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Diagnostics
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Advances in CT Images
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Advances in CT Images

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

Deadline for manuscript submissions: closed (1 April 2023) | Viewed by 9545

Special Issue Editor

Dr. Christian Booz

E-Mail Website
Guest Editor
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
Interests: computed tomography; diagnostic radiology; imaging; diagnostic imaging; medical imaging; clinical imaging; magnetic resonance; radiography
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to provide an overview of recent technical developments in CT imaging and their clinical relevance, with a special focus on spectral imaging. In this context, original articles, review articles, and case reports based on novel CT algorithms and methods will be included. CT technologies such as spectral imaging, including dual-energy CT and photon-counting CT, radiation dose reduction algorithms, and possibilities for contrast media reduction will be covered in this Special Issue. In the first part, technical articles will focus on general principles and methods with a special focus on spectral imaging. In the second part, clinical studies will evaluate and demonstrate the clinical relevance of novel CT technologies, methods, and algorithms for various anatomical regions/diseases. To end, a final discussion by two to three experts in the field will summarize and interpret the findings of this Special Issue concerning future developments and their potential.

Dr. Christian Booz
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.

Published Papers (6 papers)

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Editorial

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3 pages, 156 KiB  
Editorial
State-of-the-Art Research: Current Developments in CT Imaging
by Christian Booz
Diagnostics 2023, 13(13), 2305; https://doi.org/10.3390/diagnostics13132305 - 07 Jul 2023
Viewed by 976
Abstract
This Special Issue of Diagnostics entitled “Advances in CT Images” provides an interesting selection of articles on recent technical developments in CT imaging with a special focus on spectral imaging, including dual-energy CT (DECT) and photon-counting CT (PCCT) [...] Full article
(This article belongs to the Special Issue Advances in CT Images)

Research

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13 pages, 7098 KiB  
Article
Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus
by Giuseppe Mauro Bucolo, Tommaso D’Angelo, Ibrahim Yel, Vitali Koch, Leon D. Gruenewald, Ahmed E. Othman, Leona Soraja Alizadeh, Daniel P. Overhoff, Stephan Waldeck, Simon S. Martin, Silvio Mazziotti, Giorgio Ascenti, Alfredo Blandino, Thomas J. Vogl and Christian Booz
Diagnostics 2023, 13(10), 1790; https://doi.org/10.3390/diagnostics13101790 - 18 May 2023
Cited by 5 | Viewed by 1157
Abstract
Background: Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy [...] Read more.
Background: Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. Purpose: To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. Materials and Methods: We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. Results: Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). Conclusions: DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients. Full article
(This article belongs to the Special Issue Advances in CT Images)
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14 pages, 2240 KiB  
Article
Is There Still a Role for Two-Phase Contrast-Enhanced CT and Virtual Monoenergetic Images in the Era of Photon-Counting Detector CT?
by Arne Estler, Konstantin Nikolaou, Stefan O. Schönberg, Fabian Bamberg, Matthias F. Froelich, Fabian Tollens, Niklas Verloh, Jakob Weiss, Marius Horger and Florian Hagen
Diagnostics 2023, 13(8), 1454; https://doi.org/10.3390/diagnostics13081454 - 18 Apr 2023
Cited by 3 | Viewed by 1434
Abstract
Background: To compare the diagnostic characteristics between arterial phase imaging versus portal venous phase imaging, applying polychromatic T3D images and low keV virtual monochromatic images using a 1st generation photon-counting CT detector, of CT in patients with hepatocellular carcinoma (HCC). Methods: Consecutive patients [...] Read more.
Background: To compare the diagnostic characteristics between arterial phase imaging versus portal venous phase imaging, applying polychromatic T3D images and low keV virtual monochromatic images using a 1st generation photon-counting CT detector, of CT in patients with hepatocellular carcinoma (HCC). Methods: Consecutive patients with HCC, with a clinical indication for CT imaging, were prospectively enrolled. Virtual monoenergetic images (VMI) were reconstructed at 40 to 70 keV for the PCD-CT. Two independent, blinded radiologists counted all hepatic lesions and quantified their size. The lesion-to-background ratio was quantified for both phases. SNR and CNR were determined for T3D and low VMI images; non-parametric statistics were used. Results: Among 49 oncologic patients (mean age 66.9 ± 11.2 years, eight females), HCC was detected in both arterial and portal venous scans. The signal-to-noise ratio, the CNR liver-to-muscle, the CNR tumor-to-liver, and CNR tumor-to-muscle were 6.58 ± 2.86, 1.40 ± 0.42, 1.13 ± 0.49, and 1.53 ± 0.76 in the arterial phase and 5.93 ± 2.97, 1.73 ± 0.38, 0.79 ± 0.30, and 1.36 ± 0.60 in the portal venous phase with PCD-CT, respectively. There was no significant difference in SNR between the arterial and portal venous phases, including between “T3D” and low keV images (p > 0.05). CNRtumor-to-liver differed significantly between arterial and portal venous contrast phases (p < 0.005) for both “T3D” and all reconstructed keV levels. CNRliver-to-muscle and CNRtumor-to-muscle did not differ in either the arterial or portal venous contrast phases. CNRtumor-to-liver increased in the arterial contrast phase with lower keV in addition to SD. In the portal venous contrast phase, CNRtumor-to-liver decreased with lower keV; whereas, CNRtumor-to-muscle increased with lower keV in both arterial and portal venous contrast phases. CTDI and DLP mean values for the arterial upper abdomen phase were 9.03 ± 3.59 and 275 ± 133, respectively. CTDI and DLP mean values for the abdominal portal venous phase were 8.75 ± 2.99 and 448 ± 157 with PCD-CT, respectively. No statistically significant differences were found concerning the inter-reader agreement for any of the (calculated) keV levels in either the arterial or portal-venous contrast phases. Conclusions: The arterial contrast phase imaging provides higher lesion-to-background ratios of HCC lesions using a PCD-CT; especially, at 40 keV. However, the difference was not subjectively perceived as significant. Full article
(This article belongs to the Special Issue Advances in CT Images)
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16 pages, 8368 KiB  
Article
Correlation between Pancreatic Duct Variation and Related Diseases: An Effective Method Observing the Dual-Energy CT with Low-keV Monoenergetic Images
by Ruike Zhang, Zhengying Li, Xiaoli Hu, Hongwei Liang, Gaowu Yan, Dan Xie, Jiao Zhang and Yongmei Li
Diagnostics 2023, 13(3), 520; https://doi.org/10.3390/diagnostics13030520 - 31 Jan 2023
Cited by 1 | Viewed by 2083
Abstract
Purpose: Pancreatic duct variation can affect the secretory function of the pancreas. We aimed to explore the pancreatic duct variation, observed using low-keV monoenergetic images [MEI (+)] of dual-energy CT (DECT), and its relationship with related diseases. We further sought to compare pancreatic [...] Read more.
Purpose: Pancreatic duct variation can affect the secretory function of the pancreas. We aimed to explore the pancreatic duct variation, observed using low-keV monoenergetic images [MEI (+)] of dual-energy CT (DECT), and its relationship with related diseases. We further sought to compare pancreatic duct imaging using low-keV MEI (+) of DECT and magnetic resonance cholangiopancreatography (MRCP). Materials and Methods: The DECT and MRCP images of 854 patients were evaluated retrospectively. The 808 patients’ pancreatic duct types were classified according to the anatomy and the opening of the pancreatic ducts, and the correlation with related diseases was analyzed. The DECT and MRCP images of 852 patients were graded according to the sharpness of the pancreatic ducts for evaluation. Results: A higher prevalence of acute pancreatitis (AP), chronic pancreatitis (CP), and duodenal papillary carcinoma (DPC) was observed in the variant group. Of the 27 AP cases in the variant group, 9 patients (33.3%) were Type 3c. Additionally, Type 4a was significantly correlated with AP and CP (p < 0.05). Low-keV MEI (+) of DECT outperformed the MRCP images in the sharpness of the pancreatic ducts in 852 patients. Conclusions: Pancreatic duct variation is associated with AP, CP, and DPC. Low-keV MEI (+) DECT is an effective method to observe the pancreatic duct system. Full article
(This article belongs to the Special Issue Advances in CT Images)
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11 pages, 14216 KiB  
Article
Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
by Moritz T. Winkelmann, Florian Hagen, Kerstin Artzner, Malte N. Bongers and Christoph Artzner
Diagnostics 2022, 12(10), 2542; https://doi.org/10.3390/diagnostics12102542 - 20 Oct 2022
Cited by 4 | Viewed by 1291
Abstract
The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy [...] Read more.
The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7–100% vs. 88.2–96.7%; specificity: 100% vs. 96.7–100%; p < 0.0001; ICC: 0.96–0.99) and confidence (Likert: 5; IRQ [5–5] vs. 4, IRQ [3–4; 4–5]; p < 0.0001; ICC: 0.80–0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images. Full article
(This article belongs to the Special Issue Advances in CT Images)
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Other

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7 pages, 3087 KiB  
Case Report
Diagnosis and Management of Button Battery Ingestion Complicated by Tracheo-Esophageal and Aorto-Esophageal Fistulas
by Ludovica R. M. Lanzafame, Alfredo Blandino, Giuseppe Cicero, Placido Romeo, Salvatore Agati, Rosanna Zanai, Antonio Celona, Christian Booz, Vitali Koch, Silvio Mazziotti and Tommaso D’Angelo
Diagnostics 2022, 12(10), 2369; https://doi.org/10.3390/diagnostics12102369 - 29 Sep 2022
Cited by 3 | Viewed by 1549
Abstract
Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that [...] Read more.
Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that occurred in two previously healthy infants. Both patients presented with vague symptoms and no witness of foreign body ingestion. The prolonged time of exposure to the corrosive effects of disk batteries was responsible for the development of tracheo-esophageal fistula (TEF) and aorto-esophageal fistula (AEF). We demonstrate how prompt diagnosis and management are crucial for the infants’ survival. Full article
(This article belongs to the Special Issue Advances in CT Images)
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