A web application for sex and stature estimation from radiographic proximal femur for a Thai population

In both forensic and archaeological domains, the discovery of incomplete human remains is a frequent occurrence. Nevertheless, the estimation of biological profiles from such remains presents a challenge due to the absence of crucial skeletal elements, such as the skull and pelvis. This study aimed to assess the utility of the proximal femur in the forensic identification process by creating a web application for osteometric analysis of the proximal femur. The aim was to determine the sex and stature of an individual from radiographs of the left anteroposterior femur. To accomplish this, an automated method was developed for acquiring linear measurements from radiographic images of the proximal femur using Python tools. The application of Hough techniques and Canny edge detection was utilized to generate linear femoral dimensions from radiographs. A total of 354 left femora were radiographed and measured by the algorithm. The sex classification model employed in this study was the Naïve Bayes algorithm (accuracy = 91.2 %). Results indicated that Gaussian process regression (GPR) was the most effective method for estimating stature (mean error = 4.68 cm, SD = 3.93 cm). The proposed web application holds the potential to serve as a valuable asset in the realm of forensic investigations in Thailand, particularly in the estimation of biological profiles from fragmentary skeletal remains.     

Efficacy of machine learning assisted dental age assessment in local population

IntroductionAlthough the dental age assessment is commonly applied in forensic and maturity evaluation, the long-standing dilemma from population differences has limited its application.ObjectivesThis study aimed to verify the efficacy of the machine learning (ML) to build up the dental age standard of a local population.MethodsWe retrospectively studied 2052 panoramic films retrieved from healthy Taiwanese children aged 2.6–17.7 years with comparable sizes in each age-group. The recently reported Han population-based standard (H method) served as the control condition. To develop and validate ML models, random divisions of the sample in an 80%–20% ratio repeated 20 times. The model performances were compared with the H method, Demirjian’s method, and Willems’s method.ResultsThe ML-assisted models provided more accurate age prediction than those non-ML-assisted methods. The range of errors was effectively reduced to less than one per year in the ML models. Furthermore, the consistent agreements among the age groups from preschool to adolescence were reported for the first time. The Gaussian process regression was the best ML model; of the non-ML modalities, the H method was the most efficacious, followed by the Demirjian’s method and Willems’s methods.ConclusionThe ML-assisted dental age assessment is helpful to provide customized standards to a local population with more accurate estimations in preschool and adolescent age groups than do studied conventional methods. In addition, the earlier complete tooth developments were also observed in present study. To construct more reliable dental maturity models in the future, additional environment-related factors should be taken into account.     

A novel method to estimate adult age from the lumbar vertebral body using 3D PMCT images in Japanese

This study evaluated the age-related changes in the vertebral body using 3D Postmortem CT (PMCT) images and proposed an alternative age estimation formula. The PMCT images of 200 deceased individuals aged 25 to 99 years (126 males, 74 females) were retrospectively reviewed and included in the study. Using the open-source software ITK-SNAP and MeshLab, a 3D surface mesh of the fourth lumbar vertebral body (L4) and its convex hull models were created from the PMCT data. Using their inbuilt tools, volumes (in mm3) of the L4 surface mesh and convex hull models were subsequently computed. We derived VD, defined as the difference in volumes between the convex hull and L4 surface mesh normalized by L4 mesh volume, and VR, defined as the ratio of L4 mesh volume to convex hull volume based on individual L4. Correlation and regression analyses were performed between VD, VR, and chronological age. A statistically significant positive correlation (P < 0.001) between chronological age and VD, (r_s = 0.764, males; r_s = 0.725, females), and a significant negative correlation between chronological age and VR (r_s = -0.764, males; r_s = -0.725, females) was obtained in both sexes. The lowest standard error of the estimate was demonstrated by the VR at 11.9 years and 12.5 years for males and females, respectively. As such, their regression models to estimate adult age were Age = 248.9–2.5VR years, males; Age = 258.1–2.5VR years, females. These regression equations may be useful for estimating age in Japanese adults in forensic settings.     

Evaluation of the usage of the cervical 7th vertebra in sex estimation with measurements on computerized tomography images

Sex estimation is the primary step in biological profiling via identification using skeletal elements. The aim of the present study was to evaluate the usefulness of the seventh cervical vertebra for sex estimation. The cervical computed tomography scans of 200 female and 200 male patients aged ≥ 20 years were analyzed. Eight different measurements of the seventh cervical vertebra were performed, including the transverse and anteroposterior diameters of the foramen vertebra, transverse and anteroposterior diameters of the corpus vertebra inferior surface, height of the corpus vertebra, corpus vertebrae-spinous process angle, and height and length of the spinous process. Independent two-sample t-test was performed; significant differences were observed between the sexes in all measurements except corpus vertebrae-spinous process angle. Further, univariate logistic regression analyses revealed that the length of spinous process showed the highest dimorphism. Among the univariate models created, the model obtained using only the length of the spinous process reached an accuracy rate of 80 %. Multivariate logistic regression analysis (via Forward LR Wald) was used for sex estimation with an accuracy of up to 90.8 % (89 % for men and 92.5 % for women). In conclusion, the seventh cervical vertebra is dimorphic in the Turkish population and allows sex estimation with high accuracy rates.     

Feasibility of extracellular volume fraction calculation using myocardial CT delayed enhancement with low contrast media administration

BackgroundMyocardial extracellular volume fraction (ECV) derived from CT delayed enhancement (CTDE) may allow assessment of diffuse myocardial fibrosis. However, the amount of contrast medium required for ECV estimation has not been established. Since ECV estimation by CT is typically performed in combination with coronary CT angiography (CCTA) in clinical settings, we aimed to investigate whether reliable ECV estimation is possible using the contrast dose optimized for CCTA without additional contrast administration.MethodsTwenty patients with known or suspected coronary artery disease who underwent CTDE with a dual-source scanner using two protocols (Protocols A and B) within 2 years were retrospectively enrolled. In Protocol A, CTDE was obtained with 0.84 ml/kg of iopamidol (370 mgI/ml) injected for CCTA. In Protocol B, stress CT perfusion imaging, which requires 40 ml of contrast medium, was added to Protocol A. ECV values calculated from the two protocols were compared.ResultsDespite the different contrast doses, no significant difference in mean myocardial ECV was seen between Protocols A and B at the patient level (28.7 ± 4.3% vs. 28.7 ± 4.4%, respectively, P = 0.868). Excellent correlations in ECV were seen between the two protocols (r = 0.942, P < 0.001). Bland-Altman analysis showed slight bias (+0.06%), within a 95% limit of agreement of −2.9% and 3.0%. The coefficient of variation was 5.2%.ConclusionReliable ECV estimation can be achieved with the contrast doses optimized for CCTA. Despite the differing contrast administration schemes and doses, ECV values calculated from the two protocols showed excellent agreement, indicating the robustness of ECV estimation by CT.     

Impact of the Ablative Margin on Local Tumor Progression after Radiofrequency Ablation for Lung Metastases from Colorectal Carcinoma: Supplementary Analysis of a Phase II Trial (MLCSG-0802)

PurposeTo explore what extent of ablative margin depicted by computed tomography (CT) immediately after radiofrequency (RF) ablation is required to reduce local tumor progression (LTP) for colorectal cancer (CRC) lung metastases.Materials and MethodsThis retrospective study was undertaken as a supplementary analysis of a previous prospective trial. Seventy patients (49 men and 21 women; mean age ± standard deviation, 64.9 years ± 10.6 years) underwent RF ablation for CRC lung metastases, and 95 tumors that were treated in the trial and followed up with CT at least 12 months after RF ablation were evaluated. The mean tumor size was 1.0 cm ± 0.5 cm. The ablative margin was estimated as the shortest distance between the outer edge of the tumor and the surrounding ground-glass opacity on CT obtained immediately after RF ablation. The impact of the ablative margin on LTP was evaluated using logistic regression analysis. Multivariate logistic regression analysis was also performed to identify the risk factors for LTP. The result was validated with multivariate logistic regression applying a bootstrap method (1,000 times resampling).ResultsThe mean ablative margin was 2.7 mm ± 1.3 (range, 0.4–7.3 mm). LTP developed in 6 tumors (6%, 6/95) 6–19 months after RF ablation. The LTP rate was significantly higher when the margin was less than 2 mm (P = .023). A margin of <2 mm was also found to be a significant factor for LTP (P = .048) on multivariate analysis and validated using the bootstrap method (P = .025).ConclusionsAn ablative margin of at least 2 mm is important to reduce LTP after RF ablation for CRC lung metastases.     

Magnification Spot Radiographs Improve Assessment for Inferior Vena Cava Filter Fractures prior to Removal Compared to CT

PurposeTo determine if magnification spot radiographs acquired before attempting inferior vena cava (IVC) filter removal have value in the assessment for filter fractures.Materials and MethodsA retrospective review of complex IVC filter removals performed at a tertiary referral center from October 2015 to May 2017 was performed. Magnification spot radiographs (frontal and at least 2 oblique views) were obtained with the fluoroscopic unit in the procedure suite prior to venous access for filter removal. Patients were included in the study if a computed tomography (CT) scan of the abdomen/pelvis before filter removal was available. Ninety-six patients (47 women and 49 men) were included. Most removed filters were the Recovery/G2/G2X/Eclipse/Meridian (n = 28), the Günther Tulip (n = 26), and the Celect/Celect Platinum (n = 22). Blinded review of the pre-procedural CT scans and spot radiographs for the presence of filter fractures was performed by 2 interventional radiologists. Accuracy of each modality was assessed using the status of the explanted filter as the gold standard. Agreement between the 2 readers was assessed with the kappa statistic.ResultsFractures were present in 27 explanted filters (28%). Accuracy of CT was 88% and 68% for readers 1 and 2, respectively, which increased to 98% and 97% with magnification spot radiographs. The kappa statistic was 0.12 for CT and 0.97 for spot radiographs.ConclusionsMagnification spot radiographs acquired before attempting IVC filter removal improve detection of filter fractures and agreement among interventional radiologists. Therefore, these should be performed routinely to allow for optimal treatment planning.     

Trends and Predictors of Imaging Utilization by Modality within an Academic Health System's Active Patient Population

Rationale and ObjectivesEvaluate trends and demographic predictors of imaging utilization at a university-affiliated health system.Materials and MethodsIn this single-institution retrospective study, per capita estimates of imaging utilization among patients active in the health system were computed by cross-referencing all clinical encounters (2004-2016) for 1,628,980 unique patients with a listing of 6,157,303 diagnostic radiology encounters. Time trends in imaging utilization and effects of gender, race/ethnicity, and age were assessed, with subgroup analyses performed by imaging modality. Utilization was analyzed as both a continuous and binary outcome variable.ResultsOver 13 years, total diagnostic exams rose 6.8% a year (285,947-622,196 exams per annum), while the active population size grew 7.0% a year (244,238-543,290 active patients per annum). Per capita utilization peaked in 2007 at 1.33 studies/patient/year before dropping to 1.06 from 2011 to 2015. Latest per capita utilization was 0.22 for computed tomography, 0.10 for MR, 0.20 for US, 0.03 for NM, 0.51 for radiography, and 0.07 for mammography. Over the study period, ultrasound utilization doubled, whereas NM and radiography utilization decreased. computed tomography, MR, and mammography showed no significant net change. Univariate analysis of utilization as a continuous variable showed statistically significant effects of gender, race/ethnicity, and age (P < 0.0001), with utilization higher in males and Blacks and lower in Asian/Pacific Islanders and Hispanics. Utilization increased with age, except for a decline after age 75. Many of the effects of age, gender, and race/ethnicity were also found when analyzing the binarized utilization variable.ConclusionsAlthough absolute counts of imaging studies more than doubled, the net change in per capita utilization over the study period was minimal. Variations in utilization across age, gender, and race/ethnicity may reflect differential health needs and/or access disparities, warranting future studies.     

Patient dose increase caused by posteroanterior CT localizer radiographs

IntroductionThe aim of this study was to compare the output dose (volume CT dose index [ CTDI_vol], and dose length product [DLP]) of automatic tube current modulation (ATCM) determined by localizer radiographs obtained in the anteroposterior (AP) and posteroanterior (PA) directions.MethodsOne hundred and twenty-four patients who underwent upper abdomen and/or chest–to–pelvis computed tomography (CT) were included. Patients underwent two series of CT examinations, and localizer radiographs were obtained in the AP and PA directions. The horizontal diameter of the localizer radiograph, scan length, CTDI_vol, and DLP were measured.ResultsThere was no significant difference in the scan length; however, all the other values were significantly higher in the PA direction. The mean horizontal diameter was 33.1 ± 2.6 cm and 35.4 ± 2.9 cm in the AP and PA directions of the localizer radiographs, respectively. The CTDI_vol and DLP in the PA direction increased by approximately 7–8%.Bland-Altman plots between AP and PA localizer directions in upper abdominal CT showed a positive bias of 1.1 mGy and 30.0 mGy cm for CTDI_vol and DLP, respectively. Correspondingly, chest–to–pelvic CT showed a positive bias of 0.93 mGy and 69.3 mGy cm for CTDI_vol and DLP, respectively.ConclusionThe output dose of ATCM determined by localizer radiographs obtained in the PA direction was increased compared to the AP direction. Localizer radiographs obtained in the AP direction should be preferred for optimizing the output dose using ATCM.Implications for practiceBased on the evidence of this study, localizer radiographs obtained in the AP direction should be preferred for optimizing the output dose in CT examinations.     

Effect of high- and low-energy entrance surface dose allocation ratio for two-shot dual-energy subtraction imaging on low-contrast resolution

IntroductionDual-energy subtraction (DES) imaging can obtain chest radiographs with high contrast between nodules and healthy lung tissue, and evaluating of chest radiography and evaluating exposure conditions is crucial to obtain a high-quality diagnostic image. This study aimed to investigate the effect of the dose allocation ratio of entrance surface dose (ESD) between high- and low-energy projection in low-contrast resolution of soft-tissue images for two-shot DES imaging in digital radiography using a contrast-detail phantom (CD phantom).MethodsA custom-made phantom mimicking a human chest that combined a CD phantom, polymethylmethacrylate square plate, and an aluminum plate (1–3 mm) was used. The tube voltage was 120 kVp (high-energy) and 60 kVp (low-energy). The ESD was changed from 0.1 to 0.5 mGy in 0.1 mGy increments. Dose allocation ratio of ESD between 120 kVp and 60 kVp projection was set at 1:1, 1:2, 1:3, and 2:1. Inverse image quality figure (IQF_inv) was calculated from the custom-made phantom images.ResultsWhen the total ESD and aluminum thickness were constant, no significant difference in IQF_inv was observed under most conditions of varied dose allocation ratio. Similarly, when the total ESD and the dose allocation ratio were constant, there was no significant difference in IQF_inv based on the aluminum plate thickness.ConclusionUsing IQF_inv to evaluate the quality of the two-shot DES image suggested that dose allocation ratio did not have a significant effect on low-contrast resolution of soft-tissue images.Implications for practiceThe present results provide useful information for determining exposure conditions for two-shot DES imaging.     

Survival and Toxicities after Yttrium-90 Transarterial Radioembolization of Cholangiocarcinoma in the RESiN Registry

PurposeTo report outcomes in patients with intrahepatic cholangiocarcinoma treated with yttrium-90 resin microspheres (transarterial radioembolization [TARE]) from a multicenter, prospective observational registry.Materials and MethodsNinety-five patients (median age, 67 years [interquartile range {IQR}, 59–74]; 50 men) were treated in 27 centers between July 2015 and August 2020. Baseline demographic characteristics included imaging findings, performance status, and previous systemic or locoregional treatments. Dosimetry method was tracked. Overall survival (OS) and progression-free survival were calculated using the Kaplan-Meier method. The best imaging response was calculated using the Response Evaluation Criteria in Solid Tumors v1.1. Grade ≥3 toxicities were assessed using Common Terminology Criteria for Adverse Events v5. Cox regression analysis was performed.ResultsFifty-two of 86 (60%) patients had multifocal tumors, and 24/89 (27%) had extrahepatic tumors. The median index tumor diameter was 7.0 cm (IQR, 4.9–10 cm). The activity calculation method was reported in 59/95 (62%) patients, with body surface area being the most frequently used method (45/59, 76%). Median OS for the cohort was 14 months (95% confidence interval, 12–22). OS at 3, 6, 12, and 24 months was 94%, 80%, 63%, and 34%, respectively. Median OS was longer in patients without cirrhosis (19.1 vs 12.2 months, P = .05). Cirrhosis, previous chemotherapy (OS, 19.1 vs 10.6 months for treatment-naïve; P = .07), and imaging response at 6 months (OS, 16.4 vs 9.5 months for no response; P = .06) underwent regression analysis. Imaging response predicted OS at regression (hazard ratio, 0.39; P = .008). Grade 3–4 bilirubin toxicities were noted in 5 of 72 (7%) patients. Grade 3 albumin toxicity was noted in 1 of 72 (1.4%) patients.ConclusionsObjective response at 6 months predicted longer OS after TARE for intrahepatic cholangiocarcinoma. The incidence of liver function toxicity was <10%.     

Transjugular Renal Biopsy Bleeding Risk and Diagnostic Yield: A Systematic Review

This study aimed to better define the safety and efficacy of transjugular renal biopsy (TJRB) based on published studies. Seventeen published articles were included (1,321 biopsies). Complications were classified as major if they resulted in blood transfusion or additional invasive procedures. All other bleeding complications were considered minor. Diagnostic tissue was obtained in 1,193 procedures (90.3%). The total incidence of bleeding complications among 15 articles with complete data was 202 of 892 procedures (22.6%): 162 (18.2%) minor and 40 (4.5 %) major. These results show that TJRB is a feasible procedure for obtaining renal tissue for diagnosis and that most complications are self-limiting.     

Comparison between Antegrade versus Retrograde Ureteral Stent Placement for Malignant Ureteral Obstruction

PurposeTo compare the technical success of antegrade uteral stent (AUS) and retrograde ureteral stent (RUS) placements in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS.Materials and MethodsThis study retrospectively included 61 AUS placements (44 patients) performed under fluoroscopic guidance and 76 RUS placements (55 patients) performed under cystoscopic guidance in patients with MUO from January 2019 to December 2020. Technical success rates of the 2 techniques were compared using inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures.ResultsTechnical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4%; 95% confidence interval [CI], 35.4%–63.1%). The independent predictors for technical failure of the RUS procedure were age of ≥65 years (odds ratio [OR], 5.56; 95% CI, 1.73–21.27), ureteral orifice invasion (OR, 4.21; 95% CI, 1.46–13.46), and extrinsic cancer (OR, 15.58; 95% CI, 2.92–111.81).ConclusionsThe technical success rate of AUS placement was higher than that of RUS placement in patients with MUO. RUS failure was associated with age of ≥65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.     

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Bleomycin-Eluting versus Bland Microspheres in a Canine Model

PurposeTo prospectively assess safety and efficacy of prostatic artery embolization (PAE) with bleomycin-eluting microspheres for benign prostatic hyperplasia (BPH) in a canine model.Materials and MethodsTwelve adult male beagles (mean age, 1.6 y ± 0.2; range, 1.2–2.0 y) were randomly assigned to group A (n = 6; PAE with bleomycin-eluting 30–60-μm HepaSphere microspheres) and group B (n = 6; PAE with bland 30–60-μm HepaSphere microspheres) between April 2017 and November 2018. Plasma bleomycin concentration in group A was measured within 7 days. Prostate volume (PV) and ischemic volume after PAE were measured by magnetic resonance imaging. Prostates and adjacent organs were harvested after the last magnetic resonance study and histopathologically examined.ResultsPlasma bleomycin concentration peaked at 10 minutes at 2,055.0 ng/mL ± 606.1 and lasted for 1,440 min at low levels after PAE. PV reduction percentage was greater in group A than in group B at 1 month (74.1% ± 4.3 vs 63.7% ± 3.5; P = .006) and 3 months (61.5% ± 6.7 vs 46.1% ± 3.8; P = .001) after PAE. Proportion of prostate ischemic volume was greater in group A than in group B (75.3% ± 3.0 vs 62.0% ± 7.1; P = .006) at 1 month after PAE. Proportion of prostate ischemic volume at 1 month positively correlated with PV percentage reduction at 3 months in group A (r = 0.840, P = .036) and group B (r = 0.844, P = .035). There were no complications or nontarget embolization to surrounding organs after the procedures.ConclusionsIn a canine model, PAE with bleomycin-eluting microspheres was feasible and well tolerated and caused ischemic necrosis and reduction in PV.     

Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

BackgroundInflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.MethodsCORE320 enrolled patients referred for invasive coronary angiography with known or suspected CAD. Coronary computed tomography angiography (CCTA) images were collected for 381 patients for whom clinical outcomes were assessed 5 years after enrollment. Using semi-automated image analysis software, PCAT was obtained and normalized for the right coronary (RCA), left anterior descending (LAD), and left circumflex arteries (LCx). The association between PCAT and major adverse cardiovascular events (MACE) during follow up was assessed using Cox regression models.ResultsThirty-seven patients were excluded due to technical failure. For the remaining 344 patients, median age was 62 (interquartile range, 55–68) with 59% having ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography. Mean attenuation values for PCAT in RCA, LAD, and LCx were ?74.9, ?74.2, and ?71.2, respectively. Hazard ratios and 95% confidence intervals (CI) for normalized PCAT in the RCA, LAD, and LCx for MACE were 0.96 (CI: 0.75–1.22, p ?= ?0.71), 1.31 (95% CI: 0.96–1.78, p ?= ?0.09), and 0.98 (95% CI: 0.78–1.22, p ?= ?0.84), respectively. For death, stroke, or myocardial infarction only, hazard ratios were 0.68 (0.44–1.07), 0.85 (0.56–1.29), and 0.57 (0.41–0.80), respectively.ConclusionsIn patients referred for invasive coronary angiography with suspected CAD, PCAT did not predict MACE during long term follow up. Further studies are needed to understand the relationship of PCAT with CAD risk.     

The effect of Gaussian noise on pneumonia detection on chest radiographs,using convolutional neural networks

IntroductionChest X-rays (CXR) with under-exposure increase image noise and this may affect convolutional neural network (CNN) performance. This study aimed to train and validate CNNs for classifying pneumonia on CXR as normal or pneumonia acquired at different image noise levels.MethodsThe study used the curated and publicly available “Chest X-Ray Pneumonia” dataset of 5856 AP CXR classified into 1583 normal, 4273 viral and bacterial pneumonia cases. Gaussian noise with zero mean was added to the images, at 5 image noise variance levels, corresponding to decreasing exposure. Each noise-level dataset was split into 80% for training, 10% for validation, and 10% for test data and then classified using custom trained sequential CNN architecture. Six classification tasks were developed for five Gaussian noise levels and the original dataset. Sensitivity, specificity, predictive values and accuracy were used as evaluation performance metrics.ResultsCNN evaluation on the different datasets revealed no performance drop from the original dataset to the five datasets with different noise levels. Sensitivity, specificity and accuracy for the normal datasets were 98.7%, 76.1% and 90.2%. For the five Gaussian noise levels the sensitivity, specificity and accuracy ranged from 96.9% to 98.2%, 94.4%–98.7% and 96.8%–97.6%, respectively. A heat map was used for visual explanation of the CNNs.ConclusionThe CNNs sensitivity maintained, and the specificity increased in distinguishing between normal and pneumonia CXR with the introduction of image noise.Implications for practiceNo performance drops of CNNs in distinguishing cases with and without pneumonia CXR with different Gaussian noise levels was observed. This has potential for decreasing radiation dose to patients or maintaining exposure parameters for patients that require additional radiographs.     

Experience with Compressed Gelfoam Plugs in Children during Liver Biopsies and Other IR Procedures: A Retrospective Single-Center Case Series

PurposeTo analyze the experience using compressed gelfoam plugs (CGPs) in children during liver biopsies and other interventional procedures.Materials and MethodsThis was a single-center, retrospective, consecutive case series of 477 various pediatric interventional radiology procedures using CGPs (January 2012 to December 2016) performed on 397 children (209 males, 188 females; median age, 7 years [range, 9 days–17.8 years]; median weight, 18 kg [range, 2.7–141 kg]). Of 477 procedures, most (n = 371) were liver biopsies, 98 were biopsies of other organs, and 8 were non-biopsy procedures. Analysis focused on liver biopsies.ResultsOf liver biopsies, a median of 2 CGPs were used per procedure, and the mean drop in hemoglobin was -0.36 g/dl (-3.0% change). Thirty-seven mild, 8 moderate, 2 severe, and 1 life-threatening (an anaphylaxis to CGP) adverse events (AEs) occurred. Analysis of liver biopsies with AEs showed significant association between number of passes, cores, and focal-type lesions (unadjusted logistic regression: P = .007, P = .022, P = .028, respectively) and age, weight, and number of passes (adjusted multiple logistic regression: P = .006, P = .032, P = .046, respectively). Technical problems relating to CGP deployment were noted in 5 (1%), without any AEs.ConclusionsCGPs were used in a wide variety of procedures and organs in children. There was 1 life-threatening AE resulting from the rare risk of anaphylaxis caused by the gelfoam-containing plug. After liver biopsies, transfusion was required in 2/371 (0.5%) procedures, 1 related to pre-biopsy anemia (0.25%).     

Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy

BackgroundCardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECV_CCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECV_CMR as the reference technique.Methods39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECV_CMR and ECV_CCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed.ResultsMean age of enrolled patients was 62 ​± ​11 years, and mean LVEF at CMR was 35.4 ​± ​10.7%. Overall radiation exposure for ECV estimation was 2.1 ​± ​1.1 ​mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECV_CCT demonstrated slightly lower values compared to ECV_CMR (all segments, 31.8 ​± ​6.5% vs 33.9 ​± ​8.0%, p ​< ​0.001). At regression analysis, strong correlations were described (all segments, r ​= ​0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECV_CMR and ECV_CCT for global analysis was 2.1 (95% CI: −6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECV_CCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively).ConclusionsECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.     

Phase I Dose-Escalation Study of Tirapazamine Chemoembolization for Unresectable Early- and Intermediate-Stage Hepatocellular Carcinoma

PurposeTo investigate the safety of replacing doxorubicin with tirapazamine in conventional transarterial chemoembolization (TACE) in an Asian population with hepatocellular carcinoma (HCC), and to determine the optimal tirapazamine dose for phase II studies.Materials and MethodsThis was a phase I, 3 + 3 dose-escalation study for patients with unresectable early- and intermediate-stage HCC who received 5, 10, or 20 mg/m² of intra-arterial (IA) tirapazamine followed by ethiodized oil/gelatin sponge-based embolization. Key eligibilities included HCCs no more than 10 cm in diameter, prior embolization allowed, Eastern Cooperative Oncology Group performance status of 0 or 1, Child-Pugh score of 5–7, and platelet count of ≥60,000 μL. Dose-limiting toxicity (DLT) was defined as any grade 3 nonhematological or grade 4 hematological toxicity, with the exception of transient elevation of aminotransferase levels after the procedure.ResultsSeventeen patients were enrolled, 59% of whom had progression from a prior HCC therapy and 35% of whom had progression or recurrence after TACE. All patients tolerated the tirapazamine TACE well without any DLT or serious adverse event. Using the modified Response Evaluation Criteria in Solid Tumors, the complete response (CR) rate was 47%, and the CR + partial response rate was 65%. The median duration of response was not reached. The median time to progression was 12.6 months (95% confidence interval, 5.1–not reached). The median overall survival was 29.3 months. The selected phase II dose was set at a fixed dose of 35 mg of IA tirapazamine.ConclusionsIA tirapazamine with transarterial embolization was well tolerated and showed promising efficacy signals in intermediate-stage HCC, justifying pursuit of a phase II study.     

Effect of Median Lobe Enlargement on Early Prostatic Artery Embolization Outcomes

PurposeTo evaluate outcomes after prostatic artery embolization (PAE) in patients with severe intravesical prostatic protrusion (IPP).Materials and MethodsThis was a retrospective, single health system, 2-hospital study from April 2015 to December 2018 of 54 patients who underwent elective PAE procedures (age mean 67.5 years; standard deviation [SD] 8.5). The cohort had a mean ellipsoid prostate volume of 100.1 cm³ (SD 56.7), a mean baseline International Prostate Symptom Score (IPSS) of 18.7 (SD 8.2), a mean baseline quality of life (QOL) score of 4.1 (SD 1.4), and a median follow-up of 38 days (range 10–656 days). Outcomes including IPSS and QOL score reduction (where a lower QOL score indicates an improvement in QOL), and clinical success were compared between severe (≥10 mm) and nonsevere (<10 mm) IPP patients. A linear regression model was used to examine the impact of IPP on these outcomes.ResultsNo significant differences in patient characteristics were found between nonsevere (n = 17) and severe (n = 37) IPP patients. Both cohorts showed IPSS reduction (nonsevere 6.0, P = .0397; severe 8.2, P < .0001) and QOL score reduction (nonsevere 1.0, P = .102; severe 2.0, P < .0001). No significant differences in IPSS or QOL score reduction were found between the cohorts (P = .431 and P = .127). Linear regression found that baseline IPP was not a significant contributor to the outcomes (IPSS: R² = .5, P < .0001; IPP: P = .702; QOL: R² = .5, P = .0003; IPP: P = .108).ConclusionsThere were no significant differences in early outcomes in PAE between patients with severe and nonsevere IPP.