Daniela B. Husarik

18F-choline and/or 11C-acetate positron emission tomography : detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/ml) after radical prostatectomy

To assess the value of positron emission tomography (PET)/computed tomography (CT) with either 18F‐choline and/or 11C‐acetate, of residual or recurrent tumour after radical prostatectomy (RP) in patients with a prostate‐specific antigen (PSA) level of <1 ng/mL and referred for adjuvant or salvage radiotherapy.

Towards task-based assessment of CT performance: System and object MTF across different reconstruction algorithms

PURPOSE To investigate a measurement method for evaluating the resolution properties of CT imaging systems across reconstruction algorithms, dose, and contrast. METHODS An algorithm was developed to extract the task-based modulation transfer function (MTF) from disk images generated from the rod inserts in the ACR phantom (model 464 Gammex, WI). These inserts are conventionally employed for HU accuracy assessment. The edge of the disk objects was analyzed to determine the edge-spread function, which was differentiated to yield the line-spread function and Fourier-transformed to generate the object-specific MTF for task-based assessment, denoted MTFTask . The proposed MTF measurement method was validated against the conventional wire technique and further applied to measure the MTF of CT images reconstructed with an adaptive statistical iterative algorithm (ASIR) and a model-based iterative (MBIR) algorithm. Results were further compared to the standard filtered back projection (FBP) algorithm. Measurements were performed and compared across different doses and contrast levels to ascertain the MTFTask dependencies on those factors. RESULTS For the FBP reconstructed images, the MTFTask measured with the inserts were the same as the MTF measured from the wire-based method. For the ASIR and MBIR data, the MTFTask using the high contrast insert was similar to the wire-based MTF and equal or superior to that of FBP. However, results for the MTFTask measured using the low-contrast inserts, the MTFTask for ASIR and MBIR data was lower than for the FBP, which was constant throughout all measurements. Similarly, as a function of mA, the MTFTask for ASIR and MBIR varied as a function of noise--with MTFTask being proportional to mA. Overall greater variability of MTFTask across dose and contrast was observed for MBIR than for ASIR. CONCLUSIONS This approach provides a method for assessing the task-based MTF of a CT system using conventional and iterative reconstructions. Results demonstrated that the object-specific MTF can vary as a function of dose and contrast. The analysis highlighted the paradigm shift for iterative reconstructions when compared to FBP, where iterative reconstructions generally offer superior noise performance but with varying resolution as a function of dose and contrast. The MTFTask generated by this method is expected to provide a more comprehensive assessment of image resolution across different reconstruction algorithms and imaging tasks.PURPOSE To investigate a measurement method for evaluating the resolution properties of CT imaging systems across reconstruction algorithms, dose, and contrast. METHODS An algorithm was developed to extract the task-based modulation transfer function (MTF) from disk images generated from the rod inserts in the ACR phantom (model 464 Gammex, WI). These inserts are conventionally employed for HU accuracy assessment. The edge of the disk objects was analyzed to determine the edge-spread function, which was differentiated to yield the line-spread function and Fourier-transformed to generate the object-specific MTF for task-based assessment, denoted MTF(Task). The proposed MTF measurement method was validated against the conventional wire technique and further applied to measure the MTF of CT images reconstructed with an adaptive statistical iterative algorithm (ASIR) and a model-based iterative (MBIR) algorithm. Results were further compared to the standard filtered back projection (FBP) algorithm. Measurements were performed and compared across different doses and contrast levels to ascertain the MTF(Task) dependencies on those factors. RESULTS For the FBP reconstructed images, the MTF(Task) measured with the inserts were the same as the MTF measured from the wire-based method. For the ASIR and MBIR data, the MTF(Task) using the high contrast insert was similar to the wire-based MTF and equal or superior to that of FBP. However, results for the MTF(Task) measured using the low-contrast inserts, the MTF(Task) for ASIR and MBIR data was lower than for the FBP, which was constant throughout all measurements. Similarly, as a function of mA, the MTF(Task) for ASIR and MBIR varied as a function of noise--with MTF(Task) being proportional to mA. Overall greater variability of MTF(Task) across dose and contrast was observed for MBIR than for ASIR. CONCLUSIONS This approach provides a method for assessing the task-based MTF of a CT system using conventional and iterative reconstructions. Results demonstrated that the object-specific MTF can vary as a function of dose and contrast. The analysis highlighted the paradigm shift for iterative reconstructions when compared to FBP, where iterative reconstructions generally offer superior noise performance but with varying resolution as a function of dose and contrast. The MTF(Task) generated by this method is expected to provide a more comprehensive assessment of image resolution across different reconstruction algorithms and imaging tasks.

Elbow Nerves: MR Findings in 60 Asymptomatic Subjects—Normal Anatomy, Variants, and Pitfalls

PURPOSE To prospectively evaluate the signal intensity (SI), course, and diameter of elbow nerves and to identify anatomic variants that are potentially associated with nerve compression syndromes on magnetic resonance (MR) images of asymptomatic elbows. MATERIALS AND METHODS This study was approved by the institutional review board. Informed consent was obtained from each volunteer. Sixty subjects with asymptomatic elbows (age range, 22.4-51.7 years; median age, 32.8 years) underwent MR imaging. Increased SI compared with surrounding muscles on fluid-sensitive MR images, anatomic course, anatomic nerve and muscle variants potentially associated with nerve compression syndromes, and qualitative changes in nerve diameters were evaluated. Quantitative data on the shortest and longest nerve diameters were obtained. RESULTS Increased SI on fluid-sensitive MR images was seen in the ulnar nerve in 60% (36 of 60) of subjects but was never observed in the median and radial nerves. An atypical intermuscular course of the median nerve between the brachialis and pronator muscles was detected in 17% (10 of 60) of subjects. Ulnar nerve subluxation at the level of the cubital tunnel was seen in 2% (one of 60) of subjects; an anconeus epitrochlearis muscle, in 23% (14 of 60); and a hypertrophic leash of Henry, in 15% (nine of 60). Median nerve dimensions were 2.4 x 4.0 mm (range, 1.0-4.0 x 3.0-7.0 mm) for the ulnar nerve, 1.0 x 1.9 mm (range, 0.8-2.0 x 0.9-5.0 mm) for the radial nerve, and 3.0 x 5.4 mm (range, 1.0-5.0 x 3.0-9.0 mm) for the median nerve. CONCLUSION Increased SI of the ulnar nerve on fluid-sensitive images (60%), an atypical intermuscular course of the median nerve (17%), and an anconeus epitrochlearis muscle (23%) are common MR findings in asymptomatic elbows.

Ultralow-dose chest computed tomography for pulmonary nodule detection: first performance evaluation of single energy scanning with spectral shaping.

PurposeThe purpose of this study was to evaluate the image quality and sensitivity of ultralow radiation dose single-energy computed tomography (CT) with tin filtration for spectral shaping and iterative reconstructions for the detection of pulmonary nodules in a phantom setting. MethodsSingle-energy CT was performed using third-generation dual-source CT (SOMATOM Force; 2 × 192 slices) at 70 kVp, 100 kVp with tin filtration (100Sn kVp), and 150Sn kV with tube current-time product adjustments resulting in standard dose (CT volume dose index, 3.1 mGy/effective dose, 1.3 mSv at a scan length of 30 cm), 1/10th dose level (0.3 mGy/0.13 mSv), and 1/20th dose level (0.15 mGy/0.06 mSv). An anthropomorphic chest phantom simulating an intermediate-sized adult with randomly distributed solid pulmonary nodules of various sizes (2–10 mm; attenuation, 75 HU at 120 kVp) was used. Images were reconstructed with advanced model-based iterative reconstruction (ADMIRE; strength levels 3 and 5) and were compared with those acquired with second-generation dual-source CT at 120 kVp (reconstructed with filtered back projection) and sinogram-affirmed iterative reconstruction (strength level 3) at the lowest possible dose at 120 kVp (CT volume dose index, 0.28 mGy). One blinded reader measured image noise, and 2 blinded, independent readers determined overall image quality on a 5-grade scale (1 = nondiagnostic to 5 = excellent) and marked nodule localization with confidence rates on a 5-grade scale (1 = unsure to 5 = high confidence). The constructional drawing of the phantom served as reference standard for calculation of sensitivity. Two patients were included, for proof of concept, who were scanned with the 100Sn kVp protocol at the 1/10th and 1/20th dose level. ResultsImage noise was highest in the images acquired with second-generation dual-source CT and reconstructed with filtered back projection. At both the 1/10th and 1/20th dose levels, image noise at a tube voltage of 100Sn kVp was significantly lower than in the 70 kVp and 150Sn kV data sets (ADMIRE 3, P < 0.01; ADMIRE 5, P < 0.05). Sensitivity of nodule detection was lowest in images acquired with second-generation dual-source CT at 120 kVp and the lowest possible dose. Protocols at 100Sn kVp and ADMIRE 5 showed highest sensitivity at the 1/10th and 1/20th dose levels. Highest numbers of false-positives occurred in second-generation dual-source CT images (range, 12–15), whereas lowest numbers occurred in the 1/10th and 1/20th dose data sets acquired with third-generation dual-source CT at 100Sn kVp and reconstructed with ADMIRE strength levels 3 and 5 (total of 1 and 0 false-positives, respectively). Diagnostic confidence at 100Sn kVp was significantly higher than at 70 kVp or 150Sn kV (ADMIRE 3, P < 0.05; ADMIRE 5, P < 0.01) at both the 1/10th and 1/20th dose levels. Images of the 2 patients scanned with 100Sn kVp at the 1/10th and 1/20th dose levels were of diagnostic quality. ConclusionsOur study suggests that chest CT for the detection of pulmonary nodules can be performed with third-generation dual-source CT producing high image quality, sensitivity, and diagnostic confidence at a very low effective radiation dose of 0.06 mSv when using a single-energy protocol at 100 kVp with spectral shaping and when using advanced iterative reconstruction techniques.

Characterization of Focal Bone Lesions in the Axial Skeleton: Performance of Planar Bone Scintigraphy Compared with SPECT and SPECT Fused with CT

OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of planar 99mTc methylene diphosphonate bone scintigraphy compared with SPECT and SPECT fused with CT in patients with focal bone lesions of the axial skeleton. SUBJECTS AND METHODS Thirty-seven patients with 42 focal lesions of the axial skeleton were included in this prospective study. All patients underwent planar scintigraphy, SPECT through the focal lesions, and SPECT-guided CT. SPECT and CT images then were fused digitally. The three types of images were evaluated separately from one another by two experienced reviewers working to consensus. Visibility of the lesions, diagnostic performance, and certainty in diagnosis were evaluated. Performance for specific diagnoses also was evaluated. Histologic, MRI, and clinical follow-up findings were used as the reference standard. RESULTS Visibility of the lesions was significantly better with SPECT than with planar scintigraphy (p < 0.0001). Sensitivity and specificity for differentiation of benign and malignant bone lesions were 82% and 94% for planar scintigraphy, 91% and 94% for SPECT, and 100% and 100% for SPECT fused with CT. Differences between the three methods of differentiating benign and malignant lesions did not reach statistical significance. Certainty in diagnosis was significantly higher for SPECT fused with CT than for planar scintigraphy (p = 0.004) and SPECT (p = 0.004). A specific diagnosis was made with planar scintigraphy in 64% of cases, with SPECT in 86%, and with SPECT fused with CT in all cases. CONCLUSION Planar scintigraphy may suffice for differentiating benign and malignant lesions of the axial skeleton, but SPECT fused with CT significantly increases certainty in diagnosis and is the best tool for making a specific diagnosis.

Liver MRI in the hepatocyte phase with gadolinium-EOB-DTPA: Does increasing the flip angle improve conspicuity and detection rate of hypointense lesions?

To compare conspicuity and detection rate of hypointense lesions on T1‐weighted (T1w) gradient echo (GRE) sequences with low and high flip angles (FA) in hepatocyte phase magnetic resonance imaging (MRI) using gadoxetate disodium.

Radiation dose reduction in abdominal computed tomography during the late hepatic arterial phase using a model-based iterative reconstruction algorithm: how low can we go?

ObjectiveThe aim of this study was to compare the image quality of abdominal computed tomography scans in an anthropomorphic phantom acquired at different radiation dose levels where each raw data set is reconstructed with both a standard convolution filtered back projection (FBP) and a full model-based iterative reconstruction (MBIR) algorithm. Materials and MethodsAn anthropomorphic phantom in 3 sizes was used with a custom-built liver insert simulating late hepatic arterial enhancement and containing hypervascular liver lesions of various sizes. Imaging was performed on a 64-section multidetector-row computed tomography scanner (Discovery CT750 HD; GE Healthcare, Waukesha, WI) at 3 different tube voltages for each patient size and 5 incrementally decreasing tube current–time products for each tube voltage. Quantitative analysis consisted of contrast-to-noise ratio calculations and image noise assessment. Qualitative image analysis was performed by 3 independent radiologists rating subjective image quality and lesion conspicuity. ResultsContrast-to-noise ratio was significantly higher and mean image noise was significantly lower on MBIR images than on FBP images in all patient sizes, at all tube voltage settings, and all radiation dose levels (P < 0.05). Overall image quality and lesion conspicuity were rated higher for MBIR images compared with FBP images at all radiation dose levels. Image quality and lesion conspicuity on 25% to 50% dose MBIR images were rated equal to full-dose FBP images. ConclusionThis phantom study suggests that depending on patient size, clinically acceptable image quality of the liver in the late hepatic arterial phase can be achieved with MBIR at approximately 50% lower radiation dose compared with FBP.

Hepatobiliary transit times of gadoxetate disodium (Primovist®) for protocol optimization of comprehensive MR imaging of the biliary system—What is normal?

OBJECTIVE The purpose of this study was to determine transit times for excretion of Gd-EOB-DTPA into different segments of the hepatobiliary system in patients with normal liver function. METHODS This retrospective study was IRB approved with a waiver of consent granted. 61 patients (39 female, 22 male, mean age 52.5 years) with normal liver and renal function who underwent contrast enhanced hepatic MRI after injection of 10 mL Gd-EOB-DTPA at 1.5T and 3T were included. Two readers evaluated all delayed images (3-20 min post contrast) for the presence of contrast agent in the intrahepatic bile ducts (IBD), the common bile duct (CBD), the gallbladder and the duodenum. A two-tailed, unpaired Students t-test with p<0.05 deemed significant was used to determine whether transit times were affected by patient gender, age or body mass index. RESULTS 20 min after contrast initiation, Gd-EOB-DTPA could be detected in the IBD and the CBD in all patients (100%); gallbladder reflux was visible in 53 (86.9%), duodenal excretion in 40 patients (65.5%), respectively. Mean transit times for contrast appearance in the various segments were as follows: IBD 12 min 13s; CBD 12 min 27 s; gallbladder 13 min 32s. Transit times were not significantly affected by patient gender, age or BMI. CONCLUSION Within 20 min post contrast initiation, Gd-EOB-DTPA can be expected in the IBD and the CBD in patients with normal liver function. However, functional information about the sphincter Oddi complex can be ascertained only in about two thirds of these patients within this timeframe.

Advanced modelled iterative reconstruction for abdominal CT: Qualitative and quantitative evaluation

AIM To determine qualitative and quantitative image-quality parameters in abdominal imaging using advanced modelled iterative reconstruction (ADMIRE) with third-generation dual-source 192 section CT. MATERIALS AND METHODS Forty patients undergoing abdominal portal-venous CT at different tube voltage levels (90, 100, 110, and 120 kVp, n = 10 each) and 10 consecutive patients undergoing abdominal non-enhanced low-dose CT (100 kVp, 60 mAs) using a third-generation dual-source 192 section CT machine in the single-source mode were included. Images were reconstructed with filtered back projection (FBP) and ADMIRE (strength levels 1-5). Two blinded, independent readers subjectively determined image noise, artefacts, visibility of small structures, and image contrast, and measured attenuation in the liver, spleen, kidney, muscle, fat, and urinary bladder, and objective image noise. RESULTS Subjective noise was significantly lower and image contrast significantly higher for each increasing ADMIRE strength level and also for ADMIRE 1 compared to FBP (all, p < 0.001). No significant differences were found for artefact and visibility ratings among image sets (all, p > 0.05). Attenuation was similar across tube voltage-image datasets in all anatomical regions (all, p > 0.05). Objective noise was significantly lower for each increasing ADMIRE strength level, and for ADMIRE 1 compared to FBP (all, p < 0.001, maximal reduction 53%). Independent predictors of noise were tube voltage (p < 0.05) and current (p < 0.001), diameter (p < 0.05), and reconstruction algorithm (p<0.001); the amount of noise reduction was related only to the reconstruction algorithm (p < 0.001). CONCLUSION Abdominal CT using ADMIRE results in an improved image quality with lower image noise as compared with FBP, while the attenuation of various anatomical regions remains constant among reconstruction algorithms.

Ligaments and Plicae of the Elbow: Normal MR Imaging Variability in 60 Asymptomatic Subjects

PURPOSE To prospectively evaluate the normal variability of ligaments, plicae, and the posterior capitellum on conventional magnetic resonance (MR) images of the elbow in asymptomatic volunteers. MATERIALS AND METHODS The study was approved by the institutional ethics board, and informed consent was obtained from all subjects. MR imaging was performed at 1.5 T in 60 asymptomatic volunteers (30 women, 30 men; age range, 22-51 years; median age, 32.8 years) by using the following five pulse sequences: transverse T1-weighted spin-echo, sagittal T2-weighted fast spin-echo, coronal fast spin-echo short-inversion-time inversion recovery, transverse intermediate-weighted with fat saturation, and coronal three-dimensional water-excitation true fast imaging with steady-state precession. The visibility (completely visible over the entire course, partially visible, or not visible) and signal intensity characteristics (hypointense or hyperintense to muscle, homogeneous signal intensity vs striation) of the elbow ligaments and plicae were evaluated by three independent readers. The presence of pseudodefects at the posterior capitellum was determined. The dimensions of all structures were measured by two independent readers. RESULTS The anterior ulnar collateral ligament (UCL) and radial collateral ligament (RCL) were visible over their entire course in all 60 subjects (100%). The posterior UCL, lateral UCL, and annular ligament (AL) were completely visible in 58 (97%), 51 (85%), and 59 (98%) of the 60 subjects, respectively, and partially visible in the remaining subjects. Increased signal intensity with fluid-sensitive sequences was found in the anterior UCL in nine of the 60 subjects (15%), posterior UCL in four subjects (7%), RCL in one subject (2%), lateral UCL in six subjects (10%), and AL in one subject (2%). The median thickness and 90th percentile were 2.5 and 3.5 mm, respectively, for the anterior UCL, 1.0 and 1.7 mm for the posterior UCL, 1.9 and 2.8 mm for the RCL, 2.3 and 3.8 mm for the lateral UCL, and 1.0 and 1.3 mm for the AL. A posterolateral plica (median dimension, 4.3 × 1.9 × 3.9 mm) was found in 59 of the 60 subjects (98%), whereas a posterior plica (median dimension, 1.8 × 1.4 mm) could be detected in only 20 (33%). A pseudodefect of the capitellum was noted in 51 of the 60 subjects (85%). CONCLUSION The elbow ligaments and the posterolateral plica are consistently visible on conventional MR images of asymptomatic subjects. Most normal ligaments are thinner than 4 mm, and most plicae are thinner than 3 mm.