Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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11 pages, 627 KiB  
Review
The Role of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Neoplastic Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma
by Lucia Cerrito, Maria Elena Ainora, Silvino Di Francesco, Linda Galasso, Antonio Gasbarrini and Maria Assunta Zocco
Tomography 2023, 9(5), 1976-1986; https://doi.org/10.3390/tomography9050154 - 20 Oct 2023
Cited by 2 | Viewed by 1515
Abstract
Hepatocellular carcinoma (HCC) is the principal primary liver cancer and one of the most frequent malignant tumors worldwide in patients with chronic liver disease. When diagnosed at an advanced stage, it is often associated with portal vein tumor thrombosis (PVTT), which heavily affects [...] Read more.
Hepatocellular carcinoma (HCC) is the principal primary liver cancer and one of the most frequent malignant tumors worldwide in patients with chronic liver disease. When diagnosed at an advanced stage, it is often associated with portal vein tumor thrombosis (PVTT), which heavily affects patients’ prognosis. Imaging evaluation is crucial in PVTT detection and staging; computed tomography and magnetic resonance are the principal diagnostic tools. Contrast-enhanced ultrasound (CEUS) is a non-invasive and easily repeatable method that can also be used in patients with impaired renal function. It represents an important means for the identification of PVTT, particularly differentiating neoplastic and non-neoplastic thrombosis through the analysis of ultrasound enhancement characteristics of the thrombosis (arterial hyperenhancement and portal washout), thus allowing more refined disease staging, appropriate treatment planning, and response evaluation, along with prognosis assessment. Full article
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11 pages, 1876 KiB  
Article
Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage—A Case Series
by Michael Doppler, Christin Fürnstahl, Simone Hammer, Michael Melter, Niklas Verloh, Hans Jürgen Schlitt and Wibke Uller
Tomography 2023, 9(5), 1965-1975; https://doi.org/10.3390/tomography9050153 - 19 Oct 2023
Cited by 1 | Viewed by 1642
Abstract
Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The [...] Read more.
Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. Material and Methods: All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Results: Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. Conclusions: PTBD is a very successful strategy for bile leak therapy after pLT. Full article
(This article belongs to the Special Issue New Trends in Diagnostic and Interventional Radiology)
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11 pages, 4942 KiB  
Article
Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis
by Rubab F. Malik, Renu Berry, Brandyn D. Lau, Kiran R. Busireddy, Prasan Patel, Sunil H. Patel, Elliot K. Fishman, Trinity J. Bivalacqua, Pamela T. Johnson and Farzad Sedaghat
Tomography 2023, 9(5), 1734-1744; https://doi.org/10.3390/tomography9050138 - 11 Sep 2023
Cited by 2 | Viewed by 1391
Abstract
Background: Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early [...] Read more.
Background: Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. Methods: Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. Results: Median age at the time of pathologic diagnosis was 70 years (range: 51–88 years), and 82% (81/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66/99) of patients and on 35% (78/226) of scans performed before diagnosis. The majority (84%, 67/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. Conclusions: Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients. Full article
(This article belongs to the Special Issue Functional and Molecular Imaging of the Abdomen)
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12 pages, 2119 KiB  
Article
Impact of the COVID-19 Pandemic on Iron Overload Assessment by MRI in Patients with Hemoglobinopathies: The E-MIOT Network Experience
by Antonella Meloni, Laura Pistoia, Amalia Lupi, Riccardo Righi, Antonino Vallone, Massimiliano Missere, Stefania Renne, Priscilla Fina, Ada Riva, Maria Rita Gamberini, Valerio Cecinati, Francesco Sorrentino, Rosamaria Rosso, Giuseppe Messina, Paolo Ricchi, Vincenzo Positano, Sophie Mavrogeni, Emilio Quaia, Filippo Cademartiri and Alessia Pepe
Tomography 2023, 9(5), 1711-1722; https://doi.org/10.3390/tomography9050136 - 11 Sep 2023
Cited by 1 | Viewed by 1203
Abstract
Background. The E-MIOT (Extension-Myocardial Iron Overload in Thalassemia) project is an Italian Network assuring high-quality quantification of tissue iron overload by magnetic resonance imaging (MRI). We evaluated the impact of the COVID-19 pandemic on E-MIOT services. Methods. The activity of the E-MIOT Network [...] Read more.
Background. The E-MIOT (Extension-Myocardial Iron Overload in Thalassemia) project is an Italian Network assuring high-quality quantification of tissue iron overload by magnetic resonance imaging (MRI). We evaluated the impact of the COVID-19 pandemic on E-MIOT services. Methods. The activity of the E-MIOT Network MRI centers in the year 2020 was compared with that of 2019. A survey evaluated whether the availability of MRI slots for patients with hemoglobinopathies was reduced and why. Results. The total number of MRI scans was 656 in 2019 and 350 in 2020, with an overall decline of 46.4% (first MRI: 71.7%, follow-up MRI: 36.9%), a marked decline (86.9%) in the period March–June 2020, and a reduction in the gap between the two years in the period July–September. A new drop (41.4%) was recorded in the period October–December for two centers, due to the general reduction in the total amount of MRIs/day for sanitization procedures. In some centers, patients refused MRI scans for fear of getting COVID. Drops in the MRI services >80% were found for patients coming from a region without an active MRI site. Conclusions. The COVID-19 pandemic had a strong negative impact on MRI multi-organ iron quantification, with a worsening in the management of patients with hemoglobinopathies. Full article
(This article belongs to the Section Cardiovascular Imaging)
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9 pages, 2287 KiB  
Communication
Visualization of Metastatic Lung Cancer with TiNIR
by Seul-Ki Mun, Hyun Bo Sim, Ji Yeon Han, Hyeongyeong Kim, Dae-Han Park, Dong-Jo Chang, Sung-Tae Yee, Young-Tae Chang and Jong-Jin Kim
Tomography 2023, 9(4), 1187-1195; https://doi.org/10.3390/tomography9040096 - 21 Jun 2023
Cited by 1 | Viewed by 1827
Abstract
The development of efficient biomarkers and probes for monitoring and treating cancer, specifically metastatic cancer, is a critical research area that can have a significant impact on both patient outcomes and drug discovery. In this context, TiNIR has been developed to detect tumor-initiating [...] Read more.
The development of efficient biomarkers and probes for monitoring and treating cancer, specifically metastatic cancer, is a critical research area that can have a significant impact on both patient outcomes and drug discovery. In this context, TiNIR has been developed to detect tumor-initiating cells (TICs), with heme oxygenase 2 (HO2) as a promising therapeutic biomarker for tumor-initiating cells. In this study, TiNIR has demonstrated its effectiveness as an in vivo metastatic lung cancer tracker, highlighting its potential as a valuable tool in cancer research and therapy. The development of innovative approaches that selectively target metastatic cancers represents a promising avenue for improving survival rates and enhancing the quality of life of cancer patients. Full article
(This article belongs to the Section Cancer Imaging)
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34 pages, 6268 KiB  
Review
Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach
by Alessandra Borgheresi, Andrea Agostini, Luca Pierpaoli, Alessandra Bruno, Tommaso Valeri, Ginevra Danti, Eleonora Bicci, Michela Gabelloni, Federica De Muzio, Maria Chiara Brunese, Federico Bruno, Pierpaolo Palumbo, Roberta Fusco, Vincenza Granata, Nicoletta Gandolfo, Vittorio Miele, Antonio Barile and Andrea Giovagnoni
Tomography 2023, 9(3), 1153-1186; https://doi.org/10.3390/tomography9030095 - 14 Jun 2023
Viewed by 5541
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their [...] Read more.
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases. Full article
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13 pages, 2984 KiB  
Article
Multiclass Segmentation of Breast Tissue and Suspicious Findings: A Simulation-Based Study for the Development of Self-Steering Tomosynthesis
by Bruno Barufaldi, Yann N. G. da Nobrega, Giulia Carvalhal, Joao P. V. Teixeira, Telmo M. Silva Filho, Thais G. do Rego, Yuri Malheiros, Raymond J. Acciavatti and Andrew D. A. Maidment
Tomography 2023, 9(3), 1120-1132; https://doi.org/10.3390/tomography9030092 - 10 Jun 2023
Viewed by 1493
Abstract
In breast tomosynthesis, multiple low-dose projections are acquired in a single scanning direction over a limited angular range to produce cross-sectional planes through the breast for three-dimensional imaging interpretation. We built a next-generation tomosynthesis system capable of multidirectional source motion with the intent [...] Read more.
In breast tomosynthesis, multiple low-dose projections are acquired in a single scanning direction over a limited angular range to produce cross-sectional planes through the breast for three-dimensional imaging interpretation. We built a next-generation tomosynthesis system capable of multidirectional source motion with the intent to customize scanning motions around “suspicious findings”. Customized acquisitions can improve the image quality in areas that require increased scrutiny, such as breast cancers, architectural distortions, and dense clusters. In this paper, virtual clinical trial techniques were used to analyze whether a finding or area at high risk of masking cancers can be detected in a single low-dose projection and thus be used for motion planning. This represents a step towards customizing the subsequent low-dose projection acquisitions autonomously, guided by the first low-dose projection; we call this technique “self-steering tomosynthesis.” A U-Net was used to classify the low-dose projections into “risk classes” in simulated breasts with soft-tissue lesions; class probabilities were modified using post hoc Dirichlet calibration (DC). DC improved the multiclass segmentation (Dice = 0.43 vs. 0.28 before DC) and significantly reduced false positives (FPs) from the class of the highest risk of masking (sensitivity = 81.3% at 2 FPs per image vs. 76.0%). This simulation-based study demonstrated the feasibility of identifying suspicious areas using a single low-dose projection for self-steering tomosynthesis. Full article
(This article belongs to the Special Issue Artificial Intelligence in Breast Cancer Screening)
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10 pages, 565 KiB  
Article
Coronary Computed Tomography Angiography with Deep Learning Image Reconstruction: A Preliminary Study to Evaluate Radiation Exposure Reduction
by Rossana Bona, Piergiorgio Marini, Davide Turilli, Salvatore Masala and Mariano Scaglione
Tomography 2023, 9(3), 1019-1028; https://doi.org/10.3390/tomography9030083 - 16 May 2023
Viewed by 1543
Abstract
Coronary computed tomography angiography (CCTA) is a medical imaging technique that produces detailed images of the coronary arteries. Our work focuses on the optimization of the prospectively ECG-triggered scan technique, which delivers the radiation efficiently only during a fraction of the R–R interval, [...] Read more.
Coronary computed tomography angiography (CCTA) is a medical imaging technique that produces detailed images of the coronary arteries. Our work focuses on the optimization of the prospectively ECG-triggered scan technique, which delivers the radiation efficiently only during a fraction of the R–R interval, matching the aim of reducing radiation dose in this increasingly used radiological examination. In this work, we analyzed how the median DLP (Dose-Length Product) values for CCTA of our Center decreased significantly in recent times mainly due to a notable change in the technology used. We passed from a median DLP value of 1158 mGy·cm to 221 mGy·cm for the whole exam and from a value of 1140 mGy·cm to 204 mGy·cm if considering CCTA scanning only. The result was obtained through the association of important factors during the dose imaging optimization: technological improvement, acquisition technique, and image reconstruction algorithm intervention. The combination of these three factors allows us to perform a faster and more accurate prospective CCTA with a lower radiation dose. Our future aim is to tune the image quality through a detectability-based study, combining algorithm strength with automatic dose settings. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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12 pages, 855 KiB  
Communication
Radiation Dose Management in Computed Tomography: Introduction to the Practice at a Single Facility
by Yusuke Inoue
Tomography 2023, 9(3), 955-966; https://doi.org/10.3390/tomography9030078 - 6 May 2023
Cited by 3 | Viewed by 1997
Abstract
Although the clinical benefits of computed tomography (CT) are undoubtedly high, radiation doses received by patients are also relatively high; therefore, radiation dose management is mandatory to optimize CT radiation doses and prevent excessive radiation events. This article describes CT dose management practice [...] Read more.
Although the clinical benefits of computed tomography (CT) are undoubtedly high, radiation doses received by patients are also relatively high; therefore, radiation dose management is mandatory to optimize CT radiation doses and prevent excessive radiation events. This article describes CT dose management practice at a single facility. Many imaging protocols are used in CT depending on the clinical indications, scan region, and CT scanner; thus, managing the protocols is the first step for optimization. The appropriateness of the radiation dose for each protocol and scanner is verified, while answering whether the dose is the minimum to obtain diagnostic-quality images. Moreover, examinations with exceptionally high doses are identified, and the cause and clinical validity of the high dose are assessed. Daily imaging practice should follow standardized procedures, avoiding operator-dependent errors, and information required for radiation dose management should be recorded at each examination. The imaging protocols and procedures are reviewed for continuous improvement based on regular dose analysis and multidisciplinary team collaboration. The participation of many staff members in the dose management process is expected to contribute to promoting radiation safety through increased staff awareness. Full article
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22 pages, 7136 KiB  
Review
Computed Tomography Urography: State of the Art and Beyond
by Michaela Cellina, Maurizio Cè, Nicolo’ Rossini, Laura Maria Cacioppa, Velio Ascenti, Gianpaolo Carrafiello and Chiara Floridi
Tomography 2023, 9(3), 909-930; https://doi.org/10.3390/tomography9030075 - 30 Apr 2023
Cited by 8 | Viewed by 4726
Abstract
Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney [...] Read more.
Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients’ outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique. Full article
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15 pages, 6640 KiB  
Article
Improving Performance of Breast Lesion Classification Using a ResNet50 Model Optimized with a Novel Attention Mechanism
by Warid Islam, Meredith Jones, Rowzat Faiz, Negar Sadeghipour, Yuchen Qiu and Bin Zheng
Tomography 2022, 8(5), 2411-2425; https://doi.org/10.3390/tomography8050200 - 28 Sep 2022
Cited by 18 | Viewed by 5337
Abstract
Background: The accurate classification between malignant and benign breast lesions detected on mammograms is a crucial but difficult challenge for reducing false-positive recall rates and improving the efficacy of breast cancer screening. Objective: This study aims to optimize a new deep transfer learning [...] Read more.
Background: The accurate classification between malignant and benign breast lesions detected on mammograms is a crucial but difficult challenge for reducing false-positive recall rates and improving the efficacy of breast cancer screening. Objective: This study aims to optimize a new deep transfer learning model by implementing a novel attention mechanism in order to improve the accuracy of breast lesion classification. Methods: ResNet50 is selected as the base model to develop a new deep transfer learning model. To enhance the accuracy of breast lesion classification, we propose adding a convolutional block attention module (CBAM) to the standard ResNet50 model and optimizing a new model for this task. We assembled a large dataset with 4280 mammograms depicting suspicious soft-tissue mass-type lesions. A region of interest (ROI) is extracted from each image based on lesion center. Among them, 2480 and 1800 ROIs depict verified benign and malignant lesions, respectively. The image dataset is randomly split into two subsets with a ratio of 9:1 five times to train and test two ResNet50 models with and without using CBAM. Results: Using the area under ROC curve (AUC) as an evaluation index, the new CBAM-based ResNet50 model yields AUC = 0.866 ± 0.015, which is significantly higher than that obtained by the standard ResNet50 model (AUC = 0.772 ± 0.008) (p < 0.01). Conclusion: This study demonstrates that although deep transfer learning technology attracted broad research interest in medical-imaging informatic fields, adding a new attention mechanism to optimize deep transfer learning models for specific application tasks can play an important role in further improving model performances. Full article
(This article belongs to the Special Issue Artificial Intelligence in Breast Cancer Screening)
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17 pages, 2272 KiB  
Article
Mapping Alveolar Oxygen Partial Pressure in COPD Using Hyperpolarized Helium-3: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study
by Naz P. Taskiran, Grant T. Hiura, Xuzhe Zhang, R. Graham Barr, Stephen M. Dashnaw, Eric A. Hoffman, Daniel Malinsky, Elizabeth C. Oelsner, Martin R. Prince, Benjamin M. Smith, Yanping Sun, Yifei Sun, Jim M. Wild, Wei Shen and Emlyn W. Hughes
Tomography 2022, 8(5), 2268-2284; https://doi.org/10.3390/tomography8050190 - 13 Sep 2022
Viewed by 2286
Abstract
Chronic obstructive pulmonary disease (COPD) and emphysema are characterized by functional and structural damage which increases the spaces for gaseous diffusion and impairs oxygen exchange. Here we explore the potential for hyperpolarized (HP) 3He MRI to characterize lung structure and function in [...] Read more.
Chronic obstructive pulmonary disease (COPD) and emphysema are characterized by functional and structural damage which increases the spaces for gaseous diffusion and impairs oxygen exchange. Here we explore the potential for hyperpolarized (HP) 3He MRI to characterize lung structure and function in a large-scale population-based study. Participants (n = 54) from the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study, a nested case-control study of COPD among participants with 10+ packyears underwent HP 3He MRI measuring pAO2, apparent diffusion coefficient (ADC), and ventilation. HP MRI measures were compared to full-lung CT and pulmonary function testing. High ADC values (>0.4 cm2/s) correlated with emphysema and heterogeneity in pAO2 measurements. Strong correlations were found between the heterogeneity of global pAO2 as summarized by its standard deviation (SD) (p < 0.0002) and non-physiologic pAO2 values (p < 0.0001) with percent emphysema on CT. A regional study revealed a strong association between pAO2 SD and visual emphysema severity (p < 0.003) and an association with the paraseptal emphysema subtype (p < 0.04) after adjustment for demographics and smoking status. HP noble gas pAO2 heterogeneity and the fraction of non-physiological pAO2 results increase in mild to moderate COPD. Measurements of pAO2 are sensitive to regional emphysematous damage detected by CT and may be used to probe pulmonary emphysema subtypes. HP noble gas lung MRI provides non-invasive information about COPD severity and lung function without ionizing radiation. Full article
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10 pages, 573 KiB  
Review
Can Chest Ultrasound Replace Chest X-ray in Thoracic Surgery?
by Konstantinos Grapatsas, Vasileios Leivaditis, Benjamin Ehle and Anastasia Papaporfyriou
Tomography 2022, 8(4), 2083-2092; https://doi.org/10.3390/tomography8040175 - 20 Aug 2022
Cited by 2 | Viewed by 2141
Abstract
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to [...] Read more.
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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11 pages, 3384 KiB  
Article
Reduction in Acquisition Time and Improvement in Image Quality in T2-Weighted MR Imaging of Musculoskeletal Tumors of the Extremities Using a Novel Deep Learning-Based Reconstruction Technique in a Turbo Spin Echo (TSE) Sequence
by Daniel Wessling, Judith Herrmann, Saif Afat, Dominik Nickel, Ahmed E. Othman, Haidara Almansour and Sebastian Gassenmaier
Tomography 2022, 8(4), 1759-1769; https://doi.org/10.3390/tomography8040148 - 6 Jul 2022
Cited by 10 | Viewed by 2064
Abstract
Background: The aim of this study was to assess the technical feasibility and the impact on image quality and acquisition time of a deep learning-accelerated fat-saturated T2-weighted turbo spin echo sequence in musculoskeletal imaging of the extremities. Methods: Twenty-three patients who underwent MRI [...] Read more.
Background: The aim of this study was to assess the technical feasibility and the impact on image quality and acquisition time of a deep learning-accelerated fat-saturated T2-weighted turbo spin echo sequence in musculoskeletal imaging of the extremities. Methods: Twenty-three patients who underwent MRI of the extremities were prospectively included. Standard T2w turbo inversion recovery magnitude (TIRMStd) imaging was compared to a deep learning-accelerated T2w TSE (TSEDL) sequence. Image analysis of 23 patients with a mean age of 60 years (range 30–86) was performed regarding image quality, noise, sharpness, contrast, artifacts, lesion detectability and diagnostic confidence. Pathological findings were documented measuring the maximum diameter. Results: The analysis showed a significant improvement for the T2 TSEDL with regard to image quality, noise, contrast, sharpness, lesion detectability, and diagnostic confidence, as compared to T2 TIRMStd (each p < 0.001). There were no differences in the number of detected lesions. The time of acquisition (TA) could be reduced by 52–59%. Interrater agreement was almost perfect (κ = 0.886). Conclusion: Accelerated T2 TSEDL was technically feasible and superior to conventionally applied T2 TIRMStd. Concurrently, TA could be reduced by 52–59%. Therefore, deep learning-accelerated MR imaging is a promising and applicable method in musculoskeletal imaging. Full article
(This article belongs to the Special Issue New Advances in Magnetic Resonance Imaging (MRI))
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15 pages, 3629 KiB  
Review
Role of CT and MRI in Cardiac Emergencies
by Carlo Liguori, Stefania Tamburrini, Giovanni Ferrandino, Silvio Leboffe, Nicola Rosano and Ines Marano
Tomography 2022, 8(3), 1386-1400; https://doi.org/10.3390/tomography8030112 - 23 May 2022
Cited by 5 | Viewed by 3371
Abstract
Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT [...] Read more.
Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department. Full article
(This article belongs to the Special Issue Imaging in Non-Traumatic Emergencies)
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14 pages, 4882 KiB  
Article
Photon Counting CT and Radiomic Analysis Enables Differentiation of Tumors Based on Lymphocyte Burden
by Alex J. Allphin, Yvonne M. Mowery, Kyle J. Lafata, Darin P. Clark, Alex M. Bassil, Rico Castillo, Diana Odhiambo, Matthew D. Holbrook, Ketan B. Ghaghada and Cristian T. Badea
Tomography 2022, 8(2), 740-753; https://doi.org/10.3390/tomography8020061 - 10 Mar 2022
Cited by 6 | Viewed by 5497
Abstract
The purpose of this study was to investigate if radiomic analysis based on spectral micro-CT with nanoparticle contrast-enhancement can differentiate tumors based on lymphocyte burden. High mutational load transplant soft tissue sarcomas were initiated in Rag2+/− and Rag2−/− mice to model [...] Read more.
The purpose of this study was to investigate if radiomic analysis based on spectral micro-CT with nanoparticle contrast-enhancement can differentiate tumors based on lymphocyte burden. High mutational load transplant soft tissue sarcomas were initiated in Rag2+/− and Rag2−/− mice to model varying lymphocyte burden. Mice received radiation therapy (20 Gy) to the tumor-bearing hind limb and were injected with a liposomal iodinated contrast agent. Five days later, animals underwent conventional micro-CT imaging using an energy integrating detector (EID) and spectral micro-CT imaging using a photon-counting detector (PCD). Tumor volumes and iodine uptakes were measured. The radiomic features (RF) were grouped into feature-spaces corresponding to EID, PCD, and spectral decomposition images. The RFs were ranked to reduce redundancy and increase relevance based on TL burden. A stratified repeated cross validation strategy was used to assess separation using a logistic regression classifier. Tumor iodine concentration was the only significantly different conventional tumor metric between Rag2+/− (TLs present) and Rag2−/− (TL-deficient) tumors. The RFs further enabled differentiation between Rag2+/− and Rag2−/− tumors. The PCD-derived RFs provided the highest accuracy (0.68) followed by decomposition-derived RFs (0.60) and the EID-derived RFs (0.58). Such non-invasive approaches could aid in tumor stratification for cancer therapy studies. Full article
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11 pages, 1286 KiB  
Article
Ipsilateral Recurrence of DCIS in Relation to Radiomics Features on Contrast Enhanced Breast MRI
by Ga Eun Park, Sung Hun Kim, Eun Byul Lee, Yoonho Nam and Wonmo Sung
Tomography 2022, 8(2), 596-606; https://doi.org/10.3390/tomography8020049 - 1 Mar 2022
Cited by 6 | Viewed by 2808
Abstract
The purpose of this retrospective study was to investigate the association between ipsilateral recurrence of ductal carcinoma in situ (DCIS) and radiomics features from DCIS and contralateral normal breast on contrast enhanced breast MR imaging. A total of 163 patients with DCIS who [...] Read more.
The purpose of this retrospective study was to investigate the association between ipsilateral recurrence of ductal carcinoma in situ (DCIS) and radiomics features from DCIS and contralateral normal breast on contrast enhanced breast MR imaging. A total of 163 patients with DCIS who underwent preoperative MR imaging between January 2010 and December 2014 were included (training cohort; n = 117, validation cohort; n = 46). Radiomics features were extracted from whole tumor volume of DCIS on early dynamic T1-subtraction images and from the contralateral normal breast on precontrast T1 and early dynamic T1-subtraction images. After feature selection, a Rad-score was established by LASSO Cox regression model. Performance of Rad-score was evaluated by the receiver operating characteristic (ROC) curve and Kaplan Meier curve with log rank test. The Rad-score was significantly associated with ipsilateral recurrence free survival (RFS). The low-risk group with a low Rad-score showed higher ipsilateral RFS than the high-risk group with a high Rad-score in both training and validation cohorts (p < 0.01). The Rad-score based on radiomics features from DCIS and contralateral normal breast on breast MR imaging showed the potential for prediction of ipsilateral RFS of DCIS. Full article
(This article belongs to the Special Issue Quantitative Imaging in Oncology)
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15 pages, 1989 KiB  
Article
AI-Radiomics Can Improve Inclusion Criteria and Clinical Trial Performance
by Michal R. Tomaszewski, Shuxuan Fan, Alberto Garcia, Jin Qi, Youngchul Kim, Robert A. Gatenby, Matthew B. Schabath, William D. Tap, Denise K. Reinke, Rikesh J. Makanji, Damon R. Reed and Robert J. Gillies
Tomography 2022, 8(1), 341-355; https://doi.org/10.3390/tomography8010028 - 2 Feb 2022
Cited by 5 | Viewed by 3507
Abstract
Purpose: Success of clinical trials increasingly relies on effective selection of the target patient populations. We hypothesize that computational analysis of pre-accrual imaging data can be used for patient enrichment to better identify patients who can potentially benefit from investigational agents. Methods: This [...] Read more.
Purpose: Success of clinical trials increasingly relies on effective selection of the target patient populations. We hypothesize that computational analysis of pre-accrual imaging data can be used for patient enrichment to better identify patients who can potentially benefit from investigational agents. Methods: This was tested retrospectively in soft-tissue sarcoma (STS) patients accrued into a randomized clinical trial (SARC021) that evaluated the efficacy of evofosfamide (Evo), a hypoxia activated prodrug, in combination with doxorubicin (Dox). Notably, SARC021 failed to meet its overall survival (OS) objective. We tested whether a radiomic biomarker-driven inclusion/exclusion criterion could have been used to improve the difference between the two arms (Evo + Dox vs. Dox) of the study. 164 radiomics features were extracted from 296 SARC021 patients with lung metastases, divided into training and test sets. Results: A single radiomics feature, Short Run Emphasis (SRE), was representative of a group of correlated features that were the most informative. The SRE feature value was combined into a model along with histological classification and smoking history. This model as able to identify an enriched subset (52%) of patients who had a significantly longer OS in Evo + Dox vs. Dox groups [p = 0.036, Hazard Ratio (HR) = 0.64 (0.42–0.97)]. Applying the same model and threshold value in an independent test set confirmed the significant survival difference [p = 0.016, HR = 0.42 (0.20–0.85)]. Notably, this model was best at identifying exclusion criteria for patients most likely to benefit from doxorubicin alone. Conclusions: The study presents a first of its kind clinical-radiomic approach for patient enrichment in clinical trials. We show that, had an appropriate model been used for selective patient inclusion, SARC021 trial could have met its primary survival objective for patients with metastatic STS. Full article
(This article belongs to the Special Issue Quantitative Imaging Network)
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29 pages, 11134 KiB  
Review
MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal
by Tullio Valente, Giacomo Sica, Giorgio Bocchini, Federica Romano, Francesco Lassandro, Gaetano Rea, Emanuele Muto, Antonio Pinto, Francesca Iacobellis, Paola Crivelli, Ahmad Abu-Omar and Mariano Scaglione
Tomography 2022, 8(1), 200-228; https://doi.org/10.3390/tomography8010017 - 13 Jan 2022
Cited by 12 | Viewed by 9828
Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic [...] Read more.
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step. Full article
(This article belongs to the Special Issue Imaging in Non-Traumatic Emergencies)
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11 pages, 2290 KiB  
Article
Deep Learning Using Multiple Degrees of Maximum-Intensity Projection for PET/CT Image Classification in Breast Cancer
by Kanae Takahashi, Tomoyuki Fujioka, Jun Oyama, Mio Mori, Emi Yamaga, Yuka Yashima, Tomoki Imokawa, Atsushi Hayashi, Yu Kujiraoka, Junichi Tsuchiya, Goshi Oda, Tsuyoshi Nakagawa and Ukihide Tateishi
Tomography 2022, 8(1), 131-141; https://doi.org/10.3390/tomography8010011 - 5 Jan 2022
Cited by 15 | Viewed by 4503
Abstract
Deep learning (DL) has become a remarkably powerful tool for image processing recently. However, the usefulness of DL in positron emission tomography (PET)/computed tomography (CT) for breast cancer (BC) has been insufficiently studied. This study investigated whether a DL model using images with [...] Read more.
Deep learning (DL) has become a remarkably powerful tool for image processing recently. However, the usefulness of DL in positron emission tomography (PET)/computed tomography (CT) for breast cancer (BC) has been insufficiently studied. This study investigated whether a DL model using images with multiple degrees of PET maximum-intensity projection (MIP) images contributes to increase diagnostic accuracy for PET/CT image classification in BC. We retrospectively gathered 400 images of 200 BC and 200 non-BC patients for training data. For each image, we obtained PET MIP images with four different degrees (0°, 30°, 60°, 90°) and made two DL models using Xception. One DL model diagnosed BC with only 0-degree MIP and the other used four different degrees. After training phases, our DL models analyzed test data including 50 BC and 50 non-BC patients. Five radiologists interpreted these test data. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Our 4-degree model, 0-degree model, and radiologists had a sensitivity of 96%, 82%, and 80–98% and a specificity of 80%, 88%, and 76–92%, respectively. Our 4-degree model had equal or better diagnostic performance compared with that of the radiologists (AUC = 0.936 and 0.872–0.967, p = 0.036–0.405). A DL model similar to our 4-degree model may lead to help radiologists in their diagnostic work in the future. Full article
(This article belongs to the Special Issue Artificial Intelligence in Breast Cancer Screening)
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