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Reduced Intravenous Contrast Dose Portal Venous Phase Photon-Counting Computed Tomography Compared With Conventional Energy-Integrating Detector Portal Venous Phase Computed Tomography

Dane, Bari; Mabud, Tarub; Melamud, Kira; Ginocchio, Luke; Smereka, Paul; Okyere, Mabel; O'Donnell, Thomas; Megibow, Alec
OBJECTIVE:The aim of this study was to compare portal venous phase photon-counting CT (PCCT) using 20 cc less than weight-based contrast dosing with energy-integrating detector CT (EID-CT) using weight-based dosing by quantitative and qualitative analysis. METHODS:Fifty adult patients who underwent a reduced intravenous contrast dose portal venous phase PCCT from May 1, 2023, to August 10, 2023, and a prior portal-venous EID-CT with weight-based contrast dosing were retrospectively identified. Hounsfield units (HU) and noise (SD of HU) were obtained from region-of-interest measurements on 70-keV PCCT and EID-CT in 4 hepatic segments, the main and right portal vein, and both paraspinal muscles. Signal-to-noise and contrast-to-noise ratios were computed. Three abdominal radiologists qualitatively assessed overall image quality, hepatic enhancement, and confidence for metastasis identification on 5-point Likert scales. Readers also recorded the presence/absence of hepatic metastases. Quantitative variables were compared with paired t tests, and multiple comparisons were accounted for with a Bonferroni-adjusted α level of .0016. Ordinal logistic regression was used to evaluate qualitative assessments. Interreader agreement for hepatic metastases was calculated using Fleiss' κ. RESULTS:Fifty patients (32 women; mean [SD] age, 64 [13] years) were included. There was no significant difference in hepatic HU, portal vein HU, noise, and signal-to-noise or contrast-to-noise ratio between reduced contrast dose portal venous phase PCCT versus EID-CT (all Ps > 0.0016). Image quality, degree of hepatic enhancement, and confidence for metastasis identification were not different for reduced dose PCCT 70-keV images and EID-CT (P = 0.06-0.69). κ Value for metastasis identification was 0.86 (95% confidence interval, 0.70-1.00) with PCCT and 0.78 (95% confidence interval, 0.59-0.98) with EID-CT. CONCLUSION/CONCLUSIONS:Reduced intravenous contrast portal venous phase PCCT 70-keV images had similar attenuation and image quality as EID-CT with weight-based dosing. Metastases were identified with near-perfect agreement in reduced dose PCCT 70-keV images.
PMID: 38595174
ISSN: 1532-3145
CID: 5645932

Protocol optimization for abdominal imaging using photon-counting CT: a consensus of two academic institutions

Schwartz, Fides R; Marin, Daniele; Lofino, Ludovica; Abadia, Andres; O'Donnell, Thomas; Dane, Bari
PURPOSE/OBJECTIVE:Photon-counting detector CT (PCD CT) is a promising technology for abdominal imaging due to its ability to provide high spatial and contrast resolution images with reduced patient radiation exposure. However, there is currently no consensus regarding the optimal imaging protocols for PCD CT. This article aims to present the PCD CT abdominal imaging protocols used by two tertiary care academic centers in the United States. METHODS:A review of PCD CT abdominal imaging protocols was conducted by two abdominal radiologists at different academic institutions. Protocols were compared in terms of acquisition parameters and reconstruction settings. Both imaging centers independently selected similar protocols for PCD CT abdominal imaging, using QuantumPlus mode. RESULTS:There were some differences in the use of reconstruction kernels and iterative reconstruction levels, however the individual combination at each site resulted in similar image impressions. Overall, the imaging protocols used by both centers provide high-quality images with low radiation exposure. CONCLUSION/CONCLUSIONS:These findings provide valuable insights into the development of standardized protocols for PCD CT abdominal imaging, which can help to ensure consistent as well as high-quality imaging across different institutions and allow for future multicenter research collaborations.
PMID: 38546824
ISSN: 2366-0058
CID: 5645132

Photon-Counting Computed Tomography Versus Energy-Integrating Dual-Energy Computed Tomography: Virtual Noncontrast Image Quality Comparison

Dane, Bari; Ruff, Andrew; O'Donnell, Thomas; El-Ali, Alexander; Ginocchio, Luke; Prabhu, Vinay; Megibow, Alec
PURPOSE/OBJECTIVE:This study aimed to compare the image quality of portal venous phase-derived virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) with energy-integrating dual-energy computed tomography (EI-DECT) in the same patient using quantitative and qualitative analyses. METHODS:Consecutive patients retrospectively identified with available portal venous phase-derived VNC images from both PCCT and EI-DECT were included. Patients without available VNC in picture archiving and communication system in PCCT or prior EI-DECT and non-portal venous phase acquisitions were excluded. Three fellowship-trained radiologists blinded to VNC source qualitatively assessed VNC images on a 5-point scale for overall image quality, image noise, small structure delineation, noise texture, artifacts, and degree of iodine removal. Quantitative assessment used region-of-interest measurements within the aorta at 4 standard locations, both psoas muscles, both renal cortices, spleen, retroperitoneal fat, and inferior vena cava. Attenuation (Hounsfield unit), quantitative noise (Hounsfield unit SD), contrast-to-noise ratio (CNR) (CNRvascular, CNRkidney, CNRspleen, CNRfat), signal-to-noise ratio (SNR) (SNRvascular, SNRkidney, SNRspleen, SNRfat), and radiation dose were compared between PCCT and EI-DECT with the Wilcoxon signed rank test. A P < 0.05 indicated statistical significance. RESULTS:A total of 74 patients (27 men; mean ± SD age, 63 ± 13 years) were included. Computed tomography dose index volumes for PCCT and EI-DECT were 9.2 ± 3.5 mGy and 9.4 ± 9.0 mGy, respectively (P = 0.06). Qualitatively, PCCT VNC images had better overall image quality, image noise, small structure delineation, noise texture, and fewer artifacts (all P < 0.00001). Virtual noncontrast images from PCCT had lower attenuation (all P < 0.05), noise (P = 0.006), and higher CNR (P < 0.0001-0.04). Contrast-enhanced structures had lower SNR on PCCT (P = 0.001, 0.002), reflecting greater contrast removal. The SNRfat (nonenhancing) was higher for PCCT than EI-DECT (P < 0.00001). CONCLUSIONS:Virtual noncontrast images from PCCT had improved image quality, lower noise, improved CNR and SNR compared with those derived from EI-DECT.
PMID: 38013203
ISSN: 1532-3145
CID: 5611232

Crohn's disease phenotype analysis with iodine density from dual-energy CT enterography

Dane, Bari; Li, Xiaochun; Goldberg, Judith D; O'Donnell, Thomas; Le, Linda; Megibow, Alec
PURPOSE/OBJECTIVE:To compare dual-source dual-energy CT enterography (dsDECTE) obtained iodine density (I) (mg/mL) and I normalized to the aorta (I%) with Crohn's disease (CD) phenotypes defined by the SAR-AGA small bowel CD consensus statement. METHODS:Fifty CD patients (31 male, 19 female; mean [SD] age: 50.4 [15.2] years) who underwent dsDECTE were retrospectively identified. Two abdominal radiologists assigned CD phenotypes: no active inflammation (group-2), active inflammation without (group-3) or with luminal narrowing (group-4), stricture with active inflammation (group-5), stricture without active inflammation (group-1), and penetrating disease (group-6). Semiautomatic prototype software was used to determine the median I and I% of CD-affected small bowel mucosa for each patient. The means of the I and I% medians were compared among 4 groups ("1 + 2", "3 + 4", "5", "6") using one-way ANOVA (significance level 0.05 for each outcome) for each outcome individually followed by Tukey's range test for pairwise comparisons with adjusted p-values (overall alpha = 0.05). RESULTS:Mean [SD] I was 2.14 [1.07] mg/mL for groups 1 + 2 (n = 16), 3.54 [1.71] mg/mL for groups 3 + 4 (n = 15), 5.5 [3.27] mg/mL for group- "5" (n = 9), and 3.36 [1.43] mg/mL for group-"6" (n = 10) (ANOVA p = .001; group "1 + 2" versus "5" adj-p = .0005). Mean [SD] I% was 21.2 [6.13]% for groups 1 + 2, 39.47 [9.71]% for groups 3 + 4, 40.98 [11.76]% for group-5, and 35.01 [7.58]% for group-6 (ANOVA p < .0001; groups "1 + 2" versus "3 + 4" adj-p < .0001, group "1 + 2" versus "5" adj-p < .0001, and groups "1 + 2" versus "6" adj-p = .002). CONCLUSION/CONCLUSIONS:Iodine density obtained from dsDECTE significantly differed among CD phenotypes defined by SAR-AGA, with I (mg/mL) increasing with phenotype severity and decreasing for penetrating disease. I and I% can be used to phenotype CD.
PMID: 37097450
ISSN: 2366-0058
CID: 5459552

Crohn's disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation

Dane, Bari; Kernizan, Amelia; O'Donnell, Thomas; Petrocelli, Robert; Rabbenou, Wendy; Bhattacharya, Sumona; Chang, Shannon; Megibow, Alec
PURPOSE/OBJECTIVE:To compare terminal ileum (TI) mucosal iodine density obtained at dual-energy CT enterography (DECTE) with conventional CT interpretation and endoscopy in patients with Crohn's disease (CD). MATERIALS AND METHODS/METHODS:) from the distal 2 cm ileum (TI) mucosa obtained using semiautomatic prototype software were compared with endoscopic assessment using Mann Whitney tests. The optimal threshold I% and I were determined from receiver operating curves (ROC). Sensitivity and specificity of conventional interpretation and determined iodine thresholds were compared using McNemar's test. Inter-reader agreement was assessed using kappa. A p < 0.05 indicated statistical significance. RESULTS:was similar for patients with and without endoscopic active inflammation (0.82[0.33]mg/mL and 0.77[0.28]mg/mL, respectively, p = 0.37). Conventional interpretation sensitivity and specificity (R1/R2) were 83.3%/91.7% and 72.7%/54.5%, respectively (all p > 0.05) with moderate inter-reader agreement (Κ = 0.542[95% CI 0.0202-0.088]). CONCLUSION/CONCLUSIONS:Mean normalized iodine density is highly sensitive and specific for endoscopic active inflammation. DECTE could be considered as a surrogate to endoscopy in CD patients. Despite trends towards improved sensitivity and specificity compared with conventional interpretation, future larger studies are needed.
PMID: 35833999
ISSN: 2366-0058
CID: 5269322

Thoracic Aortic Aneurysm Sac Remodeling After Thoracic Endovascular Aortic Repair Affects Late Outcomes After Repair [Meeting Abstract]

Patel, P; Marcaccio, C; O'Donnell, T; Elmously, A; Garg, K; Schermerhorn, M; Takayama, H; Patel, V
Background: Prior studies have demonstrated that aneurysm sac expansion and failure of sac regression after endovascular aortic repair is associated with higher rates of late mortality and reinterventions. However, the effect of aneurysm sac remodeling on late outcomes after thoracic endovascular aortic repair (TEVAR) is not well-understood.
Method(s): We identified all patients who underwent TEVAR for degenerative aortic aneurysm in the VQI from 2011 to 2018 with 1-year follow-up imaging (+/-6 months) and linkage to Medicare claims data. Sac remodeling was defined as sac expansion (>=5 mm increase), sac stable (<5 mm change), or sac regression (>=5 mm decrease). Mid-term survival, rupture, and reintervention rates were also assessed using Kaplan-Meier estimates. Cox regression was used to assess the impact of sac behavior on midterm outcomes.
Result(s): Among 574 patients, 19% demonstrated sac expansion. Aortic diameter was smallest in patients with sac expansion (expansion 51 mm vs stable/regression 57 mm; P <.001). Sac expansion had the highest rate of any completion endoleak (13% vs 5%; P =.004) and type II completion endoleak (7.8% vs 2.2%; P =.006). An aortic diameter of 65 mm or greater was associated with higher odds of sac regression or stable sac (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.2-6.7; P =.020), while any completion endoleak was associated with higher odds of sac expansion (OR, 3.4; 95% CI, 1.3-8.9; P =.010). Sac expansion trended toward a higher risk of 5-year mortality (21% vs 13%; adjusted hazard ratio, 1.8; 95% CI, 0.9-3.4; P =.079) (Figure) and late rupture (12% vs 4.6%; HR, 3.5; 95% CI, 0.9-13; P =.063). Additionally, sac expansion was associated with higher risk of late reintervention (78% vs 36%; adjusted hazard ratio, 3.0; 95% CI, 18-5.1; P <.001).
Conclusion(s): Sac expansion after TEVAR is associated with increased risk of mid-term rupture and reintervention. Furthermore, completion endoleak is associated with higher odds of sac expansion during follow-up. Further study is warranted to determine if shorter interval follow-up in patients at risk for sac expansion can improve late rupture rates in these patients. [Formula presented]
ISSN: 1097-6809
CID: 5512712

Late Survival Is Affected by Renal Complication Following Endovascular Aortic Aneurysm Repair for Juxtarenal Aortic Aneurysm [Meeting Abstract]

Patel, P; Marcaccio, C; O'Donnell, T; Krimbill, J; Garg, K; Schermerhorn, M; Takayama, H; Patel, V
Background: Preoperative renal function is a predictor of morbidity and mortality after endovascular repair of juxtarenal aortic aneurysms. However, the impact of postoperative renal complication on outcomes after repair are poorly understood. Therefore, our objective was to assess the impact of postoperative renal dysfunction on midterm outcomes following endovascular repair of juxtarenal aortic aneurysms.
Method(s): We identified all endovascular repairs of juxtarenal aortic aneurysms in the Vascular Quality Initiative from 2011 to 2018 with linkage to Medicare claims data. Juxtarenal aortic aneurysm repair was defined as repair with at least one scallop, fenestration, branch, or parallel grafting into a renal vessel. Postoperative renal complication was defined as acute kidney injury (AKI; >=0.5 mg/dL serum creatinine increase) or new renal replacement therapy (RRT). We excluded any patients on preoperative hemodialysis. Kaplan-Meier estimates and Cox regression were used to determine the effect of AKI/RRT on midterm mortality, rupture, and reintervention.
Result(s): Of 931 endovascular repairs, 17% experienced postoperative AKI/RRT. Repairs with postoperative AKI/RRT more often had coverage/occlusion of renal vessels (AKI/RRT: 17% vs stable function: 4.5%; P <.001) or parallel grafting of renal vessels (24% vs 16%; P <.001). Furthermore, repairs with postoperative AKI/RRT had higher rates of postoperative mortality (18% vs 1.2%; P <.001). Postoperative AKI/RRT was independently associated with a higher risk of 5-year mortality (42% vs 16%; adjusted hazard ratio [aHR] 2.4; 95% confidence interval [CI], 1.5-3.8; P <.001) (Figure) and 3-year late rupture (17% vs 5.1%; adjusted hazard ratio, 4.0; 95% CI, 1.8-8.8; P =.001). Meanwhile, postoperative AKI/RRT trended toward a higher risk of 3-year reinterventions (28% vs 20%; adjusted hazard ratio, 1.5; 95% CI, 0.9-2.5; P =.105).
Conclusion(s): Postoperative renal complications adversely impacted late mortality, rupture, and reintervention. Future studies with longer follow-up may likely demonstrate even worse outcomes in this cohort. Our study calls for optimization of preoperative renal status and the use of protective adjuncts to reduce the risk of postoperative renal complications and its negative long-term sequala. [Formula presented]
ISSN: 1097-6809
CID: 5512742

Combined whole-lesion radiomic and iodine analysis for differentiation of pulmonary tumors

Azour, Lea; Ko, Jane P; O'Donnell, Thomas; Patel, Nihal; Bhattacharji, Priya; Moore, William H
Quantitative radiomic and iodine imaging features have been explored for diagnosis and characterization of tumors. In this work, we invistigate combined whole-lesion radiomic and iodine analysis for the differentiation of pulmonary tumors on contrast-enhanced dual-energy CT (DECT) chest images. 100 biopsy-proven solid lung lesions on contrast-enhanced DECT chest exams within 3 months of histopathologic sampling were identified. Lesions were volumetrically segmented using open-source software. Lesion segmentations and iodine density volumes were loaded into a radiomics prototype for quantitative analysis. Univariate analysis was performed to determine differences in volumetric iodine concentration (mean, median, maximum, minimum, 10th percentile, 90th percentile) and first and higher order radiomic features (n = 1212) between pulmonary tumors. Analyses were performed using a 2-sample t test, and filtered for false discoveries using Benjamini-Hochberg method. 100 individuals (mean age 65 ± 13 years; 59 women) with 64 primary and 36 metastatic lung lesions were included. Only one iodine concentration parameter, absolute minimum iodine, significantly differed between primary and metastatic pulmonary tumors (FDR-adjusted p = 0.015, AUC 0.69). 310 (FDR-adjusted p = 0.0008 to p = 0.0491) radiomic features differed between primary and metastatic lung tumors. Of these, 21 features achieved AUC ≥ 0.75. In subset analyses of lesions imaged by non-CTPA protocol (n = 72), 191 features significantly differed between primary and metastatic tumors, 19 of which achieved AUC ≥ 0.75. In subset analysis of tumors without history of prior treatment (n = 59), 40 features significantly differed between primary and metastatic tumors, 11 of which achieved AUC ≥ 0.75. Volumetric radiomic analysis provides differentiating capability beyond iodine quantification. While a high number of radiomic features differentiated primary versus metastatic pulmonary tumors, fewer features demonstrated good individual discriminatory utility.
PMID: 35821374
ISSN: 2045-2322
CID: 5269172

Inter-Reader Variability of Volumetric Subsolid Pulmonary Nodule Radiomic Features

Azour, Lea; Moore, William H; O'Donnell, Thomas; Truong, Mylene T; Babb, James; Niu, Bowen; Wimmer, Andreas; Kiumehr, Saman; Ko, Jane P
OBJECTIVE:To evaluate the inter-observer consistency for subsolid pulmonary nodule radiomic features. MATERIALS AND METHODS/METHODS:Subsolid nodules were selected by reviewing radiology reports of CT examinations performed December 1, 2015 to April 1, 2016. Patients with CTs at two time points were included in this study. There were 55 patients with subsolid nodules, of whom 14 had two nodules. Of 69 subsolid nodules, 66 were persistent at the second time point, yielding 135 lesions for segmentation. Two thoracic radiologists and an imaging fellow segmented the lesions using a semi-automated volumetry algorithm (Syngo.via Vb20, Siemens). Coefficient of variation (CV) was used to assess consistency of 91 quantitative measures extracted from the subsolid nodule segmentations, including first and higher order texture features. The accuracy of segmentation was visually graded by an experienced thoracic radiologist. Influencing factors on radiomic feature consistency and segmentation accuracy were assessed using generalized estimating equation analyses and the Exact Mann-Whitney test. RESULTS:Mean patient age was 71 (38-93 years), with 39 women and 16 men. Mean nodule volume was 1.39mL, range .03-48.2mL, for 135 nodules. Several radiomic features showed high inter-reader consistency (CV<5%), including entropy, uniformity, sphericity, and spherical disproportion. Descriptors such as surface area and energy had low consistency across inter-reader segmentations (CV>10%). Nodule percent solid component and attenuation influenced inter-reader variability of some radiomic features. The presence of contrast did not significantly affect the consistency of subsolid nodule radiomic features. Near perfect segmentation, within 5% of actual nodule size, was achieved in 68% of segmentations, and very good segmentation, within 25% of actual nodule size, in 94%. Morphologic features including nodule margin and shape (each p <0.01), and presence of air bronchograms (p = 0.004), bubble lucencies (p = 0.02) and broad pleural contact (p < 0.01) significantly affected the probability of near perfect segmentation. Stroke angle (p = 0.001) and length (p < 0.001) also significantly influenced probability of near perfect segmentation. CONCLUSIONS:The inter-observer consistency of radiomic features for subsolid pulmonary nodules varies, with high consistency for several features, including sphericity, spherical disproportion, and first and higher order entropy, and normalized non-uniformity. Nodule morphology influences the consistency of subsolid nodule radiomic features, and the accuracy of subsolid nodule segmentation.
PMID: 33610452
ISSN: 1878-4046
CID: 4794062

Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis

Dane, Bari; Sarkar, Suparna; Nazarian, Matthew; Galitzer, Hayley; O'Donnell, Thomas; Remzi, Feza; Chang, Shannon; Megibow, Alec
Background Dual-energy CT enterography (DECTE) has been shown to be useful in characterizing Crohn disease activity compared with clinical markers of inflammation but, to the knowledge of the authors, comparison has not been made with histopathologic specimens. Purpose To compare mucosal iodine density obtained at DECTE from Crohn disease-affected bowel with histopathologic specimens from surgically resected ileocolectomy bowel segments or terminal ileum colonoscopic biopsies in the same patients. Materials and Methods This was a retrospective study. Bowel segments in adults with Crohn disease who underwent DECTE from January 2017 to April 2019 within 90 days of ileocolectomy or colonoscopy were retrospectively evaluated with prototype software allowing the semiautomatic determination of inner hyperdense bowel wall (mucosal) mean iodine density, normalized to the aorta. Mean normalized iodine density and clinical activity indexes (Crohn Disease Activity Index [CDAI] and Harvey-Bradshaw Index [HBI]) were compared with histologic active inflammation grades by using two-tailed t tests. Receiver operating characteristic curves were generated for mean normalized iodine density, CDAI, and HBI to determine sensitivity, specificity, and accuracy. A P value less than .05 was considered to indicate statistical significance. Results The following 16 patients were evaluated (mean age, 41 years ± 14 [standard deviation]): 10 patients (five men, five women; mean age, 41 years ± 15) with 19 surgical resection specimens and six patients with terminal ileum colonoscopic mucosal biopsies (four men, two women; mean age, 43 years ± 14). Mean normalized iodine density was 16.5% ± 5.7 for bowel segments with no active inflammation (n = 8) and 34.7% ± 9.7 for segments with any active inflammation (n = 17; P < .001). A 20% mean normalized iodine density threshold had sensitivity, specificity, and accuracy of 17 of 17 (100%; 95% CI: 80.5, 100), six of eight (75%; 95% CI: 35, 97), and 23 of 25 (92%; 95% CI: 74, 99), respectively, for active inflammation. Clinical indexes were similar for patients with and without active inflammation at histopathologic analysis (CDAI score, 261 vs 251, respectively [P = .77]; HBI score, 7.8 vs 6.4, respectively [P = .36]). Conclusion Iodine density from dual-energy CT enterography may be used as a radiologic marker of Crohn disease activity as correlated with histopathologic analysis. © RSNA, 2021 See also the editorial by Ohliger in this issue.
PMID: 34342502
ISSN: 1527-1315
CID: 4988602