Xiangying Du

Evaluation of right ventricular function by 64-row CT in patients with chronic obstructive pulmonary disease and cor pulmonale

PURPOSE The aim of this study was to investigate the clinical application value of right ventricle (RV) function measured by 64 multi-detector row CT (MDCT) in patients with chronic obstructive pulmonary disease (COPD) and cor pulmonale. MATERIALS AND METHODS Sixty-three consecutive patients with COPD and cor pulmonale were referred for electrocardiographically gated MDCT for evaluation of suspected or known coronary artery disease. Magnetic resonance imaging (MRI) for cardiac function analysis was performed on the same day. The MDCT and MRI examinations were successfully completed in 58 patients. Forty-six patients with COPD were divided into three groups according to the severity of disease by the pulmonary function test (PFT). Twelve patients diagnosed as cor pulmonale and 32 control subjects were also included. The RV function and myocardial mass (MM) were obtained by 64-MDCT and 1.5 T cardiac MRI in all of the groups. The results were compared among the groups using the Newman-Keuls method. Pearsons correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD and cor pulmonale patients. RESULTS The RVEF was significantly lower in patients with severe COPD and cor pulmonale than it was in those patients with mild or moderate COPD (P < 0.01). There were strong correlations between MDCT and MRI (r = 0.826 for RV MM, r = 0.982 and 0.969 for RV EDV and RV ESV, r = 0.899 for RVEF) and between MDCT results and forced expiratory volume in 1s (r = 0.787 for RVEF, r = -0.774 for RV MM) in all patients. CONCLUSION MDCT can accurately quantify RV function and MM. The RVEF and RV MM measured by MDCT correlate well with the severity of disease as determined by PFT in patients with COPD and cor pulmonale. The assessment of right ventricular function is clinically important for evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy.

Noise-based tube current reduction method with iterative reconstruction for reduction of radiation exposure in coronary CT angiography

PURPOSE To investigate the potential of noise-based tube current reduction method with iterative reconstruction to reduce radiation exposure while achieving consistent image quality in coronary CT angiography (CCTA). MATERIALS AND METHODS 294 patients underwent CCTA on a 64-detector row CT equipped with iterative reconstruction. 102 patients with fixed tube current were assigned to Group 1, which was used to establish noise-based tube current modulation formulas, where tube current was modulated by the noise of test bolus image. 192 patients with noise-based tube current were randomly assigned to Group 2 and Group 3. Filtered back projection was applied for Group 2 and iterative reconstruction for Group 3. Qualitative image quality was assessed with a 5 point score. Image noise, signal intensity, volume CT dose index, and dose-length product were measured. RESULTS The noise-based tube current modulation formulas were established through regression analysis using image noise measurements in Group 1. Image noise was precisely maintained at the target value of 35.00 HU with small interquartile ranges for Group 2 (34.17-35.08 HU) and Group 3 (34.34-35.03 HU), while it was from 28.41 to 36.49 HU for Group 1. All images in the three groups were acceptable for diagnosis. A relative 14% and 41% reduction in effective dose for Group 2 and Group 3 were observed compared with Group 1. CONCLUSION Adequate image quality could be maintained at a desired and consistent noise level with overall 14% dose reduction using noise-based tube current reduction method. The use of iterative reconstruction further achieved approximately 40% reduction in effective dose.

Effect of a novel motion correction algorithm (SSF) on the image quality of coronary CTA with intermediate heart rates: segment-based and vessel-based analyses.

PURPOSE To evaluate the effect of SnapShot Freeze (SSF) reconstruction at an intermediate heart-rate (HR) range (65-75bpm) and compare this method with single-sector reconstruction and bi-sector reconstruction on segmental and vessel bases in retrospective coronary computed tomography angiography (CCTA). MATERIALS AND METHODS Retrospective electrocardiogram-gated CCTA was performed on 37 consecutive patients with HR between 65 and 75bpm using a 64-row CT scanner. Retrospective single-sector reconstruction, bi-sector reconstruction, and SSF were performed for each patient. Multi-phase single-sector reconstruction was performed to select the optimal phase. SSF and bi-sector images were also reconstructed at the optimal phase. The images were interpreted in an intent-to-diagnose fashion by two experienced readers using a 5-point scale, with 3 points as diagnostically acceptable. Image quality among the three reconstruction groups were compared on per-patient, per-vessel, and per-segment bases. RESULTS The average HR of the enrolled patients was 69.4±2.7bpm. A total of 111 vessels and 481 coronary segments were assessed. SSF provided significantly higher interpretability of the coronary segments than bi-sector reconstructions. The qualified and excellent rates of SSF (97.9% and 82.3%) were significantly higher than those of single-sector (92.9% and 66.3%) and bi-sector (90.9% and 64.7%) reconstructions. The image quality score (IQS) using SSF was also significantly higher than those of single-sector and bi-sector reconstructions both on per-patient and per-vessel bases. On per-segment analysis, IQS was improved in most segments (9/14). CONCLUSION The SSF algorithm can provide acceptable diagnostic image quality in coronary CTA for patients with intermediate HR.

Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease using MRI

Background Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle (RV). Therefore, the assessment of right ventricular function and myocardial mass (MM) is clinically important for the evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy. Purpose To assess the right ventricular function and RV MM in patients with mild to severe COPD using magnetic resonance imaging (MRI). Material and Methods We prospectively studied 49 COPD patients determined by the pulmonary function test (PFT). Using the Global Initiative for COPD classification, the COPD patients were divided into three groups according to the severity of the disease: group I = mild (n = 18); group II = moderate (n = 16); and group III = severe (n = 15). The patient groups were compared to a control group consisting of 30 age-matched, healthy, non-smoking subjects. The RV function and RV MM were obtained by 1.5T cardiac MRI in all of the four groups. The results were compared among the four groups using the ANOVA. Pearsons correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD patients. Results The RVEF was significantly lower in group III than in the other groups (P < 0.01). The RV MM differed significantly among all groups (P < 0.01) and gradually increased with the severity of COPD (P < 0.01). The correlation was significant between the MRI results and forced expiratory volume in 1 s (r = 0.860 for RVEF, r = –0.838 for RV MM) in COPD patients. Conclusion The RVEF and RV MM measured by MRI correlate significantly with the severity of disease as determined by PFT in patients with COPD.

Prospective ECG-Triggered Coronary CT Angiography: Clinical Value of Noise-Based Tube Current Reduction Method with Iterative Reconstruction

Objectives To evaluate the clinical value of noise-based tube current reduction method with iterative reconstruction for obtaining consistent image quality with dose optimization in prospective electrocardiogram (ECG)-triggered coronary CT angiography (CCTA). Materials and Methods We performed a prospective randomized study evaluating 338 patients undergoing CCTA with prospective ECG-triggering. Patients were randomly assigned to fixed tube current with filtered back projection (Group 1, n = 113), noise-based tube current with filtered back projection (Group 2, n = 109) or with iterative reconstruction (Group 3, n = 116). Tube voltage was fixed at 120 kV. Qualitative image quality was rated on a 5-point scale (1 = impaired, to 5 = excellent, with 3–5 defined as diagnostic). Image noise and signal intensity were measured; signal-to-noise ratio was calculated; radiation dose parameters were recorded. Statistical analyses included one-way analysis of variance, chi-square test, Kruskal-Wallis test and multivariable linear regression. Results Image noise was maintained at the target value of 35HU with small interquartile range for Group 2 (35.00–35.03HU) and Group 3 (34.99–35.02HU), while from 28.73 to 37.87HU for Group 1. All images in the three groups were acceptable for diagnosis. A relative 20% and 51% reduction in effective dose for Group 2 (2.9 mSv) and Group 3 (1.8 mSv) were achieved compared with Group 1 (3.7 mSv). After adjustment for scan characteristics, iterative reconstruction was associated with 26% reduction in effective dose. Conclusion Noise-based tube current reduction method with iterative reconstruction maintains image noise precisely at the desired level and achieves consistent image quality. Meanwhile, effective dose can be reduced by more than 50%.

Effects of different compression techniques on diagnostic accuracies of breast masses on digitized mammograms

Background: The JPEG 2000 compression technique has recently been introduced into the medical imaging field. It is critical to understand the effects of this technique on the detection of breast masses on digitized images by human observers. Purpose: To evaluate whether lossless and lossy techniques affect the diagnostic results of malignant and benign breast masses on digitized mammograms. Material and Methods: A total of 90 screen-film mammograms including craniocaudal and lateral views obtained from 45 patients were selected by two non-observing radiologists. Of these, 22 cases were benign lesions and 23 cases were malignant. The mammographic films were digitized by a laser film digitizer, and compressed to three levels (lossless and lossy 20:1 and 40:1) using the JPEG 2000 wavelet-based image compression algorithm. Four radiologists with 10–12 years’ experience in mammography interpreted the original and compressed images. The time interval was 3 weeks for each reading session. A five-point malignancy scale was used, with a score of 1 corresponding to definitely not a malignant mass, a score of 2 referring to not a malignant mass, a score of 3 meaning possibly a malignant mass, a score of 4 being probably a malignant mass, and a score of 5 interpreted as definitely a malignant mass. The radiologists’ performance was evaluated using receiver operating characteristic analysis. Results: The average Az values for all radiologists decreased from 0.8933 for the original uncompressed images to 0.8299 for the images compressed at 40:1. This difference was not statistically significant. The detection accuracy of the original images was better than that of the compressed images, and the Az values decreased with increasing compression ratio. Conclusion: Digitized mammograms compressed at 40:1 could be used to substitute original images in the diagnosis of breast cancer.

Comparison of dry laser printer versus paper printer in full-field digital mammography.

Background: Paper printers have been used to document radiological findings in some hospitals. It is critical to establish whether paper printers can achieve the same efficacy and quality as dry laser printers for full-field digital mammography (FFDM). Purpose: To compare the image quality and detection rate of dry laser printers and paper printers for FFDM. Material and Methods: Fifty-five cases (25 with single clustered microcalcifications and 30 controls) were selected by a radiologist not participating in the image review. All images were printed on film and paper by one experienced mammography technologist using the processing algorithm routinely used for our mammograms. Two radiologists evaluated hard copies from dry laser printers and paper printers for image quality and detectability of clustered microcalcifications. For the image quality comparisons, agreement between the reviewers was evaluated by means of kappa statistics. The significance of differences between both of the printers was determined using Wilcoxons signed-rank test. The detection rate of two printing systems was evaluated using receiver operating characteristic (ROC) analysis. Results: From 110 scores (55 patients, two readers) per printer system, the following quality results were achieved for dry laser printer images: 70 (63.6%) were rated as good and 40 (36.4%) as moderate. By contrast, for the paper printer images, 25 scores (22.7%) were rated as good and 85 (77.3%) as moderate. Therefore, the image quality of the dry laser printer was superior to that achieved by the paper printer (P=0.00). The average area-under-the-curve (Az) values for the dry laser printer and the paper printer were 0.991 and 0.805, respectively. The difference was 0.186. Results of ROC analysis showed significant difference in observer performance between the dry laser printer and paper printer (P=0.0015). Conclusion: The performance of dry laser printers is superior to that of paper printers. Paper printers should not be used in FFDM.

Comparison of diagnostic accuracy of breast masses using digitized images versus screen-film mammography

Background: Medical film digitizers play an important transitory role as digital–analogue bridges in radiology. Digitized mammograms require evaluation of performance to assure medical image quality. Purpose: To compare the diagnostic accuracy in the interpretation of breast masses using original screen-film mammograms versus digitized images. Material and Methods: A total of 72 female patients between 55 and 81 years of age suspected of having breast cancer were selected by two non-observing radiologists. Of these, 31 cases were benign lesions and 41 cases were cancer. The mammography films were digitized using a laser film digitizer. Three radiologists, each with more than 10 years of experience in mammography, interpreted the screen-film mammograms and digitized images respectively. The time interval was 4 weeks. A four-point malignancy scale was used, with 1 defined as definitely not malignant, 2 as probably not malignant, 3 as probably malignant, and 4 as definitely malignant. Receiver operating characteristic (ROC) curves, sensitivity, and specificity were compared. Results: The average area-under-the-curve (Az) value of the original screen-film mammograms was 0.921, and the average Az value of the digitized images was 0.859. This difference was not statistically significant (P=0.131). The detection specificity of extremely dense breasts was lower than that for other breast compositions for both digitized images and screen-film mammograms. No statistical significance in sensitivity and specificity was observed between digitized images and mammograms for each breast composition. Original screen-film mammograms were observed to perform better than digitized images. Conclusion: Digitized images with a spatial resolution of 175 µm can be used instead of screen-film mammograms in the diagnosis of breast cancer.

Optimization of contrast medium protocol in CT coronary arteriography: constant injection dose rate adapted to body weight

Background Fixed dose contrast medium (CM) injection protocols are often used in CT coronary arteriography (CTCA). However, vascular enhancement is related to body weight and injection dose rate. Purpose To compare aortic enhancement and coronary imaging quality between a fixed dose CM injection protocol and one adapted to body weight with a constant injection dose rate in mg I/kg/s. Material and Methods One hundred consecutive patients undergoing CTCA were randomized to two groups; group I received 65 mL CM (370 mg I/mL) at 5 mL/s and group II received 0.9 mL CM (370 mg I/mL) per kg during 12 s resulting in a constant injection dose rate of 28 mg I/kg/s.The groups were re-divided according to body weight: IA ≤ 70 kg, IB >70 kg, IIA ≤ 70 kg, IIB >70 kg. Aortic attenuation was measured and coronary imaging quality was graded using a four-grade scale. Results The resulting mean CM dose, aortic attenuation and score of coronary imaging quality in groups IA/IB/IIA/IIB were 24/24/19/27 g I, 437/403/448/440 HU and 2.8/2.3/2.7/2.6, respectively. CM dose and aortic attenuation were significantly different between groups IA and IIA (p < 0.001, p = 0.01), as well as between groups IB and IIB (p < 0.001, p < 0.001).There was no statistically significant difference regarding coronary imaging quality between groups IA and IIA (p = 0.30), while there was a significant difference between groups IB and IIB (p < 0.001). Conclusion In CTCA, body weight-adapted CM injection protocols using a constant dose rate can help save CM doses in slimmer patients and improve aortic enhancement and coronary imaging quality in heavier patients compared to fixed dose protocols.

An open label, prospective, multicenter, non-interventional study of iodixanol 270 mg I/mL for use in individuals undergoing computed tomography angiography in real-world clinical practice

Background Concern about radiation exposure is leading to an increasing interest in low-concentration contrast medium administration. Purpose To evaluate the image quality and safety profile after administration of iodixanol 270 mg I/mL at 100-kVp tube voltage with iterative reconstruction in subjects undergoing computed tomography angiography (CTA). Material and Methods Patients who completed CTA examination using iodixanol 270 mg I/mL and 100-kVp tube voltage along with iterative reconstruction for coronary, aortic, head and neck, renal, or pulmonary arteries were included. Image quality was qualitatively and quantitatively evaluated. Incidence of adverse events (AEs) and adverse drug reactions (ADRs) within seven days and radiation dose were also analyzed. Results A total of 4513 individuals in 42 centers in China were enrolled, among which 4367 were included in efficacy analysis. The mean image quality score was 4.8 ± 0.45 across all arteries (all above 4.6) and 99.7% of the individuals’ images were classified as evaluable. The CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the regions of interest (ROIs) were 431.79 ± 99.018, 18.29 ± 11.947, and 28.21 ± 19.535 HU, respectively. Of all the participants, 68 (1.5%) and 65 (1.4%) experienced AEs and ADRs, respectively. No serious AEs or AEs leading to discontinuation occurred. The average effective radiation dose was 3.13 ± 2.550 mSv. Conclusion Iodixanol 270 mg I/mL in combination with 100-kVp tube voltage and iterative reconstruction could be safely applied in CTA and yield high-quality and evaluable images with reduced radiation dose.