Mean Computed Tomography Value Research Articles

Correlation between the thyroid computed tomography value and thyroid function in hyperthyroidism: a retrospective study.

Radioiodine (I-131) therapy for hyperthyroidism is a well-established and safe treatment option. This study aimed to investigate the relationship between the computed tomography (CT) value and the function and volume of the thyroid gland by identifying the factors that induce changes in the CT value of patients with hyperthyroidism. This retrospective study evaluated 38 patients with Graves' disease and 10 patients with Plummer disease. To obtain the mean CT value and volume of the thyroid gland, the entire thyroid gland was set as the region of interest. A test dose of 3.7MBq I-131 was administered before initiating I-131 therapy, and the radioiodine uptake (RIU) rate was assessed after 3, 24, 96, and 168h. An approximate curve was plotted based on the RIU values obtained, and the effective half-life (EHL) was calculated. The correlation between the mean CT value and the volume of the thyroid gland, 24-h RIU, EHL, and the free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and TSH receptor antibody (TRAb) levels was evaluated. The CT value exhibited a significant positive correlation with EHL in patients with Graves' disease (r = 0.62, p < 0.0001) as well as patients with Plummer disease (r = 0.74, p < 0.05). However, it did not display any correlation with the remaining parameters. The CT value is significantly correlated with EHL, suggesting that it reflects thyroid function and is mainly related to the factors associated with iodine discharge.

Mean computed tomography value to predict spread through air spaces in clinical N0 lung adenocarcinoma

BackgroundThe aim of this study was to assess the ability of radiologic factors such as mean computed tomography (mCT) value, consolidation/tumor ratio (C/T ratio), solid tumor size, and the maximum standardized uptake (SUVmax) value by F-18 fluorodeoxyglucose positron emission tomography to predict the presence of spread through air spaces (STAS) of lung adenocarcinoma.MethodsA retrospective study was conducted on 118 patients those diagnosed with clinically without lymph node metastasis and having a pathological diagnosis of adenocarcinoma after undergoing surgery. Receiver operating characteristics (ROC) analysis was used to assess the ability to use mCT value, C/T ratio, tumor size, and SUVmax value to predict STAS. Univariate and multiple logistic regression analyses were performed to determine the independent variables for the prediction of STAS.ResultsForty-one lesions (34.7%) were positive for STAS and 77 lesions were negative for STAS. The STAS positive group was strongly associated with a high mCT value, high C/T ratio, large solid tumor size, large tumor size and high SUVmax value. The mCT values were − 324.9 ± 19.3 HU for STAS negative group and − 173.0 ± 26.3 HU for STAS positive group (p < 0.0001). The ROC area under the curve of the mCT value was the highest (0.738), followed by SUVmax value (0.720), C/T ratio (0.665), solid tumor size (0.649). Multiple logistic regression analyses using the preoperatively determined variables revealed that mCT value (p = 0.015) was independent predictive factors of predicting STAS. The maximum sensitivity and specificity were obtained at a cutoff value of − 251.8 HU.ConclusionsThe evaluation of mCT value has a possibility to predict STAS and may potentially contribute to the selection of suitable treatment strategies.

Long-term effects of iopamidol as a contrast medium for computed tomography in Cloudy Catsharks Scyliorhinus torazame.

The use of computed tomography (CT) in aquarium animals, including elasmobranchs, has increased dramatically. To take advantage of CT, contrast medium is used to enhance internal organs and provide contrast since elasmobranchs lack visceral fat. In this study, the contrast effects of iopamidol were examined for up to 260 days after intravenous administration to establish the time course of the CT values for the target organs in eight mature Cloudy Catsharks Scyliorhinus torazame. A micro-CT system was used to measure the CT values of the designated region of interest in the target organs (ventricular cavity, kidneys, liver, gallbladder, ovarian follicles, uterine horn cavity)over time and the eggs laid, following administration of iopamidol (700 mg of iodine/kg). The CT values of the ventricular cavity and kidneys peaked at 30 min and showed low values after day 22. The CT values for the liver increased over time and peaked at day 200, whereas values for the gallbladder and ovarian follicles peaked on day 6, with the gallbladder showing a low value and the ovarian follicles still showing a high value on day 260. Computed tomography images with identifiable enhancement within bilateral uterine horns were followed from days 1 to 35. The mean and maximum CT values of yolk and jelly in eggs laid after day 30 were significantly higher than the values for eggs laid up to day 29; embryonic development was confirmed in 88.7% of the eggs. There was no mortality or morbidity of the sharks during the experiment, indicating that the administration of iopamidol at 700 mg of iodine/kg did not result in any adverse effects for 260 days. This is the first study to describe the long-term contrast effects of iopamidol, thus contributing new information about the application of contrast studies in Cloudy Catsharks.

Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements.

The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.

Predicting subsolid pulmonary nodules before percutaneous needle biopsy: a comparison of artificial neural network and biopsy results

To establish an artificial neural network (ANN) model to predict subsolid nodules (SSNs) before percutaneous core-needle biopsy (PCNB). The results of the two methods were compared to provide guidance on the treatment of SSNs. This was a single-centre retrospective study using data from 1,459 SSNs between 2013 and 2021. The ANN was developed using data from patients who underwent surgery following computed tomography (CT) (SFC) and validated using data from patients who underwent surgery following biopsy (SFB). The prediction results of the ANN for the PCNB group and the histopathological results obtained after biopsy were compared with the histopathological results of lung nodules in the same group after surgery. Additionally, the choice of predictors for PCNB was analysed using multivariate analysis. There was no significant difference between the accuracies of the ANN and PCNB in the SFB group (p=0.086). The sensitivity of PCNB was lower than that of the ANN (p=0.000), but the specificity was higher (p=0.001). PCNB had better diagnostic ability than the ANN. The incidence of precursor lesions and non-neoplastic lesions in the SFB group was lower than that in the SFC group (p=0.000). A history of malignant tumours, size (2-3 cm), volume (>400 cm3) and mean CT value (≥-450 HU) are important factors for selecting PCNB. Both ANN and PCNB have comparable accuracy in diagnosing SSNs; however, PCNB has a slightly higher diagnostic ability than ANN. Selecting appropriate patients for PCNB is important for maximising the benefit to SSN patients.

Tumor vascularity on contrast-enhanced computed tomography as a predictive marker of metastatic potential for small nonfunctioning pancreatic neuroendocrine tumors

BackgroundAlthough surgical resection is generally suggested for nonfunctioning pancreatic neuroendocrine tumors, observation can be proposed for carefully selected patients with small tumors. However, the indications for observation remain unclear. MethodsThis retrospective study included 77 patients with nonfunctioning pancreatic neuroendocrine tumors, including small tumors (≤2.0 cm, n = 41), who received pancreatectomy. The ratio of the mean computed tomography value of a tumor in the late arterial/equilibrium phase (computed tomography a/e ratio) was used to evaluate tumor vascularity. Pathologic examinations of small tumors were conducted. The associations among the computed tomography a/e ratio, pathologic findings, and survival outcomes were investigated. ResultsSmall tumors were pathologically categorized by the degree of fibrosis as follows: medullary (n = 20), intermediate (n = 11), and fibrotic (n = 10). The fibrotic type had significantly lower computed tomography a/e ratios than the medullary type (median, 1.42 vs 2.03, P < .001). The median number of vessels with microscopic venous invasion was significantly higher in the fibrotic type than in the medullary type (4.5 vs 0.0, P < .001). The cutoff value of the computed tomography a/e ratio for predicting microscopic venous invasion was determined to be 1.54 by the receiver operating characteristic curve (area under the curve, 0.832; sensitivity, 80.0%; specificity, 83.9%; accuracy, 82.9%). Microscopic venous invasion was an independent prognostic factor for relapse-free survival in overall patients (hazard ratio 5.18, P = .017). ConclusionThe computed tomography a/e ratio may be a useful predictor of the metastatic potential of nonfunctioning pancreatic neuroendocrine tumors and may help decide the indications of observation for small nonfunctioning pancreatic neuroendocrine tumors.

Artificial intelligence system-based histogram analysis of computed tomography features to predict tumor invasiveness of ground-glass nodules.

The use of an artificial intelligence (AI)-based diagnostic system can significantly aid in analyzing the histogram of pulmonary nodules. The aim of our study was to evaluate the value of computed tomography (CT) histogram indicators analyzed by AI in predicting the tumor invasiveness of ground-glass nodules (GGNs) and to determine the added value of contrast-enhanced CT (CECT) compared with nonenhanced CT (NECT) in this prediction. This study enrolled patients with persistent GGNs who underwent preoperative NECT and CECT scanning. AI-based histogram analysis was performed for pathologically confirmed GGNs, which was followed by screening invasiveness-related factors via univariable analysis. Multivariable logistic models were developed based on candidate CT histogram indicators measured on either NECT or CECT. Receiver operating characteristic (ROC) curve and precision-recall (PR) curve were used to evaluate the models' performance. A total of 116 patients comprising 121 GGNs were included and divided into the precancerous lesion and adenocarcinoma groups based on invasiveness. In the AI-based histogram analysis, the mean CT value [NECT: odds ratio (OR) =1.009; 95% confidence interval (CI): 1.004-1.013; P<0.001] and solid component volume (NECT: OR =1.005; 95% CI: 1.000-1.010; P=0.032) were associated with the adenocarcinoma and used for multivariable logistic modeling. The area under ROC curve (AUC) and PR curve (AUPR) were not significantly different between the NECT model (AUC =0.765, 95% CI: 0.679-0.837; AUPR =0.907, 95% CI: 0.825-0.953) and the optimal CECT model (delayed phase: AUC =0.772, 95% CI: 0.687-0.843; AUPR =0.895, 95% CI: 0.812-0.944). No significantly different metrics were observed between the NECT and CECT models (precision: 0.707 vs. 0.742; P=0.616). The AI diagnostic system can help in the diagnosis of GGNs. The system displayed decent performance in GGN detection and alert to malignancy. Mean CT value and solid component volume were independent predictors of tumor invasiveness. CECT provided no additional improvement in diagnostic performance as compared with NECT.

Meta-analysis of correlation between CT-based features and invasive properties of pure ground-glass nodules.

Several studies have revealed that computed tomography (CT) features can make a distinction in the invasive properties of pure ground-glass nodules (pGGNs). However, imaging parameters related to the invasive properties of pGGNs are unclear. This meta-analysis was designed to decipher the correlation between the invasiveness of pGGNs and CT-based features, and ultimately to be conducive to making rational clinical decisions. We searched a series of databases, including PubMed, Embase, Web of Science, Cochrane Library, Scopus, wanfang, CNKI, VIP, as well as CBM databases, until September 20, 2022, for the eligible publications only in Chinese or English. This meta-analysis was implemented with the Stata 16.0 software. Ultimately, 17 studies published between 2017 and 2022 were included. According to the meta-analysis, we observed a larger maximum size of lesions in invasive adenocarcinoma (IAC) versus that in preinvasive lesions (PIL) [SMD=1.37, 95% CI (1.07-1.68), P<0.05]. Meanwhile, there were also increased mean CT values of IAC [SMD=0.71, 95% CI (0.35, 1.07), P<0.05], the incidence of pleural traction sign [OR=1.94, 95% CI (1.24, 3.03), P<0.05], the incidence of IAC spiculation [OR=1.55, 95% CI (1.05, 2.29), P<0.05] in comparison to those of PIL. Nevertheless, IAC and PIL exhibited no significant differences in vacuole sign, air bronchogram, regular shape, lobulation and vascular convergence sign (all P>0.05). Therefore, IAC and PIL manifested different CT features of pGGNs. The maximum diameter of lesions, mean CT value, pleural traction sign and spiculation are important indicators to distinguish IAC and PIL. Reasonable use of these features can be helpful to the treatment of pGGNs.

Relationships between intra-pancreatic fat deposition and lifestyle factors: a cross-sectional study.

The excess deposition of intra-pancreatic fat deposition (IPFD) has been reported to be associated with type 2 diabetes, chronic pancreatitis, and pancreatic ductal adenocarcinoma. In the current study, we aimed to identify a relationship between lifestyle factors and IPFD. 99 patients admitted to the Osaka University Hospital who had undergone abdominal computed tomography were selected. We evaluated the mean computed tomography values of the pancreas and spleen and then calculated IPFD score. Multiple regression analyses were used to assess the associations between IPFD score and lifestyle factors. Fast eating speed, late-night eating, and early morning awakening were significantly associated with a high IPFD score after adjusting for age, sex, diabetes status and Body Mass Index (p=0.04, 0.01, 0.01, respectively). The current study has elucidated the significant associations of fast eating speed, late-night eating, and early morning awakening with IPFD.

Pectoralis muscle measures on preoperative computed tomography are strong predictors of early rehospitalization after left ventricular assist device implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Skeletal muscle mass is reduced in severe heart failure and has a significantly impacts on subsequent outcomes and quality of life. The assessment of pectoralis muscle measures by computed tomography (CT) scan may be predictive of outcomes after left ventricular assist device (LVAD) implantation. Purpose This study aims to assess preoperative pectoralis muscle measures before LVAD implantation to predict early rehospitalization of the patient. Methods We measured the cross-sectional area and mean CT values of the unilateral pectoralis muscle (PHUm: mean Hounsfield unit of pectoralis muscle) by CT scans within 3 months before surgery in patients who underwent HeartMate 3 implantation for the bridge to transplant (BTT) or destination therapy (DT) at our hospital, by August 2022. The cross-sectional area of the unilateral pectoralis muscle was corrected for body surface area (PMI: pectoralis muscle index). The pectoralis muscle was measured by SYNAPSE VINCENT image analysis (Fuji Film) using an axial section of the superior margin of the aortic arch (Figure A). The area under the curve (AUC), sensitivity, and specificity of each index was calculated by receiver operating characteristic (ROC) analysis for the prediction accuracy of PHUm, PMI, and the product of PHUm and PMI in rehospitalization 30, 60, 90 and 180 days from discharge. Results Of reviewed 39 patients who underwent HeartMate 3 implantation, 32 (82%) were male, and 32 (82%) underwent BTT. The median age at LVAD implantation was 52 years (interquartile range [IQR], 42–57). During the follow-up period after discharge (median: 520 days, IQR: 116–707), 19 patients (53%) had unscheduled hospitalizations due to 8 LVAD-related infections, 1 heart failure, 1 cardiac arrhythmia, and 9 other reasons. The median time between discharge and rehospitalization was 70 days (IQR, 31–139). ROC analysis showed that the AUC was particularly high for early rehospitalization within 30 days, with the optimal cutoff of 21.8 Hounsfield unit (HU) for PHUm (sensitivity 0.903, specificity 0.800, AUC 0.884), 6.37 cm2/m2 for PMI (sensitivity 0.806, specificity 0.800, AUC 0.735), and 142.8 for the product of PHUm and PMI (sensitivity 0.903, specificity 1.000, AUC 0.948) (Figure B). Conclusion The product of PHUm and PMI may be a strong predictor of early rehospitalization within 30 days of discharge after LVAD implantation.

Changes and influencing factors of liver volume after transjugular intrahepatic portosystemic shunt: a retrospective cohort study.

Liver volume is an important measure of liver reserve and helps to determine the course of liver disease. This study aimed to observe the dynamic changes of liver volume after transjugular intrahepatic portosystemic shunt (TIPS) and analyze the related factors. Clinical data of 168 patients who underwent TIPS procedures between February 2016 and December 2021 were collected and analyzed retrospectively. The changes in liver volume after TIPS in the patients were observed, and the independent predictors affecting increases in liver volume were analyzed using a multivariable logistic regression model. The mean liver volume was decreased by 12.9% at 2±1 months post TIPS and rebounded at 9±3 months post TIPS, but did not recover to its pre-TIPS level completely. Most patients (78.6%) had decreased liver volume at 2±1 months post TIPS, and in multivariable logistic regression, a lower albumin (ALB) level, a lower subcutaneous fat area at L3 (L3-SFA), and a higher degree of ascites were identified as independent factors predicting increased liver volume. The risk score model for predicting increased liver volume was Logit(P)=1.683-0.078 (ALB) -0.01 (pre TIPS L3-SFA) +0.996 (grade 3 ascites =1; non-grade 3 ascites =0). The area under the curve of the receiver operating characteristic curve was 0.729, and the cut-off value was 0.375. The rate of liver volume change at 2±1 months post TIPS was significantly correlated with that of spleen volume change (R2=0.378, P<0.001). The rate of subcutaneous fat change at 9±3 months post TIPS was significantly correlated with that of liver volume change (R2=0.782, P<0.001). In patients with a liver volume increase, the mean computed tomography value (Hounsfield units) decreased significantly after TIPS placement (65.9±17.7 vs. 57.8±18.2, P=0.009). Liver volume was decreased at 2±1 months post TIPS and slightly increased at 9±3 months post TIPS; however, it did not recover to its pre-TIPS level completely. A lower ALB level, a lower L3-SFA, and a higher degree of ascites were all predictors for increased liver volume post TIPS.

Growth Regularity of Pulmonary Ground Glass Nodules Based on 3D Reconstruction Technology

Since the popularization of computed tomography (CT) technology, the detection rate of pulmonary ground glass nodules (GGNs) with imaging follow-up as the main management method has increased significantly. The purpose of this study is to quantitatively analyze the changes of pulmonary GGNs during the follow-up process with three-dimensional reconstruction technology, explore the natural progression of pulmonary GGNs, and provide effective basis for clinical guidance for patients to conduct reasonable management of nodules. A total of 115 cases of pulmonary GGNs with regular follow-up in the Combined Outpatient Department of Zhoushan Hospital from March 2015 to November 2022 were enrolled. Quantitative imaging features of nodules were extracted by semi-automatic segmentation of 3D Slicer software to evaluate the growth of nodules and clinical intervention during follow-up. The average baseline age of the patients was (56.9±10.1) yr. The mean follow-up time was (48.8±18.9) months. The two-dimensional diameter of baseline CT scan was (7.9±2.9) mm, and the maximum three-dimensional diameter was (10.1±3.4) mm. The two-dimensional diameter of the last CT scan was (9.9±4.7) mm, and the maximum three-dimensional diameter was (11.4±5.1) mm. A total of 27 cases (23.5%) showed an increase during follow-up, with a median volume doubling time of 822 days and a median mass doubling time of 1,007 days. 32 cases were surgically resected, including 6 cases of invasive adenocarcinoma (IAC), 16 cases of minimally invasive adenocarcinoma (MIA), 8 cases of adenocarcinoma in situ (AIS) and 2 cases of atypical adenomatous hyperplasia (AAH). Five nodules underwent surgical intervention due to the progression of two-dimensional diameter, which was pathologically confirmed as pre-invasive lesions, but their three-dimensional maximum diameter showed no significant change. Nodular morphology, lobulated sign, spiculated sign and vacuole signs all promoted the growth of nodules in univariate analysis. There were significant differences in age, baseline diameter, mean CT value, median CT value, 10% and 90% percentile CT number between the growth group and the stable group (P<0.05). Multivariate Logistic regression analysis showed that age and average CT value were risk factors for nodule growth (P<0.05). Receiver-operating characteristic (ROC) curve analysis results indicated that the age ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU were more likely to accelerate the growth of GGNs. The maximum three-dimensional diameter ≥14.4 mm and the average CT value ≥-495.7 HU may be a higher malignant probability. GGNs show an inert growth process, and the use of three-dimensional measurements during follow-up is of greater significance. For persistent glass grinding nodules ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU are more likely to increase. However, most nodules still have good prognosis after progression, and long-term follow-up is safe.

PHANTOM AND CLINICAL STUDIES ON LOW-DOSE CT PROTOCOL FOR APPLICATOR RECONSTRUCTION IN THREE-DIMENSIONAL BRACHYTHERAPY USING SIZE-SPECIFIC DOSE ESTIMATES BASED ON WATER EQUIVALENT DIAMETER.

To verify the feasibility of low-dose computed tomography (CT) protocol for applicator reconstruction in three-dimensional brachytherapy among patients of different sizes, using size-specific dose estimate based on water equivalent diameter (SSDEdw) in phantom and clinical studies. Pre-scans of a female pelvic phantom were followed by reconstruction of each image set with iDose4 levels 3-5. Imaging data from 64 cervical cancer patients were divided into low, standard and high weight groups. Among two to five CT scans required for applicator reconstruction, the first scan was adopted by routine-dose CT protocol (tube voltage = 120 kV, tube current-exposure time product = 320 mA.s) and the remaining by low-dose CT protocol (tube voltage = 120 kV, tube current-exposure time product = 80 mA.s). The SSDEdw and image quality parameters were compared among the groups, and correlations between SSDEdw and body mass index, area of reference plane (AreaROI3) and mean CT value of reference plane (CTROI3) were analyzed. According to the phantom test results, we determined tube voltage to 120 kV and tube current-exposure time product to 80 mA.s as the low-dose protocol. Clinical study revealed no statistically significant differences in signal-to-noise ratio (SNR) and contrast-noise-ratio (CNR) between low-dose and routine-dose CT in Groups A and B; in Group C, these were significantly lower in the former. The SSDEdw was significantly lower under low-dose than routine-dose protocol in all groups, with strong negative correlation with BMI and AreaROI3 in Groups A and B and moderate-to-strong negative correlation in Group C. Because of the characteristics of three-dimensional brachytherapy, in patients with BMI < 24.0 kg per m2, low-dose CT protocol can minimize radiation exposure and achieve precise, individualized treatment.

A comparison of the use of contrast media with different iodine concentrations for enhanced computed tomography.

Objective: In this study, we compared the enhancement of blood vessels and liver parenchyma on enhanced computed tomography (CT) of the upper abdomen with two concentrations of contrast media (400 and 300mg I/mL) based on similar iodine delivery rate (IDR) of 0.88 and 0.9g I/s and iodine load of 450mg I/kg. Methods: We randomly assigned 160 patients into two groups: iomeprol 400mg I/mL (A group) and iohexol 300mg I/mL (B group). The CT attenuation values of the main anatomical structures in the two groups with different scanning phases were measured and the image quality of the two groups was analyzed and compared. The peak pressure and local discomfort (including fever and pain) during contrast medium injection were recorded. Results: The mean attenuation value of the abdominal aorta was 313.6 ± 29.6 in the A group and 322.4 ± 30.1 in the B group during the late arterial phase (p = 0.8). Meanwhile, the mean enhancement values of the portal vein were 176.2 ± 19.3 and 165.9 ± 24.5 in the A and B groups, respectively, during the portal venous phase (p = 0.6). The mean CT values of liver parenchyma were 117.1 ± 15.3 and 108.8 ± 18.7 in the A and B groups, respectively, during the portal venous phase (p = 0.9). There was no statistical difference in image quality, peak injection pressure (psi), and local discomfort between the two groups (p > 0.05). Conclusion: When a similar IDR and the same iodine load are used, CT images with different concentrations of contrast media have the same subjective and objective quality, and can meet the diagnostic needs.

Analysis of the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types.

In this study, we aimed to analyze the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types. Between January 2017 and December 2018, a total of 657 patients (191 males, 466 females; mean age: 60.9±8.1 years; range, 34 to 80 years) with pathologically diagnosed ground-glass nodules were retrospectively analyzed. The clinicopathological characteristics and computed tomography characterizations of patients with ground-glass nodules who received surgical resection were analyzed. The clinical data including age, sex, smoking status and medical history were recorded. Computed tomography characterizations included the location and size of the tumor, the size of the consolidation components, density uniformity, shape, margin, tumor-lung interface, internal signs and surrounding signs. Based on the computed tomography imaging characteristics, a mean computed tomography value of ≥444.5 HU was more likely to indicate malignant lesions, while ≤444.5 HU indicated benign lesions. A malignant ground-glass nodules" maximum diameter of <6.78 mm, a diameter of the consolidation component of <3.88 mm, and a mean computed tomography value of <-536.5 HU were more likely to indicate atypical adenomatous hyperplasia and adenocarcinoma in situ. A maximum diameter of malignant ground-glass nodules of >11.52 mm, a diameter of the consolidation component of >6.20 mm, and a mean computed tomography value of ≥493.5 HU were more likely to indicate invasive adenocarcinomas. The focus between these parameters indicated minimally invasive adenocarcinomas. Ill-defined tumor-lung interface, irregular in shape, and smooth nodule margins suggest benign lesions while round or oval, clear tumor-lung interface, spiculation signs, lobulation signs, bubble signs, air bronchograms, pleural indentations, and vessel convergences are helpful in the diagnosis of malignant lesions. A clear tumor-lung interface, the spiculation signs, lobulation signs, and bubble signs indicate the invasion of the lesions.

The efficacy and safety of wedge resection for peripheral stage IA lung adenocarcinoma: a real-world study based on a single center.

The effectiveness of segmentectomy for stage IA lung adenocarcinoma (IA-LUAD) has been well-documented. However, the efficacy and safety of wedge resection for peripheral IA-LUAD remains controversial. This study evaluated the feasibility of wedge resection in patients with peripheral IA-LUAD. Patients with peripheral IA-LUAD who underwent wedge resection by video-assisted thoracoscopic surgery (VATS) at Shanghai Pulmonary Hospital were reviewed. Cox proportional hazards modeling was performed to identify predictors of recurrence. Receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoffs of identified predictors. A total of 186 patients (female/male, 115/71; mean age, 59.9 years) were included. Mean maximum dimension of consolidation component (MCD) was 5.6 mm, consolidation-to-tumor ratio (CTR) was 37%, and mean computed tomography value of tumor (CTVt) was -285.4 HU. With a median follow-up of 67 months (interquartile range, 52-72 months), the 5-year recurrence rate was 4.84%. Ten patients occurred recurrence postoperatively. No recurrence was observed adjacent to the surgical margin. Increasing MCD, CTR, and CTVt were associated with a higher risk of recurrence, with corresponding hazard ratios (HRs) of 1.212 [95% confidence interval (CI): 1.120-1.311], 1.054 (95% CI: 1.018-1.092), and 1.012 (95% CI: 1.004-1.019) with optimal cutoffs for predicting recurrence of 10 mm, 60%, and -220 HU, respectively. When a tumor had characteristics under these respective cutoffs, no recurrence was observed. Wedge resection can be considered to be a safe and efficacious management strategy for patients with peripheral IA-LUAD, especially for MCD less than 10 mm, CTR less than 60% and CTVt less than -220 HU.

Artificial intelligence-based volumetric analysis of muscle atrophy and fatty degeneration in patients with hip osteoarthritis and its correlation with health-related quality of life

PurposeArtificial intelligence (AI) technologies have enabled precise three-dimensional analysis of individual muscles on computed tomography (CT) or magnetic resonance images via automatic segmentation. This study aimed to perform three-dimensional assessments of pelvic and thigh muscle atrophy and fatty degeneration in patients with unilateral hip osteoarthritis using CT and to evaluate the correlation with health-related quality of life (HRQoL).MethodsThe study included one man and 43 women. Six muscle groups were segmented, and the muscle atrophy ratio was calculated volumetrically. The degree of fatty degeneration was defined as the difference between the mean CT values (Hounsfield units [HU]) of the healthy and affected sides. HRQoL was evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).ResultsThe mean muscle atrophy rate was 16.3%, and the mean degree of muscle fatty degeneration was 7.9 HU. Multivariate correlation analysis revealed that the WOMAC stiffness subscale was significantly related to fatty degeneration of the hamstrings, the WOMAC physical function subscale was significantly related to fatty degeneration of the iliopsoas muscle, and the JHEQ movement subscale was significantly related to fatty degeneration of the hip adductors.ConclusionWe found that fatty degeneration of the hamstrings, iliopsoas, and hip adductor muscles was significantly related to HRQoL in patients with hip osteoarthritis. These findings suggest that these muscles should be targeted during conservative rehabilitation for HOA and perioperative rehabilitation for THA.

SPECT/CT imaging features of cystic degeneration of the talus and their relation to pathological findings

BackgroundOsteochondral lesions of the talus (OLTs) are a common orthopedic condition. The image presentation is very similar to that of ischemic necrosis of the talus complicated by a talar neck fracture, but the two are very different lesions. When abnormalities in bone density (or signal) of the talar body (apex of the fornix) with concomitant bone defects and cystic changes are found on X-ray, computed tomography (CT), or magnetic resonance imaging, it is important to accurately determine the nature of the lesion and make a correct diagnosis for the treatment and prognosis of the patient. The purpose of this study was to explore the imaging features of three-phase single-photon emission computed tomography (SPECT)/CT images of cystic lesions of the talus.MethodsA total of 189 patients with chronic pain in the ankle joint suspected to be caused by cystic degeneration of the talus were enrolled. All patients underwent 99mTc-methyl diphosphonate (99mTc-MDP) three-phase SPECT/CT bone imaging and delayed scans in our hospital. The location, range of involvement, classification, CT value, and radioactivity uptake of the sclerotic areas of cystic lesions on the talus, and the continuity of the articular surface, were recorded. All recorded parameters were analyzed in comparison with pathological results.ResultsEighty-three percent (157/189) of the talar cysts were located on the medial fornix, largely involving the anterior middle part (43.27%), with larger cysts involving the posterior part (9.6%). Sixty-three percent (119/189) of the patients had type I lesions and 37% (70/189) had type II lesions. The articular surface of the medial dome of the talus was intact in all patients, but the subchondral bony articular surface was rough in 88% (166/189) of patients. The coincidence rate for the location, type, and range of involvement of cystic lesions with the pathological results was 87.83% (166/189). The mean CT value of the cystic lesions was 45 ± 15 HU (30–60 HU). The percentages of pathological chondrogenesis in high CT value ≥ 50 HU (19/70) and low CT value < 50 HU (51/70) groups were 89.47% (17/19) and 29.14% (15/51) (χ2 = 20.12, p < 0.001), respectively. The target/background ratio (T/B ratio) of the radioactivity-uptake area of the talus vault was 2.0 ± 0.5 (1.5–2.5). The percentages of pathological new trabecular bone in those with a T/B ratio ≥ 2.0 (157/189) and T/B ratio < 2.0 (32/189) were 82.80% (130/157) and 25.00% (8/32; χ2 = 45.08, p < 0.001), respectively.ConclusionsThree-phase bone imaging could identify damage of the talus caused by cystic degeneration, while delayed SPECT/CT images showed advantages for displaying bone microstructure, blood supplement, and bone metabolism when examining the location, range of involvement, classification, and repair of cystic lesions of the talus.

Robust treatment planning in scanned carbon-ion radiotherapy for pancreatic cancer: Clinical verification using in-room computed tomography images.

PurposeCarbon-ion beam (C-beam) has a sharp dose distribution called the Bragg peak. Carbon-ion radiation therapy, such as stereotactic body radiotherapy in photon radiotherapy, can be completed in a short period by concentrating the radiation dose on the tumor while minimizing the dose to organs at-risk. However, the stopping position of C-beam is sensitive to density variations along the beam path and such variations can lower the tumor dose as well as cause the delivery of an unexpectedly high dose to the organs at risk. We evaluated the clinical efficacy of a robust planning technique considering gastrointestinal gas (G-gas) to deliver accurate radiation doses in carbon-ion radiotherapy for pancreatic cancer.Materials and methodsWe focused on the computed tomography (CT) value replacement method. Replacement signifies the overwriting of CT values in the CT images. The most effective replacement method for robust treatment planning was determined by verifying the effects of the three replacement patterns. We selected 10 consecutive patients. Pattern 1 replaces the CT value of the G-gas contours with the value of the region without G-gas (P1). This condition indicates a no-gas state. Pattern 2 replaces each gastrointestinal contour using the mean CT value of each contour (P2). The effect of G-gas was included in the replacement value. Pattern 3 indicates no replacement (P3). We analyzed variations in the target coverage (TC) and homogeneity index (HI) from the initial plan using in-room CT images. We then performed correlation analysis on the variations in G-gas, TC, and HI to evaluate the robustness against G-gas.ResultsAnalysis of variations in TC and HI revealed a significant difference between P1 and P3 and between P2 and P3. Although no statistically significant difference was observed between P1 and P2, variations, including the median, tended to be fewer in P2. The correlation analyses for G-gas, TC, and HI showed that P2 was less likely to be affected by G-gas.ConclusionFor a treatment plan that is robust to G-gas, P2 mean replacement method should be used. This method does not necessitate any particular software or equipment, and is convenient to implement in clinical practice.

Correlation Analysis of Computed Tomography Features and Pathological Types of Multifocal Ground-Glass Nodular Lung Adenocarcinoma.

To investigate the correlation between computed tomography (CT) image characteristics of multiple lung ground-glass nodules (GGNs) and pathological classification, the CT image data of multiple lung GGN patients confirmed by pathology (n = 132) in our hospital were collected. The imaging features of GGNs were analyzed by qualified physicians, including lesion size (diameter, volume, and mass), location, CT values (mean and relative CT values), lesion morphology (round and irregular), marginal structure (pagination and burr), internal structure (bronchial inflation sign), and adjacent structure (pleural depression). CT imaging analysis was performed for the subtype of infiltrating adenocarcinoma (IAC). In CT findings, GGNs were greatly different from adenomatous hyperplasia (AAH), pure GGN adenocarcinoma in situ (AIS), and microinvasive adenocarcinoma (MIA) in terms of marginal structure, lesion morphology, internal structure, adjacent structure, and size (P < 0.05). The mean and relative CT values of mural adenocarcinoma, acinar adenocarcinoma, and papillary adenocarcinoma of IAC subtypes were greatly different from those of AAH/AIS/MIA (P < 0.05). In summary, the CT images of GGNs can be used as the basis for the differentiation of AAH, AIS, and MIA early noninvasive types and IAC invasive types, and the CT value of the IAC subtype can be used as the basis for the classification and differentiation of IAC pathological subtypes.