Takashi Ueguchi

Uterine Tumors: Comparison of 3D versus 2D T2-weighted Turbo Spin-Echo MR Imaging at 3.0 T—Initial Experience

PURPOSE To compare a three-dimensional (3D) T2-weighted turbo spin-echo (TSE) magnetic resonance (MR) sequence (VISTA; Philips Medical Systems, Best, the Netherlands) with a two-dimensional (2D) T2-weighted TSE sequence in terms of image quality, signal intensity (SI) difference ratios, conspicuity, and staging of uterine tumors. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. Sixty-one women (mean age, 53.0 years ± 13.7 [standard deviation]; range, 30-87 years) with cervical carcinoma (n = 28), endometrial carcinoma (n = 21), or leiomyoma (n = 30) of the uterus were included. Patients underwent T2-weighted MR imaging at 3 T with both 1-mm-thick 3D and 5-mm-thick 2D T2-weighted TSE sequences. Three-dimensional T2-weighted TSE images were reconstructed at 5-mm thickness with the aid of a workstation. Quantitative analyses of signal-to-noise ratio (SNR) and SI difference ratios between tumors and other tissues and qualitative analyses of image quality and tissue conspicuity were performed. Two radiologists independently assessed local-regional staging for carcinomas. Quantitative values, qualitative scores, and tumor staging were analyzed by using the paired t test, Wilcoxon signed rank test, and McNemar test, respectively. RESULTS Mean myometrial SNR was higher on 3D than 2D images (14.3 vs 9.8; P < .0001). Mean SI difference ratios between cervical (0.45 vs 0.34; P < .0001) or endometrial (0.46 vs 0.40; P = .044) carcinomas and gluteal muscle were higher on 3D images, but those between leiomyoma and myometrium (0.33 vs 0.43; P < .0001) were lower than those on 2D images. Image quality (P = .0004) and carcinoma conspicuity (P < .0005) were superior with the 3D T2-weighted TSE sequence. Although multiplanar reconstruction of 3D T2-weighted TSE images was useful for staging in one case, there were no significant differences between 3D and 2D T2-weighted TSE imaging in accuracy of staging for the two readers for cervical or endometrial carcinoma. CONCLUSION The 3D T2-weighted TSE sequence showed certain advantages over the 2D T2-weighted TSE sequence, and it has the potential to improve the performance of MR imaging for the evaluation of uterine carcinoma.

Quantitative Evaluation of Cerebral Blood Flow and Oxygen Metabolism in Normal Anesthetized Rats: 15O-Labeled Gas Inhalation PET with MRI Fusion

PET with 15O gas has been used for the quantitative measurement of cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF), and cerebral blood volume (CBV) in humans. However, several technical difficulties limit its use in experiments on small animals. Herein, we describe the application of the 15O gas steady-state inhalation method for normal anesthetized rats. Methods: Eight normal male Sprague–Dawley rats (mean body weight ± SD, 268 ± 14 g) under anesthesia were investigated by 15O-labeled gas PET. After tracheotomy, an airway tube was placed in the trachea, and the animals were connected to a ventilator (tidal volume, 3 cm3; frequency, 60/min). The CBF and OEF were measured according to the original steady-state inhalation technique under artificial ventilation with 15O-CO2 and 15O-O2 gases delivered through the radioactive gas stabilizer. CBV was measured by 15O-CO gas inhalation and corrected for the intravascular hemoglobin-bound 15O-O2. Arterial blood sampling was performed during each study to measure the radioactivity of the whole blood and plasma. MR image was performed with the same acrylic animal holder immediately after the PET. Regions of interest were placed on the whole brain of the PET images with reference to the semiautomatically coregistered PET/MR fused images. Results: The data acquisition time for the whole PET experiment in each rat was 73.3 ± 5.8 (range, 68–85) min. In both the 15O-CO2 and the 15O-O2 studies, the radioactivity count of the brain reached a steady state by approximately 10 min after the start of continuous inhalation of the gas. The quantitative PET data of the whole brain were as follows: CBF, 32.3 ± 4.5 mL/100 mL/min; CMRO2, 3.23 ± 0.42 mL/100 mL/min; OEF, 64.6% ± 9.1%; and CBV, 5.05 ± 0.45 mL/100 mL. Conclusion: Although further technical improvements may be needed, this study demonstrated the feasibility of quantitative PET measurement of CBF, OEF, and CMRO2 using the original steady-state inhalation method of 15O-CO2 and 15O-O2 gases and measurement of CBV using the 15O-CO gas inhalation method in the brain of normal anesthetized rats.

Gemstone spectral imaging: Determination of CT to ED conversion curves for radiotherapy treatment planning

The monochromatic images acquired by Gemstone spectral imaging (GSI) mode on the GE CT750 HD theoretically determines the computed tomography (CT) number more accurately than that of conventional scanner. Using the former, the CT number is calculated from (synthesized) monoenergetic X‐ray data. We reasoned that the monochromatic image might be applied to radiotherapy treatment planning (RTP) to calculate dose distribution more accurately. Our goal here was to provide CT to electron density (ED) conversion curves with monochromatic images for RTP. Therefore, we assessed the reproducibility of CT numbers, an important factor on quality assurance, over short and long time periods for different substances at varying energy. CT number difference between measured and theoretical value was investigated. The scanner provided sufficient reproducibility of CT numbers for dose calculation over short and long time periods. The CT numbers of monochromatic images produced by this scanner had reasonable values for dose calculation. The CT to ED conversion curve becomes linear with respect to the relationship between CT numbers and EDs as the energy increases. We conclude that monochromatic imaging from a fast switching system can be applied for the dose calculation, keeping Hounsfield units (HU) stability. PACS numbers: 87.55.‐x, 87.55.ne, 87.57.N‐, 87.59.bd

Quantitative analysis for computed tomography findings of various diffuse lung diseases using volume histogram analysis.

Objectives: The aim of this study was to achieve the quantitative analysis of the characteristic computed tomography (CT) findings and course of interstitial pneumonia using the volume histogram method. Methods: Contrast (CNT), variance (VAR), and entropy (EPY) values from whole-lung volume data were compared between normal lungs and 5 diseases that have characteristic CT findings. Thirteen cases with nonspecific interstitial pneumonia (NSIP) were evaluated before and after treatment. Results: In cases with thickening of the bronchovascular bundles and interlobular thickening, ground-glass attenuation, airspace consolidation, and honeycombing, the values of VAR and EPY were greater than those in the normal cases (P < 0.05). In the cases with NSIP, the CNT value after treatment was significantly greater and the values of VAR and EPY after treatment were significantly lower than those before treatment (P < 0.05). Conclusions: Volume histogram analysis is a promising method for the evaluation of diffuse lung diseases and the effectiveness of treatment.

Radiotherapy treatment planning with contrast-enhanced computed tomography: feasibility of dual-energy virtual unenhanced imaging for improved dose calculations

BackgroundIn radiotherapy treatment planning, intravenous administration of an iodine-based contrast agent during computed tomography (CT) improves the accuracy of delineating target volumes. However, increased tissue attenuation resulting from the high atomic number of iodine may result in erroneous dose calculations because the contrast agent is absent during the actual procedure. The purpose of this proof-of-concept study was to present a novel framework to improve the accuracy of dose calculations using dual-energy virtual unenhanced CT in the presence of an iodine-based contrast agent.MethodsSimple phantom experiments were designed to assess the feasibility of the proposed concept. By utilizing a “second-generation” dual-source CT scanner equipped with a tin filter for improved spectral separation, four CT datasets were obtained using both a water phantom and an iodine phantom: “true unenhanced” images with attenuation values of 2 ± 11 Hounsfield Units (HU), “enhanced” images with attenuation values of 274 ± 23 HU, and two series of “virtual unenhanced” images synthesized from dual-energy scans of the iodine phantom, each with a different combination of tube voltages. Two series of virtual unenhanced images demonstrated attenuation values of 12 ± 29 HU (with 80 kVp/140 kVp) and 34 ± 10 HU (with 100 kVp/140 kVp) after removing the iodine component from the contrast-enhanced images. Dose distributions of the single photon beams calculated from the enhanced images and two series of virtual unenhanced images were compared to those from true unenhanced images as a reference.ResultsThe dose distributions obtained from both series of virtual unenhanced images were almost equivalent to that from the true unenhanced images, whereas the dose distribution obtained from the enhanced images indicated increased beam attenuation caused by the high attenuation characteristics of iodine. Compared to the reference dose distribution from the true unenhanced images, the dose distribution pass rates from both series of virtual unenhanced images were greater than 90%, while those from the enhanced images were less than approximately 50–60%.ConclusionsDual-energy virtual unenhanced CT improves the accuracy of dose distributions in radiotherapy treatment planning by removing the iodine component from contrast-enhanced images.

Usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics applied to description of Extracranial Arteriovenous Malformations: Initial Experience

PURPOSE The purpose of this study was to evaluate the usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics (TRICKS-MRA) to demonstrate extracranial arteriovenous malformations (E-AVMs). MATERIALS AND METHODS TRICKS-MRA was performed in 33 patients (adults; n = 30, children; n = 3) with E-AVMs. Four different scan protocols were arranged based on the size of E-AVM, and serial images were acquired from the start of contrast injection with a time frame ranging from 1.2 to 7.1s. Demonstration of feeding arteries and drainage veins, and the extent of nidus was qualitatively graded using a three-point scale. In sixteen patients who underwent DSA 3 days to 15 months after TRICKS-MRA, the comparability of TRICKS-MRA to DSA was evaluated using a three-point scale. In each category, score of 3 or excellent was defined as the positive result. RESULTS Demonstration of the feeding arteries, the drainage veins, and the extent of nidus were graded as excellent in 68%, 65%, and 58% of the patients, respectively. Comparability of TRICKS-MRA to DSA was excellent in 75%, 88%, and 88% of the sixteen patients who underwent DSA. CONCLUSION TRICKS-MRA is a feasible and useful vascular imaging technique to provide time-resolved analysis of angioarchitecture of E-AVMs.

Volume histogram analysis for lung thin-section computed tomography: differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia.

Objective: The aim of this study was to evaluate volume histogram analysis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Methods: Sixty cases (UIP, n = 22; NSIP, n = 38) were evaluated retrospectively. Three parameters (contrast, variance, and entropy) were calculated in 3 types of regions of interest (ROIs): (a) whole lung, (b) right lower lobe, and (c) cubic ROIs. To evaluate the influence of extent of abnormal findings, the numbers of voxels with low or high density in whole lung were compared with the 3 parameters. Result: No significant differences were observed between the ROIs of whole lung and the right lower lobe. In all cubic ROIs, entropy in UIP was larger than that in NSIP (P < 0.001). The numbers of voxels with low-density areas significantly correlated with the values of contrast and entropy, whereas those with high-density areas significantly correlated with all 3 parameters. Conclusion: Volume histogram analysis for cubic ROIs may be feasible for differentiating between UIP and NSIP.

Novel display technique for reference images for visibility of temporal change on radiographs--color digital summation radiography.

PurposeThe present study investigated color digital summation radiography (CDSR) as a novel display technique for reference images for the visibility of temporal change on radiographs. In CDSR, only the parts with temporal differences are displayed in color. Moreover, all other parts are displayed in gray scale.Materials and MethodsCDSR was defined as “radiographs combined by the additive color mixture method”. The visibility of simulated nodules located in the lung fields and mediastinum was evaluated by 12 radiologists (mean experience, 9.8 years; range, 1–26 years) for 24 conventional radiographs and CDSR for 6 color patterns. A five-point rating system (5, very good; 4, good; 3, adequate; 2, poor; 1, very poor) was used.ResultsThe mean scores (average±standard deviation) for the visibility of simulated nodules were as follows: magenta, 3.88±0.90; blue, 3.08±0.72; green, 3.04±0.86; red, 3.00±0.98; cyan, 2.71±0.86; and yellow, 2.50±0.72. Compared to conventional radiography in gray scale, at 1.21±0.41, all six color patterns for CDSR displayed significantly improved scores (p<0.001).ConclusionCDSR might represent a useful technique for reference images from chest digital radiography.

Breast diffusion-weighted MRI: comparison of tetrahedral versus orthogonal diffusion sensitization for detection and localization of mass lesions.

To evaluate the potential of tetrahedral diffusion‐weighted imaging (DWI) compared to orthogonal DWI for detection and localization of early enhanced breast mass lesions at 1.5T.

Evaluation of usefulness of color digital summation radiography for solitary pulmonary nodules on chest radiographs.

PurposeThe aim of this study was to evaluate the usefulness of novel color digital summation radiography (CDSR) for detecting solitary pulmonary nodules on chest radiographs by observers with different levels of experience.Materials and methodsA total of 30 healthy controls and 30 patients with newly detected solitary pulmonary nodules were evaluated. Six radiologists and five residents evaluated three image sets: set A, current and prior radiographs only; set B, set A with temporal subtraction images; and set C, set A with CDSR. The observers were asked to rate each image set using a continuous rating scale. In addition, the reading time required for each set was recorded.ResultsThe radiologists showed no significant differences in the mean Az value between set A, set B, and set C. However, the residents showed significant differences between set A and set B and between set A and set C. In addition, for set B and set C, the mean reading time per case of all readers was significantly shorter than that for set A.ConclusionThe detection capability of observers with little experience is comparable to that of experienced observers when reading radiographs with temporal subtraction images or with CDSR. The usefulness of CDSR is comparable to that of temporal subtraction.