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Diagnostics
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Advances in Computed Tomography Imaging for Clinical Diagnosis
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Advances in Computed Tomography Imaging for Clinical Diagnosis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 4831

Special Issue Editor

Dr. Ibrahim Yel

E-Mail Website
Guest Editor
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
Interests: computed tomography; diagnostic radiology

Special Issue Information

Dear Colleagues,

I would like to invite you to submit your work to the Special Issue on "Advances in Computed Tomography Imaging for Clinical Diagnosis". This Special Issue aims to present the latest developments in computed tomography (CT) imaging, including new image reconstruction methods and clinical applications, to enhance clinical diagnosis. Thanks to recent technological advancements, such as spectral imaging (including dual-energy CT and photon-counting CT) and artificial intelligence-based image analysis, the accuracy and diagnostic potential of CT imaging are continuing to improve.

With your contributions, this Special Issue will provide valuable insights into the current state and future directions of CT imaging for clinical diagnosis. We are excited to have your contributions and believe your research on this topic will greatly benefit the medical imaging community. We look forward to your submissions and participation in this exciting Special Issue.

Best regards,

Dr. Ibrahim Yel
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (7 papers)

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Research

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12 pages, 1827 KiB  
Article
Predictive Value of Dual-Energy CT-Derived Metrics for the Use of Bone Substitutes in Distal Radius Fracture Surgery
by Philipp Reschke, Vitali Koch, Scherwin Mahmoudi, Christian Booz, Ibrahim Yel, Jennifer Gotta, Adrian Stahl, Robin Reschke, Jan-Erik Scholtz, Simon S. Martin, Tatjana Gruber-Rouh, Katrin Eichler, Thomas J. Vogl and Leon D. Gruenewald
Diagnostics 2024, 14(7), 697; https://doi.org/10.3390/diagnostics14070697 - 26 Mar 2024
Viewed by 359
Abstract
(1) Background: Low bone mineral density (BMD) is a significant risk factor for complicated surgery and leads to the increased use of bone substitutes in patients with distal radius fractures (DRFs). No accepted model has yet been established to predict the use of [...] Read more.
(1) Background: Low bone mineral density (BMD) is a significant risk factor for complicated surgery and leads to the increased use of bone substitutes in patients with distal radius fractures (DRFs). No accepted model has yet been established to predict the use of bone substitutes to facilitate preoperative planning. (2) Methods: Unenhanced dual-energy CT (DECT) images of DRFs were retrospectively acquired between March 2016 and September 2020 using the internal PACS system. Available follow-up imaging and medical health records were reviewed to determine the use of bone substitutes. DECT-based BMD, trabecular Hounsfield units (HU), cortical HU, and cortical thickness ratio were measured in non-fractured segments of the distal radius. Diagnostic accuracy parameters were calculated for all metrics using receiver-operating characteristic (ROC) curves and associations of all metrics with the use of bone substitutes were evaluated using logistic regression models. (3) The final study population comprised 262 patients (median age 55 years [IQR 43–67 years]; 159 females, 103 males). According to logistic regression analysis, DECT-based BMD was the only metric significantly associated with the use of bone substitutes (odds ratio 0.96, p = 0.003). However, no significant associations were found for cortical HU (p = 0.06), trabecular HU (p = 0.33), or cortical thickness ratio (p = 0.21). ROC-curve analysis revealed that a combined model of all four metrics had the highest diagnostic accuracy with an area under the curve (AUC) of 0.76. (4) Conclusions: DECT-based BMD measurements performed better than HU-based measurements and cortical thickness ratio. The diagnostic performance of all four metrics combined was superior to that of the individual parameters. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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17 pages, 4181 KiB  
Article
Dual-Energy CT Iodine Uptake of Head and Neck: Definition of Reference Values in a Big Data Cohort
by Ibrahim Yel, Giuseppe Mauro Bucolo, Scherwin Mahmoudi, Vitali Koch, Aynur Gökduman, Tommaso D′Angelo, Leon David Grünewald, Mirela Dimitrova, Katrin Eichler, Thomas J. Vogl and Christian Booz
Diagnostics 2024, 14(5), 496; https://doi.org/10.3390/diagnostics14050496 - 26 Feb 2024
Viewed by 565
Abstract
Background: Despite a considerable amount of literature on dual-energy CT (DECT) iodine uptake of the head and neck, the physiologic iodine uptake of this region has not been defined yet. This study aims to establish reference values for the iodine uptake of healthy [...] Read more.
Background: Despite a considerable amount of literature on dual-energy CT (DECT) iodine uptake of the head and neck, the physiologic iodine uptake of this region has not been defined yet. This study aims to establish reference values for the iodine uptake of healthy organs to facilitate clinical application. Methods: Consecutive venous DECT scans of the head and neck were reviewed, and unremarkable exams were included (n = 617). A total of 35 region of interest measurements were performed in 16 anatomical regions. Iodine uptake was compared among different organs/tissues and subgroup analysis was performed (male (n = 403) vs. female (n = 214); young (n = 207) vs. middle-aged (n = 206) vs. old (n = 204); and normal weight (n = 314) vs. overweight (n = 196) vs. obese (n = 107)). Results: Overall mean iodine uptake values ranged between 0.5 and 9.4 mg/mL. Women showed higher iodine concentrations in the cervical vessels and higher uptake for the parotid gland, masseter muscle, submandibular glands, sublingual glands, palatine tonsils, tongue body, thyroid gland, and the sternocleidomastoid muscle than men (p ≤ 0.04). With increasing age, intravascular iodine concentrations increased as well as iodine uptake for cerebellum and thyroid gland, while values for the tongue and palatine tonsils were lower compared to younger subjects (p ≤ 0.03). Iodine concentrations for parotid glands and sternocleidomastoid muscles decreased with a higher BMI (p ≤ 0.004), while normal-weighted patients showed higher iodine values inside the jugular veins, other cervical glands, and tonsils versus patients with a higher BMI (p ≤ 0.04). Conclusion: physiologic iodine uptake values of cervical organs and tissues show gender-, age-, and BMI-related differences, which should be considered in the clinical routine of head and neck DECT. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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15 pages, 3915 KiB  
Article
A Novel Approach for Position Verification and Dose Calculation through Local MVCT Reconstruction
by Jun Zhang, Zerui Chen, Yuxin Lei and Junhai Wen
Diagnostics 2024, 14(5), 482; https://doi.org/10.3390/diagnostics14050482 - 23 Feb 2024
Viewed by 506
Abstract
Traditional positioning verification using cone-beam computed tomography (CBCT) may incur errors due to potential misalignments between the isocenter of CBCT and the treatment beams in radiotherapy. This study introduces an innovative method for verifying patient positioning in radiotherapy. Initially, the transmission images from [...] Read more.
Traditional positioning verification using cone-beam computed tomography (CBCT) may incur errors due to potential misalignments between the isocenter of CBCT and the treatment beams in radiotherapy. This study introduces an innovative method for verifying patient positioning in radiotherapy. Initially, the transmission images from an electronic portal imaging device (EPID) are acquired from 10 distinct angles. Utilizing the ART-TV algorithm, a sparse reconstruction of local megavoltage computed tomography (MVCT) is performed. Subsequently, this MVCT is aligned with the planning CT via a three-dimensional mutual information registration technique, pinpointing any patient-positioning discrepancies and facilitating corrective adjustments to the treatment setup. Notably, this approach employs the same radiation source as used in treatment to obtain three-dimensional images, thereby circumventing errors stemming from misalignment between the isocenter of CBCT and the accelerator. The registration process requires only 10 EPID images, and the dose absorbed during this process is included in the total dose calculation. The results show that our method’s reconstructed MVCT images fulfill the requirements for registration, and the registration algorithm accurately detects positioning errors, thus allowing for adjustments in the patient’s treatment position and precise calculation of the absorbed dose. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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11 pages, 1840 KiB  
Article
Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer
by Ibrahim Yel, Tommaso D’Angelo, Leon D. Gruenewald, Vitali Koch, Rejane Golbach, Scherwin Mahmoudi, Giorgio Ascenti, Alfredo Blandino, Thomas J. Vogl, Christian Booz and Giuseppe M. Bucolo
Diagnostics 2024, 14(5), 466; https://doi.org/10.3390/diagnostics14050466 - 21 Feb 2024
Viewed by 739
Abstract
Purpose: To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. Materials and Methods: 30 female patients (mean age, 63.12 ± 14.2 years) [...] Read more.
Purpose: To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. Materials and Methods: 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. Results: A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) (p < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) (p = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. Conclusions: DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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14 pages, 6669 KiB  
Article
Comparison of Bone Evaluation and Metal Artifact between Photon-Counting CT and Five Energy-Integrating-Detector CT under Standardized Conditions Using Cadaveric Forearms
by Takeshi Fukuda, Takenori Yonenaga, Ryo Akao, Tohru Hashimoto, Kazuhiro Maeda, Tomokazu Shoji, Shoichi Shioda, Yu Ishizaka and Hiroya Ojiri
Diagnostics 2024, 14(4), 350; https://doi.org/10.3390/diagnostics14040350 - 06 Feb 2024
Viewed by 831
Abstract
Background: To compare the potential of various bone evaluations by considering photon-counting CT (PCCT) and multiple energy-integrating-detector CT (EIDCT), including three dual-energy CT (DECT) scanners with standardized various parameters in both standard resolution (STD) and ultra-high-resolution (UHR) modes. Methods: Four cadaveric forearms were [...] Read more.
Background: To compare the potential of various bone evaluations by considering photon-counting CT (PCCT) and multiple energy-integrating-detector CT (EIDCT), including three dual-energy CT (DECT) scanners with standardized various parameters in both standard resolution (STD) and ultra-high-resolution (UHR) modes. Methods: Four cadaveric forearms were scanned using PCCT and five EIDCTs, by applying STD and UHR modes. Visibility of bone architecture, image quality, and a non-displaced fracture were subjectively scored against a reference EIDCT image by using a five-point scale. Image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also compared. To assess metal artifacts, a forearm with radial plate fixation was scanned by with and without Tin filter (Sn+ and Sn−), and virtual monoenergetic image (VMI) at 120 keV was created. Regarding Sn+ and VMI, images were only obtained from the technically available scanners. Subjective scores and the areas of streak artifacts were compared. Results: PCCT demonstrated significantly lower noise (p < 0.001) and higher bone SNR and CNR (p < 0.001) than all EIDCTs in both resolution modes. However, there was no significant difference between PCCT and EIDCTs in almost all subjective scores, regardless of scan modes, except for image quality where a significant difference was observed, compared to several EIDCTs. Metal artifact analysis revealed PCCT had larger artifact in Sn− and Sn+ (p < 0.001), but fewer in VMIs than three DECTs (p < 0.001 or 0.001). Conclusions: Under standardized conditions, while PCCT had almost no subjective superiority in visualizing bone structures and fracture line when compared to EIDCTs, it outperformed in quantitative analysis related to image quality, especially in lower noise and higher tissue contrast. When using PCCT to assess cases with metal implants, it may be recommended to use VMIs to minimize the possible tendency for artifact to be pronounced. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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13 pages, 5469 KiB  
Article
Image Characteristics of Virtual Non-Contrast Series Derived from Photon-Counting Detector Coronary CT Angiography—Prerequisites for and Feasibility of Calcium Quantification
by Franziska M. Braun, Franka Risch, Josua A. Decker, Piotr Woźnicki, Stefanie Bette, Judith Becker, Katharina Rippel, Christian Scheurig-Münkler, Thomas J. Kröncke and Florian Schwarz
Diagnostics 2023, 13(22), 3402; https://doi.org/10.3390/diagnostics13223402 - 08 Nov 2023
Cited by 1 | Viewed by 721
Abstract
In photon-counting detector CT (PCD-CT), coronary artery calcium scoring (CACS) can be performed using virtual non-contrast (VNC) series derived from coronary CT angiography (CCTA) datasets. Our study analyzed image characteristics of VNC series in terms of the efficacy of virtual iodine “removal” and [...] Read more.
In photon-counting detector CT (PCD-CT), coronary artery calcium scoring (CACS) can be performed using virtual non-contrast (VNC) series derived from coronary CT angiography (CCTA) datasets. Our study analyzed image characteristics of VNC series in terms of the efficacy of virtual iodine “removal” and image noise to determine whether the prerequisites for calcium quantification were satisfied. We analyzed 38 patients who had undergone non-enhanced CT followed by CCTA on a PCD-CT. VNC reconstructions were performed at different settings and algorithms (conventional VNCConv; PureCalcium VNCPC). Virtual iodine “removal” was investigated by comparing histograms of heart volumes. Noise was assessed within the left ventricular cavity. Calcium was quantified on the true non-contrast (TNC) and all VNC series. The histograms were comparable for TNC and all VNC. Image noise between TNC and all VNC differed slightly but significantly. VNCConv CACS showed a significant underestimation regardless of the reconstruction setting, while VNCPC CACS were comparable to TNC. Correlations between TNC and VNC were excellent, with a higher predictive accuracy for VNCPC. In conclusion, the iodine contrast can be effectively subtracted from CCTA datasets. The remaining VNC series satisfy the requirements for CACS, yielding results with excellent correlation compared to TNC-based CACS and high predicting accuracy. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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21 pages, 7463 KiB  
Review
Utility of Dual-Energy Computed Tomography in Clinical Conundra
by Ahmad Abu-Omar, Nicolas Murray, Ismail T. Ali, Faisal Khosa, Sarah Barrett, Adnan Sheikh, Savvas Nicolaou, Stefania Tamburrini, Francesca Iacobellis, Giacomo Sica, Vincenza Granata, Luca Saba, Salvatore Masala and Mariano Scaglione
Diagnostics 2024, 14(7), 775; https://doi.org/10.3390/diagnostics14070775 - 07 Apr 2024
Viewed by 597
Abstract
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing [...] Read more.
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT’s diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems. Full article
(This article belongs to the Special Issue Advances in Computed Tomography Imaging for Clinical Diagnosis)
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