Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy

PurposeTo compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis.Materials and MethodsA retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d’Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm).ResultsThe population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°.ConclusionsPercutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.     

Automated quantitative thin slice volumetric low dose CT analysis predicts disease severity in COVID-19 patients

PurposeThis study aimed to identify predictive (bio-)markers for COVID-19 severity derived from automated quantitative thin slice low dose volumetric CT analysis, clinical chemistry and lung function testing.MethodsSeventy-four COVID-19 patients admitted between March 16th and June 3rd 2020 to the Asklepios Lung Clinic Munich-Gauting, Germany, were included in the study. Patients were categorized in a non-severe group including patients hospitalized on general wards only and in a severe group including patients requiring intensive care treatment. Fully automated quantification of CT scans was performed via IMBIO CT Lung Texture analysis™ software. Predictive biomarkers were assessed with receiver-operator-curve and likelihood analysis.ResultsFifty-five patients (44% female) presented with non-severe COVID-19 and 19 patients (32% female) with severe disease. Five fatalities were reported in the severe group. Accurate automated CT analysis was possible with 61 CTs (82%). Disease severity was linked to lower residual normal lung (72.5% vs 87%, p = 0.003), increased ground glass opacities (GGO) (8% vs 5%, p = 0.031) and increased reticular pattern (8% vs 2%, p = 0.025). Disease severity was associated with advanced age (76 vs 59 years, p = 0.001) and elevated serum C-reactive protein (CRP, 92.2 vs 36.3 mg/L, p < 0.001), lactate dehydrogenase (LDH, 485 vs 268 IU/L, p < 0.001) and oxygen supplementation (p < 0.001) upon admission. Predictive risk factors for the development of severe COVID-19 were oxygen supplementation, LDH >313 IU/L, CRP >71 mg/L, <70% normal lung texture, >12.5% GGO and >4.5% reticular pattern.ConclusionAutomated low dose CT analysis upon admission might be a useful tool to predict COVID-19 severity in patients.     

Feasibility of low-dose unenhanced multi-detector CT in patients with suspected acute appendicitis: comparison with sonography

ObjectivesTo compare unenhanced low-dose computed tomography (LDCT) and ultrasound (US) in patients with suspected acute appendicitis.MethodsA total of 104 patients underwent US and LDCT examinations within an hour.ResultsThirty-nine of the 104 patients had surgically confirmed acute appendicitis. Sensitivity, specificity, and accuracy for US vs. LDCT were 82.5% vs. 92.5%, 83% vs. 89%, and 82.7% vs. 90.4%, respectively. The area under the curve (Az) was 0.85 for US and 0.92 for LDCT. The diagnostic performance of LDCT was better than US (P< .001).ConclusionsUnenhanced LDCT is a feasible technique in the diagnosis of acute appendicitis.     

Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography

BackgroundThere is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy.ObjectiveEvaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography (DECT) vs a standard iodinated contrast volume coronary CT angiography protocol (SCCTA).MethodsA total of 102 consecutive patients were randomized to SCCTA (n = 53) or DECT with rapid kVp switching (n = 49). Eighty milliliters and 35 mL of iodinated contrast were administered in the SCCTA and DECT cohorts, respectively. Two readers measured signal and noise in the coronary arteries; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A 5-point signal/noise Likert scale was used to evaluate image quality; scores of <3 were nondiagnostic. Agreement was assessed through kappa analyses.ResultsDemographics and radiation dose were not significantly different; there was no difference in CNR between both cohorts (P = .95). A significant difference in SNR between the groups (P = .02) lost significance (P = .13) when adjusted for body mass index. The median Likert score was inferior for DECT for reader 1 (3.6 ± 0.6 vs 4.3 ± 0.6; P < .001) but not reader 2 (4.1 ± 0.6 vs 4.3 ± 0.5; P = .06). Agreement in diagnostic interpretability in the DECT and SCCTA groups was 91% (95% confidence interval, 86%–100%) and 96% (95% confidence interval, 90%–100%), respectively.ConclusionDECT resulted in inferior image quality scores but demonstrated comparable SNR, CNR, and rate of diagnostic interpretability without a radiation dose penalty while allowing for >50% reduction in contrast volume compared with SCCTA.     

Transabdominal ultrasound of pancreatic ductal adenocarcinoma: A multi-centered population-based study in sensitivity,associated diagnostic intervals,and survival

ObjectivesTo determine the sensitivity of ultrasound (US) in detecting pancreatic ductal adenocarcinoma in our region, to identify factors associated with US test result, and assess the impact on the diagnostic interval and survival.MethodsPatients diagnosed between January 1, 2014 and December 31, 2015 in Nova Scotia, Canada were identified by a cancer registry. US performed prior to diagnosis were retrospectively graded as true positive (TP), indeterminate or false negative (FN). Amongst US results, differences in age, weight and tumor size were assessed [one-way analysis of variance (ANOVA)]. Associations between result and sex, tumor location (proximal/distal), clinical suspicion of malignancy, and visualization of the pancreas, tumor, secondary signs and liver metastases were assessed (Chi-square). Mean follow-up imaging, diagnostic, and survival intervals were assessed (one-way ANOVA).ResultsOne hundred thirteen US of 107 patients (54 women; mean 70 ± 13 years) were graded as follows: 48/113 (42.5%) TPs; 42/113 (37.2%) indeterminates; and 23/113 (20.4%) FNs. Sensitivity was 48/71(67.6%). There was no difference in age, weight or tumor size amongst US result (P > 0.5). FNs had proportionally more men (P = 0.011) and lacked clinical suspicion of malignancy (P = 0.0006); TPs had proportionally more proximal tumors (P = 0.017). US result was associated with visualization of the pancreas, tumor, secondary signs and liver metastases (P < 0.005). FNs had longer mean follow-up imaging (P < 0.0001) and diagnostic (P = 0.0007) intervals, and worse mean survival (P = 0.034).ConclusionsIn our region, the sensitivity of US in detecting pancreatic ductal adenocarcinoma is 67.6%. A false negative US is associated with delayed diagnostic work-up and worse mean survival.     

Technical and nidus-specific factors associated with adequacy of intraprocedural biopsy samples preceding radiofrequency ablation of osteoid osteoma

PurposeTo examine the diagnostic yield of intraprocedural percutaneous biopsy performed at the time of radiofrequency ablation of suspected Osteoid Osteoma (OO) and identify technical and nidus-specific factors associated with diagnostic adequacy.Materials and methodsFollowing IRB approval, a total of 42 patients (male: 28, female: 14; mean age: 29 years) who underwent intraprocedural biopsy immediately prior to RFA between June 2010 and June 2017 were retrospectively identified. The nidi were located in various locations. The nidi had a mean size of 6.3 mm (range: 3–11 mm, Standard deviation (SD): 2.26). Core biopsies were performed by one of 15 operators. Biopsies were performed with two needle types ranging from 11-G to 15-G with a mean number of samples of 1.8 (range: 1–5, SD: 1.01). Electronic records and imaging were reviewed for demographics, nidus characteristics, biopsy details and diagnostic yield. Multivariate logistic regression of nidus-specific and biopsy-specific factors was performed.ResultsA total of 22/42 (52.3%) of the biopsies were adequate for histological diagnosis of OO. For the two experienced operators, the diagnostic yield was 67% (6/9) and 80% (8/10). Biopsy adequacy was significantly correlated with presence of an osteoid matrix (p = 0.03), obtaining >1 core sample (p = 0.03), the needle track passing through the nidus (p = 0.0003) and thinner (2.5 mm) intraprocedural CT slices (p = 0.03). On multivariate analysis, use of thinner intraprocedural CT slices was found to be associated with adequate biopsy (p = 0.02).ConclusionIntraprocedural percutaneous biopsy samples of nidi highly-suspected to be OO at the time of RFA were diagnostic in 52% of patients. Multivariate analysis shows thinner intraprocedural CT slices to be a significantly associated with biopsy adequacy.     

Quantification of liver fat content with ultrasonographic attenuation measurement function: Correlation with unenhanced multidimensional computerized tomography

PurposeTo evaluate the efficacy of attenuation measurement function (ATT), a newly developed quantitative ultrasonography(US) method based on measurement of the attenuation coefficient, using unenhanced computerized tomography(CT) attenuation values as a reference standard, for the detection and measurement of hepatosteatosis.Material and methodsA total of 98 patients were analyzed. The diagnostic ability of ATT was evaluated using receiver operating characteristic (ROC) curve analysis, and the correlation between liver attenuation index (LAI), the liver-to-spleen attenuation ratio (CT^L/S), liver attenuation value (CT^L), and ATT was determined.ResultsATT is negatively correlated with LAI (r = −0.571, p < 0.001), CT^L/S (r = −0.532, p < 0.001), and mean CT^L (r = −0.50, p < 0.001). A significant difference was found between ATT values of patients with different grades of hepatosteatosis (p < 0.001). A significant difference was found between ATT values of patients with LAI < −10 and LAI > −10, CT^L < 40 and CT^L > 40, and CT^L/S < 1 and CT^L/S > 1 (p < 0.001). An ATT ≥ 0.665 showed a sensitivity of 100% and a specificity of 90% in diagnosing moderate-severe steatosis. The corresponding area under the ROC curve(AUROC) was 0.935. The intraclass correlation coefficient for the interobserver variability of ATT was 0.907 (95% CI, 0.85–0.95).ConclusionIn conclusion, ATT values for evaluation of hepatosteatosis was closely correlated with the degree of hepatosteatosis and liver fat content. It can be used as a noninvasive method in the diagnosis and follow-up.     

Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention

BackgroundThe ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP.MethodsWe enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP ​+ ​CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of “subendocardial” perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. “transmural” perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness.ResultsIn 150 patients (132 men, mean age 65.1 ​± ​9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p ​< ​0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p ​< ​0.001) and 94.9% vs. 97.9% (p ​= ​0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p ​< ​0.0001).ConclusionsThis study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.     

头颈部恶性肿瘤156个颈部淋巴结超声与CT比较研究

目的:探讨超声(US)和CT在头颈部恶性肿瘤颈部淋巴结(CLN)转移中的诊断价值,提高对CLN转移诊断的准确性。方法:对63例头颈部恶性肿瘤患者共156个CLN(82个转移性,74个非转移性)行US和CT检查,其中36例(19个转移性,17个非转移性)进行了CT灌注成像,对比分析US和CT对CLN转移的诊断价值。结果:US与CT对CLN转移的诊断符合率分别为83.3%和85.3%,两者差异无显著性意义(P>0.05),US与CT联合诊断的符合率为92.3%,高于单独US或CT检查(P<0.05)。US对淋巴结内部结构的显示优于CT(P<0.05),CT对结节内坏死、囊变的显示优于US(P<0.05)。CT灌注成像显示转移组淋巴结血流量(BF)高于非转移组(P<0.05)。结论:联合US和CT检查是提高对CLN转移诊断准确性的有效方法,CT灌注成像在CLN转移的鉴别诊断中有一定的价值。     

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

ObjectiveSepsis is defined as organ dysfunction due to severe infection. Septic patients face a significant mortality risk. Thus, timely recognition with prompt focus identification and control are essential. This study aims to determine the current role of computed tomography (CT) in the diagnostic workup of septic patients.MethodsWe retrospectively identified 357 patients in the emergency department (ED) of a large university center with suspected sepsis in a two-year period. A total of 132 patients underwent CT scanning within 72 h of admission. Patients were characterized by clinical and laboratory findings. CT reports were categorized and matched with clinical data.ResultsOf 357 ED patients with suspected sepsis, 37.0% (132/357) underwent CT imaging within 72 h. The most commonly identified septic foci in CT were chest 38.6% (49/127), abdomen 22.0% (28/127) and genitourinary tract 20.5% (26/127) in descending order. The focus detection rate was 76.5% per patient with a concurrent number-needed-to-scan of 1.31. Contrast medium administration in CT did not improve focus detection rate (p = 0.631) or diagnostic confidence in this patient population (p = 0.432). CT had a positive predictive value of 81.82% (CI 76.31 to 86.28%) in predicting the focus of the discharge diagnosis. Follow-up imaging in patients with unclear focus reveals a new focus in 39.5% of patients.ConclusionsOur investigation of the role of CT in ED patients with suspected sepsis indicated a high positive predictive value for CT with regard to the discharge diagnosis. Repeat imaging may help identify further septic foci in a subgroup with persistently unclear focus. Use of contrast medium seems less relevant for focus detection than expected, as it did not increase diagnostic confidence.     

Intravascular Ultrasound-Guided Transvenous Biopsy of Retroperitoneal Lymph Nodes: Diagnostic Accuracy and Safety Compared with CT-Guided Percutaneous Biopsy

PurposeTo compare the diagnostic accuracy and adverse event rates of intravascular ultrasound (US)-guided transvenous biopsy (TVB) versus those of computed tomography (CT)-guided percutaneous needle biopsy (PNB) for retroperitoneal (RP) lymph nodes.Materials and MethodsIn this single-institution, retrospective study, 32 intravascular US-guided TVB procedures and a sample of 34 CT-guided PNB procedures for RP lymph nodes where targets were deemed amenable to intravascular US-guided TVB were analyzed. Procedural metrics, including diagnostic accuracy, defined as diagnostic of malignancy or a clinically verifiable benign result, and adverse event rates were compared.ResultsThe targets of intravascular US-guided TVB were primarily aortocaval (47%, 15/32) or precaval (34%, 11/32), whereas those of CT-guided PNB were primarily right pericaval (44%, 15/34) or retrocaval (44%, 15/34) (P < .001). The targets of intravascular US-guided TVB averaged 2.4 cm in the long axis (range, 1.3–3.7 cm) compared with 2.9 cm (range, 1.4–5.7 cm) for those of CT-guided PNB (P = .02). There was no difference in the average number of needle passes (3.8 for intravascular US-guided TVB vs 3.9 for CT-guided PNB; P = .68). The diagnostic accuracy was 94% (30/32) and the adverse event rate was 3.1% (1/32) for intravascular US-guided TVB, similar to those of CT-guided PNB (accuracy, 91% [31/34]; adverse event rate, 2.9% [1/34]).ConclusionsIntravascular US-guided TVB had a diagnostic accuracy and adverse event rate similar to CT-guided PNB for RP lymph nodes, indicating that intravascular US-guided TVB may be as safe and effective as conventional biopsy approaches for appropriately selected targets.     

Comparison of utilization rate of CT scans of the abdomen and pelvis in patients with elevated BMI compared to patients with normal BMI presenting to the ER with gastrointestinal symptoms

PurposeThe purpose of this study was to determine if patients with elevated BMI were more likely to get Abdominopelvic CT imaging compared to patients with normal BMI presenting with similar Gastrointestinal (GI) symptoms to the Emergency Room (ER).MethodsThe study included 611 adults presenting to the ER with GI symptoms during the study period, of which 291 patients underwent CT imaging. ER triage notes and electronic records were used to identify patients' demographic data, symptoms, body weight and height. BMI was used as a measure of obesity. Reports of the CT scans were reviewed and categorized into normal cases, cases with non-acute incidental findings and cases with acute significant findings by the reviewers. A chi-square test was used to compare the two groups.ResultsOf the 611 patients, 231 (37.8%) had a normal BMI (<25 kg/m²), and 380 (62.2%) had an elevated BMI (>25 kg/m²). Of the 231 patients with normal BMI, 98 (42.4%) received CT imaging. Of the 380 patients with elevated BMI, 193 (50.8%) underwent CT imaging, (p = 0.045). The percentage of acute significant CT findings was similar in both groups (45.9% vs. 45.6%), (p > 0.05). The elevated BMI group had a higher percentage of normal exams compared to the normal BMI group (44.0% vs. 10.2%), (p < 0.0001). The percentage of non-acute incidental findings was higher in the normal BMI group compared to the elevated BMI group (43.8% vs. 10.3%), (p < 0.0001).ConclusionAccording to our study results, there is a positive correlation between increased BMI and a higher utilization rate of abdominal CT imaging, (p = 0.045).     

Utility of coronary CT angiography in outpatients with hypertrophic cardiomyopathy presenting with angina symptoms

BackgroundAngina is a frequent symptom in patients with hypertrophic cardiomyopathy (HCM); however, it is often not because of significant epicardial coronary artery stenosis. Coronary CT angiography (CCTA) is an excellent modality to rule out significant coronary artery stenosis in the low- and intermediate-risk patients; however, its value in patients with HCM has not been explored. We sought to assess the utility of CCTA in the assessment of patients with HCM and stable anginal symptoms and compare the incidence of epicardial coronary artery stenosis to an age- and gender-matched control group.MethodsConsecutive outpatients with HCM referred for CCTA over a 3-year period because of stable anginal symptoms (chest pain or shortness of breath) were identified retrospectively. Age- and gender-matched patients without HCM referred for CCTA because of similar symptoms over a 6-month period were used as controls. All patients had CCTA using an Aquilion ONE 320 scanner. The coronary arteries were evaluated independently by 2 blinded observers, and any luminal narrowing was scored quantitatively as follows: >70% = severe; 50% to 70% = moderate; <50% = mild; and none. For the HCM group, results of cardiac single-photon emission CT (SPECT) or cardiac magnetic resonance perfusion studies as well as catheter angiograms were recorded where available.ResultsA total of 91 patients with HCM and 91 controls were included. No significant difference in cardiac risk factors was present between the 2 groups. The CCTA was of diagnostic quality in all patients. The median (interquartile range) calcium score was lower in patients with HCM (0 [0–50] vs 2 [0–189]) but did not reach statistical significance (P = .23). The incidence of moderate-to-severe coronary artery stenosis was significantly lower in patients with HCM than in controls (6.6% vs 33.0%; P < .001). The incidence of left anterior descending artery luminal narrowing overall was also significantly lower in the HCM patients (7.0% vs 20.9%; P = .002). There was a higher incidence of myocardial bridging in patients with HCM (40.7% vs 6.6%; P < .001), with longer and deeper bridged segments. Among a subgroup of HCM patients (n = 24) who had either stress perfusion CMR or cardiac single-photon emission CT studies performed, 15 of 24 had false-positive perfusion abnormalities without evidence of luminal obstruction on CCTA.ConclusionWe demonstrate the use of CCTA for the assessment of stable anginal symptoms in patients with HCM. The incidence of moderate-to-severe coronary artery stenosis was significantly lower in our HCM patients in comparison to our age-matched, gender-matched, and risk factor–matched control group. Given the high incidence of false-positive findings on perfusion stress studies, we propose that CCTA may be useful for appropriate triage to coronary angiography in the HCM patient with anginal symptoms.     

Diagnostic value of 99mTc-MDP SPECT/spiral CT in assessing indeterminate spinal solitary lesion of patients without malignant history

Objective

Metastases and benign conditions of spine are common, however, the diagnoses of imaging modalities in the nature of spinal lesions are difficult, especially for the solitary lesions in spine. This study aims to retrospectively evaluate the diagnostic value of single photon emission computed tomography (SPECT)/spiral computed tomography (CT) in assessing indeterminate spinal solitary lesion of patients without certain medical history of malignancies.

Methods

A total of 48 patients (28 male, 20 female, average 54.9 ± 14.8 years) without malignant history but with a solitary lesion of spine on the Tc-99m-methylene diphosphonate planar scintigraphy, were enrolled in this study. SPECT/spiral CT was simultaneously performed on the abnormal lesions of the spine. SPECT alone and SPECT/spiral CT images were independently analyzed and interpreted by two experienced nuclear medicine physicians. Finally, the indeterminate spinal single lesion was confirmed with pathological results. The agreements of the SPECT and SPECT/spiral CT diagnoses with the pathology were evaluated using a weighted kappa score, respectively.

Results

Among 48 patients, the pathological results revealed 37.5 % (18/48) benign and 62.5 % (30/48) malignant lesions. For SPECT alone, 6 of 18 benign cases and 28 of 30 malignant conditions were correctly diagnosed. For SPECT/spiral CT, 9 of 18 benign and 29 of 31 malignant lesions were exactly judged. For these patients without malignant history, the diagnostic accuracy, specificity, positive predictive value, and negative predictive value of SPECT and SPECT/spiral CT in assessing abnormal spinal solitary lesion were 70.8 % (34/48) vs 79.2 % (38/48), 33.3 % (6/18) vs 50.0 % (9/18), 70.0 % (28/40) vs 76.3 % (29/38), 75.0 % (6/8) vs 90.0 % (9/10), respectively. Moreover, the kappa scores for the agreement of SPECT alone and SPECT/spiral CT with the pathological confirmation were 0.300 and 0.512, respectively (both P < 0.005).

Conclusions

Compared with SPECT imaging, hybrid SPECT/spiral CT imaging improves the diagnostic accuracy and specificity in evaluating indeterminate spinal solitary lesion of patients without certain malignant history. Moreover, based on whole-body bone scan with high sensitivity, cheap price, widespread and time-saving use, SPECT/spiral CT is a good imaging modality for the diagnosis and evaluation of the nature of solitary lesion in spine.     

Evaluation of a Multimodality MR/US Coregistration System for Investigation of Hepatic Metastases from Colorectal Cancer

PurposeTo evaluate a magnetic resonance (MR)/ultrasound (US) coregistration system with US used in follow-up diagnostic studies of lesions originally identified by MR imaging.Materials and MethodsA single-center prospective study enrolled 21 consecutive patients (age, 64.0 y±7.5; eight men [age, 63.0 y±7.1] and 13 women [age, 65.0 y±7.3]) evaluated for potential surgical resection of liver metastases. Each patient underwent same-day MR examination and two US examinations: one regular and one with the MR/US coregistration system. Target lesions were identified on MR imaging, and US was used in follow-up diagnostic studies of lesions originally identified by MR imaging. During US, two outcome measures (target localization success and target localization time) were collected. Ratios of lesions found per patient were compared with a paired Wilcoxon test, and a Student t test was used to compare target localization time.ResultsRatios of lesions found per patient with the coregistered system (93.7%) and conventional US (73.3%) were statistically different (P =.003). Lesions found by the coregistration system but not conventional US were statistically smaller than those found by both systems (6.1 mm±4.0 vs 15.6 mm±9.8; P<.0006). There was no statistical difference in target localization time for detection of lesions found by coregistered (100 s±89) and conventional US (108 s±86; P = .78).ConclusionsThe MR/US coregistration system increases the number of lesions detected with US versus standard US alone. This may prove beneficial in surgical and nonsurgical management of patients with focal liver lesions.     

Differentiation of small intrahepatic mass-forming cholangiocarcinoma from small liver abscess by dual source dual-energy CT quantitative parameters

PurposeTo investigate the use of dual source dual-energy CT (DECT) quantitative parameters compared with the use of conventional CT for differentiating small (≤3 cm) intrahepatic mass-forming cholangiocarcinoma (IMCC) from small liver abscess (LA) during the portal venous phase (PVP).Material and methodsIn this institutional review board-approved, retrospective study, 64 patients with IMCCs and 52 patients with LAs who were imaged in PVP using dual-energy mode were included retrospectively. A radiologist drew circular regions of interest in the lesion on the virtual monochromatic images (VMI), color-coded iodine overlay images, and linear blending images with a linear blending ratio of 0.3 to obtain CT value, its standard deviation, slope (k) of spectral curve and normalized iodine concentration (NIC). Two radiologists assessed lesion type on the basis of qualitative CT imaging features.ResultsCT values on VMI at 50–130 keV (20 keV-interval), k, and NIC values were significantly higher in IMCCs than in LAs (p < 0.0001). The best single parameter for differentiating IMCC from LA was CT value at 90 keV, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89.1%, 86.5%, 87.9%, 89.1%, and 86.5%, respectively. The best combination of parameters was CT value at 90 keV, k, and NIC, with values of 87.5%, 84.6%, 83.6%, 87.5%, and 84.6%, respectively. Compared with CT value at linear blending images, CT value at 90 keV showed greater sensitivity (89.1% vs 60.9%, p < 0.0001) and similar specificity (86.5% vs 84.6%, p = 1.0000), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 60.9%, p < 0.0001) and similar specificity (84.6% vs 84.6%, p = 1.0000). Compared with qualitative analysis, CT value at 90 keV showed greater sensitivity (89.1% vs 65.6%, p = 0.0059) and specificity (86.5% vs 69.2%, p = 0.0352), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 65.6%, p = 0.0094) and similar specificity (84.6% vs 69.2%, p > 0.05).ConclusionQuantitative analysis of dual source dual-energy CT quantitative parameters showed greater accuracy than quantitative and qualitative analyses of conventional CT for differentiating small IMCCs from small LAs on single PVP scan.     

Prognostic implications of visceral obesity on gastric adenocarcinoma: does it really matter?

PurposeTo evaluate the association of visceral adiposity measured on computed tomography (CT) in preoperative period with lymph node (LN) metastasis and overall survival in gastric adenocarcinoma patients.MethodsPreoperative CT scans of 246 gastric adenocarcinoma patients who did not receive neoadjuvant chemoradiotherapy were evaluated. Visceral fat area (VFA), subcutaneous fat area (SFA) and Total fat area (TFA), VFA/TFA ratio were quantified by CT. VFA/TFA > 29% was defined as visceral obesity. The differentiation, t-stage, n-stage and the number of harvested-metastatic LNs were noted. The maximum thickness of tumor and localization were recorded from CT. Chi-square, Student's t-test, multiple Cox regression, Spearman's correlation coefficient, and Kaplan-Meier algorithm were performed.ResultsThe overall survival (OS) rates and N-stage were not different significantly between viscerally obese and non-obese group (p = 0.994, p = 0.325). The number of metastatic LNs were weakly inversely correlated with VFA (r = −0.144, p = 0.024). Univariate analysis revealed no significant association between visceral obesity and OS or LN metastasis (p = 0.377, p = 0.736). In multivariate analyses, OS was significantly associated with poorly differentiation (HR = 1.72, 95% CI =1.04–2.84, p = 0.035), higher pathologic T and N stage (T4 vs T1 + T2 HR = 2.67, 95% CI =1.18–6.04, p = 0.019; T3 vs T1 + T2 HR = 1.98, 95% CI = 0.90–4.33, p = 0.089; N3b vs N0 HR = 2.97, 95% CI1.45–6.0, p = 0.003; N3 (3a+ 3b) vs N0 HR = 2.24 95% CI =1.15–4.36, p = 0.018).ConclusionVisceral obesity may not be a prognostic factor in resectable gastric adenocarcinoma patients.     

National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?

PurposePer American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4 cm in diameter are excellent candidates for curative brachytherapy. Using that criterion, we evaluated national patterns of care and predictors of use of radiation techniques using the National Cancer Database.Methods and MaterialsThe National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis.ResultsAmong 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%).There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70).ConclusionsMen with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.     

Does Direct Radiologist-Patient Verbal Communication Affect Follow-Up Compliance of Probably Benign Assessments?

PurposeThe aim of this study was to determine whether direct verbal communication of results by a radiologist affected follow-up compliance rates for probably benign breast imaging findings.MethodsThis study was institutional review board approved and HIPAA compliant. A retrospective search identified all patients from January 1, 2010 to December 31, 2010 who had breast findings newly assessed as probably benign (BI-RADS category 3). Patients were categorized by whether the radiologist or the technologist verbally communicated the result and follow-up recommendation. Patient adherence to 6-, 12-, and 24-month follow-up imaging recommendations was recorded.ResultsCompliance data were available for 770 of 819 patients in the study. Overall compliance was 83.0% (639 of 770) for 6-month examinations, 68.1% (524 of 770) for 6- and 12-month examinations, and 57.4% (442 of 770) for 6-, 12-, and 24-month examinations. For patients who initially underwent diagnostic mammography alone, there was no significant difference in compliance between those who had and those who did not have radiologist-patient communication (6 months, 81.9% vs 80.8% [P = .83]; 6 and 12 months, 70.8% vs 67.3% [P = .58]; 6, 12, and 24 months, 54.2% vs 58.4% [P = .53]). For patients who initially underwent diagnostic mammography alone versus ultrasound with or without diagnostic mammography, there was no significant difference in compliance (6 months, 81.1% vs 84.3% [P = .24]; 6 and 12 months, 68.1% vs 68.0% [P = .96]; 6, 12, and 24 months, 57.4% vs 57.4% [P = .00]).ConclusionsHigh initial compliance was achieved by radiologist or technologist verbal communication of findings and recommendations. Direct communication by the radiologist did not increase compliance compared with communication by a technologist.