Diagnostic Confidence Research Articles

Multi-centre post-mortem study on the use of coronary inflammation in CCTA to improve the diagnosis of the coronary related cause of death with histopathology validation

Abstract Background/Introduction A limitation of post-mortem computed tomography (PMCT) is the diagnostic accuracy of coronary related death, which constitute majority of investigations. Measurements using coronary inflammation with fat attenuation index (FAI) Score, clinical risk factors and coronary plaque metrics from CCTA to predict fatal cardiac events (AI-Risk) in living patients has not been used in post-mortem setting. Purpose This study investigates two new techniques to aid the diagnosis of coronary related death in the post-mortem setting: (1) minimally invasive interventional technique to perform PMCT; (2) diagnostic accuracy of FAI-assisted PMCT with histopathology validation. Method Adults with sudden death of unknown cause <48 hours from death were included. Ultrasound guided femoral access to deliver guidewire to the aortic root (Figure 1A), followed by inflation of aortic occlusion balloon and injection of contrast for angiogram. A cardiac radiologist performed the coronary and FAI analysis (1B &C). Two experienced radiologists reported the cause of death without/with aid of FAI score results. The technique was introduced at a second PMCT centre. Results PMCT analysis of 37 participants (27 males, 10 females, age range 42-98) – 15 minimally invasive PMCT, and 22 PMCT from previous study showed FAI score (1D) and AI-Risk (1E) were significantly higher in participants who had coronary related death vs non-coronary related causes. In the receiver operating characteristic (ROC, 1F) analysis, thresholding at 42% for AI-Risk and 34 for Mean FAI score, was able to detect all 18 true positives, 2 false positives (1xpulmonary embolism, and 1xdual pathology of ruptured abdominal aneurysm with severe coronary artery disease; these cases showed high FAI score and AI-Risk), and all true negatives. Both radiologists identified 17/18 coronary related death. There were 5 cases of false positives for coronary related death in Radiologist 1 (3 years’ experience); 8 false positives in Radiologists 2 (10 years’ experience). In non-coronary related deaths, Radiologist 1 identified 14/19 true negative cases, and Radiologist 2 identified 11/19 true negative cases. In all the false positive and negative cases, the radiologists’ diagnostic confidence level was either possible, or unascertain. With the aid of FAI score results, all the true coronary related deaths were identified and no false negative case. This method was introduced at a second centre with 108 PMCTs analysed. There were 40 cases of non-coronary death, and 68 cases of coronary related death on PMCT (imaging diagnosis only). In the non-coronary group, FAI-score assisted results showed 100% concordance. In the coronary group, there was 10% dis-concordance (7/68). Conclusion Minimally invasive PMCT with FAI score-assisted diagnosis has the potential to increase the diagnostic confidence and accuracy of coronary-related cause of death.

3D color-rendered MR neurography heatmaps in visualizing normal lumbosacral (LS) plexus and increasing conspicuity of LS plexopathy.

To determine whether color-rendered 3D MR neurography (MRN) images (heatmaps) improve diagnostic accuracy, reader confidence levels, and time savings to assess LS plexus lesions compared to the conventional grayscale images. A cross-sectional study included adults of all genders with randomly chosen MRNs of LS plexus and known reference standards of normal or neuropathy (plexopathy and radiculopathy). Heatmaps were constructed using 3D MRN STIR images and color rendered with higher intensity to yellow and lower intensity to darker-red colors in 1-2 min on average and were available on PACS for the readers. 2D plus 3D grayscale MIP images and 2D plus 3D MIP heatmaps were analyzed by four musculoskeletal radiologists (two faculty and two fellows) in two separate rounds blinded to the final diagnosis. Readers evaluated: neuropathy and number of nerves affected (neuropathy score: 0-normal; 1-one nerve affected; and 2-two or more nerves affected); final diagnosis; confidence levels; and time taken to evaluate the studies. Conger's kappa and paired t-test were used for analysis. Among 70 MRNs from 70 patients, there were 32 males and 38 females with average age ± SD of 54.8 ± 20.1 years and 49.9 ± 16.6 years, respectively. There were 30 normal and 40 LS plexus lesion scans. Interreader agreements for neuropathy scores were substantial to moderate on conventional imaging and heat maps (Conger's kappa: 0.65; 95% CI: 0.55, 0.73, and 0.59; 95% CI: 0.47, 0.69), respectively. The mean neuropathy score and final diagnosis accuracies were similar in both rounds 85.7% ± 0.1% vs 83.2% ± 0.1% (p = 0.13), and 83.6% ± 0.1% vs 80.0% ± 0.1%; p = 0.16), respectively. Time savings were significant when using heatmaps for all readers (p < 0.001). Time savings using heatmaps ranged from 57.7% to 74.6% and 56.3% to 75% of the original time for the fellows and faculty, respectively. Average confidence levels for neuropathy score significantly increased using heatmaps for one fellow and one faculty (p < 0.05), while average confidence levels for final diagnosis improved for both fellows and one faculty (p < 0.05). 3D color-rendered MRN heatmaps show comparable diagnostic accuracy to conventional MRN imaging but with significant time savings to identify LS plexus lesions. Question Do color-rendered 3D MRN images (heatmaps) improve accuracy, and confidence, and save time when assessing lumbosacral (LS) plexus lesions compared to conventional grayscale images? Findings 3D-rendered heatmaps showed comparable diagnostic accuracy with time savings ranging from 56.3% to 75%. Clinical relevance 3D color-rendered heatmaps increase time efficiency in evaluating MRNs of LS plexus, allowing for improved radiologist productivity and diagnostic confidence.

Ultra-high resolution CT angiography for the assessment of intracranial stents and flow diverters using photon counting detector CT

BackgroundThe patency of intracranial stents may not be reliably assessed with either CT angiography or MR angiography due to imaging artifacts. We investigated the potential of ultra-high resolution CT angiography...

Evaluating small coronary stents with dual-source photon-counting computed tomography: effect of different scan modes on image quality and performance in a phantom.

The study aimed to assess the feasibility and image quality of dual-source photon-counting detector computed tomography (PCD-CT) in evaluating small-sized coronary artery stents with respect to different acquisition modes in a phantom model. Utilizing a phantom setup mimicking the average patient's water-equivalent diameter, we examined six distinct coronary stents inflated in a silicon tube, with stent sizes ranging from 2.0 to 3.5 mm, applying four different CT acquisition modes of a dual-source PCD-CT scanner: "high-pitch," "sequential," "spiral" (each with collimation of 144 × 0.4 mm and full spectral information), and "ultra-high-resolution (UHR)" (collimation of 120 × 0.2 mm and no spectral information). Image quality and diagnostic confidence were assessed using subjective measures, including a 4-point visual grading scale (4 = excellent; 1 = non-diagnostic) utilized by two independent radiologists, and objective measures, including the full width at half maximum (FWHM). A total of 24 scans were acquired, and all were included in the analysis. Among all CT acquisition modes, the highest image quality was obtained for the UHR mode [median score: 4 (interquartile range (IQR): 3.67-4.00)] (P = 0.0015, with 37.5% rated as "excellent"), followed by the sequential mode [median score: 3.5 (IQR: 2.84-4.00)], P = 0.0326 and the spiral mode [median score: 3.0 (IQR: 2.53-3.47), P > 0.05]. The lowest image quality was observed for the high-pitch mode [median score: 2 (IQR: 1- 3), P = 0.028]. Similarly, diagnostic confidence for evaluating stent patency was highest for UHR and lowest for high-pitch (P < 0.001, respectively). Measurement of stent dimensions was accurate for all acquisition modes, with the UHR mode showing highest robustness (FWHM for sequential: 0.926 ± 0.061 vs. high-pitch: 0.990 ± 0.083 vs. spiral: 0.962 ± 0.085 vs. UHR: 0.941 ± 0.036, P = non-significant, respectively). Assessing small-sized coronary stents using PCD-CT technology is feasible. The UHR mode offers superior image quality and diagnostic confidence, while all modes show consistent and accurate measurements. These findings highlight the potential of PCD-CT technology, particularly the UHR mode, to enhance non-invasive coronary stent evaluation. Confirmatory research is necessary to influence the guidelines, which recommend cardiac CT only for stents of 3 mm or larger.

Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned.

The inpatient setting is a challenging clinical environment where systems and situational factors predispose clinicians to making diagnostic errors. Environmental complexities limit trialing of interventions to improve diagnostic error in active inpatient clinical settings. Informed by prior work, we piloted a multi-component intervention designed to reduce diagnostic error to understand its feasibility and uptake. From September 2018 to June 2019, we conducted a prospective, pre-test/post-test pilot study of hospital medicine physicians during admitting shifts at a tertiary-care, academic medical center. Optional intervention components included use of dedicated workspaces, privacy barriers, noise cancelling headphones, application-based breathing exercises, a differential diagnosis expander application, anda checklist to enable a diagnostic pause. Participants rated their confidence in patient diagnoses and completed a survey on intervention component use. Data on provider resource utilization and patient diagnoses were collected, and qualitative interviews were held with a subset of participants in order to better understand experience with the intervention. Data from 37 physicians and 160 patients were included. No intervention component was utilized by more than 50 % of providers, and no differences were noted in diagnostic confidence or number of diagnoses documented pre-vs. post-intervention. Lab utilization increased, but there were no other differences in resource utilization during the intervention. Qualitative feedback highlighted workflow integration challenges, among others, for poor intervention uptake. Our pilot study demonstrated poor feasibility and uptake of an intervention designed to reduce diagnostic error. This study highlights the unique challenges of implementing solutions within busy clinical environments.

Comparison of different iterative reconstruction algorithms with contrast-enhancement boost technique on the image quality of CT pulmonary angiography for obese patients

ObjectiveTo evaluate the effect of the contrast-enhancement-boost (CE-boost) postprocessing technique on improving the image quality of obese patients in computed tomography pulmonary angiography (CTPA) compared to hybrid iterative reconstruction (HIR) and model-based iterative reconstruction (MBIR) algorithms.MethodsThis prospective study was conducted on 100 patients who underwent CTPA for suspected pulmonary embolism. Non-obese patients with a body mass index (BMI) under 25 were designated as group 1, while obese patients (group 2) had a BMI exceeding 25. The CE-boost images were generated by subtracting non-contrast HIR images from contrast-enhanced HIR images to improve the visibility of pulmonary arteries further. The CT value, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively assessed. Two chest radiologists independently reviewed the CT images (5, best; 1, worst) across three subjective characteristics including diagnostic confidence, subjective image noise, and vascular contrast. The Friedman test and Dunn-Bonferroni correction were used for statistical analysis.ResultsThe CE-boost had significantly higher CT values than HIR and MBIR in both groups (all p < 0.001). The MBIR yielded the lowest image noise compared with HIR and CE-boost (all p < 0.001). The SNR and CNR of main pulmonary artery (MPA) were significantly higher in CE-boost than in MBIR (all p < 0.05), with HIR showing the lowest values (all p < 0.001). Group 2 MBIR received significantly better subjective image noise scores, while the diagnostic confidence and vascular contrast scored highest with the group 2 CE-boost (all p < 0.05).ConclusionCompared to the HIR algorithm, both the CE-boost technique and the MBIR algorithm can improve the image quality of CTPA in obese patients. CE-boost had the greatest potential in increasing the visualization of pulmonary artery and its branches.

Opportunistic Identification of Coronary Artery Calcium and Valve/Vascular Calcifications on Chest X-Ray: Improvements With Single-Exposure Dual-Energy Imaging.

Purpose: To evaluate whether single-exposure, dual-energy chest X-ray (DEX) improves visualization of coronary artery calcium (CAC) and valve/vascular calcifications compared to conventional X-ray. Materials and Methods: Sixty-one bone-marrow transplant patients (22- 79 years; median 61; IQR 15; w/m, 24/37), underwent single-exposure dual-energy X-ray (Reveal 35C, KA imaging) in pa and lateral projection, followed by a standard-of-care chest CT. Two DEX pairs (pa/lateral) were calculated: a composite image (COMP) and a bone image with soft-tissue subtraction (BI). The COMP pair was reviewed by 2 chest radiologists, assessing the presence/absence of CAC and valve/vascular calcifications on a confidence scale from -2 (confidently not present) to 2 (confidently present). Subsequently, the BI pair was revealed, and readers reevaluated both pairs (COMP and BI) jointly using the identical scale. CTCAC scores were categorized according to the CAC-DRS (0-3) and served as standard of reference, valve/vascular calcifications were categorized on CT as present or absent. Results: For detecting CAC on DEX in any CAC-DRS category (1-3), in category 2-3, in category 3, and for valve/vascular calcifications, the ROC-AUC (combined for both readers) for COMP images was 0.74 (CI: 0.64-0.84), 0.81 (CI: 0.68-0.94), 0.84 (CI: 0.69-0.98), and 0.90 (CI: 0.83-0.99), and for the BI images 0.91 (CI: 0.83-0.98), 0.94 (CI: 0.86- 1.00), 0.89 (CI: 0.77-1.00), and 0.98 (CI: 0.96-1.00), with P = .0003, P = .044, P = .42, and P = .55, respectively. The Intraclass-Correlation-Coefficient (ICC) for CAC on COMP/BI was 0.973/0.954, and for valve/vascular calcifications 0.971/0.965. Conclusion: Single-exposure, dual-energy acquisition improves diagnostic confidence for coronary artery calcium and valve/vascular calcification identification on chest X-rays.

Improved diagnostic confidence using Super Resolution CEUS imaging in testicular lesions.

Ultrasound is the most used interdisciplinary non-ionizing imaging technique in clinical pathologies of the testis. The testis may be affected by a plethora of different disorders such as vasculopathies, trauma, infections and manifestations of primary and secondary malignant masses. Conventional ultrasound represents the basic imaging modality of choice to assess scrotal disorders. Contrast-enhanced ultrasound (CEUS) can provide further information to distinguish between benign and malignant testicular mass lesions. The recent introduction of Super Resolution CEUS Micro-Vascular Imaging (MVI SR) and Time of Arrival (TOA SR) parametric mapping compliments the information provided by conventional CEUS, since these two new post-processing techniques improve the visualization of microvascular structures with slow blood flow and provide high-resolution images of the peak contrast enhancement and temporal perfusion patterns. This paper gives a comprehensive overview of differential diagnoses of the testicular disorder and their corresponding sono-morphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.

The providing multidisciplinary ILD diagnoses (PROMISE) study – study design of the national registry of Japan facilitating interactive online multidisciplinary discussion diagnosis

BackgroundMultidisciplinary discussion (MDD), in which physicians, radiologists, and pathologists communicate and diagnose together, has been reported to improve diagnostic accuracy compared to diagnoses made solely by physicians. However, even among experts, diagnostic concordance of MDD is not always good, and some patients may not receive a specific diagnosis due to insufficient findings. A provisional diagnosis based on the ontology with a diagnostic confidence level has recently been proposed. Additionally, we developed an artificial intelligence model to differentiate idiopathic pulmonary fibrosis (IPF) from other chronic interstitial lung diseases (ILD)s, which needs validation in a broader population.MethodsThis prospective nationwide ILD registry has recruited patients with newly diagnosed ILD at the referral respiratory hospitals in Japan and provides rapid MDD diagnoses and treatment recommendations through a central online MDD platform with a 3-year follow-up period. A modified diagnostic ontology is used. If no diagnosis reaches more than 50% certainty, the diagnosis is unclassifiable ILD. If multiple diseases are expected, the diagnosis with a high probability takes precedence. If the confidence levels for the top two possible diagnoses are equal, the diagnosis can be unclassifiable. The registry uses tentative diagnostic criteria for nonspecific interstitial pneumonia with organising pneumonia and smoking-related ILD not otherwise specified as possible new entities. Central MDD diagnosticians review the clinical data, test results, radiology images, and pathological specimens on a dedicated website and conduct MDD diagnoses using online meetings with a cloud-based reporting system. This study aims to (1) provide MDD diagnoses with treatment recommendations; (2) determine the overall ILD rates in Japan; (3) clarify the reasons for unclassifiable ILDs; (4) evaluate possible new disease entities; (5) identify progressive phenotypes and create a clinical prediction model; (6) measure the agreement rate between institutional and central diagnoses in ILD referral and non-referral centres; (7) identify key factors for each specific ILD diagnosis; and (8) create a new disease classification system based on treatment strategies, including the use of antifibrotic drugs.DiscussionThis study will provide ILD frequencies, including new entities, using central MDD on dedicated online systems, and develop a machine learning model for ILD diagnosis and prognosis prediction.Trial registrationUMIN-CTR Clinical Trial Registry (UMIN000040678).

“3 + X D” structured report in radiology standardized resident training: Can it meet high-level teaching objectives?

PurposeTo evaluate the impact of the innovative “3 + X D” structured report (SR) designed based on Bloom’s taxonomy on the learning outcomes of radiology residents during standardized training. MethodsThis is a prospective study that recruited 120 radiology residents from our hospital between 2020 and 2022. Randomly selected 60 residents from the 2020 grade to constituted the control group, and randomly selected 60 residents from the 2021 grade to formed the experimental group. The former group was trained utilizing the Free-text Reports (FTR) template, while the latter group received training with the “3 + X D” structured reports (SR) template. The learning outcomes of both groups was evaluated utilizing both objective and subjective measures. Objective assessments encompassed examinations of theoretical knowledge, diagnostic skills, and total scores, aligning with the cognitive domains of remembering, understanding, applying, and analyzing as outlined by Bloom’s Taxonomy. Subjective assessments, on the other hand, comprised survey questionnaires administered to residents and feedback from clinical instructors, which correlated with the higher-order cognitive level of analyzing, evaluating, and creating within Bloom’s Taxonomy. ResultsOn 60 residents (mean age, 24.15 years ± 2.11[SD]; 25 male) from control group, and 60 residents (mean age, 24.58 years ± 1.88 [SD]; 27 male) from experimental group. Following the training, significant improvements were observed in the theoretical knowledge, diagnostic skills, and total scores for both groups (p < 0.001). Furthermore, the experimental group demonstrated significantly higher diagnostic skills and total scores compared to the control group (p < 0.001). However, no significant difference was observed in the theoretical knowledge exam between the two groups (p = 0.236). The questionnaire used for subjective assessments had good reliability (Cronbach α was 0.826) and acceptable validity (The KMO was 0.692). Additionally, the survey questionnaires indicated that the experimental group rated higher than the control group in terms of cultivating imaging thinking ability, diagnostic confidence, diagnostic speed, and the convenience of the templates (p < 0.001). Clinicians’ feedback scores for the experimental group markedly surpassed those for the control group (p < 0.05). ConclusionsUtilizing the “3 + X D” SR template grounded in Bloom’s taxonomy for training, the professional competency of radiology residents, particularly their diagnostic skills, saw a marked enhancement, successfully meeting the higher-level educational objectives. Consequently, the “3 + X D” SR template is highly recommended for the standardized training of radiology residents.

MRI radiomics model differentiates small hepatic metastases and abscesses in periampullary cancer patients

This multi-center, retrospective study focused on periampullary cancer patients undergoing MRI for hepatic metastasis and abscess differentiation. T1-weighted, T2-weighted, and arterial phase images were utilized to create radiomics models. In the training-set, 112 lesions in 54 patients (median age [IQR, interquartile range], 73 [63–80]; 38 men) were analyzed, and 123 lesions in 55 patients (72 [66–78]; 34 men) comprised the validation set. The T1-weighted + T2-weighted radiomics model showed the highest AUC (0.82, 95% CI 0.75–0.89) in the validation set. Notably, < 30% T1-T2 size discrepancy in MRI findings predicted metastasis (Ps ≤ 0.037), albeit with AUCs of 0.64–0.68 for hepatic metastasis. The radiomics model enhanced radiologists’ performance (AUCs, 0.85–0.87 vs. 0.80–0.84) and significantly increased diagnostic confidence (P < 0.001). Although the performance increase lacked statistical significance (P = 0.104–0.281), the radiomics model proved valuable in differentiating small hepatic lesions and enhancing diagnostic confidence. This study highlights the potential of MRI-based radiomics in improving accuracy and confidence in the diagnosis of periampullary cancer-related hepatic lesions.

Comparison of diagnostic accuracy of radiomics parameter maps and standard reconstruction for the detection of liver lesions in computed tomography.

The liver is a frequent location of metastatic disease in various malignant tumor entities. Computed tomography (CT) is the most frequently employed modality for initial diagnosis. However, liver metastases may only be delineated vaguely on CT. Calculating radiomics features in feature maps can unravel textures not visible to the human eye on a standard CT reconstruction (SCTR). This study aimed to investigate the comparative diagnostic accuracy of radiomics feature maps and SCTR for liver metastases. Forty-seven patients with hepatic metastatic colorectal cancer were retrospectively enrolled. Whole-liver maps of original radiomics features were generated. A representative feature was selected for each feature class based on the visualization of example lesions from five patients. These maps and the conventional CT image data were viewed and evaluated by four readers in terms of liver parenchyma, number of lesions, visual contrast of lesions and diagnostic confidence. T-tests and chi²-tests were performed with a significance cut off of p<0.05 to compare the feature maps with SCRT, and the data were visualized as boxplots. Regarding the number of lesions detected, SCTR showed superior performance compared to radiomics maps. However, the feature map for firstorder RootMeanSquared was ranked superior in terms of very high visual contrast in 57.4% of cases, compared to 41.0% in standard reconstructions (p < 0.001). All other radiomics maps ranked significantly lower in visual contrast when compared to SCTR. For diagnostic confidence, firstorder RootMeanSquared reached very high ratings in 47.9% of cases, compared to 62.8% for SCTR (p < 0.001). The conventional CT images showed superior results in all categories for the other features investigated. The application of firstorder RootMeanSquared feature maps may help visualize faintly demarcated liver lesions by increasing visual contrast. However, reading of SCTR remains necessary for diagnostic confidence.

Huntington Disease Health Related Quality of Life, Function and Well Being: The Patient's Perspective.

Limited information is available on patients' experience living with Huntington's disease (HD). The primary objective of this study was to assess the health-related quality of life and well being of patients with HD. A non-interventional, cross-sectional study was conducted in 17 hospitals-based movement disorders units in Spain. Patients aged≥18years, genetically HD diagnosed [with a diagnostic confidence level score of 4, and an Independence Scale (IS) score≥70] were included. The primary variables were the Huntington's Disease Health-related Quality of Life (HDQLIFE) scores and results of the Satisfaction with Life Scale (SWLS). Secondary outcomes include the Unified HD Rating Scale (UHDRS), Beck Hopelessness Scale (BHS), Stigma Scale for Chronic Illness (SSCI-8), Beck Depression Inventory-Fast Screen (BDI-FS) and Problem Behaviours Assessment for HD short Version (PBA-S). A total of 102 patients were included. The mean age (SD) was 53.1 (12.1) years and 56% were male. Most of the patients (99.0%) showed motor symptoms (87.3%), behavioural and psychiatric disturbances (59.8%), or cognitive impairment (20.6%). HDQLIFE domain score means (SD) includes concern with death and dying 45.97 (9.60) end-of-life planning 37.91 (8.84), and meaning and purpose 44.74 (9.05). SWLS score mean was 24.25 (7.33). Depressive symptoms were found in 37.4% of patients and moderate-to-severe feelings of hopelessness in 32.9%. The prevalence of stigma was 55.9% (n=57). HD impacted quality of life, with prevalent motor, psychiatric symptoms and cognitive impairment. Patient perspectives may provide complementary information to implement specific interventions.

Golden-angle radial sparse parallel (GRASP) magnetic resonance angiography (MRA) for endoleak evaluation after endovascular repair of the aorta: a prospective comparison to conventional time-resolved MRA.

Time-resolved angiography with interleaved stochastic trajectories (TWIST) magnetic resonance angiography (MRA) may obscure smaller vessels and is highly susceptibility to motion artifacts, potentially reducing endoleak detection accuracy after endovascular aortic repair (EVAR). The novel golden-angle radial sparse parallel (GRASP) sequence enhances spatial and temporal resolution with continuous, motion-robust datasets, showing promise for accurate endoleak detection post-EVAR. This study aimed to compare the diagnostic effectiveness of contrast-enhanced compressed-sensing radial GRASP-volume interpolated breath-hold examination (VIBE) sequence with standard contrast-enhanced dynamic TWIST-VIBE sequence in patients with inconclusive computed tomography angiography (CTA) findings regarding endoleak after EVAR. This single-center prospective study consecutively enrolled adults with inconclusive findings regarding the presence or type of endoleak in multiphasic CTA following EVAR for abdominal aortic aneurysms. Participants underwent contrast-enhanced MRA, acquiring dynamic TWIST-VIBE and GRASP-VIBE sequences. Two independent radiologists assessed the datasets for image quality, diagnostic confidence, and the presence and type of endoleak. Additionally, quantitative assessments with signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were performed. Statistical analyses included interrater and intermethod agreement, and diagnostic performance testing. Twenty participants (mean age, 72±9 years; 13 males) were included. GRASP-VIBE demonstrated superior image quality over TWIST-VIBE sequence with predominantly absent motion artifacts and increased diagnostic confidence (all P<0.001). Diagnostic performance significantly improved for detecting type II endoleaks in GRASP-VIBE compared to TWIST-VIBE scans [area under the curve (AUC): 0.96 vs. 0.73; P=0.04]. Diagnostic accuracy improved with GRASP-VIBE for overall (AUC: 0.94 vs. 0.79) and endoleak type I detection (AUC: 1.0 vs. 0.90), however, not significantly (P≥0.05). TWIST-VIBE sequences demonstrated significantly higher SNR for measurements in the clotted aneurysm sac (P=0.01). No significant differences were observed in CNR for the aorta and any aneurysm sacs across the compared imaging sequences. Compressed-sensing dynamic GRASP-VIBE sequence, with its superior image quality, diagnostic confidence, and performance, may be preferred over standard TWIST-VIBE sequence in inconclusive endoleak cases.

Accelerating brain three-dimensional T2 fluid-attenuated inversion recovery using artificial intelligence-assisted compressed sensing: a comparison study with parallel imaging.

Shortening the acquisition time of brain three-dimensional T2 fluid-attenuated inversion recovery (3D T2 FLAIR) by using acceleration techniques has the potential to reduce motion artifacts in images and facilitate clinical application. This study aimed to assess the image quality of brain 3D T2 FLAIR accelerated by artificial intelligence-assisted compressed sensing (ACS) in comparison to 3D T2 FLAIR accelerated by parallel imaging (PI). In this prospective cohort study, 102 consecutive participants, including both healthy individuals and those with suspected brain diseases, were recruited and underwent both ACS- and PI-3D T2 FLAIR scans with a 3.0-Tesla magnetic resonance imaging system from February 2023 to October 2023 in Beijing Tiantan Hospital, Capital Medical University. Quantitative assessment involved white matter (WM) and gray matter (GM) signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), whole-image sharpness, and tumor volume. Qualitative assessment included the scoring of overall image quality, GM-WM border sharpness, and diagnostic confidence in lesion detection. ACS-3D T2 FLAIR exhibited a shorter acquisition time compared to PI-3D T2 FLAIR (105 vs. 320 seconds). ACS-3D T2 FLAIR, compared to PI-3D T2 FLAIR, demonstrated a significantly higher mean SNRWM (25.922±6.811 vs. 22.544±5.853; P<0.001), SNRGM (18.324±7.137 vs. 17.102±6.659; P=0.049), CNRWM/GM (4.613±1.547 vs. 4.160±1.552; P<0.001), and sharpness (0.413±0.049 vs. 0.396±0.034; P<0.001), while no significant differences were found for the overall image quality ratings (P=0.063) or GM-WM border sharpness ratings (P=0.125). A good agreement on tumor volume was achieved between ACS-3D T2 FLAIR and PI-3D T2 FLAIR images (intraclass correlation coefficient =0.999; 0.998-1.000; P<0.001). Images acquired with ACS demonstrated nearly equivalent diagnostic confidence to those obtained with PI (P>0.05). The ACS technique offers a substantial reduction in scanning time for brain 3D T2 FLAIR compared to PI while maintaining good image quality and equivalent diagnostic confidence.

A multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness.

Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization. We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization. Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4%vs. 42.4%, p<0.001) on day of treatment, more likely to resume normal activities sooner (83.3%vs. 69.4%, p=0.039), and more confident in their illness cause (60.7%vs. 29.6%, p<0.001); however, the rate of antibiotic utilization did not differ (33.5%vs. 26%, p=1.0). In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.

Detectability of Hypoattenuating Liver Lesions with Deep Learning CT Reconstruction: A Phantom and Patient Study.

Background CT deep learning image reconstruction (DLIR) improves image quality by reducing noise compared with adaptive statistical iterative reconstruction-V (ASIR-V). However, objective assessment of low-contrast lesion detectability is lacking. Purpose To investigate low-contrast detectability of hypoattenuating liver lesions on CT scans reconstructed with DLIR compared with CT scans reconstructed with ASIR-V in a patient and a phantom study. Materials and Methods This single-center retrospective study included patients undergoing portal venous phase abdominal CT between February and May 2021 and a low-contrast-resolution phantom scanned with the same protocol. Four reconstructions (ASIR-V at 40% strength [ASIR-V 40] and DLIR at three strengths) were generated. Five radiologists qualitatively assessed the images using the five-point Likert scale for image quality, lesion diagnostic confidence, conspicuity, and small lesion (≤1 cm) visibility. Up to two key lesions per patient, confirmed at histopathologic testing or at prior or follow-up imaging studies, were included. Lesion-to-background contrast-to-noise ratio was calculated. Interreader variability was analyzed. Intergroup qualitative and quantitative metrics were compared between DLIR and ASIR-V 40 using proportional odds logistic regression models. Results Eighty-six liver lesions (mean size, 15 mm ± 9.5 [SD]) in 50 patients (median age, 62 years [IQR, 57-73 years]; 27 [54%] female patients) were included. Differences were not detected for various qualitative low-contrast detectability metrics between ASIR-V 40 and DLIR (P > .05). Quantitatively, medium-strength DLIR and high-strength DLIR yielded higher lesion-to-background contrast-to-noise ratios than ASIR-V 40 (medium-strength DLIR vs ASIR-V 40: odds ratio [OR], 1.96 [95% CI: 1.65, 2.33]; high-strength DLIR vs ASIR-V 40: OR, 5.36 [95% CI: 3.68, 7.82]; P < .001). Low-contrast lesion attenuation was reduced by 2.8-3.6 HU with DLIR. Interreader agreement was moderate to very good for the qualitative metrics. Subgroup analysis based on lesion size of larger than 1 cm and 1 cm or smaller yielded similar results (P > .05). Qualitatively, phantom study results were similar to those in patients (P > .05). Conclusion The detectability of low-contrast liver lesions was similar on CT scans reconstructed with low-, medium-, and high-strength DLIR and ASIR-V 40 in both patient and phantom studies. Lesion-to-background contrast-to-noise ratios were higher for DLIR medium- and high-strength reconstructions compared with ASIR-V 40. © RSNA, 2024 Supplemental material is available for this article.

Accelerated Cartesian cardiac T2 mapping based on a calibrationless locally low-rank tensor constraint.

Cardiac T2 mapping is a valuable tool for diagnosing myocardial edema, inflammation, and infiltration, yet its spatial resolution is limited by the single-shot balanced steady-state free precession acquisition and duration of the cardiac quiescent period, which may reduce sensitivity in detecting focal lesions in the myocardium. To improve spatial resolution without extending the acquisition window, this study examined a novel accelerated Cartesian cardiac T2 mapping technique. We introduce a novel improved-resolution cardiac T2 mapping approach leveraging a calibrationless space-contrast-coil locally low-rank tensor (SCC-LLRT)-constrained reconstruction algorithm in conjunction with Cartesian undersampling trajectory. The method was validated with phantom imaging and in vivo imaging that involved 13 healthy participants and 20 patients. The SCC-LLRT algorithm was compared with a conventional locally low-rank (LLR)-constrained algorithm and a nonlinear inversion (NLINV) reconstruction algorithm. The improved-resolution T2 mapping (1.4 mm × 1.4 mm) was compared globally and regionally with the regular-resolution T2 mapping (2.3 mm × 1.9 mm) according to the 16-segment model of the American Heart Association. The agreement between the improved-resolution and regular-resolution T2 mappings was evaluated by linear regression and Bland-Altman analyses. Image quality was scored by two experienced reviewers on a five-point scale (1, worst; 5, best). In healthy participants, SCC-LLRT significantly reduced artifacts (4.50±0.39) compared with LLR (2.31±0.60; P<0.001) and NLINV (3.65±0.56; P<0.01), suppressed noise (4.12±0.35) compared with NLINV (2.65±0.50; P<0.001), and improved the overall image quality (4.38±0.40) compared with LLR (2.54±0.41; P<0.001) and NLINV (3.04±0.50; P<0.001). Compared with the regular-resolution T2 mapping, the proposed method significantly improved the sharpness of myocardial boundaries (4.46±0.60 vs. 3.04±0.50; P<0.001) and the conspicuity of papillary muscles and fine structures (4.46±0.63 vs. 2.65±0.30; P<0.001). Myocardial T2 values obtained with the proposed method correlated significantly with those from regular-resolution T2 mapping in both healthy participants (r=0.79; P<0.01) and patients (r=0.94; P<0.001). The proposed SCC-LLRT-constrained reconstruction algorithm in conjunction with Cartesian undersampling pattern achieved improved-resolution cardiac T2 mapping of comparable accuracy, precision, and scan-rescan reproducibility compared with the regular-resolution T2 mapping. The higher resolution improved the sharpness of myocardial borders and the conspicuity of image fine details, which may increase diagnostic confidence in cardiac T2 mapping for detecting small lesions.

S190 Patients Managed for Chronic Pancreatitis in a VA Population Are Done So With Low Diagnostic Confidence

S190 Patients Managed for Chronic Pancreatitis in a VA Population Are Done So With Low Diagnostic Confidence

The role of 3D cinematic rendering in the evaluation of upper extremity trauma.

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning.