such a requirement motivates the use of different and sophisticated data processing approaches in order to compare more than one image of the same scene, thus improving the reliability and objectiveness of the GPR survey results. Among GPR data processing procedures, Microwave Tomography approaches based on the Born approximation face the imaging as the solution of a linear inverse problem, which is solved by using the Truncated Singular Value Decomposition as a regularized inversion scheme [1]. So far, an approach exploiting a 2D scalar model of the scattering phenomenon have been adopted to process GPR data gathered along a single scan. In this case, 3D images are obtained by interpolating 2D reconstructions (this is referred commonly as pseudo 3D imaging). Such an imaging approach have provided valuable results in several real cases dealing with not only surveys for civil engineering but also archeological prospection, subservice monitoring, security surveys and so on [1-4]. These encouraging results have motivated the development of a full 3D Microwave Tomography approach capable of accounting for the vectorial nature of the wave propagation. The reconstruction capabilities of this novel approach have been assessed mainly against experimental data collected in laboratory controlled conditions. The obtained results corroborate that, the use of a full 3D scattering model allows an improved estimation of the objects shape and size with respect to pseudo 3D imaging [5]. In this communication, the performance offered by the full 3D imaging approach is investigated by using a dataset from infrastructure inspection. Since the collapse of a car park in Switzerland killing 7 firemen, "punching", where a pile remains upright but the ceiling carried by the pile falls down, is considered a serious problem The 3D tomography approach was applied to a dataset acquired in a car park in the vicinity of piles. Such datasets can be used for an assessment of the safety of such structures and can therefore be considered as relevant test cases for innovative data processing and inversion strategies. REFERENCES [1] F. Soldovieri, J. Hugenschmidt, R. Persico and G. Leone, "A linear inverse scattering algorithm for realistic GPR applications, Near Surf. Geophys., vol. 5, pp.29-42, 2007. [2] I. Catapano, L. Crocco R. Di Napoli, F. Soldovieri, A. Brancaccio, F. Pesando, A. Aiello, "Microwave tomography enhanced GPR surveys in Centaur's Domus, Regio VI of Pompeii, Italy", J. Geophys. Eng., vol.9, S92-S99, 2012. [3] I. Catapano, R. Di Napoli, F. Soldovieri, M. Bavusi, A. Loperte, J. Dumoulin, Structural monitoring via microwave tomography-enhanced GPR: the Montagnole test site, J. Geophys. Eng., vol. 9, S100-S107, 2012 [4] J. Hugenschmidt, A. Kalogeropoulos, F. Soldovieri, G. Prisco (2010) Processing Strategies for high-resolution GPR Concrete Inspections, NDT & E International, Volume 43, Issue 4: 334-342. [5] I. Catapano, A. Affinito, G. Gennarelli, F. di Maio, A. Loperte, F. Soldovieri, Full three-dimensional imaging via ground penetrating radar: assessment in controlled conditions and on field for archaeological prospecting, Appl. Phys. A: Materials Science and Processing, pp. 1-8, Article in Press

Suprachoroidal layer and suprachoroidal space delineating the outer margin of the choroid in swept-source optical coherence tomography.

PubMed

Michalewska, Zofia; Michalewski, Janusz; Nawrocka, Zofia; Dulczewska-Cichecka, Karolina; Nawrocki, Jerzy

2015-02-01

To define the morphology of outer choroidal margins in swept-source optical coherence tomography. This is a prospective observational study of 180 eyes: 20 eyes of healthy volunteers, 20 eyes of myopic patients, and 20 eyes from each of the following groups: macular hole, lamellar macular hole, epiretinal membranes, drusen, dry age-related macular degeneration (AMD), neovascular AMD, and vitreomacular traction. A single 12-mm wide swept-source optical coherence tomography image for each of the examined eyes consisting of 1,024 A-scans has been created. The main outcome measure selected was to estimate the presence of suprachoroidal layer, as well as to estimate the ability to delineate the outer choroidoscleral boundary using the software available (DRI-OCT) and to determine its shape. Suprachoroidal layer was observed in 5% of healthy emmetropic eyes, in 50% of eyes with full-thickness macular holes, and in 60% of eyes with vitreomacular traction syndrome. It was also present in 50% of eyes with dry AMD and in 20% of eyes with neovascular AMD. The outer margin of the choroid in all eyes of the healthy volunteers and in eyes with macular diseases has been delineated correctly. In all healthy and myopic eyes, we recognized the outer choroidoscleral boundary as having a regular shape following the natural oval contour of the globe. In eyes with epiretinal membranes, macular hole, vitreomacular traction, and AMD, the outer choroidoscleral boundary was irregular; the choroid varied in thickness from point to point. Swept-source optical coherence tomography enables exact visualization of the outer choroidoscleral boundary. Suprachoroidal layer consisting of two bands has been recognized, the upper of which is hyperreflective and the lower of which is hyporeflective. It may be supposed that the lower hyporeflective band corresponds to suprachoroidal space, which was not earlier visualized in vivo in eyes without choroidal effusion. Suprachoroidal layer in myopic and emmetropic healthy subjects has been rarely observed. We observed it more frequently in different macular diseases.

Integrated Geophysycal Prospecting in Late Antiquity and Early Medieval Sites in Italy

NASA Astrophysics Data System (ADS)

Giannotta, Maria Teresa; Leucci, Giovanni; De Giorgi, Lara; Matera, Loredana; Persico, Raffaele; Muci, Giuseppe

2016-04-01

In this contribution, the results of some integrated geophysical prospecting (magnetometric and GPR) are exposed. This work has been performed in collaboration between archaeologists and geophysicists within the research project "History and Global Archaeology of the Rural Landascapes in Italy, between Late Antiquity and Medieval period. Integrated systems of sources, methodologies, and technologies for a sustainable development", financed by the Italian Ministry for Instruction, University and Research MIUR. In particular, the archaeological sites of Badia and San Giovanni in Malcantone, both in the Apulia Region (eastern-southern Italy) have been prospect. The sites have been identified on the basis of available documents, archaeological surveys and testimonies. In particular, we know that in Badia [1] it was probable the presence of an ancient roman villa of the late ancient period (strongly damaged by the subsequent ploughing activities). Whereas in San Giovanni there is still, today, a small chapel (deconsecrated) that was likely to be part of a previous larger church (probably a basilica of the early Christian period) restricted in the subsequent centuries (probably in more phases). The Saracen raids of the XVI centuries made the site ruined and abandoned. In both sites integrated prospecting have been performed [2-6] with a the integration of archaeological, magnetometer and a GPR data have provided some interesting results, allowing to overcome the difficulties relative to an extensive GPR prospecting, that could not be performed because of the intrinsic superficial roughness and/or the intensive ploughing activities. The prospecting activities, in particular, have added elements that seem to confirm the main archaeological hypothesis that motivate their performing, as it will be show at the conference. References [1] M. T, Giannotta, G. Leucci, R. Persico, M. Leo Imperiale, The archaeological site of Badia in terra d'Otranto: contribution of the geophysical prospecting to the reconstruction of the landscape from the late antiquity to the middle age, Proc. of 6th International Congress "Science and Technology for the Safeguard of Cultural Heritage in the Mediterranean Basin", Athens, Greece, 22nd-25th October 2013. [2] L. De Giorgi, G. Leucci, Detection of hazardous cavities below a road using combined geophysical methods. Surveys in Geophysics, online DOI 10.1007/s10712-013-9277-4, 2014. [3] R. Persico, Introduction to Ground Penetrating Radar: Inverse Scattering and data processing. Wiley, 2014 [4] S. Piscitelli, E.Rizzo, F. Cristallo,V. Lapenna, L. Crocco, R. Persico, F. Soldovieri, GPR and Microwave Tomography for Detecting shallow Cavities in the Historical Area of Sassi of Matera (Southern Italy), Near Surface Geophysics, vol. 5, pp. 275-285, 2007. [5] G. Leucci, N. Masini, R. Persico, F. Soldovieri." GPR and sonic tomography for structural restoration: the case of the Cathedral of Tricarico", Journal of Geophysics and Engineering, vol. 8, pp. S76-S92, Aug. 2011. [6] L. Matera, M. Noviello, M. Ciminale, R. Persico, Integration of multisensor data: an experiment in the archaeological park of Egnazia (Apulia, Southern Italy), Near Surface Geophysics, vol. 13, n. 6, pp. 613-621, 2015

Breaking the acoustic diffraction barrier with localization optoacoustic tomography

NASA Astrophysics Data System (ADS)

Deán-Ben, X. Luís.; Razansky, Daniel

2018-02-01

Diffraction causes blurring of high-resolution features in images and has been traditionally associated to the resolution limit in light microscopy and other imaging modalities. The resolution of an imaging system can be generally assessed via its point spread function, corresponding to the image acquired from a point source. However, the precision in determining the position of an isolated source can greatly exceed the diffraction limit. By combining the estimated positions of multiple sources, localization-based imaging has resulted in groundbreaking methods such as super-resolution fluorescence optical microscopy and has also enabled ultrasound imaging of microvascular structures with unprecedented spatial resolution in deep tissues. Herein, we introduce localization optoacoustic tomography (LOT) and discuss on the prospects of using localization imaging principles in optoacoustic imaging. LOT was experimentally implemented by real-time imaging of flowing particles in 3D with a recently-developed volumetric optoacoustic tomography system. Provided the particles were separated by a distance larger than the diffraction-limited resolution, their individual locations could be accurately determined in each frame of the acquired image sequence and the localization image was formed by superimposing a set of points corresponding to the localized positions of the absorbers. The presented results demonstrate that LOT can significantly enhance the well-established advantages of optoacoustic imaging by breaking the acoustic diffraction barrier in deep tissues and mitigating artifacts due to limited-view tomographic acquisitions.

A Mid-scala Cochlear Implant Electrode Design Achieves a Stable Post-surgical Position in the Cochlea of Patients Over Time-A Prospective Observational Study.

PubMed

Dees, Guido; Smits, Jeroen Jules; Janssen, A Miranda L; Hof, Janny R; Gazibegovic, Dzemal; Hoof, Marc van; Stokroos, Robert J

2018-04-01

Cochlear implant (CI) electrode design impacts the clinical performance of patients. Stability and the occurrence of electrode array migration, which is the postoperative movement of the electrode array, were investigated using a mid-scalar electrode array and postoperative image analysis. A prospective observational study was conducted. A mid-scalar electrode was surgically placed using a mastoidectomy, followed by a posterior tympanotomy and an extended round-window or cochleostomy insertion. A few days after surgery and 3 months later Cone Beam Computed Tomography (CBCT) was performed. The two different CBCT's were fused, and the differences between the electrode positions in three dimensions were calculated (the migration). A migration greater than 0.5 mm was deemed clinically relevant. Fourteen subjects participated. The mid-scalar electrode migrated in one patient (7%). This did not lead to the extrusion of an electrode contact. The mean migration of every individual electrode contact in all patients was 0.36 mm (95% confidence interval 0.22-0.50 mm), which approximates to the estimated measurement error of the CBCT technique. A mid-scalar electrode array achieves a stable position in the cochlea in a small but representative group of patients. The methods applied in this work can be used for providing postoperative feedback for surgeons and for benchmarking electrode designs.

Macular Choroidal Thickness May Be the Earliest Determiner to Detect the Onset of Diabetic Retinopathy in Patients with Prediabetes: A Prospective and Comparative Study.

PubMed

Yazgan, Serpil; Arpaci, Dilek; Celik, Haci Ugur; Dogan, Mustafa; Isık, Irem

2017-07-01

To evaluate the macular and peripapillary choroidal thickness and retinal volume in prediabetes. This prospective comparative study included 53 patients with prediabetes and 53 age- and sex-matched healthy subjects. Only right eyes were selected. Choroidal thicknesses (CT) and retinal volume were measured by optical coherence tomography. Macular CT was measured at the seven points including macular center, 1, 2, and 3 mm distances along the temporal and nasal scans. Peripapillary CT was measured at the eight points of the optic disk area. Systemic and laboratory findings of the subjects were also recorded. There were no significant differences in blood pressures, ocular findings including intraocular pressure, visual acuity, and refractive powers, and macular volumes between the two groups (p > 0.005). Macular and peripapillary CT at all measuring points, body mass index (BMI), fasting blood glucose (FBG), hemoglobinA1C, and lipid profile were significantly higher in prediabetic patients (p < 0.05). There was a significant positive correlation between all points of macular choroidal thicknesses with BMI, FBG, and hemoglobin A1C (p < 0.05). Prediabetic factors including impaired FBG, increased hemoglobinA1C, and BMI are independent risk factors for increase in choroidal thickness. Increased macular choroidal thickness may be the earliest determiner to detect the onset of diabetic retinopathy in prediabetes.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus.

PubMed

Woo, Seung Hoon; Kim, Kyung Hee

2015-11-01

To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol. Prospective cohort study. A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy. In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%). CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

INTRAVITREAL DEXAMETHASONE IMPLANT AS ADJUVANT TREATMENT FOR BEVACIZUMAB- AND RANIBIZUMAB-RESISTANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Prospective Pilot Study.

PubMed

Barikian, Anita; Salti, Haytham; Safar, Ammar; Mahfoud, Ziyad R; Bashshur, Ziad F

2017-07-01

To study the benefit of intravitreal dexamethasone implant in the management of neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. Patients with persistent macular fluid on optical coherence tomography despite monthly treatment with at least three consecutive bevacizumab injections followed by at least three ranibizumab injections were prospectively enrolled. A single dexamethasone implant was administered followed by intravitreal ranibizumab 1 week later. Ranibizumab was continued afterward on an as-needed basis. Main outcomes were improvement in central retinal thickness and best-corrected visual acuity. Nineteen patients (19 eyes) were enrolled. There was no significant change in best-corrected visual acuity over 6 months. Greatest reduction in mean central retinal thickness, from 295.2 μm to 236.2 μm, occurred 1 month after dexamethasone implant (P < 0.0001). By Month 6, mean central retinal thickness was 287.3 μm (P = 0.16). Eyes with only intraretinal fluid (13 eyes) achieved a fluid-free macula. Eyes with predominantly subretinal fluid (6 eyes) did not improve central retinal thickness and continued monthly ranibizumab. Mean baseline intraocular pressure was 13.2 mmHg, which peaked at 15.6 mmHg by Month 2 (P = 0.004). Intravitreal dexamethasone implant improved only macular intraretinal fluid in eyes with neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. However, this treatment had a limited duration.

MULTIMODAL IMAGING OF MOSAIC RETINOPATHY IN CARRIERS OF HEREDITARY X-LINKED RECESSIVE DISEASES.

PubMed

Wu, An-Lun; Wang, Jung-Pan; Tseng, Yun-Ju; Liu, Laura; Kang, Yu-Chuan; Chen, Kuan-Jen; Chao, An-Ning; Yeh, Lung-Kun; Chen, Tun-Lu; Hwang, Yih-Shiou; Wu, Wei-Chi; Lai, Chi-Chun; Wang, Nan-Kai

2018-05-01

To investigate the clinical features in carriers of X-linked retinitis pigmentosa, X-linked ocular albinism, and choroideremia (CHM) using multimodal imaging and to assess their diagnostic value in these three mosaic retinopathies. We prospectively examined 14 carriers of 3 X-linked recessive disorders (X-linked retinitis pigmentosa, X-linked ocular albinism, and CHM). Details of abnormalities of retinal morphology were evaluated using fundus photography, fundus autofluorescence (FAF) imaging, and spectral domain optical coherence tomography. In six X-linked retinitis pigmentosa carriers, fundus appearance varied from unremarkable to the presence of tapetal-like reflex and pigmentary changes. On FAF imaging, all carriers exhibited a bright radial reflex against a dark background. By spectral domain optical coherence tomography, loss of the ellipsoid zone in the macula was observed in 3 carriers (50%). Regarding the retinal laminar architecture, 4 carriers (66.7%) showed thinning of the outer nuclear layer and a dentate appearance of the outer plexiform layer. All five X-linked ocular albinism carriers showed a characteristic mud-splatter patterned fundus, dark radial streaks against a bright background on FAF imaging, and a normal-appearing retinal structure by spectral domain optical coherence tomography imaging. Two of the 3 CHM carriers (66.7%) showed a diffuse moth-eaten appearance of the fundus, and all 3 showed irregular hyper-FAF and hypo-FAF spots throughout the affected area. In the CHM carriers, the structural changes observed by spectral domain optical coherence tomography imaging were variable. Our findings in an Asian cohort suggest that FAF imaging is a practical diagnostic test for differentiating X-linked retinitis pigmentosa, X-linked ocular albinism, and CHM carriers. Wide-field FAF is an easy and helpful adjunct to testing for the correct diagnosis and identification of lyonization in carriers of these three mosaic retinopathies.

Systolic hypertension and progression of aortic valve calcification in patients with aortic stenosis: results from the PROGRESSA study.

PubMed

Tastet, Lionel; Capoulade, Romain; Clavel, Marie-Annick; Larose, Éric; Shen, Mylène; Dahou, Abdellaziz; Arsenault, Marie; Mathieu, Patrick; Bédard, Élisabeth; Dumesnil, Jean G; Tremblay, Alexe; Bossé, Yohan; Després, Jean-Pierre; Pibarot, Philippe

2017-01-01

Hypertension is highly prevalent in patients with aortic stenosis (AS) and is associated with worse outcomes. The current prospective study assessed the impact of systolic hypertension (SHPT) on the progression of aortic valve calcification (AVC) measured by multidetector computed tomography (MDCT) in patients with AS. The present analysis includes the first series of 101 patients with AS prospectively recruited in the PROGRESSA study. Patients underwent comprehensive Doppler echocardiography and MDCT exams at baseline and after 2-year follow-up. AVC and coronary artery calcification (CAC) were measured using the Agatston method. Patients with SHPT at baseline (i.e. systolic blood pressure ≥140 mmHg; n = 37, 37%) had faster 2-year AVC progression compared with those without SHPT (i.e. systolic blood pressure <140 mmHg) (AVC median [25th percentile-75th percentile]: +370 [126-824] vs. +157 [58-303] AU; P = 0.007, respectively). Similar results were obtained with the analysis of AVC progression divided by the cross-sectional area of the aortic annulus (AVC density : +96 [34-218] vs. +45 [14-82] AU/cm 2 , P = 0.01, respectively). In multivariable analysis, SHPT remained significantly associated with faster progression of AVC or AVC density (all P = 0.001). There was no significant difference between groups with respect to progression of CAC (+39 [3-199] vs. +41 [0-156] AU, P = 0.88). This prospective study shows for the first time that SHPT is associated with faster AVC progression but not with CAC progression in AS patients. These findings provide further support for the elaboration of randomized clinical trials to assess the efficacy of antihypertensive medication to slow the stenosis progression in patients with AS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Diagnostic performance of computed tomography coronary angiography (from the Prospective National Multicenter Multivendor EVASCAN Study).

PubMed

Gueret, Pascal; Deux, Jean-François; Bonello, Laurent; Sarran, Anthony; Tron, Christophe; Christiaens, Luc; Dacher, Jean-Nicolas; Bertrand, David; Leborgne, Laurent; Renard, Cedric; Caussin, Christophe; Cluzel, Philippe; Helft, Gerard; Crochet, Dominique; Vernhet-Kovacsik, Hélène; Chabbert, Valérie; Ferrari, Emile; Gilard, Martine; Willoteaux, Serge; Furber, Alain; Barone-Rochette, Gilles; Jankowski, Adrien; Douek, Philippe; Mousseaux, Elie; Sirol, Marc; Niarra, Ralph; Chatellier, Gilles; Laissy, Jean-Pierre

2013-02-15

Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity. Copyright © 2013 Elsevier Inc. All rights reserved.

Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE): a prospective study.

PubMed

West, Sarah L; Lok, Charmaine E; Jamal, Sophie A

2010-08-20

Chronic kidney disease (CKD) is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD. This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1) bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2) volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3) serum markers of bone turnover; 4) bone formation rate by bone biopsy; and 5) muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls. This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy--we will reduce the burden of disease due to fractures among patients with CKD.

Cone-beam computed tomography in children with cochlear implants: The effect of electrode array position on ECAP.

PubMed

Lathuillière, Marine; Merklen, Fanny; Piron, Jean-Pierre; Sicard, Marielle; Villemus, Françoise; Menjot de Champfleur, Nicolas; Venail, Frédéric; Uziel, Alain; Mondain, Michel

2017-01-01

To assess the feasibility of using cone-beam computed tomography (CBCT) in young children with cochlear implants (CIs) and study the effect of intracochlear position on electrophysiological and behavioral measurements. A total of 40 children with either unilateral or bilateral cochlear implants were prospectively included in the study. Electrode placement and insertion angles were studied in 55 Cochlear ® implants (16 straight arrays and 39 perimodiolar arrays), using either CBCT or X-ray imaging. CBCT or X-ray imaging were scheduled when the children were leaving the recovery room. We recorded intraoperative and postoperative neural response telemetry threshold (T-NRT) values, intraoperative and postoperative electrode impedance values, as well as behavioral T (threshold) and C (comfort) levels on electrodes 1, 5, 10, 15 and 20. CBCT imaging was feasible without any sedation in 24 children (60%). Accidental scala vestibuli insertion was observed in 3 out of 24 implants as assessed by CBCT. The mean insertion angle was 339.7°±35.8°. The use of a perimodiolar array led to higher angles of insertion, lower postoperative T-NRT, as well as decreased behavioral T and C levels. We found no significant effect of either electrode array position or angle of insertion on electrophysiological data. CBCT appears to be a reliable tool for anatomical assessment of young children with CIs. Intracochlear position had no significant effect on the electrically evoked compound action potential (ECAP) threshold. Our CBCT protocol must be improved to increase the rate of successful investigations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Diagnostic Capability of Spectral Domain Optical Coherence Tomography for Glaucoma

PubMed Central

Wu, Huijuan; de Boer, Johannes F.; Chen, Teresa C.

2012-01-01

Purpose To determine the diagnostic capability of spectral domain optical coherence tomography (OCT) in glaucoma patients with visual field (VF) defects. Design Prospective, cross-sectional study. Methods Setting Participants were recruited from a university hospital clinic. Study Population One eye of 85 normal subjects and 61 glaucoma patients [with average VF mean deviation (MD) of -9.61 ± 8.76 dB] were randomly selected for the study. A subgroup of the glaucoma patients with early VF defects was calculated separately. Observation Procedures Spectralis OCT circular scans were performed to obtain peripapillary retinal nerve fiber layer (RNFL) thicknesses. The RNFL diagnostic parameters based on the normative database were used alone or in combination for identifying glaucomatous RNFL thinning. Main Outcome Measures To evaluate diagnostic performance, calculations included areas under the receiver operating characteristic curve (AROC), sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Results Overall RNFL thickness had the highest AROC value (0.952 for all patients, 0.895 for the early glaucoma subgroup). For all patients, the highest sensitivity (98.4%, CI 96.3-100%) was achieved by using two criteria: ≥1 RNFL sectors being abnormal at the < 5% level, and overall classification of borderline or outside normal limits, with specificities of 88.9% (CI 84.0-94.0%) and 87.1% (CI 81.6-92.5%) respectively for these two criteria. Conclusions Statistical parameters for evaluating the diagnostic performance of the Spectralis spectral domain OCT were good for early perimetric glaucoma and excellent for moderately-advanced perimetric glaucoma. PMID:22265147

The use of portable intraoperative computed tomography scanning for real-time image guidance: a pilot cadaver study.

PubMed

Das, Subinoy; Maeso, Patricia A; Figueroa, Ramon E; Senior, Brent A; Delgaudio, John M; Sillers, Michael J; Schlosser, Rod J; Kountakis, Stilianos E

2008-01-01

This study was performed to assess the feasibility of using intraoperative computed tomography (CT) to provide real-time updates to image guidance systems (IGSs) during surgery. The xCAT ENT portable intraoperative CT scanner (Xoran Technologies, Ann Arbor, MI) was used to acquire scans before, midway, and at the end of six cadaver dissections during the Southern States Rhinology Course, Augusta, GA, in October 2006. These scans were used to recalibrate three different IGSs used during the dissection. Time measurements were recorded and dosimetry was obtained from the cornea, sphenoid sinus (near the optic chiasm), and from the operative field during acquisition of the images. IGS accuracy was determined at the skull base and lamina papyracea. Surgeons were interviewed on benefits of real-time updates to the IGS after completion of dissections. The xCAT ENT scanner was compatible with all three IGS platforms. The average time to update the IGS was 13 minutes. Radiation doses to the cornea were 620 mrad per scan, and optic chiasm was 800 mrad/scan. The accuracy at the anterior skull base improved from 1.58 to 0.62 mm (p=0.026). The accuracy at the posterior skull base improved from 1.46 to 0.71 mm (p=0.014). The accuracy at the lamina was not significantly changed. Intraoperative portable CT scanning with real-time IGS updates is feasible and likely would add little additional time. Accuracy is improved at the skull base. Prospective studies on actual patients are warranted.

Outer Retinal Assessment Using Spectral-Domain Optical Coherence Tomography in Patients With Alzheimer's and Parkinson's Disease.

PubMed

Uchida, Atsuro; Pillai, Jagan A; Bermel, Robert; Bonner-Jackson, Aaron; Rae-Grant, Alexander; Fernandez, Hubert; Bena, James; Jones, Stephen E; Leverenz, James B; Srivastava, Sunil K; Ehlers, Justis P

2018-06-01

To investigate outer retinal parameters among patients with various chronic neurodegenerative disorders by using spectral-domain coherence tomography (OCT) in a prospective cross-sectional cohort study. A total of 132 participants were enrolled following a comprehensive diagnostic evaluation with neurologic, neuropsychology, and magnetic resonance imaging volumetric evaluations. Participants were 50 years or older, either diagnosed with Alzheimer's disease (AD) dementia, amnestic mild cognitive impairment (MCI), non-AD dementia, Parkinson's disease (PD), or age- and sex-matched controls. All participants underwent a macular cube scan for both eyes by using the Cirrus 4000 HD-OCT (Zeiss, Oberkochen, Germany). The OCT image with the best quality was selected for further analysis. Outer retinal parameters including ellipsoid zone mapping and outer nuclear layer metrics were evaluated with a novel software platform. One hundred twenty-four eyes of 124 participants with AD dementia (24 eyes), amnestic MCI (22 eyes), non-AD dementia (20 eyes), PD (22 eyes), and age- and sex-matched controls (36 eyes) were included in the analysis. Eight eyes were excluded either due to the presence of macular disease or poor quality of the OCT image. The mean ages of participants were 65.9 ± 8.9 years. The outer retinal thickness measures did not show any statistical significance between the groups. However, ellipsoid zone to retinal pigment epithelium volume correlated with cognitive testing scores in all study participants. There were no identifiable differences in the outer retinal metrics across neurodegenerative disease groups and controls. The relationship between the degree of cognitive impairment and ellipsoid zone to retinal pigment epithelium volume warrants further study.

Retinal ganglion cell complex and peripapillary retinal nerve fiber layer thicknesses following carotid endarterectomy.

PubMed

Guclu, Orkut; Guclu, Hande; Huseyin, Serhat; Korkmaz, Selcuk; Yuksel, Volkan; Canbaz, Suat; Pelitli Gurlu, Vuslat

2018-06-23

To examine changes in retinal ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses by optical coherence tomography (OCT) in contralateral and ipsilatateral eyes of carotid artery stenosis (CAS) patients before and after carotid endarterectomy (CEA). Forty-two consecutive patients diagnosed with CAS (70-99% stenosis rate) who underwent CEA were included in this prospective cross-sectional study. The indication for CEA was based on the Asymptomatic Carotid Atherosclerosis Study. Doppler ultrasonography and computed tomography angiography were performed to calculate CAS. All the subjects underwent an ophthalmological examination, including best corrected visual acuity (BCVA), intraocular pressure (IOP) measurements, biomicroscopy, fundoscopy, and OCT before and after the surgery. The mean preoperative intraocular pressure was 15.2 ± 2.1 mmHg in the ipsilateral eye and 15.8 ± 2.7 in the contralateral eye. The mean postoperative intraocular pressure in the ipsilateral and contralateral eye was 18.6 ± 3.0 and 19.3 ± 3.8, respectively. The intraocular pressure was significantly higher in postoperative eyes (p = 0.0001). There was a statistically significant decrease in peripapillary RNFL thickness in superior quadrants postoperatively in ipsilateral eyes. The retinal GCC layer thickness was not significantly different before and after CEA in ipsilateral and contralateral eyes. Carotid endarterectomy results in thinning of the superior peripapillary RNFL thickness. To the best of our knowledge, this is the first study to examine peripapillary RNFL and GCC thicknesses before and after CEA.

Detection of new-onset choroidal neovascularization.

PubMed

Do, Diana V

2013-05-01

To highlight the most common methods that are used to detect new-onset choroidal neovascularization (CNV) as a result of age-related macular degeneration (AMD). Numerous modalities are available to try to detect CNV. Amsler grid testing, preferential hyperacuity perimetry (PHP), optical coherence tomography (OCT), and fluorescein angiography are tools that may be used to detect CNV. The Age-Related Macular Degeneration: Detection of Onset of new Choroidal neovascularization Study (AMD DOC Study) evaluated the sensitivity of time domain OCT, relative to fluorescein angiography, in detecting new-onset neovascular AMD within a 2-year period. The sensitivity of each modality for detecting CNV was OCT 0.40 [(95% confidence interval (95% CI) (0.16-0.68), supervised Amsler grid 0.42 (95% CI 0.15-0.72), and PHP 0.50 (95% CI 0.23-0.77)]. Numerous modalities are available to try to detect CNV. The prospective AMD DOC Study demonstrated that fluorescein angiography still remains the best method to detect new-onset CNV.

Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography.

PubMed

Klop, Cornelis; Deden, Laura N; Aarts, Edo O; Janssen, Ignace M C; Pijl, Milan E J; van den Ende, Anneline; Witteman, Bart P L; de Jong, Gabie M; Aufenacker, Theo J; Slump, Cornelis H; Berends, Frits J

2018-02-05

The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation. 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples.

Detection of new-onset choroidal neovascularization using optical coherence tomography: the AMD DOC Study.

PubMed

Do, Diana V; Gower, Emily W; Cassard, Sandra D; Boyer, David; Bressler, Neil M; Bressler, Susan B; Heier, Jeffrey S; Jefferys, Joan L; Singerman, Lawrence J; Solomon, Sharon D

2012-04-01

To determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard. Prospective, multicenter, observational study. Individuals aged ≥50 years with nonneovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. At study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. The sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV. A total of 98 participants were enrolled; 87 (89%) of these individuals either completed the 24-month visit or exited the study after developing CNV. Fifteen (17%) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.16-0.68), supervised Amsler grid 0.42 (95% CI, 0.15-0.72), and PHP 0.50 (95% CI, 0.23-0.77). Treatment for incident CNV was recommended by the study investigator in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95% CI, 0.39-0.91) for OCT, 0.50 (95% CI, 0.19-0.81) for supervised Amsler grid, and 0.70 (95% CI, 0.35-0.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP. Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA. Optical coherence tomography has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Venous phase of computed tomography angiography increases spot sign detection, but intracerebral hemorrhage expansion is greater in spot signs detected in arterial phase.

PubMed

Rodriguez-Luna, David; Dowlatshahi, Dar; Aviv, Richard I; Molina, Carlos A; Silva, Yolanda; Dzialowski, Imanuel; Lum, Cheemun; Czlonkowska, Anna; Boulanger, Jean-Martin; Kase, Carlos S; Gubitz, Gord; Bhatia, Rohit; Padma, Vasantha; Roy, Jayanta; Stewart, Teri; Huynh, Thien J; Hill, Michael D; Demchuk, Andrew M

2014-03-01

Variability in computed tomography angiography (CTA) acquisitions may be one explanation for the modest accuracy of the spot sign for predicting intracerebral hemorrhage expansion detected in the multicenter Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study. This study aimed to determine the frequency of the spot sign in intracerebral hemorrhage and its relationship with hematoma expansion depending on the phase of image acquisition. PREDICT study was a prospective observational cohort study of patients with intracerebral hemorrhage presenting within 6 hours from onset. A post hoc analysis of the Hounsfield units of an artery and venous structure were measured on CTA source images of the entire PREDICT cohort in a core laboratory. Each CTA study was classified into arterial or venous phase and into 1 of 5 specific image acquisition phases. Significant hematoma expansion and total hematoma enlargement were recorded at 24 hours. Overall (n=371), 77.9% of CTA were acquired in arterial phase. The spot sign, present in 29.9% of patients, was more frequently seen in venous phase as compared with arterial phase (39% versus 27.3%; P=0.041) and the later the phase of image acquisition (P=0.095). Significant hematoma expansion (P=0.253) and higher total hematoma enlargement (P=0.019) were observed more frequently among spot sign-positive patients with earlier phases of image acquisition. Later image acquisition of CTA improves the frequency of spot sign detection. However, spot signs identified in earlier phases may be associated with greater absolute enlargement. A multiphase CTA including arterial and venous acquisitions could be optimal in patients with intracerebral hemorrhage.

Impact of Extraperitoneal Dioxyde Carbon Insufflation on Respiratory Function in Anesthetized Adults: A Preliminary Study Using Electrical Impedance Tomography and Wash-out/Wash-in Technic

PubMed Central

Bordes, Julien; Mazzeo, Cecilia; Gourtobe, Philippe; Cungi, Pierre Julien; Antonini, Francois; Bourgoin, Stephane; Kaiser, Eric

2015-01-01

Background: Extraperitoneal laparoscopy has become a common technique for many surgical procedures, especially for inguinal hernia surgery. Investigations of physiological changes occurring during extraperitoneal carbon dioxide (CO2) insufflation mostly focused on blood gas changes. To date, the impact of extraperitoneal CO2 insufflation on respiratory mechanics remains unknown, whereas changes in respiratory mechanics have been extensively studied in intraperitoneal insufflation. Objectives: The aim of this study was to investigate the effects of extraperitoneal CO2 insufflation on respiratory mechanics. Patients and Methods: A prospective and observational study was performed on nine patients undergoing laparoscopic inguinal hernia repair. Anesthetic management and intraoperative care were standardized. All patients were mechanically ventilated with a tidal volume of 8 mL/kg using an Engström Carestation ventilator (GE Healthcare). Ventilation distribution was assessed by electrical impedance tomography (EIT). End-expiratory lung volume (EELV) was measured by a nitrogen wash-out/wash-in method. Ventilation distribution, EELV, ventilator pressures and hemodynamic parameters were assessed before extraperitoneal insufflation, and during insufflation with a PEEP of 0 cmH2O, 5 cmH20 and of 10 cmH20. Results: EELV and thoracopulmonary compliance were significantly decreased after extraperitoneal insufflation. Ventilation distribution was significantly higher in ventral lung regions during general anesthesia and was not modified after insufflation. A 10 cmH20 PEEP application resulted in a significant increase in EELV, and a shift of ventilation toward the dorsal lung regions. Conclusions: Extraperitoneal insufflation decreased EELV and thoracopulmonary compliance. Application of a 10 cmH20 PEEP increased EELV and homogenized ventilation distribution. This preliminary clinical study showed that extraperitoneal insufflation worsened respiratory mechanics, which may justify further investigations to evaluate the clinical impact. PMID:25789238

Cardiac multidetector computed tomography: basic physics of image acquisition and clinical applications.

PubMed

Bardo, Dianna M E; Brown, Paul

2008-08-01

Cardiac MDCT is here to stay. And, it is more than just imaging coronary arteries. Understanding the differences in and the benefits of one CT scanner from another will help you to optimize the capabilities of the scanner, but requires a basic understanding of the MDCT imaging physics.This review provides key information needed to understand the differences in the types of MDCT scanners, from 64 - 320 detectors, flat panels, single and dual source configurations, step and shoot prospective and retrospective gating, and how each factor influences radiation dose, spatial and temporal resolution, and image noise.

[Neuromyelitis optica: problems of heterogeneity and systematization].

PubMed

Totolian, N A; Prakhova, L N; Sofienko, L Iu; Kataeva, G V; Il'ves, A G; Stoliarov, I D; Skoromets, A A

2009-01-01

Prospective-retrospective data on 10 cases of neuromyelitis optica (NO) have been analyzed. Demographic and clinical features of patients with primary NO as well as NO comorbid with other organospecific disorders are discussed. Magnetic-resonance imaging data of the brain and spinal cord are summarized and discussed in the context of its heterogeneity. Positron emission tomography with the functional imaging of the brain performed in 3 patients revealed changes in glucose metabolism in the brain regions corresponding to deficits in motor and sensory functional systems. The issues of additional laboratory analyses, including those of cerebrospinal fluid, are reviewed.

Effect of Abdominal Visceral Fat Change on Regression of Erosive Esophagitis: Prospective Cohort Study.

PubMed

Nam, Su Youn; Kim, Young Woo; Park, Bum Joon; Ryu, Kum Hei; Kim, Hyun Boem

2018-05-04

Although abdominal visceral fat has been associated with erosive esophagitis in cross-sectional studies, there are few data on the longitudinal effect. We evaluated the effects of abdominal visceral fat change on the regression of erosive esophagitis in a prospective cohort study. A total of 163 participants with erosive esophagitis at baseline were followed up at 34 months and underwent esophagogastroduodenoscopy and computed tomography at both baseline and follow-up. The longitudinal effects of abdominal visceral fat on the regression of erosive esophagitis were evaluated using relative risk (RR) and 95% confidence intervals (CIs). Regression was observed in approximately 49% of participants (n=80). The 3rd (RR, 0.13; 95% CI, 0.02 to 0.71) and 4th quartiles (RR, 0.07; 95% CI, 0.01 to 0.38) of visceral fat at follow-up were associated with decreased regression of erosive esophagitis. The highest quartile of visceral fat change reduced the probability of the regression of erosive esophagitis compared to the lowest quartile (RR, 0.10; 95% CI, 0.03 to 0.28). Each trend showed a dose-dependent pattern (p for trend <0.001). The presence of baseline Helicobacter pylori increased the regression of erosive esophagitis (RR, 2.40; 95% CI, 1.05 to 5.48). Higher visceral fat at follow-up and a greater increase in visceral fat reduced the regression of erosive esophagitis in a dose-dependent manner.

Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome.

PubMed

Bansal, V; Singh, S; Garg, N; Dubey, P

2014-02-01

This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Magnetic resonance imaging, computed tomography, and gross anatomy of the canine tarsus.

PubMed

Deruddere, Kirsten J; Milne, Marjorie E; Wilson, Kane M; Snelling, Sam R

2014-11-01

To describe the normal anatomy of the soft tissues of the canine tarsus as identified on computed tomography (CT) and magnetic resonance imaging (MRI) and to evaluate specific MRI sequences and planes for observing structures of diagnostic interest. Prospective descriptive study. Canine cadavers (n = 3). A frozen cadaver pelvic limb was used to trial multiple MRI sequences using a 1.5 T superconducting magnet and preferred sequences were selected. Radiographs of 6 canine cadaver pelvic limbs confirmed the tarsi were radiographically normal. A 16-slice CT scanner was used to obtain 1 mm contiguous slices through the tarsi. T1-weighted, proton density with fat suppression (PD FS) and T2-weighted MRI sequences were obtained in the sagittal plane, T1-weighted, and PD FS sequences in the dorsal plane and PD FS sequences in the transverse plane. The limbs were frozen for one month and sliced into 4-5 mm thick frozen sections. Anatomic sections were photographed and visually correlated to CT and MR images. Most soft tissue structures were easiest to identify on the transverse MRI sections with cross reference to either the sagittal or dorsal plane. Bony structures were easily identified on all CT, MR, and gross sections. The anatomy of the canine tarsus can be readily identified on MR imaging. © Copyright 2014 by The American College of Veterinary Surgeons.

Pretreatment with diphenoxylate hydrochloride/atropine sulfate (Lomotil) does not decrease physiologic bowel FDG activity on PET/CT scans of the abdomen and pelvis.

PubMed

Murphy, Robert; Doerger, Kirk M; Nathan, Mark A; Lowe, Val J

2009-01-01

Physiologic uptake of 2-[(18)F]-fluoro-2-deoxy-D: -glucose (FDG) by bowel can confound positron emission tomography/computed tomography (PET/CT) assessment for abdominal pathology, particularly within the bowel itself. We wished to determine if oral administration of the antimotility agent, Lomotil (5 mg diphenoxylate hydrochloride/0.05 mg atropine sulfate; G.D. Searle and Company, a division of Pfizer), prior to PET/CT scanning would reduce physiologic uptake of FDG by the small bowel and colon (lower gastrointestinal [GI] tract). Patients undergoing PET/CT scans for lymphoma were enrolled in a prospective, randomized, double-blinded study and received either 10 mL water (control group) or 10 mL Lomotil (experimental group) orally 30-60 min prior to scanning. Scans were reviewed independently by two blinded experienced readers and scored for the degree of FDG activity in the lower GI tract relative to liver activity. The administration of Lomotil prior to PET/CT scanning did not reduce physiologic FDG activity in the small bowel and colon. In contrast, increased radiotracer uptake by the lower GI tract was observed in the Lomotil group compared to the control group. Pretreatment with Lomotil prior to PET/CT scanning confers no benefit toward the reduction of physiologic FDG uptake by the small bowel and colon.

Full-field speckle interferometry for non-contact photoacoustic tomography.

PubMed

Horstmann, Jens; Spahr, Hendrik; Buj, Christian; Münter, Michael; Brinkmann, Ralf

2015-05-21

A full-field speckle interferometry method for non-contact and prospectively high speed Photoacoustic Tomography is introduced and evaluated as proof of concept. Thermoelastic pressure induced changes of the objects topography are acquired in a repetitive mode without any physical contact to the object. In order to obtain high acquisition speed, the object surface is illuminated by laser pulses and imaged onto a high speed camera chip. In a repetitive triple pulse mode, surface displacements can be acquired with nanometre sensitivity and an adjustable sampling rate of e.g. 20 MHz with a total acquisition time far below one second using kHz repetition rate lasers. Due to recurring interferometric referencing, the method is insensitive to thermal drift of the object due to previous pulses or other motion. The size of the investigated area and the spatial and temporal resolution of the detection are scalable. In this study, the approach is validated by measuring a silicone phantom and a porcine skin phantom with embedded silicone absorbers. The reconstruction of the absorbers is presented in 2D and 3D. The sensitivity of the measurement with respect to the photoacoustic detection is discussed. Potentially, Photoacoustic Imaging can be brought a step closer towards non-anaesthetized in vivo imaging and new medical applications not allowing acoustic contact, such as neurosurgical monitoring or burnt skin investigation.

Optical Coherence Tomography Angiography versus Dye Angiography in Age-Related Macular Degeneration: Sensitivity and Specificity Analysis.

PubMed

Nikolopoulou, Eleni; Lorusso, Massimo; Micelli Ferrari, Luisa; Cicinelli, Maria Vittoria; Bandello, Francesco; Querques, Giuseppe; Micelli Ferrari, Tommaso

2018-01-01

Optical coherence tomography angiography (OCTA) could be a valid tool to detect choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD), allowing the analysis of the type, the morphology, and the extension of CNV in most of the cases. To determine the sensitivity and specificity of OCTA in detecting CNV secondary to nAMD, compared to fluorescein angiography (FA) and indocyanine green angiography (ICGA). Prospective observational study. Patients with suspected nAMD were recruited between May and December 2016. Patients underwent FA, ICGA, spectral domain OCT, and OCTA (AngioVue, Optovue, Inc.). Sensitivity and specificity of FA, with or without ICGA, were assessed and compared with OCTA. Seventy eyes of 70 consecutive patients were included: 32 eyes (45.7%) with type I CNV, 8 eyes (11.4%) with type II CNV, 4 eyes (5.7%) with type III CNV, 6 eyes (8.6%) with mixed type I and type II CNV, and 20 eyes (28.6%) with no CNV. Sensitivity of OCTA was 88% and specificity was 90%. Concordance between FA/ICGA and OCTA was very good (0,91; range 0,81-1,00). OCTA showed high sensitivity and specificity for detection of CNV. Concordance between OCTA and gold-standard dye-based techniques was excellent. OCTA may represent a first-line noninvasive method for the diagnosis of nAMD.

Non-invasive detection of vulnerable coronary plaque

PubMed Central

Sharif, Faisal; Lohan, Derek G; Wijns, William

2011-01-01

Critical coronary stenoses have been shown to contribute to only a minority of acute coronary syndromes and sudden cardiac death. Autopsy studies have identified a subgroup of high-risk patients with disrupted vulnerable plaque and modest stenosis. Consequently, a clinical need exists to develop methods to identify these plaques prospectively before disruption and clinical expression of disease. Recent advances in invasive and non-invasive imaging techniques have shown the potential to identify these high-risk plaques. Non-invasive imaging with magnetic resonance imaging, computed tomography and positron emission tomography holds the potential to differentiate between low- and high-risk plaques. There have been significant technological advances in non-invasive imaging modalities, and the aim is to achieve a diagnostic sensitivity for these technologies similar to that of the invasive modalities. Molecular imaging with the use of novel targeted nanoparticles may help in detecting high-risk plaques that will ultimately cause acute myocardial infarction. Moreover, nanoparticle-based imaging may even provide non-invasive treatments for these plaques. However, at present none of these imaging modalities are able to detect vulnerable plaque nor have they been shown to definitively predict outcome. Further trials are needed to provide more information regarding the natural history of high-risk but non-flow-limiting plaque to establish patient specific targeted therapy and to refine plaque stabilizing strategies in the future. PMID:21860703

[Slit lamp optical coherence tomography study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation].

PubMed

Yan, Pi-song; Zhang, Zhen-ping; Lin, Hao-tian; Wu, Wen-jie; Bai, Ling

2009-09-01

To investigate quantitative changes of the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation with slit-lamp-adapted optical coherence tomography (SL-OCT). In prospective consecutive case series, clear corneal incision phacoemulsification and foldable intraocular lens implantation were performed in 44 eyes of 40 patients. The changes of the anterior segment configuration were performed by SL-OCT before and 1 day, 1 week, 2 weeks and 1 month after surgery. SPSS 16.0 software was used to analyze statistical difference. For all patients, the central corneal thickness (CCT) and the incisional corneal thickness (ICT) increased significantly 1 day after surgery (CCT increased 99.59 microm, ICT increased 234.57 microm; P = 0.490). At 1 month, the CCT almost had returned to baseline, but the ICT had been thicker about 19.25 microm than baseline(P = 0.001). The measurements of ACD, AOD500, AOD750, TISA500, TISA750 also increased significantly 1 day after surgery. Although the ACD had no changes within 2 weeks (all P < 0.05), it had been not stable. The changes of the width of the anterior chamber had been stable in the early period after surgery (all P > 0.05). The SL-OCT could impersonality and quantificationally evaluate the anterior segment changes induced by cataract surgery.

Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors.

PubMed

Bhatti, Aftab A; Chugtai, Aamir; Haslam, Philip; Talbot, David; Rix, David A; Soomro, Naeem A

2005-11-01

To prospectively compare the accuracy of multislice spiral computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) in evaluating the renal vascular anatomy in potential living renal donors. Thirty-one donors underwent multislice spiral CTA and gadolinium-enhanced MRA. In addition to axial images, multiplanar reconstruction and maximum intensity projections were used to display the renal vascular anatomy. Twenty-four donors had a left laparoscopic donor nephrectomy (LDN), whereas seven had right open donor nephrectomy (ODN); LDN was only considered if the renal vascular anatomy was favourable on the left. CTA and MRA images were analysed by two radiologists independently. The radiological and surgical findings were correlated after the surgery. CTA showed 33 arteries and 32 veins (100% sensitivity) whereas MRA showed 32 arteries and 31 veins (97% sensitivity). CTA detected all five accessory renal arteries whereas MRA only detected one. CTA also identified all three accessory renal veins whereas MRA identified two. CTA had a sensitivity of 97% and 47% for left lumbar and left gonadal veins, whereas MRA had a sensitivity of 74% and 46%, respectively. Multislice spiral CTA with three-dimensional reconstruction was more accurate than MRA for both renal arterial and venous anatomy.

Laser radar: from early history to new trends

NASA Astrophysics Data System (ADS)

Molebny, Vasyl; Kamerman, Gary; Steinvall, Ove

2010-10-01

The first steps of laser radar are discussed with the examples from range finding and designation. The followed successes in field tests and further fast development provided their wide use. Coherent laser radar, developed almost simultaneously, tried the ideas from microwaves including chirp technology for pulse compression, and Doppler mode of operation. This latter found a unique implementation in a cruise missile. In many applications, environmental studies very strongly rely upon the lidars sensing the wind, temperature, constituents, optical parameters. Lidars are used in the atmosphere and in the sea water measurements. Imaging and mapping is an important role prescribed to ladars. One of the prospective trends in laser radar development is incorporation of range and velocity data into the image information. Deep space program, even having not come to the finish, gave a lot for 3D imaging. Gated imaging, as one of the 3D techniques, demonstrated its prospects (seeing through scattering layers) for military and security usage. Synthetic aperture laser radar, which had a long incubation period, started to show first results, at least in modeling. Coherent laser radar baptized as the optical coherence tomography, along with the position sensitive laser radar, synthetic aperture laser radar, multispectral laser radar demonstrated very pragmatic results in the micro-scale applications.

CT-derived indices of canine osteosarcoma-affected antebrachial strength.

PubMed

Garcia, Tanya C; Steffey, Michele A; Zwingenberger, Allison L; Daniel, Leticia; Stover, Susan M

2017-05-01

To improve the prediction of fractures in dogs with bone tumors of the distal radius by identifying computed tomography (CT) indices that correlate with antebrachial bone strength and fracture location. Prospective experimental study. Dogs with antebrachial osteosarcoma (n = 10), and normal cadaver bones (n=9). Antebrachia were imaged with quantitative CT prior to biomechanical testing to failure. CT indices of structural properties were compared to yield force and maximum force using Pearson correlation tests. Straight beam failure (Fs), axial rigidity, curved beam failure (Fc), and craniocaudal bending moment of inertia (MOICrCd) CT indices most highly correlated (0.77 > R > 0.57) with yield and maximum forces when iOSA-affected and control bones were included in the analysis. Considering only OSA-affected bones, Fs, Fc, and axial rigidity correlated highly (0.85 > R > 0.80) with maximum force. In affected bones, the location of minimum axial rigidity and maximum MOICrCd correlated highly (R > 0.85) with the actual fracture location. CT-derived axial rigidity, Fs, and MOICrCd have strong linear relationships with yield and maximum force. These indices should be further evaluated prospectively in OSA-affected dogs that do, and do not, experience pathologic fracture. © 2017 The American College of Veterinary Surgeons.

A Prospective Study of {sup 18}FDG-PET With CT Coregistration for Radiation Treatment Planning of Lymphomas and Other Hematologic Malignancies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Terezakis, Stephanie A.; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Schöder, Heiko

2014-06-01

Purpose: This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[{sup 18}F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma. Methods and Materials: 118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients weremore » used for analysis. Results: 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined by NMPs. Conclusions: Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.« less

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer.

PubMed

Ghaneh, Paula; Hanson, Robert; Titman, Andrew; Lancaster, Gill; Plumpton, Catrin; Lloyd-Williams, Huw; Yeo, Seow Tien; Edwards, Rhiannon Tudor; Johnson, Colin; Abu Hilal, Mohammed; Higginson, Antony P; Armstrong, Tom; Smith, Andrew; Scarsbrook, Andrew; McKay, Colin; Carter, Ross; Sutcliffe, Robert P; Bramhall, Simon; Kocher, Hemant M; Cunningham, David; Pereira, Stephen P; Davidson, Brian; Chang, David; Khan, Saboor; Zealley, Ian; Sarker, Debashis; Al Sarireh, Bilal; Charnley, Richard; Lobo, Dileep; Nicolson, Marianne; Halloran, Christopher; Raraty, Michael; Sutton, Robert; Vinjamuri, Sobhan; Evans, Jonathan; Campbell, Fiona; Deeks, Jon; Sanghera, Bal; Wong, Wai-Lup; Neoptolemos, John P

2018-02-01

Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Patients with suspected pancreatic malignancy. All patients to undergo PET/CT following standard diagnostic work-up. The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUV max. ) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity ( p  = 0.01) and specificity ( p  = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios ( p  < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients ( p  = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Current Controlled Trials ISRCTN73852054 and UKCRN 8166. The National Institute for Health Research Health Technology Assessment programme.

WE-G-BRD-06: Variation in Dynamic Positron Emission Tomography Imaging of Tumor Hypoxia in Early Stage Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kelada, O; Department of Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg; Decker, R

2014-06-15

Purpose: Tumor hypoxia is correlated with treatment failure. To date, there are no published studies investigating hypoxia in non-small cell lung cancer (NSCLC) patients undergoing SBRT. We aim to use 18F-fluoromisonidazole (18F-FMISO) positron emission tomography (PET) imaging to non-invasively quantify the tumor hypoxic volume (HV), to elucidate potential roles of reoxygenation and tumor vascular response at high doses, and to identify an optimal prognostic imaging time-point. Methods: SBRT-eligible patients with NSCLC tumors >1cm were prospectively enrolled in an IRB-approved study. Computed Tomography and dynamic PET images (0–120min, 150–180min, and 210–240min post-injection) were acquired using a Siemens BiographmCT PET/CT scanner. 18F-FMISOmore » PET was performed on a single patient at 3 different time points around a single SBRT delivery of 18 Gy and HVs were compared using a tumor-to-blood ratio (TBR)>1.2 and rate of influx (Ki)>0.0015 (Patlak). Results: Results from our first patient showed substantial temporal changes in HV following SBRT. Using a TBR threshold >1.2 and summed images 210–240min, the HVs were 19%, 31% and 13% of total tumor volume on day 0, 2 (48 hours post-SBRT), and 4 (96 hours post-SBRT). The absolute volume of hypoxia increased by nearly a factor of 2 after 18 Gy and then decreased almost to baseline 96 hours later. Selected imaging timepoints resulted in temporal changes in HV quantification obtained with TBR. Ki, calculated using 4-hour dynamic data, evaluated HVs as 22%, 75% and 21%, respectively. Conclusions: ith the results of only one patient, this novel pilot study highlights the potential benefit of 18F-FMISO PET imaging as results indicate substantial temporal changes in tumor HV post-SBRT. Analysis suggests that TBR is not a robust parameter for accurate HV quantification and heavily influenced by imaging timepoint selection. Kinetic modeling parameters are more sensitive and may aid in future treatment individualization based on patient-specific biological information.« less

Prospective evaluation of 68 Ga-DOTATATE PET/CT in limited disease neuroendocrine tumors and/or elevated serum neuroendocrine biomarkers.

PubMed

Gabriel, Sophie; Garrigue, Philippe; Dahan, Laetitia; Castinetti, Frédéric; Sebag, Frédéric; Baumstark, Karine; Archange, Cendrine; Abhishek, Jha; Pacak, Karel; Guillet, Benjamin; Taïeb, David

2018-05-22

The 68 Ga-labelled somatostatin analogues ( 68 Ga-DOTA-SSAs) is becoming popular as an important diagnostic tool in neuroendocrine tumors as evidenced by a growing number of reports detailing institutional experience with various DOTA peptides. However, only few prospective studies have compared 68 Ga-DOTA-SSAs and somatostatin receptor scintigraphy (SRS) in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and pulmonary neuroendocrine tumors. The aim of our prospective study was to perform head-to-head comparison between 68 Ga-DOTATATE PET/CT and standard imaging work-up (SI) that included multiphasic CT, liver MRI, and SRS using single photon emission computed tomography. In this prospective study, the patients were enrolled only if they met any of the following inclusion criteria were: i- initial staging of a NETs without distant metastases on SI or neuroendocrine tumor with unknown primary on SI; ii-restaging of NETs that could be treated by focused therapeutic interventions; iii- elevated serum neuroendocrine hormones or peptides. The exclusion criteria was grade 3 GEP-NETs. Thirty-two patients were enrolled in the study. Eleven patients (6 pancreas, 4 ileum, 1 duodenal) were included for initial evaluation and staging of NETs, 8 patients (5 pancreas, 1 ileal, 1 lung, 1 duodenal gastrinoma) for restaging, and 13 patients for elevated serum neuroendocrine biomarkers (5 ectopic Cushing's syndrome, 5 organic hypoglycemia, 1 patient each with elevated vasoactive inhibitory peptide, chromogranin A, and neuron-specific enolase). 68 Ga-DOTATATE PET/CT detected more primary tumors than SRS (15/18 vs 10/18: p=0.074). The missed tumors on 68 Ga-DOTATATE PET/CT were located in the lung in 2 cases and duodenum in 1 case. For other anatomical regions (nodal and distant metastasis), no statistical difference was observed between imaging modalities using 68 Ga-DOTATATE PET/CT and SRS. Overall, 68 Ga-DOTATATE PET/CT+CT+MRI detected 31/33 of the involved regions (including primaries) (29 and 22 for 68 Ga-DOTATATE and SRS, respectively). Our study shows that 68 Ga-DOTATATE PET/CT detected similar number of sites than combination of SRS, liver MRI and thoraco-abdominopelvic CT region-based analysis. 68 Ga-DOTATATE PET/CT missed half of primary lung carcinoids with ectopic Cushing's syndrome. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Lack of association between dopaminergic antagonism and negative symptoms in schizophrenia: a positron emission tomography dopamine D2/3 receptor occupancy study

PubMed Central

Fervaha, Gagan; Caravaggio, Fernando; Mamo, David C.; Mulsant, Benoit H.; Pollock, Bruce G.; Nakajima, Shinichiro; Gerretsen, Philip; Rajji, Tarek K.; Mar, Wanna; Iwata, Yusuke; Plitman, Eric; Chung, Jun Ku; Remington, Gary; Graff-Guerrero, Ariel

2016-01-01

Rationale Several pre-clinical studies suggest that antipsychotic medications cause secondary negative symptoms. However, direct evidence for a relationship among antipsychotic medications, their direct effects on neurotransmitter systems, and negative symptoms in schizophrenia remains controversial. Objective The objective of this study was to examine the relationship between antipsychotic-related dopamine D2/3 receptor occupancy and negative symptoms in patients with schizophrenia. Methods Forty-one clinically stable outpatients with schizophrenia participated in this prospective dose reduction positron emission tomography (PET) study. Clinical assessments and [11C]-raclopride PET scans were performed before and after participants underwent gradual dose reduction of their antipsychotic medication by up to 40% from the baseline dose. Results No significant relationship was found between antipsychotic-related dopamine D2/3 receptor occupancy and negative symptom severity at baseline or follow-up. Similar null findings were found for subdomains of negative symptoms (amotivation and diminished expression). Occupancy was significantly lower following dose reduction; however, negative symptom severity did not change significantly, though a trend toward reduction was noted. Examination of change scores between these two variables revealed no systematic relationship. Conclusions Our cross-sectional and longitudinal results failed to find a significant dose-dependent relationship between severity of negative symptoms and antipsychotic-related dopaminergic antagonism in schizophrenia. These findings argue against the notion that antipsychotics necessarily cause secondary negative symptoms. Our results are also in contrast with the behavioural effects of dopaminergic antagonism routinely reported in pre-clinical investigations, suggesting that the role of this variable in the context of chronic treatment and schizophrenia needs to be re-examined. PMID:27557949

Rationale and design for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study.

PubMed

Parekh, Rulan S; Meoni, Lucy A; Jaar, Bernard G; Sozio, Stephen M; Shafi, Tariq; Tomaselli, Gordon F; Lima, Joao A; Tereshchenko, Larisa G; Estrella, Michelle M; Kao, W H Linda

2015-04-24

Sudden cardiac death occurs commonly in the end-stage renal disease population receiving dialysis, with 25% dying of sudden cardiac death over 5 years. Despite this high risk, surprisingly few prospective studies have studied clinical- and dialysis-related risk factors for sudden cardiac death and arrhythmic precursors of sudden cardiac death in end-stage renal disease. We present a brief summary of the risk factors for arrhythmias and sudden cardiac death in persons with end-stage renal disease as the rationale for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, a prospective cohort study of patients recently initiated on chronic hemodialysis, with the overall goal to understand arrhythmic and sudden cardiac death risk. Participants were screened for eligibility and excluded if they already had a pacemaker or an automatic implantable cardioverter defibrillator. We describe the study aims, design, and data collection of 574 incident hemodialysis participants from the Baltimore region in Maryland, U.S.A.. Participants were recruited from 27 hemodialysis units and underwent detailed clinical, dialysis and cardiovascular evaluation at baseline and follow-up. Cardiovascular phenotyping was conducted on nondialysis days with signal averaged electrocardiogram, echocardiogram, pulse wave velocity, ankle, brachial index, and cardiac computed tomography and angiography conducted at baseline. Participants were followed annually with study visits including electrocardiogram, pulse wave velocity, and ankle brachial index up to 4 years. A biorepository of serum, plasma, DNA, RNA, and nails were collected to study genetic and serologic factors associated with disease. Studies of modifiable risk factors for sudden cardiac death will help set the stage for clinical trials to test therapies to prevent sudden cardiac death in this high-risk population.

[Computed tomography of the lungs. A step into the fourth dimension].

PubMed

Dinkel, J; Hintze, C; Rochet, N; Thieke, C; Biederer, J

2009-08-01

To discuss the techniques for four dimensional computed tomography of the lungs in tumour patients. The image acquisition in CT can be done using respiratory gating in two different ways: the helical or cine mode. In the helical mode, the couch moves continuously during image and respiratory signal acquisition. In the cine mode, the couch remains in the same position during at least one complete respiratory cycle and then moves to next position. The 4D images are either acquired prospectively or reconstructed retrospectively with dedicated algorithms in a freely selectable respiratory phase. The time information required for motion depiction in 4D imaging can be obtained with tolerable motion artefacts. Partial projection and stepladder-artifacts are occurring predominantly close to the diaphragm, where the displacement is most prominent. Due to the long exposure times, radiation exposure is significantly higher compared to a simple breathhold helical acquisition. Therefore, the use of 4D-CT is restricted to only specific indications (i.e. radiotherapy planning). 4D-CT of the lung allows evaluating the respiration-correlated displacement of lungs and tumours in space for radiotherapy planning.

Non-invasive imaging of the crystalline structure within a human tooth.

PubMed

Egan, Christopher K; Jacques, Simon D M; Di Michiel, Marco; Cai, Biao; Zandbergen, Mathijs W; Lee, Peter D; Beale, Andrew M; Cernik, Robert J

2013-09-01

The internal crystalline structure of a human molar tooth has been non-destructively imaged in cross-section using X-ray diffraction computed tomography. Diffraction signals from high-energy X-rays which have large attenuation lengths for hard biomaterials have been collected in a transmission geometry. Coupling this with a computed tomography data acquisition and mathematically reconstructing their spatial origins, diffraction patterns from every voxel within the tooth can be obtained. Using this method we have observed the spatial variations of some key material parameters including nanocrystallite size, organic content, lattice parameters, crystallographic preferred orientation and degree of orientation. We have also made a link between the spatial variations of the unit cell lattice parameters and the chemical make-up of the tooth. In addition, we have determined how the onset of tooth decay occurs through clear amorphization of the hydroxyapatite crystal, and we have been able to map the extent of decay within the tooth. The described method has strong prospects for non-destructive probing of mineralized biomaterials. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

A hyperspectral X-ray computed tomography system for enhanced material identification

NASA Astrophysics Data System (ADS)

Wu, Xiaomei; Wang, Qian; Ma, Jinlei; Zhang, Wei; Li, Po; Fang, Zheng

2017-08-01

X-ray computed tomography (CT) can distinguish different materials according to their absorption characteristics. The hyperspectral X-ray CT (HXCT) system proposed in the present work reconstructs each voxel according to its X-ray absorption spectral characteristics. In contrast to a dual-energy or multi-energy CT system, HXCT employs cadmium telluride (CdTe) as the x-ray detector, which provides higher spectral resolution and separate spectral lines according to the material's photon-counter working principle. In this paper, a specimen containing ten different polymer materials randomly arranged was adopted for material identification by HXCT. The filtered back-projection algorithm was applied for image and spectral reconstruction. The first step was to sort the individual material components of the specimen according to their cross-sectional image intensity. The second step was to classify materials with similar intensities according to their reconstructed spectral characteristics. The results demonstrated the feasibility of the proposed material identification process and indicated that the proposed HXCT system has good prospects for a wide range of biomedical and industrial nondestructive testing applications.

Prospective ECG-triggered, axial 4-D imaging of the aortic root, valvular, and left ventricular structures: a lower radiation dose option for preprocedural TAVR imaging.

PubMed

Bolen, Michael A; Popovic, Zoran B; Dahiya, Arun; Kapadia, Samir R; Tuzcu, E Murat; Flamm, Scott D; Halliburton, Sandra S; Schoenhagen, Paul

2012-01-01

Transcatheter valve interventions rely on imaging for patient selection, preprocedural planning, and intraprocedural guidance. We explored the use of prospective electrocardiogram (ECG)-triggered 4-dimensional (4-D) CT imaging in patients evaluated for transcatheter aortic valve replacement (TAVR). A total of 47 consecutive patients underwent 128-slice dual-source CT with wide-window dose-modulated prospective ECG-triggered, axial acquisition of the aortic root, reconstructed during diastolic and systolic cardiac phases. Image quality was evaluated, aortic root and left ventricular (LV) geometry and function were analyzed, and radiation exposure was estimated. Image quality was generally good, with 41 of 47 (87%) patients scored as good or excellent. The mean aortic valve area was 0.93 ± 0.24 cm(2). Mean LV ejection fraction was 56.8% ± 16.4%, and mean LV mass was 130.4 ± 43.8 g. The minor diameter of the annulus was larger in systole (systole, 2.29 ± 0.24 cm; diastole, 2.14 ± 0.25 cm; P = 0.006), but the mean and major diameters did not vary significantly between systole and diastole. The mean estimated effective dose was 5.9 ± 2.4 mSv. Multiphase, prospective ECG-triggered axial image acquisition is a lower dose acquisition technique for 4-D aortic root imaging in patients being considered for TAVR. Copyright © 2012 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern.

PubMed

Baerg, Joanne; Thirumoorthi, Arul; Vannix, Rosemary; Taha, Asma; Young, Amy; Zouros, Alexander

2017-05-01

The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36months with inflicted trauma. An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48h. Variables were compared by t-test and Fisher-exact test. There were 53 children (median age: five months; range: 1-35months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p=0.02), shaking (p=0.04), lower Glasgow coma score (GCS) (p=0.01), brain infarcts (p=0.01), and hypoxic/ischemic injury (p=0.01) were associated with c-spine injury. One with AOD died. Six had significant disability. For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging. Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis. Copyright © 2017 Elsevier Inc. All rights reserved.

A multicenter, prospective study to evaluate the use of contrast stress echocardiography in early menopausal women at risk for coronary artery disease: trial design and baseline findings.

PubMed

Abdelmoneim, Sahar S; Bernier, Mathieu; Hagen, Mary E; Eifert-Rain, Susan; Bott-Kitslaar, Dalene; Wilansky, Susan; Castello, Ramon; Bhat, Gajanan; Pellikka, Patricia A; Best, Patricia J M; Hayes, Sharonne N; Mulvagh, Sharon L

2013-02-01

This multisite prospective trial, Stress Echocardiography in Menopausal Women At Risk for Coronary Artery Disease (SMART), aimed to evaluate the prognostic value of contrast stress echocardiography (CSE), coronary artery calcification (CAC), and cardiac biomarkers for prediction of cardiovascular events after 2 and 5 years in early menopausal women experiencing chest pain symptoms or risk factors. This report describes the study design, population, and initial test results at study entry. From January 2004 through September 2007, 366 early menopausal women (age 54±5 years, Framingham risk score 6.51%±4.4 %, range 1%-27%) referred for stress echocardiography were prospectively enrolled. Image quality was enhanced with an ultrasound contrast agent. Tests for cardiac biomarkers [high-sensitivity C-reactive protein (hsCRP), atrial natriuretic protein (ANP), brain natriuretic protein (BNP), endothelin (ET-1)] and cardiac computed tomography (CT) for CAC were performed. CSE (76% exercise, 24% dobutamine) was abnormal in 42 women (11.5%), and stress electrocardiogram (ECG) was positive in 22 women (6%). Rest BNP correlated weakly with stress wall motion score index (WMSI) (r=0.189, p<0.001). Neither hsCRP, ANP, endothelin, nor CAC correlated with stress WMSI. Predictors of abnormal CSE were body mass index (BMI), diabetes mellitus, family history of premature coronary artery disease (CAD), and positive stress ECG. Twenty-four women underwent clinically indicated coronary angiography (CA); 5 had obstructive (≥50%), 15 had nonobstructive (10%-49%), and 4 had no epicardial CAD. The SMART trial is designed to assess the prognostic value of CSE in early menopausal women. Independent predictors of positive CSE were BMI, diabetes mellitus, family history of premature CAD, and positive stress ECG. CAC scores and biomarkers (with the exception of rest BNP) were not correlated with CSE results. We await the follow-up data.

A Multicenter, Prospective Study to Evaluate the Use of Contrast Stress Echocardiography in Early Menopausal Women at Risk for Coronary Artery Disease: Trial Design and Baseline Findings

PubMed Central

Abdelmoneim, Sahar S.; Bernier, Mathieu; Hagen, Mary E.; Eifert-Rain, Susan; Bott-Kitslaar, Dalene; Wilansky, Susan; Castello, Ramon; Bhat, Gajanan; Pellikka, Patricia A.; Best, Patricia J. M.; Hayes, Sharonne N.

2013-01-01

Abstract Aims This multisite prospective trial, Stress Echocardiography in Menopausal Women At Risk for Coronary Artery Disease (SMART), aimed to evaluate the prognostic value of contrast stress echocardiography (CSE), coronary artery calcification (CAC), and cardiac biomarkers for prediction of cardiovascular events after 2 and 5 years in early menopausal women experiencing chest pain symptoms or risk factors. This report describes the study design, population, and initial test results at study entry. Methods From January 2004 through September 2007, 366 early menopausal women (age 54±5 years, Framingham risk score 6.51%±4.4 %, range 1%–27%) referred for stress echocardiography were prospectively enrolled. Image quality was enhanced with an ultrasound contrast agent. Tests for cardiac biomarkers [high-sensitivity C-reactive protein (hsCRP), atrial natriuretic protein (ANP), brain natriuretic protein (BNP), endothelin (ET-1)] and cardiac computed tomography (CT) for CAC were performed. Results CSE (76% exercise, 24% dobutamine) was abnormal in 42 women (11.5%), and stress electrocardiogram (ECG) was positive in 22 women (6%). Rest BNP correlated weakly with stress wall motion score index (WMSI) (r=0.189, p<0.001). Neither hsCRP, ANP, endothelin, nor CAC correlated with stress WMSI. Predictors of abnormal CSE were body mass index (BMI), diabetes mellitus, family history of premature coronary artery disease (CAD), and positive stress ECG. Twenty-four women underwent clinically indicated coronary angiography (CA); 5 had obstructive (≥50%), 15 had nonobstructive (10%–49%), and 4 had no epicardial CAD. Conclusions The SMART trial is designed to assess the prognostic value of CSE in early menopausal women. Independent predictors of positive CSE were BMI, diabetes mellitus, family history of premature CAD, and positive stress ECG. CAC scores and biomarkers (with the exception of rest BNP) were not correlated with CSE results. We await the follow-up data. PMID:23398128

The Natural History of the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) Studies: Design and Baseline Characteristics: ProgStar Report No. 1.

PubMed

Strauss, Rupert W; Ho, Alex; Muñoz, Beatriz; Cideciyan, Artur V; Sahel, José-Alain; Sunness, Janet S; Birch, David G; Bernstein, Paul S; Michaelides, Michel; Traboulsi, Elias I; Zrenner, Eberhart; Sadda, SriniVas; Ervin, Ann-Margret; West, Sheila; Scholl, Hendrik P N

2016-04-01

To describe the design and baseline characteristics of patients enrolled into 2 natural history studies of Stargardt disease (STGD1). Multicenter retrospective and prospective cohort studies. Three hundred sixty-five unique patients aged 6 years and older at baseline harboring disease-causing variants in the ABCA4 gene and with specified ocular lesions were enrolled from 9 centers in the United States and Europe. In the retrospective study, patients contributed medical record data from at least 2 and up to 4 visits for at least 1 examination modality: fundus autofluorescence (FAF), spectral-domain (SD) optical coherence tomography (SD OCT), and/or microperimetry (MP). The total observational period was at least 2 years and up to 5 years between single visits. Demographic and visual acuity (VA) data also were obtained. In the prospective study, eligible patients were examined at baseline using a standard protocol, with 6-month follow-up visits planned for a 2-year period for serial Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected VA, SD OCT, FAF, and MP. Design and rationale of a multicenter study to determine the progression of STGD1 in 2 large retrospective and prospective international cohorts. Detailed baseline characteristics of both cohorts are presented, including demographics, and structural and functional retinal metrics. Into the retrospective study, 251 patients (458 eyes) were enrolled; mean follow-up ± standard deviation was 3.9±1.6 years. At baseline, 36% had no or mild VA loss, and 47% of the study eyes had areas of definitely decreased autofluorescence (DDAF) with an average lesion area of 2.5±2.9 mm(2) (range, 0.02-16.03 mm(2)). Two hundred fifty-nine patients (489 eyes) were enrolled in the prospective study. At baseline, 20% had no or mild VA loss, and 64% had areas of DDAF with an average lesion area of 4.0±4.4 mm(2) (range, 0.03-24.24 mm(2)). The mean retinal sensitivity with MP was 10.8±5.0 dB. The ProgStar cohorts have baseline characteristics that encompass a wide range of disease severity and are expected to provide valuable data on progression based on serial quantitative measurements derived from multiple methods, which will be critical to the design of planned clinical trials. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series.

PubMed

Mahapatra, Santosh Kumar; Malhotra, Kundan; Mendke, Rohit Ganapatrao

2018-02-01

The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball. A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months. Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001). Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

Evaluation of Retinal and Choroidal Thickness by Swept-Source Optical Coherence Tomography: Repeatability and Assessment of Artifacts

PubMed Central

Mansouri, Kaweh; Medeiros, Felipe A.; Tatham, Andrew J.; Marchase, Nicholas; Weinreb, Robert N.

2017-01-01

PURPOSE To determine the repeatability of automated retinal and choroidal thickness measurements with swept-source optical coherence tomography (SS OCT) and the frequency and type of scan artifacts. DESIGN Prospective evaluation of new diagnostic technology. METHODS Thirty healthy subjects were recruited prospectively and underwent imaging with a prototype SS OCT instrument. Undilated scans of 54 eyes of 27 subjects (mean age, 35.1 ± 9.3 years) were obtained. Each subject had 4 SS OCT protocols repeated 3 times: 3-dimensional (3D) 6 × 6-mm raster scan of the optic disc and macula, radial, and line scan. Automated measurements were obtained through segmentation software. Interscan repeatability was assessed by intraclass correlation coefficients (ICCs). RESULTS ICCs for choroidal measurements were 0.92, 0.98, 0.80, and 0.91, respectively, for 3D macula, 3D optic disc, radial, and line scans. ICCs for retinal measurements were 0.39, 0.49, 0.71, and 0.69, respectively. Artifacts were present in up to 9% scans. Signal loss because of blinking was the most common artifact on 3D scans (optic disc scan, 7%; macula scan, 9%), whereas segmentation failure occurred in 4% of radial and 3% of line scans. When scans with image artifacts were excluded, ICCs for choroidal thickness increased to 0.95, 0.99, 0.87, and 0.93 for 3D macula, 3D optic disc, radial, and line scans, respectively. ICCs for retinal thickness increased to 0.88, 0.83, 0.89, and 0.76, respectively. CONCLUSIONS Improved repeatability of automated choroidal and retinal thickness measurements was found with the SS OCT after correction of scan artifacts. Recognition of scan artifacts is important for correct interpretation of SS OCT measurements. PMID:24531020

Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab

PubMed Central

Jansen, Yanina; Schreuer, Max; Everaert, Hendrik; Velkeniers, Brigitte; Neyns, Bart; Bravenboer, Bert

2016-01-01

Context: Immune checkpoint blockade is associated with endocrine-related adverse events. Thyroid dysfunction during pembrolizumab therapy, an anti-programmed cell death 1 (PD-1) receptor monoclonal antibody, remains to be fully characterized. Objective: To assess the incidence and characteristics of pembrolizumab-associated thyroid dysfunction. Design and Setting: Thyroid function was monitored prospectively in melanoma patients who initiated pembrolizumab within an expanded access program at a referral oncology center. 18Fluorodeoxyglucose uptake on positron emission tomography/computed tomography (18FDG-PET/CT) was reviewed in cases compatible with inflammatory thyroiditis. Patients: Ninety-nine patients with advanced melanoma (age, 26.3–93.6 years; 63.6% females) who received at least one administration of pembrolizumab. Main Outcome Measures: Patient characteristics, thyroid function (TSH, free T4), thyroid autoantibodies, and 18FDG-PET/CT. Results: Eighteen adverse events of thyroid dysfunction were observed in 17 patients. Thyrotoxicosis occurred in 12 patients, of which nine evolved to hypothyroidism. Isolated hypothyroidism was present in six patients. Levothyroxine therapy was required in 10 of 15 hypothyroid patients. Thyroid autoantibodies were elevated during thyroid dysfunction in four of 10 cases. Diffuse increased 18FDG uptake by the thyroid gland was observed in all seven thyrotoxic patients who progressed to hypothyroidism. Conclusions: Thyroid dysfunction is common in melanoma patients treated with pembrolizumab. Hypothyroidism and thyrotoxicosis related to inflammatory thyroiditis are the most frequent presentations. Serial measurements of thyroid function tests are indicated during anti-PD-1 monoclonal antibody therapy. Thyrotoxicosis compatible with inflammatory thyroiditis was associated with diffuse increased 18FDG uptake by the thyroid gland. The prospective role of thyroid autoantibodies should be further investigated, together with the histopathological correlates. PMID:27571185

A new prospect in magnetic nanoparticle-based cancer therapy: Taking credit from mathematical tissue-mimicking phantom brain models.

PubMed

Saeedi, Mostafa; Vahidi, Omid; Goodarzi, Vahabodin; Saeb, Mohammad Reza; Izadi, Leila; Mozafari, Masoud

2017-11-01

Distribution patterns/performance of magnetic nanoparticles (MNPs) was visualized by computer simulation and experimental validation on agarose gel tissue-mimicking phantom (AGTMP) models. The geometry of a complex three-dimensional mathematical phantom model of a cancer tumor was examined by tomography imaging. The capability of mathematical model to predict distribution patterns/performance in AGTMP model was captured. The temperature profile vs. hyperthermia duration was obtained by solving bio-heat equations for four different MNPs distribution patterns and correlated with cell death rate. The outcomes indicated that bio-heat model was able to predict temperature profile throughout the tissue model with a reasonable precision, to be applied for complex tissue geometries. The simulation results on the cancer tumor model shed light on the effectiveness of the studied parameters. Copyright © 2017 Elsevier Inc. All rights reserved.

Choroidal thickness alterations in diabetic nephropathy patients with early or no diabetic retinopathy.

PubMed

Kocasarac, Can; Yigit, Yavuz; Sengul, Erkan; Sakalar, Yildirim Beyazit

2018-04-01

To assess changes in choroidal thickness (CT) in diabetes patients with and without diabetic nephropathy using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT). Thirty-five type 2 diabetes patients with a diagnosis of diabetic nephropathy (DNP) in nephrology department and 35 type 2 diabetes patients without nephropathy (non-DNP) were included in our prospective study consecutively. The control group comprised 34 healthy individuals. CT measurements were recorded under the fovea and at 1500 µm from the foveal center in the nasal and temporal sides. The study parameters also included age, refractive error, axial length, intraocular pressure, HbA1c, glomerular filtration rate and proteinuria amount. The subfoveal, temporal and nasal choroidal thickness was noted to be thinner in patients with DNP compared with non-DNP and normal subjects (p < 0.05). However, CT measurements did not show any difference between the healthy and non-DNP group. CT decreases significantly in diabetic patients when diabetic nephropathy accompanies diabetes mellitus.

[Management of acute respiratory distress syndrome in Midi-Pyrnees].

PubMed

Fuzier, R; Mercier-Fuzier, V; Chaminade, B; Georges, B; Decun, J F; Cougot, P; Ducassé, J L; Virenque, C

2000-10-07

To assess management of acute respiratory distress syndrome (ARDS) in Midi-Pyrénées, France. A prospective study using a questionnaire divided into 10 parts, definition, etiology, radiography, computed tomography, management, was conducted in 26 intensive care units in the Midi-Pyrénées. Management of ARDS in Midi-Pyrénées was comparted with management elsewhere as described in the literature. Overall participation rate was 73%. Disparities were found concerning the definition. Four etiologies accounted for 75% of all ARDS cases. Chest x-rays were used for positive diagnosis and thoracic scans for complications. Ventilatory and hemodynamic optimizations were the first line therapy used. Twenty-nine percent and 41% of the intensive care unites used nitric oxide and prone position respectively. There are differences between ARDS management in Midi-Pyrénées and that described in the current literature. Epidemiologic studies such as this one are necessary before publishing guidelines for the management of ARDS.

Assessment methodologies and statistical issues for computer-aided diagnosis of lung nodules in computed tomography: contemporary research topics relevant to the lung image database consortium.

PubMed

Dodd, Lori E; Wagner, Robert F; Armato, Samuel G; McNitt-Gray, Michael F; Beiden, Sergey; Chan, Heang-Ping; Gur, David; McLennan, Geoffrey; Metz, Charles E; Petrick, Nicholas; Sahiner, Berkman; Sayre, Jim

2004-04-01

Cancer of the lung and bronchus is the leading fatal malignancy in the United States. Five-year survival is low, but treatment of early stage disease considerably improves chances of survival. Advances in multidetector-row computed tomography technology provide detection of smaller lung nodules and offer a potentially effective screening tool. The large number of images per exam, however, requires considerable radiologist time for interpretation and is an impediment to clinical throughput. Thus, computer-aided diagnosis (CAD) methods are needed to assist radiologists with their decision making. To promote the development of CAD methods, the National Cancer Institute formed the Lung Image Database Consortium (LIDC). The LIDC is charged with developing the consensus and standards necessary to create an image database of multidetector-row computed tomography lung images as a resource for CAD researchers. To develop such a prospective database, its potential uses must be anticipated. The ultimate applications will influence the information that must be included along with the images, the relevant measures of algorithm performance, and the number of required images. In this article we outline assessment methodologies and statistical issues as they relate to several potential uses of the LIDC database. We review methods for performance assessment and discuss issues of defining "truth" as well as the complications that arise when truth information is not available. We also discuss issues about sizing and populating a database.

A prospective evaluation of the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography staging on survival for patients with locally advanced esophageal cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blackstock, A. William; Farmer, Michael R.; Lovato, James

2006-02-01

Purpose: To determine the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging and prognosis of patients with locally advanced esophageal cancer (LAEC). Methods and Materials: Between January 2000 and October 2004, all patients with LAEC evaluated in the Department of Radiation Oncology were considered for enrollment into a Phase II trial of preoperative chemoradiation. Entry required a staging whole-body FDG-PET scan. Results: One hundred ten consecutive patients were evaluated; 38 were ineligible for reasons including treatment elsewhere, prior malignancy, or refusal of treatment. After conventional staging (clinical examination, endoscopic ultrasound, and chest/abdominal computerized tomography), 33 patients were ineligiblemore » because of metastatic disease or poor performance status. Of the remaining 39 patients, 23 were confirmed to have LAEC after FDG-PET staging and were treated in the Phase II trial (Cohort I). Sixteen patients, however, had FDG-PET findings consistent with occult metastatic disease and were deemed ineligible for the trial but were treated with curative intent (Cohort II). The 2-year survival rate for the 23 patients in Cohort I was 64%, compared with 17% (p = 0.003) for patients in Cohort II (FDG-PET positive). Conclusions: More than one-third of patients determined to have LAEC with conventional staging were upstaged with the use of FDG-PET. Despite comparable therapy, upstaging with FDG-PET predicts poor 2-year survival.« less

Two-Phase Helical Computed Tomography Study of Salivary Gland Warthin Tumors: A Radiologic Findings and Surgical Applications

PubMed Central

Joo, Yeon Hee; Kim, Jin Pyeong; Park, Jung Je

2014-01-01

Objectives The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings. Methods We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates. Results Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05). Conclusion Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy. PMID:25177439

Two-phase helical computed tomography study of salivary gland warthin tumors: a radiologic findings and surgical applications.

PubMed

Joo, Yeon Hee; Kim, Jin Pyeong; Park, Jung Je; Woo, Seung Hoon

2014-09-01

The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings. We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates. Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05). Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy.

Diagnostic capability of scanning laser polarimetry with and without enhanced corneal compensation and optical coherence tomography.

PubMed

Benítez-del-Castillo, Javier; Martinez, Antonio; Regi, Teresa

2011-01-01

To compare the abilities of the current commercially available versions of scanning laser polarimetry (SLP) and optical coherence tomography (OCT), SLP-variable corneal compensation (VCC), SLP-enhanced corneal compensation (ECC), and high-definition (HD) OCT, in discriminating between healthy eyes and those with early-to-moderate glaucomatous visual field loss. Healthy volunteers and patients with glaucoma who met the eligibility criteria were consecutively enrolled in this prospective, cross-sectional, observational study. Subjects underwent complete eye examination, automated perimetry, SLP-ECC, SLP-VCC, and HD-OCT. Scanning laser polarimetry parameters were recalculated in 90-degree segments (quadrants) in the calculation circle to be compared. Areas under the receiver operating characteristic curve (AUROCs) were calculated for every parameter in order to compare the ability of each imaging modality to differentiate between normal and glaucomatous eyes. Fifty-five normal volunteers (mean age 59.1 years) and 33 patients with glaucoma (mean age 63.8 years) were enrolled. Average visual field mean deviation was -6.69 dB (95% confidence interval -8.07 to -5.31) in the glaucoma group. The largest AUROCs were associated with nerve fiber indicator (0.880 and 0.888) for the SLP-VCC and SLP-ECC, respectively, and with the average thickness in the HD-OCT (0.897). The best performing indices for the SLP-VCC, SLP-ECC, and HD OCT gave similar AUROCs, showing moderate diagnostic accuracy in patients with early to moderate glaucoma. Further studies are needed to evaluate the ability of these technologies to discriminate between normal and glaucomatous eyes.

Diagnostic value of FDG-PET/(CT) in children with fever of unknown origin and unexplained fever during immune suppression.

PubMed

Blokhuis, Gijsbert J; Bleeker-Rovers, Chantal P; Diender, Marije G; Oyen, Wim J G; Draaisma, Jos M Th; de Geus-Oei, Lioe-Fee

2014-10-01

Fever of unknown origin (FUO) and unexplained fever during immune suppression in children are challenging medical problems. The aim of this study is to investigate the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET combined with computed tomography (FDG-PET/CT) in children with FUO and in children with unexplained fever during immune suppression. All FDG-PET/(CT) scans performed in the Radboud university medical center for the evaluation of FUO or unexplained fever during immune suppression in the last 10 years were reviewed. Results were compared with the final clinical diagnosis. FDG-PET/(CT) scans were performed in 31 children with FUO. A final diagnosis was established in 16 cases (52 %). Of the total number of scans, 32 % were clinically helpful. The sensitivity and specificity of FDG-PET/CT in these patients was 80 % and 78 %, respectively. FDG-PET/(CT) scans were performed in 12 children with unexplained fever during immune suppression. A final diagnosis was established in nine patients (75 %). Of the total number of these scans, 58 % were clinically helpful. The sensitivity and specificity of FDG-PET/CT in children with unexplained fever during immune suppression was 78 % and 67 %, respectively. FDG-PET/CT appears a valuable imaging technique in the evaluation of children with FUO and in the diagnostic process of children with unexplained fever during immune suppression. Prospective studies of FDG-PET/CT as part of a structured diagnostic protocol are warranted to assess the additional diagnostic value.

Late complications of percutaneous tracheostomy using the balloon dilation technique.

PubMed

Araujo, J B; Añón, J M; García de Lorenzo, A; García-Fernandez, A M; Esparcia, M; Adán, J; Relanzon, S; Quiles, D; de Paz, V; Molina, A

2018-04-01

The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. A prospective, observational cohort study was carried out. Two medical-surgical intensive care units (ICU). All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. All patients underwent PT according to the Ciaglia Blue Dolphin ® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. Percutaneous tracheostomy using the Ciaglia Blue Dolphin ® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Use of Electrical Impedance Tomography to Monitor Regional Cerebral Edema during Clinical Dehydration Treatment

PubMed Central

Hu, Shi-Jie; Li, Xia; Xu, Can-Hua; Wang, Bing; Yang, Bin; Tang, Meng-Xing; Dong, Xiu-Zhen; Fei, Zhou; Shi, Xue-Tao

2014-01-01

Objective Variations of conductive fluid content in brain tissue (e.g. cerebral edema) change tissue impedance and can potentially be measured by Electrical Impedance Tomography (EIT), an emerging medical imaging technique. The objective of this work is to establish the feasibility of using EIT as an imaging tool for monitoring brain fluid content. Design a prospective study. Setting In this study EIT was used, for the first time, to monitor variations in cerebral fluid content in a clinical model with patients undergoing clinical dehydration treatment. The EIT system was developed in house and its imaging sensitivity and spatial resolution were evaluated on a saline-filled tank. Patients 23 patients with brain edema. Interventions The patients were continuously imaged by EIT for two hours after initiation of dehydration treatment using 0.5 g/kg intravenous infusion of mannitol for 20 minutes. Measurement and Main Results Overall impedance across the brain increased significantly before and after mannitol dehydration treatment (p = 0.0027). Of the all 23 patients, 14 showed high-level impedance increase and maintained this around 4 hours after the dehydration treatment whereas the other 9 also showed great impedance gain during the treatment but it gradually decreased after the treatment. Further analysis of the regions of interest in the EIT images revealed that diseased regions, identified on corresponding CT images, showed significantly less impedance changes than normal regions during the monitoring period, indicating variations in different patients' responses to such treatment. Conclusions EIT shows potential promise as an imaging tool for real-time and non-invasive monitoring of brain edema patients. PMID:25474474

Usefulness of intraoperative ultrasonography in liver resections due to colon cancer metastasis.

PubMed

Lucchese, Angélica Maria; Kalil, Antônio Nocchi; Schwengber, Alex; Suwa, Eiji; Rolim de Moura, Gabriel Garcia

2015-08-01

Intraoperative ultrasonography (IOUS) of the liver has been used both as an aid for intraoperative anatomical definition and for the detection of new lesions. The present study aimed to evaluate the impact of IOUS and to identify factors that can predict the detection of new lesions intraoperatively. In this observational and prospective study, with a cross-sectional design, patients with colorectal cancer metastases who underwent hepatectomy were selected. Abdominal computed tomography, magnetic resonance imaging, and positron emission tomography were the preoperative evaluation tests. All patients underwent IOUS performed by the same surgeon. The intraoperative findings were compared with the preoperative tests results. In total, 56 hepatectomies were evaluated. Half of the patients were men, with a mean age of 57 (30-85) years. New lesions were found intraoperatively in 12 patients (21.4% of cases) and were detected on both palpation and ultrasonography in 11 of these patients. Ultrasonography helped to revise the surgical plans by providing additional information in 35.7% of cases. On multivariate analysis, the presence of more than 4 preoperative nodules was predictive of the intraoperative occurrence of new lesions. IOUS remains the only way to evaluate the relationships between tumors, liver vascular structures, and bile ducts intraoperatively. Alone, IOUS was not useful for identifying new lesions intraoperatively, as all new lesions were also detected on palpation. The number of lesions diagnosed on preoperative tests influenced the probability of identifying new lesions intraoperatively. There may be additional influential factors. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Is it possible to reduce intra-hospital transport time for computed tomography evaluation in critically ill cases using the Easy Tube Arrange Device?

PubMed

Song, Kyung Hyeok; Cho, Sung Uk; Lee, Jin Woong; Cho, Yong Chul; Jeong, Won Joon; You, Yeon Ho; Ryu, Seung; Kim, Seung Whan; Yoo, In Sool; Joo, Ki Hyuk

2018-03-01

Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. This prospective randomized control study included 60 volunteers. Each participant arranged five or six intravenous fluid lines, monitoring lines (noninvasive blood pressure, electrocardiography, central venous pressure, arterial catheter), and therapeutic equipment (O2 supply device, Foley catheter) on a Resusci Anne mannequin. We measured transport time for the CT evaluation by using conventional and ETAD method. The median transport time for CT evaluation was 488.50 seconds (95% confidence interval [CI], 462.75 to 514.75) and, 503.50 seconds (95% CI, 489.50 to 526.75) with 5 and 6 fluid lines using the conventional method and 364.50 seconds (95% CI, 335.00 to 388.75), and 363.50 seconds (95% CI, 331.75 to 377.75) with ETAD (all P<0.001). The time differences were 131.50 (95% CI, 89.25 to 174.50) and 148.00 (95% CI, 116.00 to 177.75) (all P<0.001). The transport time for CT evaluation was reduced using the ETAD, which would be expected to reduce the complications that may occur during transport in cases of critical illness.

Comparison of two spectral domain optical coherence tomography devices for angle-closure assessment.

PubMed

Quek, Desmond T; Narayanaswamy, Arun K; Tun, Tin A; Htoon, Hla M; Baskaran, Mani; Perera, Shamira A; Aung, Tin

2012-08-03

To compare two spectral domain optical coherence tomography (SD-OCT) devices for the identification of angle structures and the presence of angle closure. This was a prospective comparative study. Consecutive patients underwent gonioscopy and anterior segment imaging using two SD-OCT devices (iVue and Cirrus). Images were evaluated for the ability to detect angle structures such as Schwalbe's line (SL), trabecular meshwork (TM), Schlemm's canal (SC), and scleral spur (SS), and the presence of angle closure. Angle closure was defined as iris contact with the angle wall anterior to the SS on SD-OCT, and nonvisibility of the posterior TM on gonioscopy. Angle closure in an eye was defined as ≥two quadrants of closed angles. AC1 statistic was used to assess the agreement between devices. Of the 69 subjects studied (46.4% male, 84.1% Chinese, mean age 64.0 ± 10.5 years), 40 subjects (40 eyes, 58.0%) had angle closure on gonioscopy. The most identifiable structure on Cirrus SD-OCT was the SS (82.2%) and SL on iVue SD-OCT (74.5%). Angle closure was indeterminable in 14.5% and 50.7% of Cirrus and iVue scans (P < 0.001), respectively. Interdevice agreement for angle closure was moderately strong (AC1 = 0.67), but agreement with gonioscopy was only fair (AC1 = 0.35 and 0.50 for Cirrus and iVue, respectively). It was more difficult to determine angle closure status with iVue compared with Cirrus SD-OCT. There was fair agreement between both devices with gonioscopy for identifying angle closure.

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography.

PubMed

Gabriel, Fabíola Santos; Gonçalves, Luiz Flávio Galvão; Melo, Enaldo Vieira de; Sousa, Antônio Carlos Sobral; Pinto, Ibraim Masciarelli Francisco; Santana, Sara Melo Macedo; Matos, Carlos José Oliveira de; Souto, Maria Júlia Silveira; Conceição, Flávio Mateus do Sacramento; Oliveira, Joselina Luzia Menezes

2018-05-03

In view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature. To evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA). This is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted. The frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable. The frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

ANATOMICAL STUDY OF CRANIAL NERVE EMERGENCE AND SKULL FORAMINA IN THE HORSE USING MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY.

PubMed

Gonçalves, Rita; Malalana, Fernando; McConnell, James Fraser; Maddox, Thomas

2015-01-01

For accurate interpretation of magnetic resonance (MR) images of the equine brain, knowledge of the normal cross-sectional anatomy of the brain and associated structures (such as the cranial nerves) is essential. The purpose of this prospective cadaver study was to describe and compare MRI and computed tomography (CT) anatomy of cranial nerves' origins and associated skull foramina in a sample of five horses. All horses were presented for euthanasia for reasons unrelated to the head. Heads were collected posteuthanasia and T2-weighted MR images were obtained in the transverse, sagittal, and dorsal planes. Thin-slice MR sequences were also acquired using transverse 3D-CISS sequences that allowed mutliplanar reformatting. Transverse thin-slice CT images were acquired and multiplanar reformatting was used to create comparative images. Magnetic resonance imaging consistently allowed visualization of cranial nerves II, V, VII, VIII, and XII in all horses. The cranial nerves III, IV, and VI were identifiable as a group despite difficulties in identification of individual nerves. The group of cranial nerves IX, X, and XI were identified in 4/5 horses although the region where they exited the skull was identified in all cases. The course of nerves II and V could be followed on several slices and the main divisions of cranial nerve V could be distinguished in all cases. In conclusion, CT allowed clear visualization of the skull foramina and occasionally the nerves themselves, facilitating identification of the nerves for comparison with MRI images. © 2015 American College of Veterinary Radiology.

Image quality of mixed convolution kernel in thoracic computed tomography.

PubMed

Neubauer, Jakob; Spira, Eva Maria; Strube, Juliane; Langer, Mathias; Voss, Christian; Kotter, Elmar

2016-11-01

The mixed convolution kernel alters his properties geographically according to the depicted organ structure, especially for the lung. Therefore, we compared the image quality of the mixed convolution kernel to standard soft and hard kernel reconstructions for different organ structures in thoracic computed tomography (CT) images.Our Ethics Committee approved this prospective study. In total, 31 patients who underwent contrast-enhanced thoracic CT studies were included after informed consent. Axial reconstructions were performed with hard, soft, and mixed convolution kernel. Three independent and blinded observers rated the image quality according to the European Guidelines for Quality Criteria of Thoracic CT for 13 organ structures. The observers rated the depiction of the structures in all reconstructions on a 5-point Likert scale. Statistical analysis was performed with the Friedman Test and post hoc analysis with the Wilcoxon rank-sum test.Compared to the soft convolution kernel, the mixed convolution kernel was rated with a higher image quality for lung parenchyma, segmental bronchi, and the border between the pleura and the thoracic wall (P < 0.03). Compared to the hard convolution kernel, the mixed convolution kernel was rated with a higher image quality for aorta, anterior mediastinal structures, paratracheal soft tissue, hilar lymph nodes, esophagus, pleuromediastinal border, large and medium sized pulmonary vessels and abdomen (P < 0.004) but a lower image quality for trachea, segmental bronchi, lung parenchyma, and skeleton (P < 0.001).The mixed convolution kernel cannot fully substitute the standard CT reconstructions. Hard and soft convolution kernel reconstructions still seem to be mandatory for thoracic CT.

Usefulness of dual-energy computed tomography with and without dedicated software in identifying uric acid kidney stones.

PubMed

Salvador, R; Luque, M P; Ciudin, A; Paño, B; Buñesch, L; Sebastia, C; Nicolau, C

2016-01-01

To prospectively evaluate the usefulness of dual-energy computed tomography (DECT) with and without dedicated software in identifying uric acid kidney stones in vivo. We studied 65 kidney stones in 63 patients. All stones were analyzed in vivo by DECT and ex vivo by spectrophotometry. We evaluated the diagnostic performance in identifying uric acid stones with DECT by analyzing the radiologic densities with dedicated software and without using it (through manual measurements) as well as by analyzing the attenuation ratios of the stones in both energies with and without the dedicated software. The six uric acid stones included were correctly identified by evaluating the attenuation ratios with a cutoff of 1.21, both with the dedicated software and without it, yielding perfect diagnostic performance without false positives or false negatives. The study of the attenuations of the stones obtained the following values on the receiver operating characteristic curves in the classification of the uric acid stones: 0.92 for the measurements done with the software and 0.89 for the manual measurements; a cutoff of 538 HU yielded 84% (42/50) diagnostic accuracy for the software and 83.1% (54/65) for the manual measurements. DECT enabled the uric acid stones to be identified correctly through the calculation of the ratio of the attenuations in the two energies. The results obtained with the dedicated software were similar to those obtained manually. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Analysis of high-pitched phonation using three-dimensional computed tomography.

PubMed

Hiramatsu, Hiroyuki; Tokashiki, Ryoji; Nakamura, Hirokazu; Motohashi, Ray; Sakurai, Eriko; Nomoto, Masaki; Toyomura, Fumimasa; Suzuki, Mamoru

2012-09-01

Our aim was to use three-dimensional computed tomography (3DCT) to examine arytenoid cartilage movement during a high-pitched tone task. This was a prospective study. This study included 14 patients with male-to-female gender identity disorder who had undergone 3DCT imaging for surgical simulation between January 2007 and May 2008. First, to prove that the phonation condition was indeed one of the high-pitched phonation, we confirmed the rotational movement of the thyroid cartilage, horizontal gliding movement of the inferior horn, and vocal fold elongation on a high-pitched tone task. Next, we detected the arytenoid cartilage positions of the joint during a comparison of comfortable and high-pitched phonations. We measured the movement direction and movement distance of the arytenoid cartilage. In all cases, the cricothyroid space became narrower (rotation movement), and we observed anterior gliding movement of the inferior horn. In all cases, elongation of the vocal folds by the high-pitched phonation was confirmed and the arytenoid cartilages were displaced both anteriorly and caudally from the position during comfortable phonation by the high-pitched tone task. The arytenoid cartilages did not move posteriorly to elongate the vocal folds during high-pitched phonation. The arytenoid cartilages were pulled anteriorly and moved caudally because of tension associated with vocal fold elongation because of the task of high-pitched phonation. These results suggest that there are no movements at the cricoarytenoid joint that directly control the length of the vocal folds in accordance with pitch. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens.

PubMed

García-Bella, Javier; Martínez de la Casa, José M; Talavero González, Paula; Fernández-Vigo, José I; Valcarce Rial, Laura; García-Feijóo, Julián

2018-01-01

To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and -5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

Dynamic contrast-enhanced MRI versus 18F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

PubMed

Feng, Feng; Qiang, Fulin; Shen, Aijun; Shi, Donghui; Fu, Aiyan; Li, Haiming; Zhang, Mingzhu; Xia, Ganlin; Cao, Peng

2018-02-01

To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) with that of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in the differentiation of malignant and benign solitary pulmonary nodules (SPNs). Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and 18 F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant (K trans ), redistribution rate constant (K ep ), and fractional volume (V e ), were calculated using the Extended-Tofts Linear two-compartment model. The 18 F-FDG PET/CT parameter, maximum standardized uptake value (SUV max ), was also measured. Spearman's correlations were calculated between the MRI pharmacokinetic parameters and the SUV max of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability between the DCE-MRI and 18 F-FDG PET/CT indexes. Positive correlations were found between K trans and SUV max , and between K ep and SUV max (P<0.05). There were significant differences between the malignant and benign nodules in terms of the K trans , K ep and SUV max values (P<0.05). The areas under the ROC curve (AUC) of K trans , K ep and SUV max between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for K trans ; 87.5% and 76.5% for K ep ; and 75.0% and 70.6% for SUV max , respectively. The sensitivity and specificity of K trans and K ep were higher than those of SUV max , but there was no significant difference between them (P>0.05). DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.

Dynamic contrast-enhanced MRI versus 18F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

PubMed Central

Feng, Feng; Qiang, Fulin; Shen, Aijun; Shi, Donghui; Fu, Aiyan; Li, Haiming; Zhang, Mingzhu; Xia, Ganlin; Cao, Peng

2018-01-01

Objective To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) with that of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the differentiation of malignant and benign solitary pulmonary nodules (SPNs). Methods Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and 18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant (Ktrans), redistribution rate constant (Kep), and fractional volume (Ve), were calculated using the Extended-Tofts Linear two-compartment model. The 18F-FDG PET/CT parameter, maximum standardized uptake value (SUVmax), was also measured. Spearman’s correlations were calculated between the MRI pharmacokinetic parameters and the SUVmax of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability between the DCE-MRI and 18F-FDG PET/CT indexes. Results Positive correlations were found between Ktrans and SUVmax, and between Kep and SUVmax (P<0.05). There were significant differences between the malignant and benign nodules in terms of the Ktrans, Kep and SUVmax values (P<0.05). The areas under the ROC curve (AUC) of Ktrans, Kep and SUVmax between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for Ktrans; 87.5% and 76.5% for Kep; and 75.0% and 70.6% for SUVmax, respectively. The sensitivity and specificity of Ktrans and Kep were higher than those of SUVmax, but there was no significant difference between them (P>0.05). Conclusions DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free. PMID:29545716

Fluorodeoxyglucose Uptake on Positron Emission Tomography Is a Useful Predictor of Long-Term Pain Control After Palliative Radiation Therapy in Patients With Painful Bone Metastases: Results of a Single-Institute Prospective Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tahara, Takatoshi, E-mail: taka.t-may7@med.Tottori-u.ac.jp; Fujii, Shinya; Ogawa, Toshihide

Purpose: To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) before and after palliative radiation therapy (RT) can predict long-term pain control in patients with painful bone metastases. Methods and Materials: Thirty-one patients with bone metastases who received RT were prospectively included. Forty painful metastatic treatment fields were evaluated. All patients had undergone pre-RT and post-RT PET/CT scanning. We evaluated the relationships between the pre-RT, post-RT, and changes in maximum standardized uptake value (SUV{sub max}) and the pain response, and between SUV{sub max} and pain relapse of the bone metastases in the treatment field. In addition, we compared the SUV{sub max}more » according to the length of time from the completion of RT to pain relapse of the bone metastases. Results: Regarding the pain response at 4 weeks after the completion of RT, there were 36 lesions of 27 patients in the responder group and 4 lesions of 4 patients in the nonresponder group. Changes in the SUV{sub max} differed significantly between the responder and nonresponder groups in both the early and delayed phases (P=.0292 and P=.0139, respectively), but no relationship was observed between the pre-RT and post-RT SUV{sub max} relative to the pain response. The responder group was evaluated for the rate of relapse. Thirty-five lesions of 26 patients in the responder group were evaluated, because 1 patient died of acute renal failure at 2 months after RT. Twelve lesions (34%) showed pain relapse, and 23 lesions (66%) did not. There were significant differences between the relapse and nonrelapse patients in terms of the pre-RT (early/delayed phases: P<.0001/P<.0001), post-RT (P=.0199/P=.0261), and changes in SUV{sub max} (P=.0004/P=.004). Conclusions: FDG-PET may help predict the outcome of pain control in the treatment field after palliative RT for painful bone metastases.« less

Prognostic study of cardiac events in Japanese high risk hemodialysis patients using I-BMIPP-SPECT: B-SAFE study design.

PubMed

Hasebe, Naoyuki; Moroi, Masao; Nishimura, Masato; Hara, Kazuhiro; Hase, Hiroki; Hashimoto, Akiyoshi; Kumita, Shinichiro; Haze, Kazuo; Momose, Mitsuru; Nagai, Yoji; Sugimoto, Tokuichiro; Kusano, Eiji; Akiba, Takashi; Nakata, Tomoaki; Nishimura, Tsunehiko; Tamaki, Nagara; Kikuchi, Kenjiro

2008-12-01

Cardiovascular disease is the leading cause of morbidity and mortality in patients undergoing hemodialysis. Such patients frequently develop complications such as asymptomatic coronary artery disease (CAD). Accordingly, CAD must ideally be diagnosed at an early stage to improve prognosis. Although myocardial perfusion single photon emission computed tomography (SPECT) is valuable for diagnosing CAD, the stress test is not always applicable to patients on hemodialysis. Thus, we proposed a multicenter, prospective cohort study called "B-SAFE" to investigate the applicability of resting (123)I-labeled beta-methyl-iodophenylpentadecanoic acid ((123)I-BMIPP)-SPECT will be used to diagnose cardiac disease and evaluate the prognosis of hemodialysis patients by imaging myocardial fatty acid metabolism. B-SAFE began enrolling patients from June 2006 at 48 facilities. We performed (123)I-BMIPP-SPECT on 702 hemodialysis patients with risk factors for CAD until 30 November 2007 and plan to follow up for three years. The primary endpoints will be cardiac death and sudden death. This study should end in 2010.

Retinal micropseudocysts in diabetic retinopathy: prospective functional and anatomic evaluation.

PubMed

Forte, Raimondo; Cennamo, Gilda; Finelli, Maria Luisa; Bonavolontà, Paola; Greco, Giovanni Maria; de Crecchio, Giuseppe

2012-01-01

To evaluate the prevalence, progression and functional predictive value of retinal micropseudocysts (MPCs) in diabetic patients. Prospective controlled observational study. From among all the type 2 diabetic patients evaluated during a period of 5 months between September 2009 and January 2010, we enrolled all patients with retinal MPCs at spectral-domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) not previously treated for diabetic retinopathy. Forty diabetic patients without MPCs served as the control group. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), macular sensitivity and stability of fixation at SD-SLO/OCT microperimetry were measured monthly for 12 months. 22/156 patients with type 2 diabetes (14.1%, 32 eyes) met the inclusion criteria. The 95% confidence interval for the prevalence estimate of MPCs was 12.3-16.6%. Mean BCVA, CRT and central retinal sensitivity at baseline were 77.53 ± 2.2 Early Treatment Diabetic Retinopathy Study letters, 242.31 ± 31.0 µm and 15.95 ± 0.61 dB, respectively. Fixation was stable in all cases. Compared to the control group, eyes with MPCs had similar BCVA but greater CRT (p = 0.01) and reduced macular sensitivity (p = 0.001) at baseline and at each follow-up visit. Over time, CRT remained stable in eyes with MPCs, whereas macular sensitivity progressively decreased. MPCs in diabetic retinopathy are associated, temporally or causally, with a progressive reduction of macular sensitivity despite a stable BCVA, CRT and fixation. Copyright © 2011 S. Karger AG, Basel.

99mTc Glucarate as a Potential Radiopharmaceutical Agent for Assessment of Tumor Viability: From Bench to the Bed Side

PubMed Central

Choudhury, Partha S.; Savio, E.; Solanki, K. K.; Alonso, O.; Gupta, A.; Gambini, J. P.; Doval, Dinesh; Sharma, P.; Dondi, M.

2012-01-01

Several radiotracers have been used for assessing cell death, whether by necrosis or apoptosis. 99mTc glucarate, which has initially been reported to be concentrating/accumulating in myocardial infarction or zones of cerebral injury, has also shown some tumor-seeking properties in a few preliminary studies. Under International Atomic Energy Agency (IAEA)'s coordinated research program, we report here the standardization, quality control, and clinical evaluation (detection, evaluation of response, and comparison with 18F Fluorodeoxyglucose) of this tracer in well-characterized lung cancer and head neck malignancies in a single-arm prospective observational study. Forty-seven patients (29 inoperable lung carcinoma and 18 head and neck malignancies) were prospectively enrolled and underwent 99mTc glucarate imaging [whole body planar and single-photon emission computed tomography of the region of interest] 4-5 hours after injection of 20 mCi of the radiopharmaceutical. Excellent 99mTc glucarate concentration was noted in the target lesion in lung cancer and head and neck malignancies. The sensitivity was found to be better in lung cancer. Avid concentration of tracer was seen in the metastatic sites. During response evaluation, the glucarate concentration correlated well with the clinical and other radiological findings. 99mTc glucarate showed avid concentration of tracer in the tumor, suggesting it to be a potential tumor imaging agent which can be used for detection and assessment of therapeutic response in malignancy. PMID:23372437

Evaluation of posterior ocular changes using enhanced depth imaging-optical coherence tomography in patients with obstructive sleep apnea syndrome.

PubMed

Yuvacı, İsa; Pangal, Emine; Bayram, Nurettin; Yüksel, Sevgi Arık; Alabay, Bedirhan; Ağadayı, Alperen; Sırakaya, Ender; Gülhan, Ahmet

2016-01-01

Evaluation of the nerve fiber thicknesses of the macula, choroid, and retina using the apnea-hypopnea index in individuals with obstructive sleep apnea syndrome (OSAS) without systemic components. Prospective, controlled study. The central macular, choroidal, and retinal nerve fiber layer (RNFL) thicknesses were evaluated using enhanced depth imaging-spectral domain optical coherence tomography in individuals with OSAS. In people with severe OSAS who had received treatment, posterior ocular structures were examined over 3 months (4th and 12th weeks), and changes were evaluated. Only the right eyes of the participants were evaluated in the study. A total of 72 people were involved in the study, with 18 in the control group and 19 with mild, 16 with moderate, and 19 with severe OSAS. No significant difference was found among the groups in terms of demographic measures. No significant differences were found among the groups in terms of the measures of central macular, central subfoveal choroidal (CSCT), temporal choroidal, nasal choroidal, and RNFL thicknesses. In severe OSAS cases in which treatment was administered, although subjective clinical recovery was observed, statistically significant thinning was detected during the 3-month follow-up period in the CSCT, general RNFL, as well as in the inferior and superior nasal quadrants, and temporal superior quadrant (p=0.005, p=0.009, p=0.039, p=0.003, and p=0.02, respectively). In the group with severe OSAS, thinning in some posterior ocular tissues was observed. Although patients with severe OSAS may experience clinical recovery, we recommend that they would be followed up in terms of ocular ischemic injury.

Is Routine Use of High Resolution Computerized Tomography of Temporal Bone in Patients of Atticoantral Chronic Suppurative Otitis Media without Intracranial Complications Justified?

PubMed

Bathla, Meeta; Doshi, Hiren; Kansara, Atul

2018-03-01

Role of high resolution computerized tomography (HRCT) of temporal bone is established in cases of atticoantral chronic suppurative otitis media (CSOM) with intracranial complications. Routine use of HRCT in management of patients of atticoantral CSOM without intracranial complications has been an issue of debate. The aim of this study was to evaluate the routine use of HRCT of temporal bone in such cases. This study was a prospective study done at LG hospital, AMC MET Medical College, Ahmedabad to evaluate and compare the temporal bone findings in HRCT and intraoperative findings in 100 patients with atticoantral CSOM. All patients underwent HRCT screening followed by surgical exploration of middle ear cleft. In extent of disease HRCT showed very high sensitivity and specificity for epitympanum (100, 94%) and mesotympanum (98, 98%) areas. It gave valuable information of disease extent in hidden areas like sinus tympani and facial recess of mesotympanum. HRCT satisfactorily delineated malleus and incus erosion but had 75% sensitivity for detecting erosion of stapes suprastructure, though specificity was of 97%. For bony anatomical landmarks HRCT showed very high sensitivity and specificity for detecting erosion of lateral semicircular canal, tegmen tympani and sinus plate. Detection of facial canal erosion on HRCT had moderate sensitivity of 75%. We concluded that routine use of HRCT is justified as a reliable preoperative tool in patients with atticoantral CSOM without intracranial complications and it helps to plan type of surgical intervention. HRCT has limited role to distinguish between granulations and cholesteatoma and also to delineate stapes supra structure and facial nerve canal.

Persistent decrease in alpha current density in fully remitted subjects with major depressive disorder treated with fluoxetine: A prospective electric tomography study.

PubMed

Almeida Montes, Luis Guillermo; Prado Alcántara, Hugo; Portillo Cedeño, Bertha Alicia; Hernández García, Ana Olivia; Fuentes Rojas, Patricia Elisa

2015-06-01

Major depressive disorder (MDD) is recurrent, and its pathophysiology is not fully understood. Studies using electric tomography (ET) have identified abnormalities in the current density (CD) of MDD subjects in regions associated with the neurobiology of MDD, such as the anterior cingulate cortex (ACC) and medial orbitofrontal cortex (mOFC). However, little is known regarding the long-term CD changes in MDD subjects who respond to antidepressants. The aim of this study was to compare CD between healthy and MDD subjects who received 1-year open-label treatment with fluoxetine. Thirty-two-channel electroencephalograms (EEGs) were collected from 70 healthy controls and 74 MDD subjects at baseline (pre-treatment), 1 and 2weeks and 1, 2, 6, 9 and 12months. Variable-resolution ET (VARETA) was used to assess the CD between subject groups at each time point. The MDD group exhibited decreased alpha CD (αCD) in the occipital and parietal cortices, ACC, mOFC, thalamus and caudate nucleus at each time point. The αCD abnormalities persisted in the MDD subjects despite their achieving full remission. The low sub-alpha band was different between the healthy and MDD subjects. Differences in the amount of αCD between sexes and treatment outcomes were observed. Lack of a placebo arm and the loss of depressed patients to follow-up were significant limitations. The persistence of the decrease in αCD might suggest that the underlying pathophysiologic mechanisms of MDD are not corrected despite the asymptomatic state of MDD subjects, which could be significant in understanding the highly recurrent nature of MDD. Copyright © 2015 Elsevier B.V. All rights reserved.

Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review.

PubMed

Salem, A; Salem, A F; Al-Ibraheem, A; Lataifeh, I; Almousa, A; Jaradat, I

2011-01-01

In recent years, the role of positron emission tomography (PET) in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. Systematic literature review. Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered para-aortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of “adaptive” brachytherapy in cervical cancer. This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure.

The pattern of renal vessels in live related potential donors pool. A multislice computed tomography angiography review.

PubMed

Mishra, Anuj; Ehtuish, Ehtuish F

2006-06-01

To assess the renal vessel anatomy, compare the findings with the perioperative findings, to determine the sensitivity of multislice computed tomography (CT) angiography in the work-up of live potential donors and to discuss and compare the results of the present study with the reported results using single slice CT, magnetic resonance (MRI) and conventional angiography (CA). Retrospective analysis of the angiographic data of 118 of prospective live related kidney donors was carried out from October 2004 to August 2005 at the National Organ Transplant Centre, Tripoli Central Hospital, Libya. All donors underwent renal angiography on multislice (16-slice) CT scan using 80 cc intravenous contrast with 1.25 mm slice thickness followed by maximum intensity projection (MIP) and volume rendering techniques (VRT) post-processing algorithms. The number of vessels, vessel bifurcation, vessel morphology and venous anatomy were analyzed and the findings were compared with the surgical findings. Multislice spiral CT angiography (MSCTA) showed clear delineation of the main renal arteries in all donors with detailed vessel morphology. The study revealed 100% sensitivity in detection of accessory renal vessels, with an overall incidence of 26.7%, which is the most common distribution in the parahilar region. The present study showed 100% sensitivity in the visualization and detection of main and accessory renal vessels. These results were comparable with conventional angiography which has so far been considered as the gold standard and were found superior in specificity and accuracy to the use of single slice CT (SSCT) and MR in the angiographic work-up of live renal donors. Due to improved detection of accessory vessels less than 2 mm in diameter, a higher incidence of aberrant vessels was seen on the right side as has been suggested so far.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Perez, Rodrigo O.; Angelita and Joaquim Gama Institute, Sao Paulo; Habr-Gama, Angelita, E-mail: gamange@uol.com.br

Purpose: To estimate the metabolic activity of rectal cancers at 6 and 12 weeks after completion of chemoradiation therapy (CRT) by 2-[fluorine-18] fluoro-2-deoxy-D-glucose-labeled positron emission tomography/computed tomography ([{sup 18}FDG]PET/CT) imaging and correlate with response to CRT. Methods and Materials: Patients with cT2-4N0-2M0 distal rectal adenocarcinoma treated with long-course neoadjuvant CRT (54 Gy, 5-fluouracil-based) were prospectively studied ( (ClinicalTrials.org) identifier (NCT00254683)). All patients underwent 3 PET/CT studies (at baseline and 6 and 12 weeks from CRT completion). Clinical assessment was at 12 weeks. Maximal standard uptake value (SUVmax) of the primary tumor was measured and recorded at each PET/CT study aftermore » 1 h (early) and 3 h (late) from {sup 18}FDG injection. Patients with an increase in early SUVmax between 6 and 12 weeks were considered 'bad' responders and the others as 'good' responders. Results: Ninety-one patients were included; 46 patients (51%) were 'bad' responders, whereas 45 (49%) patients were 'good' responders. 'Bad' responders were less likely to develop complete clinical response (6.5% vs. 37.8%, respectively; P=.001), less likely to develop significant histological tumor regression (complete or near-complete pathological response; 16% vs. 45%, respectively; P=.008) and exhibited greater final tumor dimension (4.3 cm vs. 3.3 cm; P=.03). Decrease between early (1 h) and late (3 h) SUVmax at 6-week PET/CT was a significant predictor of 'good' response (accuracy of 67%). Conclusions: Patients who developed an increase in SUVmax after 6 weeks were less likely to develop significant tumor downstaging. Early-late SUVmax variation at 6-week PET/CT may help identify these patients and allow tailored selection of CRT-surgery intervals for individual patients.« less

Long-term Characterization of Retinal Degeneration in Royal College of Surgeons Rats Using Spectral-Domain Optical Coherence Tomography

PubMed Central

Ryals, Renee C.; Andrews, Michael D.; Datta, Shreya; Coyner, Aaron S.; Fischer, Cody M.; Wen, Yuquan; Pennesi, Mark E.; McGill, Trevor J.

2017-01-01

Purpose Prospective treatments for age-related macular degeneration and inherited retinal degenerations are commonly evaluated in the Royal College of Surgeons (RCS) rat before translation into clinical application. Historically, retinal thickness obtained through postmortem anatomic assessments has been a key outcome measure; however, utility of this measurement is limited because it precludes the ability to perform longitudinal studies. To overcome this limitation, the present study was designed to provide a baseline longitudinal quantification of retinal thickness in the RCS rat by using spectral-domain optical coherence tomography (SD-OCT). Methods Horizontal and vertical linear SD-OCT scans centered on the optic nerve were captured from Long-Evans control rats at P30, P60, P90 and from RCS rats between P17 and P90. Total retina (TR), outer nuclear layer+ (ONL+), inner nuclear layer (INL), and retinal pigment epithelium (RPE) thicknesses were quantified. Histologic sections of RCS retina obtained from P21 to P60 were compared to SD-OCT images. Results In RCS rats, TR and ONL+ thickness decreased significantly as compared to Long-Evans controls. Changes in INL and RPE thickness were not significantly different between control and RCS retinas. From P30 to P90 a subretinal hyperreflective layer (HRL) was observed and quantified in RCS rats. After correlation with histology, the HRL was identified as disorganized outer segments and the location of accumulated debris. Conclusions Retinal layer thickness can be quantified longitudinally throughout the course of retinal degeneration in the RCS rat by using SD-OCT. Thickness measurements obtained with SD-OCT were consistent with previous anatomic thickness assessments. This study provides baseline data for future longitudinal assessment of therapeutic agents in the RCS rat. PMID:28253400

Long-term Characterization of Retinal Degeneration in Royal College of Surgeons Rats Using Spectral-Domain Optical Coherence Tomography.

PubMed

Ryals, Renee C; Andrews, Michael D; Datta, Shreya; Coyner, Aaron S; Fischer, Cody M; Wen, Yuquan; Pennesi, Mark E; McGill, Trevor J

2017-03-01

Prospective treatments for age-related macular degeneration and inherited retinal degenerations are commonly evaluated in the Royal College of Surgeons (RCS) rat before translation into clinical application. Historically, retinal thickness obtained through postmortem anatomic assessments has been a key outcome measure; however, utility of this measurement is limited because it precludes the ability to perform longitudinal studies. To overcome this limitation, the present study was designed to provide a baseline longitudinal quantification of retinal thickness in the RCS rat by using spectral-domain optical coherence tomography (SD-OCT). Horizontal and vertical linear SD-OCT scans centered on the optic nerve were captured from Long-Evans control rats at P30, P60, P90 and from RCS rats between P17 and P90. Total retina (TR), outer nuclear layer+ (ONL+), inner nuclear layer (INL), and retinal pigment epithelium (RPE) thicknesses were quantified. Histologic sections of RCS retina obtained from P21 to P60 were compared to SD-OCT images. In RCS rats, TR and ONL+ thickness decreased significantly as compared to Long-Evans controls. Changes in INL and RPE thickness were not significantly different between control and RCS retinas. From P30 to P90 a subretinal hyperreflective layer (HRL) was observed and quantified in RCS rats. After correlation with histology, the HRL was identified as disorganized outer segments and the location of accumulated debris. Retinal layer thickness can be quantified longitudinally throughout the course of retinal degeneration in the RCS rat by using SD-OCT. Thickness measurements obtained with SD-OCT were consistent with previous anatomic thickness assessments. This study provides baseline data for future longitudinal assessment of therapeutic agents in the RCS rat.

Resection plane-dependent error in computed tomography volumetry of the right hepatic lobe in living liver donors

PubMed Central

Kwon, Heon-Ju; Kim, Bohyun; Kim, So Yeon; Lee, Chul Seung; Lee, Jeongjin; Song, Gi Won; Lee, Sung Gyu

2018-01-01

Background/Aims Computed tomography (CT) hepatic volumetry is currently accepted as the most reliable method for preoperative estimation of graft weight in living donor liver transplantation (LDLT). However, several factors can cause inaccuracies in CT volumetry compared to real graft weight. The purpose of this study was to determine the frequency and degree of resection plane-dependent error in CT volumetry of the right hepatic lobe in LDLT. Methods Forty-six living liver donors underwent CT before donor surgery and on postoperative day 7. Prospective CT volumetry (VP) was measured via the assumptive hepatectomy plane. Retrospective liver volume (VR) was measured using the actual plane by comparing preoperative and postoperative CT. Compared with intraoperatively measured weight (W), errors in percentage (%) VP and VR were evaluated. Plane-dependent error in VP was defined as the absolute difference between VP and VR. % plane-dependent error was defined as follows: |VP–VR|/W∙100. Results Mean VP, VR, and W were 761.9 mL, 755.0 mL, and 696.9 g. Mean and % errors in VP were 73.3 mL and 10.7%. Mean error and % error in VR were 64.4 mL and 9.3%. Mean plane-dependent error in VP was 32.4 mL. Mean % plane-dependent error was 4.7%. Plane-dependent error in VP exceeded 10% of W in approximately 10% of the subjects in our study. Conclusions There was approximately 5% plane-dependent error in liver VP on CT volumetry. Plane-dependent error in VP exceeded 10% of W in approximately 10% of LDLT donors in our study. This error should be considered, especially when CT volumetry is performed by a less experienced operator who is not well acquainted with the donor hepatectomy plane. PMID:28759989

Present assessment of myocardial viability by nuclear imaging.

PubMed

Saha, G B; MacIntyre, W J; Brunken, R C; Go, R T; Raja, S; Wong, C O; Chen, E Q

1996-10-01

Prospective delineation of viable from nonviable myocardium in patients with coronary artery disease in an important factor in deciding whether a patient should be revascularized or treated medically. Two common techniques--single-photon emission computed tomography (SPECT) and positron-emission computed tomography (PET)--are used in nuclear medicine using various radiopharmaceuticals for the detection of myocardial viability in patients. Thallium-201 (201Tl) and technetium-99m (99mTc)-sestamibi are the common radiopharmaceuticals used in different protocols using SPECT, whereas fluoride-18 (18F)-fluorodeoxyglucose (FDG) and rubidium-82 (82Rb) are most widely used in PET. The SPECT protocols involve stress/redistribution, stress/redistribution/reinjection, and rest/redistribution imaging techniques. Many studies have compared the results of 201Tl and (99mTc)-sestamibi SPECT with those of FDG PET; in some studies, concordant results have been found between delayed thallium and FDG results, indicating that 201Tl, although considered a perfusion agent, shows myocardial viability. Discordant results in a number of studies have been found between sestamibi and FDG, suggesting that the efficacy of sestamibi as a viability marker has yet to be established. Radiolabeled fatty acids such as iodine-123 (123I)-para-iodophenylpentadecanoic acid and carbon-11 (11C)-palmitic acid have been used for the assessment of myocardial viability with limited success. 11C-labeled acetate is a good marker of oxidative metabolism in the heart and has been used to predict the reversibility of wall motion abnormalities. (18F)-FDG is considered the marker of choice for myocardial viability, although variable results are obtained under different physiological conditions. Detection of myocardial viability can be greatly improved by developing new equipment and radiopharmaceuticals of better quality.

The spot sign and tranexamic acid on preventing ICH growth--AUStralasia Trial (STOP-AUST): protocol of a phase II randomized, placebo-controlled, double-blind, multicenter trial.

PubMed

Meretoja, Atte; Churilov, Leonid; Campbell, Bruce C V; Aviv, Richard I; Yassi, Nawaf; Barras, Christen; Mitchell, Peter; Yan, Bernard; Nandurkar, Harshal; Bladin, Christopher; Wijeratne, Tissa; Spratt, Neil J; Jannes, Jim; Sturm, Jonathan; Rupasinghe, Jayantha; Zavala, Jorge; Lee, Andrew; Kleinig, Timothy; Markus, Romesh; Delcourt, Candice; Mahant, Neil; Parsons, Mark W; Levi, Christopher; Anderson, Craig S; Donnan, Geoffrey A; Davis, Stephen M

2014-06-01

No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions. The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation 'spot sign' will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4.5-hours of stroke onset compared with placebo. The Spot sign and Tranexamic acid On Preventing ICH growth--AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale >7, intracerebral hemorrhage volume <70 ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months. The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either >33% or >6 ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score. This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

A quantitative assessment of volumetric and anatomic changes of the parotid gland during intensity-modulated radiotherapy for head and neck cancer using serial computed tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ajani, Abdallah A.; Qureshi, Muhammad M.; Kovalchuk, Nataliya

To evaluate the change in volume and movement of the parotid gland measured by serial contrast-enhanced computed tomography scans in patients with head and neck cancer treated with parotid-sparing intensity-modulated radiotherapy (IMRT). A prospective study was performed on 13 patients with head and neck cancer undergoing dose-painted IMRT to 69.96 Gy in 33 fractions. Serial computed tomography scans were performed at baseline, weeks 2, 4, and 6 of radiotherapy (RT), and at 6 weeks post-RT. The parotid volume was contoured at each scan, and the movement of the medial and lateral borders was measured. The patient's body weight was recordedmore » at each corresponding week during RT. Regression analyses were performed to ascertain the rate of change during treatment as a percent change per fraction in parotid volume and distance relative to baseline. The mean parotid volume decreased by 37.3% from baseline to week 6 of RT. The overall rate of change in parotid volume during RT was−1.30% per fraction (−1.67% and−0.91% per fraction in≥31 Gy and<31 Gy mean planned parotid dose groups, respectively, p = 0.0004). The movement of parotid borders was greater in the≥31 Gy mean parotid dose group compared with the<31 Gy group (0.22% per fraction and 0.14% per fraction for the lateral border and 0.19% per fraction and 0.06% per fraction for the medial border, respectively). The median change in body weight was−7.4% (range, 0.75% to−17.5%) during RT. A positive correlation was noted between change in body weight and parotid volume during the course of RT (Spearman correlation coefficient, r = 0.66, p<0.01). Head and neck IMRT results in a volume loss of the parotid gland, which is related to the planned parotid dose, and the patient's weight loss during RT.« less

C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients.

PubMed

Kamran, Mudassar; Byrne, James V

2015-09-01

C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31%) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91% sensitive and 100% specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (≈ 60% blood flow and ≈ 40% blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (≈ 60%) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia.

Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) trial.

PubMed

Bhindi, Ravinay; Kajander, Olli A; Jolly, Sanjit S; Kassam, Saleem; Lavi, Shahar; Niemelä, Kari; Fung, Anthony; Cheema, Asim N; Meeks, Brandi; Alexopoulos, Dimitrios; Kočka, Viktor; Cantor, Warren J; Kaivosoja, Timo P; Shestakovska, Olga; Gao, Peggy; Stankovic, Goran; Džavík, Vladimír; Sheth, Tej

2015-08-01

Manual thrombectomy has been proposed as a strategy to reduce thrombus burden during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). However, the effectiveness of manual thrombectomy in reducing thrombus burden is uncertain. In this substudy of the TOTAL (ThrOmbecTomy versus PCI ALone) trial, we compared the thrombus burden at the culprit lesion using optical coherence tomography (OCT) in patients treated with thrombectomy vs. PCI-alone. The TOTAL trial (N = 10 732) was an international, multicentre, randomized trial of thrombectomy (using the Export catheter, Medtronic Cardiovascular, Santa Rosa, CA, USA) in STEMI patients treated with primary PCI. The OCT substudy prospectively enrolled 214 patients from 13 sites in 5 countries. Optical coherence tomography was performed immediately after thrombectomy or PCI-alone and then repeated after stent deployment. Thrombus quantification was performed by an independent core laboratory blinded to treatment assignment. The primary outcome of pre-stent thrombus burden as a percentage of segment analysed was 2.36% (95% CI: 1.73-3.22) in the thrombectomy group and 2.88% (95% CI: 2.12-3.90) in the PCI-alone group (P = 0.373). Absolute pre-stent thrombus volume was not different (2.99 vs. 3.74 mm(3), P = 0.329). Other secondary outcomes of pre-stent quadrants of thrombus, post-stent atherothrombotic burden, and post-stent atherothrombotic volume were not different between groups. Manual thrombectomy did not reduce pre-stent thrombus burden at the culprit lesion compared with PCI-alone. Both strategies were associated with low thrombus burden at the lesion site after the initial intervention to restore flow. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Development of a combined OCT-Raman probe for the prospective in vivo clinical melanoma skin cancer screening

NASA Astrophysics Data System (ADS)

Mazurenka, M.; Behrendt, L.; Meinhardt-Wollweber, M.; Morgner, U.; Roth, B.

2017-10-01

A combined optical coherence tomography (OCT)-Raman probe was designed and built into a spectral domain OCT head, and its performance was evaluated and compared to the most common Raman probe setups, based on a fiber bundle and confocal free space optics. Due to the use of the full field of view of an OCT scanning lens, the combined probe has a superior performance within maximum permissible exposure limits, compared to the other two probes. Skin Raman spectra, recorded in vivo, further prove the feasibility of the OCT-Raman probe for the future in vivo clinical applications in skin cancer screening.

Radiation Exposure from CT Scans: How to Close Our Knowledge Gaps, Monitor and Safeguard Exposure—Proceedings and Recommendations of the Radiation Dose Summit, Sponsored by NIBIB, February 24–25, 2011

PubMed Central

Boone, John M.; Hendee, William R.; McNitt-Gray, Michael F.

2012-01-01

This article summarizes the proceedings of a portion of the Radiation Dose Summit, which was organized by the National Institute of Biomedical Imaging and Bioengineering and held in Bethesda, Maryland, in February 2011. The current understandings of ways to optimize the benefit-risk ratio of computed tomography (CT) examinations are summarized and recommendations are made for priority areas of research to close existing gaps in our knowledge. The prospects of achieving a submillisievert effective dose CT examination routinely are assessed. © RSNA, 2012 PMID:22966066

The metabolism of the human brain studied with positron emission tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greitz, T.; Ingvar, D.H.; Widen, L.

1985-01-01

This volume presents coverage of the use of positron emission tomography (PET) to study the human brain. The contributors assess new developments in high-resolution positron emission tomography, cyclotrons, radiochemistry, and tracer kinetic models, and explore the use of PET in brain energy metabolism, blood flow, and protein synthesis measurements, receptor analysis, and pH determinations, In addition, they discuss the relevance and applications of positron emission tomography from the perspectives of physiology, neurology, and psychiatry.

Usefulness of bowel sound auscultation: a prospective evaluation.

PubMed

Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

2014-01-01

Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened to bowel sounds, whereas 17% reported that they always listened. Auscultation of bowel sounds is not a useful clinical practice when differentiating patients with normal versus pathologic bowel sounds. The listener frequently arrives at an incorrect diagnosis. If routine abdominal auscultation is to be continued, our findings emphasize the need for improvements in training and education as well as advancements in the understanding of the objective acoustical properties of bowel sounds. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evolution of Geographic Atrophy in Participants Treated with Ranibizumab for Neovascular Age-related Macular Degeneration.

PubMed

Thavikulwat, Alisa T; Jacobs-El, Naima; Kim, Jane S; Agrón, Elvira; Hasan, Jesia; Meyerle, Catherine B; Valent, David; Cukras, Catherine A; Wiley, Henry E; Wong, Wai T; Chew, Emily Y

2017-01-01

To evaluate the risk factors, incidence, and rate of progression of geographic atrophy (GA) in eyes with neovascular age-related macular degeneration (nAMD) treated with ranibizumab. Post-hoc analysis of a prospective clinical study. 69 participants with nAMD in at least one eye. Participants were prospectively treated in the study eye with 0.5 mg intravitreal ranibizumab. Study eyes received 4 monthly injections followed by pro re nata injections until a fluid-free macula was achieved on optical coherence tomography. Risk factors assessed included baseline demographics, treatment, and ocular characteristics on imaging. Eyes were evaluated on fundus autofluorescence (FAF) for GA. The rate of GA area growth in study and fellow eyes was analyzed by linear regression of square-root transformed areas. Development of new-onset GA and rate of GA area growth measured on ocular imaging, including FAF images of the study eyes. Sixty-nine participants (mean age 78.8±7.8 years) with an average of 40.0±13.6 months of follow-up were analyzed. Twenty-two of 69 study eyes (32%) were treatment naïve. During their first year of the study, participants received an average of 9.2±3.3 injections in the study eye. Of 63 study eyes with quality baseline images, 22 (35%) had pre-existing GA. Of the remaining 41 eyes, 7 (17%) developed new-onset GA during study follow-up. Those who developed new GA were older (all ≥79 years old) and had received fewer study injections on average (6.9 vs. 10.4 injections at 1 year) compared to those who did not develop new GA. Of the 12 treatment naïve study eyes without GA at baseline, 1 (8.3%) developed new GA during the study. In 21 study eyes with quantifiable GA area, eyes with GA present at baseline (16/21) enlarged by 0.34±0.26 mm/year, compared to 0.19±0.12 mm/year in eyes developing new-onset GA (5/21). While 17% of study eyes without GA present at baseline receiving ranibizumab developed new GA, the role of ranibizumab in the development of GA is unclear. Further prospective longitudinal studies are required to determine the eyes most at risk of developing GA in the setting of anti-VEGF treatment.

Glaucoma diagnostic capacity of optic nerve head haemoglobin measures compared with spectral domain OCT and HRT III confocal tomography.

PubMed

Mendez-Hernandez, Carmen; Rodriguez-Uña, Ignacio; Gonzalez-de-la Rosa, Manuel; Arribas-Pardo, Paula; Garcia-Feijoo, Julian

2016-11-01

The computer program laguna onhe determines optic nerve head haemoglobin (ONH Hb) on retinal photographs based on detecting colour differences. This study compares the diagnostic capacity of Laguna ONhE with that of spectral domain optical coherence tomography (OCT) and confocal tomography (HRT III). In a prospective, observational, cross-sectional study, glaucomatous (n = 66) and healthy (n = 52) eyes were examined by Spectralis OCT, HRT III and Laguna ONhE. The following Laguna ONhE variables were determined: ONH Hb across the vertical disc diameter (8&20 Hb), estimated cup-disc ratio (C/D) and the glaucoma discriminant function (GDF), which combines the slope of Hb amount with the mean in 8&20 Hb. The three diagnostic methods were compared by calculating areas under ROC curves (AUCs). Correlations between variables were assessed through Spearman's rho coefficient. Areas under ROC curves (AUCs) were 0.785 (95% CI: 0.700-0.863) for GDF, 0.807 (95% CI: 0.730-0.883) for OCT retinal nerve fibre layer thickness (OCT-RNFL) and 0.714 (95% CI: 0.618-0.810) and 0.721 (95% CI: 0.628-0.815) for the HRT III variable GPS (glaucoma probability score) and vertical C/D ratio, respectively. Glaucoma discriminant function (GDF) was correlated with OCT-RNFL (0.587, p 0.001; 0.507, p 0.045; and -0.119, p 0.713 for mild, moderate and advanced glaucoma, respectively), mostly so with inferior OCT-RNFL (0.622; p < 0.001). Glaucoma discriminant function (GDF)-HRT III correlations were lower (rim area 0.471, p < 0.0001; rim/disc area 0.426, p < 0.0001; vertical C/D -0.413, p < 0.0001; GPS -0.408, p < 0.0001; rim volume 0.341, p < 0.0001). Similar diagnostic power was observed for Laguna ONhE, Spectralis OCT and HRT III. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Bleomycin-Induced Pulmonary Changes on Restaging Computed Tomography Scans in Two Thirds of Testicular Cancer Patients Show No Correlation With Fibrosis Markers.

PubMed

den Hollander, Martha W; Westerink, Nico-Derk L; Lubberts, Sjoukje; Bongaerts, Alfons H H; Wolf, Rienhart F E; Altena, Renska; Nuver, Janine; Oosting, Sjoukje F; de Vries, Elisabeth G E; Walenkamp, Anna M E; Meijer, Coby; Gietema, Jourik A

2016-08-01

In metastatic testicular cancer patients treated with bleomycin, etoposide, and cisplatin (BEP) chemotherapy, bleomycin-induced pneumonitis is a well-known and potentially fatal side effect. We sought to determine the prevalence of lesions as signs of bleomycin-induced pulmonary changes on restaging computed tomography (CT) scans after treatment and to ascertain whether fibrosis markers were predictive of these changes. This prospective nonrandomized cohort study included metastatic testicular cancer patients, 18-50 years of age, treated with BEP chemotherapy. Restaging CT scans were examined for lesions as signs of bleomycin-induced pulmonary changes by two independent radiologists and graded as minor, moderate, or severe. Plasma samples were collected before, during, and after treatment and were quantified for transforming growth factor-β1 (TGF-β1), growth differentiation factor-15 (GDF-15), and high-sensitivity C-reactive protein (hs-CRP). In total, 66 patients were included: forty-five (68%) showed signs of bleomycin-induced pulmonary changes on the restaging CT scan, 37 of which were classified as minor and 8 as moderate. No differences in TGF-β1, GDF-15, or hs-CRP plasma levels were found between these groups. Bleomycin-induced pulmonary changes are common on restaging CT scans after BEP chemotherapy for metastatic testicular cancer. Changes in TGF-β1, GDF-15, and hs-CRP plasma levels do not differ between patients with and without radiological lesions as signs of bleomycin-induced pulmonary changes and are therefore not helpful as predictive biomarkers. Bleomycin-induced pneumonitis (BIP) is a well-known and potentially fatal side effect in metastatic testicular cancer patients treated with bleomycin, etoposide, and cisplatin chemotherapy. Currently, the decision to discontinue bleomycin administration is made during treatment and is based on clinical signs. An upfront or early marker or biomarker that identifies patients likely to develop BIP would be preferable. This study found that bleomycin-induced pulmonary changes are common on restaging computed tomography scans and mostly resolve. No correlation was seen between these changes and fibrosis or inflammation markers (transforming growth factor-β1, growth differentiation factor-15, and high-sensitivity C-reactive protein). ©AlphaMed Press.

Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications

PubMed Central

Rozen, Warren Matthew; Chowdhry, Muhammad; Band, Bassam; Ramakrishnan, Venkat V.; Griffiths, Matthew

2016-01-01

Background The approach and operative techniques associated with breast reconstruction have steadily been refined since its inception, with abdominal perforator-based flaps becoming the gold standard reconstructive option for women undergoing breast cancer surgery. The current study comprises a cohort of 632 patients, in whom specific operative times are recorded by a blinded observer, and aims to address the potential benefits seen with the use of computer tomography (CT) scanning preoperatively on operative outcomes, complications and surgical times. Methods A prospectively recorded, retrospective review was undertaken of patients undergoing autologous breast reconstruction with a DIEP flap at the St Andrews Centre over a 4-year period from 2010 to 2014. Computed tomography angiography (CTA) scanning of patients began in September 2012 and thus 2 time periods were compared: 2 years prior to the use of CTA scans and 2 years afterwards. For all patients, key variables were collected including patient demographics, operative times, flap harvest time, pedicle length, surgeon experience and complications. Results In group 1, comprising patients within the period prior to CTA scans, 265 patients underwent 312 flaps; whilst in group 2, the immediately following 2 years, 275 patients had 320 flaps. The use of preoperative CTA scans demonstrated a significant reduction in flap harvest time of 13 minutes (P<0.013). This significant time saving was seen in all flap modifications: unilateral, bilateral and bipedicled DIEP flaps. The greatest time saving was seen in bipedicle flaps, with a 35-minute time saving. The return to theatre rate significantly dropped from 11.2% to 6.9% following the use of CTA scans, but there was no difference in the total failure rate. Conclusions The study has demonstrated both a benefit to flap harvest time as well as overall operative times when using preoperative CTA. The use of CTA was associated with a significant reduction in complications requiring a return to theatre in the immediate postoperative period. Modern scanners and techniques can reduce the level of ionising radiation, facilitating patients being able to benefit from the advantages that this preoperative planning can convey. PMID:27047777

Reduced penetrance of the PSEN1 H163Y autosomal dominant Alzheimer mutation: a 22-year follow-up study.

PubMed

Thordardottir, Steinunn; Rodriguez-Vieitez, Elena; Almkvist, Ove; Ferreira, Daniel; Saint-Aubert, Laure; Kinhult-Ståhlbom, Anne; Thonberg, Håkan; Schöll, Michael; Westman, Eric; Wall, Anders; Eriksdotter, Maria; Zetterberg, Henrik; Blennow, Kaj; Nordberg, Agneta; Graff, Caroline

2018-05-10

The range of onset ages within some PSEN1 families is wide, and a few cases of reduced penetrance of PSEN1 mutations have been reported. However, published data on reduced penetrance have been limited to clinical histories, often collected retrospectively and lacking biomarker information. We present a case of reduced penetrance of the PSEN1 H163Y mutation in a carrier prospectively followed for 22 years. Two brothers (A and B), both carriers of the H163Y mutation, were followed between 1995 and 2017. They underwent repeated clinical evaluations, neuropsychological assessments, and cerebrospinal fluid analyses, as well as brain imaging examinations with structural magnetic resonance, [ 18 F]fluorodeoxyglucose positron emission tomography, and [ 11 C]Pittsburgh compound B positron emission tomography. Brother A was followed between 44 and 64 years of age. Cognitive symptoms due to Alzheimer's disease set in at the age of 54. Gradual worsening of symptoms resulted in admittance to a nursing home owing to dependence on others for all activities of daily living. He showed a curvilinear decline in cognitive function on neuropsychological tests, and changes on magnetic resonance imaging, positron emission tomography, and biomarkers in the cerebrospinal fluid supported a clinical diagnosis of Alzheimer's disease. Brother A died at the age of 64 and fulfilled the criteria for definitive Alzheimer's disease according to neuropathological examination results. Brother B was followed between the ages of 43 and 65 and showed no cognitive deterioration on repeated neuropsychological test occasions. In addition, no biomarker evidence of Alzheimer's disease pathology was detected, either on imaging examinations or in cerebrospinal fluid. The average (SD) age of symptom onset for PSEN1 H163Y is 51 ± 7 years according to previous studies. However, we present a case of a biomarker-verified reduction in penetrance in a mutation carrier who was still symptom-free at the age of 65. This suggests that other genetic, epigenetic, and/or environmental factors modify the onset age.

Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study.

PubMed

Noguchi, Teruo; Tanaka, Atsushi; Kawasaki, Tomohiro; Goto, Yoichi; Morita, Yoshiaki; Asaumi, Yasuhide; Nakao, Kazuhiro; Fujiwara, Reiko; Nishimura, Kunihiro; Miyamoto, Yoshihiro; Ishihara, Masaharu; Ogawa, Hisao; Koga, Nobuhiko; Narula, Jagat; Yasuda, Satoshi

2015-07-21

Coronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR). This pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR. Prospective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed. In the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001). Statin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition. (Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technique [AQUAMARINE]; UMIN000003567). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Radical lateral body-wall resection for fibrosarcoma with reconstruction using polypropylene mesh and a caudal superficial epigastric axial pattern flap: a prospective clinical study of the technique and results in 6 cats.

PubMed

Lidbetter, David A; Williams, Fred A; Krahwinkel, D J; Adams, William H

2002-01-01

To describe and evaluate a technique for radical resection of the lateral body wall for treatment of fibrosarcoma with reconstruction using polypropylene mesh and a caudal superficial epigastric axial pattern flap in cats. Prospective, clinical study. Six client-owned cats with fibrosarcoma. Six cats with histologically confirmed fibrosarcoma of the lateral body wall were staged using radiography and/or computer tomography scanning. Preoperative radiotherapy was used in 3 cats. All cats had the lateral abdominal wall resected and reconstructed with polypropylene mesh. A caudal superficial epigastric flap was mobilized and rotated to close the skin deficit. The animals were evaluated after surgery for wound complications, tumor recurrence, and metastasis. Outcome was assessed by patient examination and client consultation. Minor dehiscence of the skin flaps occurred in 2 cats, and 1 other cat was successfully resuscitated from respiratory and cardiac arrest after surgery. All tissue specimens were tumor-free at the surgical margins. Follow-up times ranged from 12 to 21 months, with a mean time of 17.2 months. None of the cats had evidence of local tumor recurrence or metastasis; outcome was judged good to excellent in all cats. Radical lateral body-wall resection and reconstruction is an effective technique for achieving local tumor control with acceptable patient morbidity. Further studies are needed to assess whether the technique will result in improved tumor-free intervals and survival times. Copyright 2002 by The American College of Veterinary Surgeons

Distraction arthrodesis of the sacroiliac joint: 2-year results of a descriptive prospective multi-center cohort study in 171 patients.

PubMed

Fuchs, Volker; Ruhl, Benjamin

2018-01-01

The aim of the given study was to evaluate the long-term outcomes of patients undergoing sacroiliac joint (SIJ) distraction arthrodesis to treat SIJ-related pain. Descriptive prospective multi-center cohort study involving 20 hospitals in Germany. Between January 2011 and June 2012, 171 patients with chronic SIJ pain underwent indirect arthrodesis of the SIJ using a distraction implant. The patients were questioned prior to surgery, 6-weeks, and 3-, 6-, 12- and 24-months postoperatively. Overall patient satisfaction was surveyed along with pain medication intake, the Million Visual Analogue Scale (MVAS), Oswestry Disability Index (ODI), Short-form McGill Pain Questionnaire (SF-MPQ), 12-Item Short-Form Health Survey (SF-12), Visual Analogue Scale (VAS) and a pain drawing. Bony fusion of the SIJ was evaluated using X-ray and computed tomography (CT). A majority of patients (73%) reported to feel better or much better 24 months post-surgery, 49% of the patients reduced their pain medication intake. The MVAS dropped from 63 to 36%, the ODI improved from 51 to 33%, the SF-MPQ decreased from 50 to 31%, the SF-12 physical component summary rose from 22 to 41%, the mental component summary increased from 40 to 55%, and pain as measured by the VAS decreased from 74 to 37 points (all comparisons p < 0.001). In the follow-up CT scans 31% of the patients showed SIJ fusion. SIJ distraction arthrodesis has shown satisfactory outcomes in patients with SIJ-related pain for all scores reported in the surveys, accompanied by increased functionality.

Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome.

PubMed

Avallone, Antonio; Aloj, Luigi; Caracò, Corradina; Delrio, Paolo; Pecori, Biagio; Tatangelo, Fabiana; Scott, Nigel; Casaretti, Rossana; Di Gennaro, Francesca; Montano, Massimo; Silvestro, Lucrezia; Budillon, Alfredo; Lastoria, Secondo

2012-12-01

The aim of the present study is to prospectively evaluate the prognostic value of previously defined [(18)F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) criteria of early metabolic response in patients with locally advanced rectal cancer (LARC) after long-term follow-up. Forty-two patients with poor prognosis LARC underwent three biweekly courses of chemotherapy with oxaliplatin, raltitrexed and 5-fluorouracil modulated by levofolinic acid during pelvic radiotherapy. FDG PET studies were performed before and 12 days after the beginning of the chemoradiotherapy (CRT) treatment. Total mesorectal excision (TME) was carried out 8 weeks after completion of CRT. A previously identified cutoff value of ≥52 % reduction of the baseline mean FDG standardized uptake value (SUV(mean)) was applied to differentiate metabolic responders from non-responders and correlated to tumour regression grade (TRG) and survival. Twenty-two metabolic responders showed complete (TRG1) or subtotal tumour regression (TRG2) and demonstrated a statistically significantly higher 5-year relapse-free survival (RFS) compared with the 20 non-responders (86 vs 55 %, p = .014) who showed TRG3 and TRG4 pathologic responses. A multivariate analysis demonstrated that early ∆SUV(mean) was the only pre-surgical parameter correlated to the likelihood of recurrence (p = .05). This study is the first prospective long-term evaluation demonstrating that FDG PET is not only an early predictor of pathologic response but is also a valuable prognostic tool. Our results indicate the potential of FDG PET for optimizing multidisciplinary management of patients with LARC.

Clinical value of whole body fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of metastatic bladder cancer.

PubMed

Yang, Zhongyi; Pan, Lingling; Cheng, Jingyi; Hu, Silong; Xu, Junyan; Ye, Dingwei; Zhang, Yingjian

2012-07-01

To investigate the value of whole-body fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography for the detection of metastatic bladder cancer. From December 2006 to August 2010, 60 bladder cancer patients (median age 60.5 years old, range 32-96) underwent whole body positron emission tomography/computed tomography positron emission tomography/computed tomography. The diagnostic accuracy was assessed by performing both organ-based and patient-based analyses. Identified lesions were further studied by biopsy or clinically followed for at least 6 months. One hundred and thirty-four suspicious lesions were identified. Among them, 4 primary cancers (2 pancreatic cancers, 1 colonic and 1 nasopharyngeal cancer) were incidentally detected, and the patients could be treated on time. For the remaining 130 lesions, positron emission tomography/computed tomography detected 118 true positive lesions (sensitivity = 95.9%). On the patient-based analysis, the overall sensitivity and specificity resulted to be 87.1% and 89.7%, respectively. There was no difference of sensitivity and specificity in patients with or without adjuvant treatment in terms of detection of metastatic sites by positron emission tomography/computed tomography. Compared with conventional imaging modality, positron emission tomography/computed tomography correctly changed the management in 15 patients (25.0%). Positron emission tomography/computed tomography has excellent sensitivity and specificity in the detection of metastatic bladder cancer and it provides additional diagnostic information compared to standard imaging techniques. © 2012 The Japanese Urological Association.

Post-traumatic stress disorder and incidence of coronary heart disease: a twin study.

PubMed

Vaccarino, Viola; Goldberg, Jack; Rooks, Cherie; Shah, Amit J; Veledar, Emir; Faber, Tracy L; Votaw, John R; Forsberg, Christopher W; Bremner, J Douglas

2013-09-10

The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Among Vietnam-era veterans, PTSD is a risk factor for CHD. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion.

PubMed

Chirica, Mircea; Resche-Rigon, Matthieu; Zagdanski, Anne Marie; Bruzzi, Matthieu; Bouda, Damien; Roland, Eric; Sabatier, François; Bouhidel, Fatiha; Bonnet, Francine; Munoz-Bongrand, Nicolas; Marc Gornet, Jean; Sarfati, Emile; Cattan, Pierre

2016-07-01

Endoscopy is the standard of care for emergency patient evaluation after caustic ingestion. However, the inaccuracy of endoscopy in determining the depth of intramural necrosis may lead to inappropriate decision-making with devastating consequences. Our aim was to evaluate the use of computed tomography (CT) for the emergency diagnostic workup of patients with caustic injuries. In a prospective study, we used a combined endoscopy-CT decision-making algorithm. The primary outcome was pathology-confirmed digestive necrosis. The respective utility of CT and endoscopy in the decision-making process were compared. Transmural endoscopic necrosis was defined as grade 3b injuries; signs of transmural CT necrosis included absence of postcontrast gastric/ esophageal-wall enhancement, esophageal-wall blurring, and periesophageal-fat blurring. We included 120 patients (59 men, median age 44 years). Emergency surgery was performed in 24 patients (20%) and digestive resection was completed in 16. Three patients (3%) died and 28 patients (23%) experienced complications. Pathology revealed transmural necrosis in 9/11 esophagectomy and 16/16 gastrectomy specimens. Severe oropharyngeal injuries (P = 0.015), increased levels of blood lactate (P = 0.007), alanine aminotransferase (P = 0.027), bilirubin (P = 0.005), and low platelet counts (P > 0.0001) were predictive of digestive necrosis. Decision-making relying on CT alone or on a combined CT-endoscopy algorithm was similar and would have spared 19 unnecessary esophagectomies and 16 explorative laparotomies compared with an endoscopy-alone algorithm. Endoscopy did never rectify a wrong CT decision. Emergency decision-making after caustic injuries can rely on CT alone.

"Silent" kidney stones in "asymptomatic" primary hyperparathyroidism-a comparison of multidetector computed tomography and ultrasound.

PubMed

Selberherr, Andreas; Hörmann, Marcus; Prager, Gerhard; Riss, Philipp; Scheuba, Christian; Niederle, Bruno

2017-03-01

The purpose of this study was to demonstrate the high number of kidney stones in primary hyperparathyroidism (PHPT) and the low number of in fact "asymptomatic" patients. Forty patients with PHPT (28 female, 12 male; median age 58 (range 33-80) years; interquartile range 17 years [51-68]) without known symptoms of kidney stones prospectively underwent multidetector computed tomography (MDCT) and ultrasound (US) examinations of the urinary tract prior to parathyroid surgery. Images were evaluated for the presence and absence of stones, as well as for the number of stones and sizes in the long axis. The MDCT and US examinations were interpreted by two experienced radiologists who were blinded to all clinical and biochemical data. Statistical analysis was performed using the Wilcoxon signed-rank test. US revealed a total of 4 kidney stones in 4 (10 %) of 40 patients (median size 6.5 mm, interquartile range 11.5 mm). MDCT showed a total of 41 stones (median size was 3 mm, interquartile range 2.25 mm) in 15 (38 %) of 40 patients. The number of kidney stones detected with MDCT was significantly higher compared to US (p = 0.00124). MDCT is a highly sensitive method for the detection of "silent" kidney stones in patients with PHPT. By widely applying this method, the number of asymptomatic courses of PHPT may be substantially reduced. MDCT should be used primarily to detect kidney stones in PHPT and to exclude asymptomatic PHPT.

Standardized Index of Shape (DCE-MRI) and Standardized Uptake Value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile

PubMed Central

Petrillo, Antonella; Fusco, Roberta; Petrillo, Mario; Granata, Vincenza; Delrio, Paolo; Bianco, Francesco; Pecori, Biagio; Botti, Gerardo; Tatangelo, Fabiana; Caracò, Corradina; Aloj, Luigi; Avallone, Antonio; Lastoria, Secondo

2017-01-01

Purpose To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. Results 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. Conclusions CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR. PMID:28042958

Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

PubMed Central

2011-01-01

Background Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present. PMID:21995807

Diagnostic value of 18F-FDG-PET/CT for the follow-up and restaging of soft tissue sarcomas in adults.

PubMed

Kassem, T W; Abdelaziz, O; Emad-Eldin, S

2017-10-01

The purpose of this study was to evaluate the clinical utility of 2-[ 18 F] fluoro-2-deoxy-D-glucose ( 18 FDG) positron emission tomography (PET)/computed tomography (CT) ( 18 F-FDG-PET/CT) in the follow-up of adult patients with soft tissue sarcomas. We prospectively evaluated 37 consecutive patients with known soft tissue sarcoma with 18 F-FDG-PET/CT examination for suspected recurrence of disease. They were 21 men and 16 women with a mean age of 49.6±10.6 (SD) years (range, 34-75years). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18 F-FDG-PET/CT examination were calculated on a per patient basis. 18 F-FDG-PET/CT showed an overall diagnostic accuracy of 91.8%, sensitivity of 90% and a specificity of 100%. The positive predictive value and negative predictive value were 100 and 70%, respectively. The 18 F-FDG-PET/CT interpretations were correct in 34/37 patients (91.8%). Incorrect interpretations occurred in three patients (8.1%). Reasons for false negative findings were low 18 F-FDG uptake of local recurrence in one patient and low 18 F-FDG uptake of subcentimetric inguinal lymph node metastases. 18 F-FDG-PET/CT has a high diagnostic value in the follow-up of patients with soft tissue sarcoma. Copyright © 2017 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software.

PubMed

Ueda, Kazuhiro; Tanaka, Toshiki; Li, Tao-Sheng; Tanaka, Nobuyuki; Hamano, Kimikazu

2009-03-01

The prediction of pulmonary functional reserve is mandatory in therapeutic decision-making for patients with resectable lung cancer, especially those with underlying lung disease. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative computed tomography (CT) helps to identify residual pulmonary function, although the utility of this modality needs investigation. The subjects of this prospective study were 30 patients with resectable lung cancer. A three-dimensional CT lung model was created with voxels representing normal lung attenuation (-600 to -910 Hounsfield units). Residual pulmonary function was predicted by drawing a boundary line between the lung to be preserved and that to be resected, directly on the lung model. The predicted values were correlated with the postoperative measured values. The predicted and measured values corresponded well (r=0.89, p<0.001). Although the predicted values corresponded with values predicted by simple calculation using a segment-counting method (r=0.98), there were two outliers whose pulmonary functional reserves were predicted more accurately by CT than by segment counting. The measured pulmonary functional reserves were significantly higher than the predicted values in patients with extensive emphysematous areas (<-910 Hounsfield units), but not in patients with chronic obstructive pulmonary disease. Quantitative CT yielded accurate prediction of functional reserve after lung cancer surgery and helped to identify patients whose functional reserves are likely to be underestimated. Hence, this modality should be utilized for patients with marginal pulmonary function.

Evaluation of a semi-automated computer algorithm for measuring total fat and visceral fat content in lambs undergoing in vivo whole body computed tomography.

PubMed

Rosenblatt, Alana J; Scrivani, Peter V; Boisclair, Yves R; Reeves, Anthony P; Ramos-Nieves, Jose M; Xie, Yiting; Erb, Hollis N

2017-10-01

Computed tomography (CT) is a suitable tool for measuring body fat, since it is non-destructive and can be used to differentiate metabolically active visceral fat from total body fat. Whole body analysis of body fat is likely to be more accurate than single CT slice estimates of body fat. The aim of this study was to assess the agreement between semi-automated computer analysis of whole body volumetric CT data and conventional proximate (chemical) analysis of body fat in lambs. Data were collected prospectively from 12 lambs that underwent duplicate whole body CT, followed by slaughter and carcass analysis by dissection and chemical analysis. Agreement between methods for quantification of total and visceral fat was assessed by Bland-Altman plot analysis. The repeatability of CT was assessed for these measures using the mean difference of duplicated measures. When compared to chemical analysis, CT systematically underestimated total and visceral fat contents by more than 10% of the mean fat weight. Therefore, carcass analysis and semi-automated CT computer measurements were not interchangeable for quantifying body fat content without the use of a correction factor. CT acquisition was repeatable, with a mean difference of repeated measures being close to zero. Therefore, uncorrected whole body CT might have an application for assessment of relative changes in fat content, especially in growing lambs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Standardized Index of Shape (DCE-MRI) and Standardized Uptake Value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile.

PubMed

Petrillo, Antonella; Fusco, Roberta; Petrillo, Mario; Granata, Vincenza; Delrio, Paolo; Bianco, Francesco; Pecori, Biagio; Botti, Gerardo; Tatangelo, Fabiana; Caracò, Corradina; Aloj, Luigi; Avallone, Antonio; Lastoria, Secondo

2017-01-31

To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR.

Assessment of ultrasonography and computed tomography for the evaluation of unilateral orbital disease in dogs.

PubMed

Boroffka, Susanne A E B; Verbruggen, Anne-Marie; Grinwis, Guy C M; Voorhout, George; Barthez, Paul Y

2007-03-01

To describe clinical, ultrasonographic, and computed tomographic (CT) features of confirmed neoplastic and nonneoplastic disease in dogs with unilateral orbital diseases, determine criteria to differentiate between the 2 conditions, and assess the relative value of ultrasonography and CT for the differential diagnosis of these 2 conditions. Prospective study. 29 dogs with unilateral neoplastic orbital disease and 16 dogs with unilateral nonneoplastic orbital disease. Clinical history and results of physical and ophthalmologic examinations were recorded. Ultrasonographic and CT images were evaluated, and discriminating factors were identified to differentiate neoplastic from nonneoplastic diseases. Diagnostic value of ultrasonography and CT was assessed. Dogs with neoplastic disease were significantly older; had clinical signs for a longer time before initial examination; had more progressive onset of clinical signs; and more frequently had protrusion of the nictitating membrane, fever, and anorexia. The most discriminating factor for both imaging modalities was delineation of the margins (odds ratio was 41.7 for ultrasonography and 45 for CT), with neoplastic lesions clearly delineated more often. Ultrasonographically, neoplastic lesions were more frequently hypoechoic and homogeneous, with indentation of the globe and bone involvement evident more frequently than for nonneoplastic lesions. Mineralization was detected only with neoplasia. Fluctuant fluid was seen more frequently in dogs with nonneoplastic disease. Computed tomography more frequently revealed extraorbital involvement. Diagnostic value was similar for both imaging modalities. Ultrasonography and CT are valuable imaging modalities to assist in differentiating neoplastic from nonneoplastic unilateral orbital disease in dogs.

Emergency Department Triage of Traumatic Head Injury Using a Brain Electrical Activity Biomarker: A Multisite Prospective Observational Validation Trial.

PubMed

Hanley, Daniel; Prichep, Leslie S; Bazarian, Jeffrey; Huff, J Stephen; Naunheim, Rosanne; Garrett, John; Jones, Elizabeth B; Wright, David W; O'Neill, John; Badjatia, Neeraj; Gandhi, Dheeraj; Curley, Kenneth C; Chiacchierini, Richard; O'Neil, Brian; Hack, Dallas C

2017-05-01

A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in emergency department (ED) patients presenting with high Glasgow Coma Scale (GCS) after sustaining a head injury has shown promise for objective, rapid triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being computed tomography (CT) positive, in high-functioning TBI patients in the acute state. Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12 to 15 were candidates for study. A total of 720 patients (18-85 years) meeting inclusion/exclusion criteria were enrolled in this observational, prospective validation trial, at 11 U.S. EDs. GCS was 15 in 97%, with the first and third quartiles being 15 (interquartile range = 0) in the study population at the time of the evaluation. Standard clinical evaluations were conducted and 5 to 10 minutes of electroencephalogram (EEG) was acquired from frontal and frontal-temporal scalp locations. Using an a priori derived EEG-based classification algorithm developed on an independent population and applied to this validation population prospectively, the likelihood of each subject being CT+ was determined, and performance metrics were computed relative to adjudicated CT findings. Sensitivity of the binary classifier (likely CT+ or CT-) was 92.3% (95% confidence interval [CI] = 87.8%-95.5%) for detection of any intracranial injury visible on CT (CT+), with specificity of 51.6% (95% CI = 48.1%-55.1%) and negative predictive value (NPV) of 96.0% (95% CI = 93.2%-97.9%). Using ternary classification (likely CT+, equivocal, likely CT-) demonstrated enhanced sensitivity to traumatic hematomas (≥1 mL of blood), 98.6% (95% CI = 92.6%-100.0%), and NPV of 98.2% (95% CI = 95.5%-99.5%). Using an EEG-based biomarker high accuracy of predicting the likelihood of being CT+ was obtained, with high NPV and sensitivity to any traumatic bleeding and to hematomas. Specificity was significantly higher than standard CT decision rules. The short time to acquire results and the ease of use in the ED environment suggests that EEG-based classifier algorithms have potential to impact triage and clinical management of head-injured patients. © 2017 by the Society for Academic Emergency Medicine.

Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series.

PubMed

Tsuang, Fon-Yih; Chen, Chia-Hsien; Kuo, Yi-Jie; Tseng, Wei-Lung; Chen, Yuan-Shen; Lin, Chin-Jung; Liao, Chun-Jen; Lin, Feng-Huei; Chiang, Chang-Jung

2017-09-01

Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy. A technical report (a retrospective and prospective case series) was carried out. Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample. We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions. In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary. This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Diagnosis of sinusoidal obstruction syndrome by positron emission tomography/computed tomography: report of two cases treated by defibrotide.

PubMed

Gauthé, Mathieu; Bozec, Laurence; Bedossa, Pierre

2014-11-01

Sinusoidal obstruction syndrome (SOS) is a potentially fatal liver injury that mainly occurs after myeloablative chemotherapy. We report two cases of SOS investigated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography and treated with defibrotide. © 2014 by the American Association for the Study of Liver Diseases.

Personalized Risk Assessment in Never, Light, and Heavy Smokers in a prospective cohort in Taiwan.

PubMed

Wu, Xifeng; Wen, Chi Pang; Ye, Yuanqing; Tsai, MinKwang; Wen, Christopher; Roth, Jack A; Pu, Xia; Chow, Wong-Ho; Huff, Chad; Cunningham, Sonia; Huang, Maosheng; Wu, Shuanbei; Tsao, Chwen Keng; Gu, Jian; Lippman, Scott M

2016-11-02

The objective of this study was to develop markedly improved risk prediction models for lung cancer using a prospective cohort of 395,875 participants in Taiwan. Discriminatory accuracy was measured by generation of receiver operator curves and estimation of area under the curve (AUC). In multivariate Cox regression analysis, age, gender, smoking pack-years, family history of lung cancer, personal cancer history, BMI, lung function test, and serum biomarkers such as carcinoembryonic antigen (CEA), bilirubin, alpha fetoprotein (AFP), and c-reactive protein (CRP) were identified and included in an integrative risk prediction model. The AUC in overall population was 0.851 (95% CI = 0.840-0.862), with never smokers 0.806 (95% CI = 0.790-0.819), light smokers 0.847 (95% CI = 0.824-0.871), and heavy smokers 0.732 (95% CI = 0.708-0.752). By integrating risk factors such as family history of lung cancer, CEA and AFP for light smokers, and lung function test (Maximum Mid-Expiratory Flow, MMEF 25-75% ), AFP and CEA for never smokers, light and never smokers with cancer risks as high as those within heavy smokers could be identified. The risk model for heavy smokers can allow us to stratify heavy smokers into subgroups with distinct risks, which, if applied to low-dose computed tomography (LDCT) screening, may greatly reduce false positives.

Risk of progression in macula-on rhegmatogenous retinal detachment.

PubMed

Callizo, Josep; Pfeiffer, Sebastian; Lahme, Eva; van Oterendorp, Christian; Khattab, Mohammed; Bemme, Sebastian; Kulanga, Miroslav; Hoerauf, Hans; Feltgen, Nicolas

2017-08-01

To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8 ± 1.4 days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p = 0.0036) and without (p = 0.0014) macular involvement. For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.

Participation in colorectal cancer screening trials after first-time invitation: a systematic review.

PubMed

Khalid-de Bakker, C; Jonkers, D; Smits, K; Mesters, I; Masclee, A; Stockbrügger, R

2011-12-01

Colorectal cancer (CRC) screening is implemented by an increasing number of countries. Participation rates of screening programs influence the health benefit and cost-effectiveness of the applied method. The aim was to systematically review participation rate after first-time invitation for CRC screening with fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, and/or computed tomography (CT) colonography. A systematic literature search was performed prior to October 1 2009. Prospective CRC screening studies of unselected populations reporting participation rates were included. After meta-analyses, overall participation rates were found to be 47 % for FOBT, 42 % for fecal immunologic tests (FITs), 35 % for sigmoidoscopy, 41 % for sigmoidoscopy combined with FIT/FOBT, 28 % for colonoscopy, and 22 % for CT colonography. Studies comparing screening methods showed higher participation rates for less invasive methods. Studies comparing invitation methods showed higher participation rates with general practitioner involvement, a more personalized recruitment approach, and reduction of barriers that discourage participation. Knowledge of identified factors affecting CRC screening participation can be used to improve screening programs. © Georg Thieme Verlag KG Stuttgart · New York.

Non-small cell lung cancer brain metastasis screening in the era of positron emission tomography-CT staging: Current practice and outcomes.

PubMed

Diaz, Mauricio E; Debowski, Maciej; Hukins, Craig; Fielding, David; Fong, Kwun M; Bettington, Catherine S

2018-05-10

Several clinical guidelines indicate that brain metastasis screening (BMS) should be guided by disease stage in non-small cell lung cancer (NSCLC). We estimate that screening is performed more broadly in practice, and patients undergo brain imaging at considerable cost with questionable benefit. Our aim was to quantify the use and detection rate of BMS in a contemporary cohort staged with 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT). We conducted a retrospective review of prospectively collected data from three major lung cancer referral centres in Brisbane between January 2011 and December 2015. Patients included had a new diagnosis of NSCLC and had undergone a PET-CT to stage extra-cranial disease. BMS was defined as dedicated brain imaging with contrast-enhanced computed tomography (CE-CT) or magnetic resonance (MR), in the absence of clinically apparent neurological deficits. A total of 1751 eligible cases were identified and of these 718 (41%) underwent BMS. The majority had CE-CT imaging (n = 703). Asymptomatic brain metastases (BM) were detected in 18 patients (2.5%). Of these patients, 12 had concurrent non-brain metastases. Only six patients (0.8%) had BM alone. The rate of detection increased with N-stage (P = 0.02) and overall stage (P < 0.001). It was 0.5%, 1%, 1.6% and 7.3% for stage I, II, III and IV respectively. The overall screening rate increased with T-stage (P = 0.001), N-Stage (P < 0.001) and overall stage (P < 0.001). Non-small cell lung cancer BMS practices remain at odds with published guidelines. The low number of occult BMs detected supports the existing international recommendations. Rationalising BMS would minimise the burden on patients and the health care system. © 2018 The Royal Australian and New Zealand College of Radiologists.

Computed Tomography

NASA Astrophysics Data System (ADS)

Castellano, Isabel; Geleijns, Jacob

After its clinical introduction in 1973, computed tomography developed from an x-ray modality for axial imaging in neuroradiology into a versatile three dimensional imaging modality for a wide range of applications in for example oncology, vascular radiology, cardiology, traumatology and even in interventional radiology. Computed tomography is applied for diagnosis, follow-up studies and screening of healthy subpopulations with specific risk factors. This chapter provides a general introduction in computed tomography, covering a short history of computed tomography, technology, image quality, dosimetry, room shielding, quality control and quality criteria.

Positron Computed Tomography: Current State, Clinical Results and Future Trends

DOE R&D Accomplishments Database

Schelbert, H. R.; Phelps, M. E.; Kuhl, D. E.

1980-09-01

An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends. (ACR)

Terahertz Computed Tomography of NASA Thermal Protection System Materials

NASA Technical Reports Server (NTRS)

Roth, D. J.; Reyes-Rodriguez, S.; Zimdars, D. A.; Rauser, R. W.; Ussery, W. W.

2011-01-01

A terahertz axial computed tomography system has been developed that uses time domain measurements in order to form cross-sectional image slices and three-dimensional volume renderings of terahertz-transparent materials. The system can inspect samples as large as 0.0283 cubic meters (1 cubic foot) with no safety concerns as for x-ray computed tomography. In this study, the system is evaluated for its ability to detect and characterize flat bottom holes, drilled holes, and embedded voids in foam materials utilized as thermal protection on the external fuel tanks for the Space Shuttle. X-ray micro-computed tomography was also performed on the samples to compare against the terahertz computed tomography results and better define embedded voids. Limits of detectability based on depth and size for the samples used in this study are loosely defined. Image sharpness and morphology characterization ability for terahertz computed tomography are qualitatively described.

Assessing the response to targeted therapies in renal cell carcinoma: technical insights and practical considerations.

PubMed

Bex, Axel; Fournier, Laure; Lassau, Nathalie; Mulders, Peter; Nathan, Paul; Oyen, Wim J G; Powles, Thomas

2014-04-01

The introduction of targeted agents for the treatment of renal cell carcinoma (RCC) has resulted in new challenges for assessing response to therapy, and conventional response criteria using computed tomography (CT) are limited. It is widely recognised that targeted therapies may lead to significant necrosis without significant reduction in tumour size. In addition, the vascular effects of antiangiogenic therapy may occur long before there is any reduction in tumour size. To perform a systematic review of conventional and novel imaging methods for the assessment of response to targeted agents in RCC and to discuss their use from a clinical perspective. Relevant databases covering the period January 2006 to April 2013 were searched for studies reporting on the use of anatomic and functional imaging techniques to predict response to targeted therapy in RCC. Inclusion criteria were randomised trials, nonrandomised controlled studies, retrospective case series, and cohort studies. Reviews, animal and preclinical studies, case reports, and commentaries were excluded. A narrative synthesis of the evidence is presented. A total of 331 abstracts and 76 full-text articles were assessed; 34 studies met the inclusion criteria. Current methods of response assessment in RCC include anatomic methods--based on various criteria including Choi, size and attenuation CT, and morphology, attenuation, size, and structure--and functional techniques including dynamic contrast-enhanced (DCE) CT, DCE-magnetic resonance imaging, DCE-ultrasonography, positron emission tomography, and approaches utilising radiolabelled monoclonal antibodies. Functional imaging techniques are promising surrogate biomarkers of response in RCC and may be more appropriate than anatomic CT-based methods. By enabling quantification of tumour vascularisation, functional techniques can directly and rapidly detect the biologic effects of antiangiogenic therapies compared with the indirect detection of belated effects on tumour size by anatomic methods. However, larger prospective studies are needed to validate early results and standardise techniques. Copyright © 2013 European Association of Urology. All rights reserved.

Correlation Between Arterial FDG Uptake and Biomarkers in Peripheral Artery Disease

PubMed Central

Myers, Kelly S.; Rudd, James H. F.; Hailman, Eric P.; Bolognese, James A.; Burke, Joanne; Pinto, Cathy Anne; Klimas, Michael; Hargreaves, Richard; Dansky, Hayes M.; Fayad, Zahi A.

2014-01-01

OBJECTIVES A prospective, multicenter 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging study was performed to estimate the correlations among arterial FDG uptake and atherosclerotic plaque biomarkers in patients with peripheral artery disease. BACKGROUND Inflammation within atherosclerotic plaques is associated with instability of the plaque and future cardiovascular events. Previous studies have shown that 18F-FDG-PET/CT is able to quantify inflammation within carotid artery atherosclerotic plaques, but no studies to date have investigated this correlation in peripheral arteries with immunohistochemical confirmation. METHODS Thirty patients across 5 study sites underwent 18F-FDG-PET/CT imaging before Silver-Hawk atherectomy (FoxHollow Technologies, Redwood City, California) for symptomatic common or superficial femoral arterial disease. Vascular FDG uptake (expressed as target-to-background ratio) was measured in the carotid arteries and aorta and femoral arteries, including the region of atherectomy. Immunohistochemistry was performed on the excised atherosclerotic plaque extracts, and cluster of differentiation 68 (CD68) level as a measure of macrophage content was determined. Correlations between target-to-background ratio of excised lesions, as well as entire arterial regions, and CD68 levels were determined. Imaging was performed during the 2 weeks before surgery in all cases. RESULTS Twenty-one patients had adequate-quality 18F-FDG-PET/CT peripheral artery images, and 34 plaque specimens were obtained. No significant correlation between lesion target-to-background ratio and CD68 level was observed. CONCLUSIONS There were no significant correlations between CD68 level (as a measure of macrophage content) and FDG uptake in the peripheral arteries in this multicenter study. Differences in lesion extraction technique, lesion size, the degree of inflammation, and imaging coregistration techniques may have been responsible for the failure to observe the strong correlations with vascular FDG uptake observed in previous studies of the carotid artery and in several animal models of atherosclerosis. PMID:22239891

Interlaced X-ray diffraction computed tomography

PubMed Central

Vamvakeros, Antonios; Jacques, Simon D. M.; Di Michiel, Marco; Senecal, Pierre; Middelkoop, Vesna; Cernik, Robert J.; Beale, Andrew M.

2016-01-01

An X-ray diffraction computed tomography data-collection strategy that allows, post experiment, a choice between temporal and spatial resolution is reported. This strategy enables time-resolved studies on comparatively short timescales, or alternatively allows for improved spatial resolution if the system under study, or components within it, appear to be unchanging. The application of the method for studying an Mn–Na–W/SiO2 fixed-bed reactor in situ is demonstrated. Additionally, the opportunities to improve the data-collection strategy further, enabling post-collection tuning between statistical, temporal and spatial resolutions, are discussed. In principle, the interlaced scanning approach can also be applied to other pencil-beam tomographic techniques, like X-ray fluorescence computed tomography, X-ray absorption fine structure computed tomography, pair distribution function computed tomography and tomographic scanning transmission X-ray microscopy. PMID:27047305

Aerosolized intranasal midazolam for safe and effective sedation for quality computed tomography imaging in infants and children.

PubMed

Mekitarian Filho, Eduardo; de Carvalho, Werther Brunow; Gilio, Alfredo Elias; Robinson, Fay; Mason, Keira P

2013-10-01

This pilot study introduces the aerosolized route for midazolam as an option for infant and pediatric sedation for computed tomography imaging. This technique produced predictable and effective sedation for quality computed tomography imaging studies with minimal artifact and no significant adverse events. Copyright © 2013 Mosby, Inc. All rights reserved.

The natural history of adult pulmonary Langerhans cell histiocytosis: a prospective multicentre study.

PubMed

Tazi, Abdellatif; de Margerie, Constance; Naccache, Jean Marc; Fry, Stéphanie; Dominique, Stéphane; Jouneau, Stéphane; Lorillon, Gwenaël; Bugnet, Emmanuelle; Chiron, Raphael; Wallaert, Benoit; Valeyre, Dominique; Chevret, Sylvie

2015-03-14

The natural history of pulmonary Langerhans cell histiocytosis (PLCH) has been unclear due to the absence of prospective studies. The rate of patients who experience an early progression of their disease is unknown. Additionally, conflicting effects of smoking cessation on the outcome of PLCH have been reported. In this prospective, multicentre study, 58 consecutive patients with newly diagnosed PLCH were comprehensively evaluated over a two-year period. Our objectives were to estimate the incidence of early progression of the disease and to evaluate the impact of smoking status on lung function outcomes. Lung function deterioration was defined as a decrease of at least 15% in FEV1 and/or FVC and/or DLCO, compared with baseline values. At each visit, smoking status was recorded based on the patients' self-reports and urinary cotinine measurements that were blinded for the patients. The cumulative incidence of lung function outcomes over time was estimated using the non-parametric Kaplan-Meier method. Multivariate Cox models with time-dependent covariates were used to calculate the hazards ratios of the lung function deterioration associated with smoking status with adjustment for potential confounders. The cumulative incidence of lung function deterioration at 24 months was 38% (22% for FEV1 and DLCO, and 9% for FVC). In the multivariate analysis, smoking status and PaO2 at inclusion were the only factors associated with the risk of lung function deterioration. The patients' smoking statuses markedly changed over time. Only 20% of the patients quit using tobacco for the entire study period. Nevertheless, being a non-smoker was associated with a decreased risk of subsequent lung function deterioration, even after adjustment for baseline predictive factors. By serial lung computed tomography, the extent of cystic lesions increased in only 11% of patients. Serial lung function evaluation on a three- to six-month basis is essential for the follow-up of patients with recently diagnosed PLCH to identify those who experience an early progression of their disease. These patients are highly addicted to tobacco, and robust efforts should be undertaken to include them in smoking cessation programs. ClinicalTrials.gov: No: NCT01225601 .

Three dimensional rock microstructures: insights from FIB-SEM tomography

NASA Astrophysics Data System (ADS)

Drury, Martyn; Pennock, Gill; de Winter, Matthijs

2016-04-01

Most studies of rock microstructures investigate two-dimensional sections or thin slices of three dimensional grain structures. With advances of X-ray and electron tomography methods the 3-D microstructure can be(relatively) routinely investigated on scales from a few microns to cm. 3D studies are needed to investigate the connectivity of microstructures and to test the assumptions we use to calculate 3D properties from 2D sections. We have used FIB-SEM tomography to study the topology of melts in synthetic olivine rocks, 3D crystal growth microstructures, pore networks and subgrain structures. The technique uses a focused ion beam to make serial sections with a spacing of tens to hundreds of nanometers. Each section is then imaged or mapped using the electron beam. The 3D geometry of grains and subgrains can be investigated using orientation contrast or EBSD mapping. FIB-SEM tomography of rocks and minerals can be limited by charging of the uncoated surfaces exposed by the ion beam. The newest generation of FIB-SEMs have much improved low voltage imaging capability allowing high resolution charge free imaging. Low kV FIB-SEM tomography is now widely used to study the connectivity of pore networks. In-situ fluids can also be studied using cryo-FIB-SEM on frozen samples, although special freezing techniques are needed to avoid artifacts produced by ice crystallization. FIB-SEM tomography is complementary, in terms of spatial resolution and sampled volume, to TEM tomography and X-ray tomography, and the combination of these methods can cover a wide range of scales. Our studies on melt topology in synthetic olivine rocks with a high melt content show that many grain boundaries are wetted by nanometre scale melt layers that are too thin to resolve by X-ray tomography. A variety of melt layer geometries occur consistent with several mechanisms of melt layer formation. The nature of melt geometries along triple line junctions and quadruple points can be resolved. Quadruple point junctions between four grains cannot be investigated in 2D studies. 3D microstructural studies suggest that triple lines and quadruple points are important sites for the initiation of recrystallization, reaction and fracture.

Early simultaneous fundus autofluorescence and optical coherence tomography features after pars plana vitrectomy for primary rhegmatogenous retinal detachment.

PubMed

Dell'Omo, Roberto; Mura, Marco; Lesnik Oberstein, Sarit Y; Bijl, Heico; Tan, H Stevie

2012-04-01

To describe fundus autofluorescence and optical coherence tomography (OCT) features of the macula after pars plana vitrectomy for rhegmatogenous retinal detachment. Thirty-three eyes of 33 consecutive patients with repaired rhegmatogenous retinal detachment with or without the involvement of the macula were prospectively investigated with simultaneous fundus autofluorescence and OCT imaging using the Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) within a few weeks after the operation. Fundus autofluorescence imaging of the macula showed lines of increased and decreased autofluorescence in 19 cases (57.6%). On OCT, these lines corresponded to the following abnormalities: outer retinal folds, inner retinal folds, and skip reflectivity abnormalities of the photoreceptor inner segment/outer segment band. Other OCT findings, not related to abnormal lines on fundus autofluorescence, consisted of disruption of photoreceptor inner segment/outer segment band and collection of intraretinal or subretinal fluid. The presence of outer retinal folds significantly related to metamorphopsia but did not relate to poor postoperative visual acuity. Partial-thickness retinal folds occur commonly after vitrectomy for rhegmatogenous retinal detachment repair and may represent an important anatomical substrate for postoperative metamorphopsia. Fundus autofluorescence and OCT are both sensitive techniques for the detection of these abnormalities.