Unenhanced Computed Tomography Scan Research Articles

Can we screen opportunistically for low BMD using CT scans of the shoulder and artificial intelligence.

To evaluate whether the computed tomography (CT) attenuation of bones seen on shoulder CT scans could be used to predict low bone mineral density (BMD) (osteopenia/osteoporosis), and to compare the performance of two machine learning models to predict low BMD. 194 patients aged 50 years or greater (69.2 +/- 9.1 years; 170 females) who had unenhanced shoulder CT scans and dual-energy x-ray absorptiometry (DXA) within 1 year of each other between January 1st, 2010 and December 31st, 2021 were evaluated. The CT attenuation of the humerus, glenoid, coracoid, acromion, clavicle, first, second, and third ribs were obtained using 3D-Slicer. Support vector machines (SVM) and k-nearest neighbors (kNN) were used to predict low BMD. DeLong's test was used to compare the area under the curve (AUCs). A CT attenuation of 195.4 Hounsfield Units (HU) of the clavicle had a sensitivity of 0.577, specificity of 0.781 and AUC of 0.701 to predict low BMD. In the test dataset, the SVM had sensitivity of 0.686, specificity of 1.00 and AUC of 0.857; while the kNN model had sensitivity of 0.966, specificity of 0.200, and AUC of 0.583. The SVM was superior to the CT attenuation of the clavicle (P = 0.003), but not better than the kNN model (P = 0.098). The CT attenuation of the clavicle was best for predicting low BMD, however, a multivariable SVM was superior for predicting low BMD. SVM utilizing the CT attenuations at many sites was best for predicting low BMD.

Deep learning imaging phenotype can classify metabolic syndrome and is predictive of cardiometabolic disorders

BackgroundCardiometabolic disorders pose significant health risks globally. Metabolic syndrome, characterized by a cluster of potentially reversible metabolic abnormalities, is a known risk factor for these disorders. Early detection and intervention for individuals with metabolic abnormalities can help mitigate the risk of developing more serious cardiometabolic conditions. This study aimed to develop an image-derived phenotype (IDP) for metabolic abnormality from unenhanced abdominal computed tomography (CT) scans using deep learning. We used this IDP to classify individuals with metabolic syndrome and predict future occurrence of cardiometabolic disorders.MethodsA multi-stage deep learning approach was used to extract the IDP from the liver region of unenhanced abdominal CT scans. In a cohort of over 2,000 individuals the IDP was used to classify individuals with metabolic syndrome. In a subset of over 1,300 individuals, the IDP was used to predict future occurrence of hypertension, type II diabetes, and fatty liver disease.ResultsFor metabolic syndrome (MetS) classification, we compared the performance of the proposed IDP to liver attenuation and visceral adipose tissue area (VAT). The proposed IDP showed the strongest performance (AUC 0.82) compared to attenuation (AUC 0.70) and VAT (AUC 0.80). For disease prediction, we compared the performance of the IDP to baseline MetS diagnosis. The models including the IDP outperformed MetS for type II diabetes (AUCs 0.91 and 0.90) and fatty liver disease (AUCs 0.67 and 0.62) prediction and performed comparably for hypertension prediction (AUCs of 0.77).ConclusionsThis study demonstrated the superior performance of a deep learning IDP compared to traditional radiomic features to classify individuals with metabolic syndrome. Additionally, the IDP outperformed the clinical definition of metabolic syndrome in predicting future morbidities. Our findings underscore the utility of data-driven imaging phenotypes as valuable tools in the assessment and management of metabolic syndrome and cardiometabolic disorders.

Comparing Visual and Software-Based Quantitative Assessment Scores of Lungs' Parenchymal Involvement Quantification in COVID-19 Patients.

(1) Background: Computed tomography (CT) plays a paramount role in the characterization and follow-up of COVID-19. Several score systems have been implemented to properly assess the lung parenchyma involved in patients suffering from SARS-CoV-2 infection, such as the visual quantitative assessment score (VQAS) and software-based quantitative assessment score (SBQAS) to help in managing patients with SARS-CoV-2 infection. This study aims to investigate and compare the diagnostic accuracy of the VQAS and SBQAS with two different types of software based on artificial intelligence (AI) in patients affected by SARS-CoV-2. (2) Methods: This is a retrospective study; a total of 90 patients were enrolled with the following criteria: patients' age more than 18 years old, positive test for COVID-19 and unenhanced chest CT scan obtained between March and June 2021. The VQAS was independently assessed, and the SBQAS was performed with two different artificial intelligence-driven software programs (Icolung and CT-COPD). The Intraclass Correlation Coefficient (ICC) statistical index and Bland-Altman Plot were employed. (3) Results: The agreement scores between radiologists (R1 and R2) for the VQAS of the lung parenchyma involved in the CT images were good (ICC = 0.871). The agreement score between the two software types for the SBQAS was moderate (ICC = 0.584). The accordance between Icolung and the median of the visual evaluations (Median R1-R2) was good (ICC = 0.885). The correspondence between CT-COPD and the median of the VQAS (Median R1-R2) was moderate (ICC = 0.622). (4) Conclusions: This study showed moderate and good agreement upon the VQAS and the SBQAS; enhancing this approach as a valuable tool to manage COVID-19 patients and the combination of AI tools with physician expertise can lead to the most accurate diagnosis and treatment plans for patients.

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement.

Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95%CI: 1.01-1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068-1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.

Low skeletal muscle quality extracted from CT is associated with poor outcomes in severe acute pancreatitis patients

PurposeTo evaluate the association between body composition parameters derived from computed tomography (CT) scans and clinical outcomes in patients with severe acute pancreatitis (AP). MethodsPatients who have been diagnosed AP with a CT scan at ICU admission were included. Body composition parameters were measured on a single slice at L2-3 of the unenhanced CT scans. The intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), skeletal muscle area (SMA) and skeletal muscle density (SMD) were assessed using HUs by image analysis software. Univariable and multivariable analyses were performed to analyze the association between body composition parameters and clinical outcomes including all-cause mortality or prolonged ICU stay. The area under the curve (AUC) of a receiver operating characteristic curve was used to explore the predictive value of the body composition on treatment clinical outcomes. ResultsA total of 158 patients were included. The IMAT (8.3 cm2 vs 6.0 cm2, P = 0.001) and VAT (190.3 cm2 vs 143.7 cm2, P < 0.001) were significantly higher in the severe AP group than in the moderately severe group, but were notassociatedwithoutcomes. For 1 HU of SMD increased, the risk of poor clinical outcomes decresed 11 % (adjusted OR 0.892, 95 %CI 0.806–0.987, P = 0.026), while an SMD below the median value (32.1 HU for males and 28.5 HU for females) was independently associated with worse outcomes in the multivariable analysis (adjusted OR 8.868, 95 % CI 2.146–36.650, P = 0.003). The SMD had a good predictive ability for clinical outcomes, AUC was 0.824 (95 % CI, 0.715–0.933) for males and 0.803 (95 % CI, 0.639–0.967) for females. ConclusionLow SMD was associated with poor outcomes in patients with severe and moderately severe AP and might be used as a novel marker to predict outcomes in patients suffering from severe and moderately severe AP.

CT features of calcified micro-gastric gastrointestinal stromal tumors: a case series

BackgroundDue to the lack of corresponding clinical symptoms, small calcified gastric gastrointestinal stromal tumors (GISTs) are often overlooked in clinical practice. Therefore, there is an unmet need to define the imaging features of calcified micro-gastric GISTs to facilitate diagnosis. This study retrospectively analyzed the computed tomography (CT) features of pathologically confirmed calcified micro-gastric GISTs.MethodsThe medical records (gastroscopy, pre-treatment gastric CT imaging [pre- and post-contrast scans], pathology) of patients with calcified gastric GISTs < 1 cm in diameter confirmed pathologically after endoscopic submucosal dissection, endoscopic submucosal excavation, or endoscopic full-thickness resection were retrospectively reviewed.ResultsSeven patients had 8 calcified gastric GISTs < 1 cm in diameter. Six patients hadsingle lesions, and 1patients had multiple lesions. Six patients had lesions in the gastric fundus, 1 patient had a lesion in the body of the stomach. Lesions had a mean diameter of 5.2 mm (range, 1.3 mm ~ 7 mm). Unenhanced CT scans showed spots and high-density nodular calcifications in 3 submucosal lesions, 2 lesions in the muscularis propria, and 3 subserosal lesions that protruded outside the stomach. Among the 8 lesions, only two had solid soft tissue components surrounding the calcification, with one of these two showing post contrast enhancement of the solid soft tissue component.ConclusionsNovel CT features of gastric GISTs included: commonly found in the gastric antrum, small size (< 1 cm in diameter), calcification, few solid soft tissue components, and no abnormal enhancement in most cases.

Convolutional neural network-based kidney volume estimation from low-dose unenhanced computed tomography scans

PurposeKidney volume is important in the management of renal diseases. Unfortunately, the currently available, semi-automated kidney volume determination is time-consuming and prone to errors. Recent advances in its automation are promising but mostly require contrast-enhanced computed tomography (CT) scans. This study aimed at establishing an automated estimation of kidney volume in non-contrast, low-dose CT scans of patients with suspected urolithiasis.MethodsThe kidney segmentation process was automated with 2D Convolutional Neural Network (CNN) models trained on manually segmented 2D transverse images extracted from low-dose, unenhanced CT scans of 210 patients. The models’ segmentation accuracy was assessed using Dice Similarity Coefficient (DSC), for the overlap with manually-generated masks on a set of images not used in the training. Next, the models were applied to 22 previously unseen cases to segment kidney regions. The volume of each kidney was calculated from the product of voxel number and their volume in each segmented mask. Kidney volume results were then validated against results semi-automatically obtained by radiologists.ResultsThe CNN-enabled kidney volume estimation took a mean of 32 s for both kidneys in a CT scan with an average of 1026 slices. The DSC was 0.91 and 0.86 and for left and right kidneys, respectively. Inter-rater variability had consistencies of ICC = 0.89 (right), 0.92 (left), and absolute agreements of ICC = 0.89 (right), 0.93 (left) between the CNN-enabled and semi-automated volume estimations.ConclusionIn our work, we demonstrated that CNN-enabled kidney volume estimation is feasible and highly reproducible in low-dose, non-enhanced CT scans. Automatic segmentation can thereby quantitatively enhance radiological reports.

SAT339 Osteopenia In The Setting of Mild Autonomous Cortisol Secretion

Abstract Disclosure: J.J. Mao: None. K.C. McCowen: None. C. Choe: None. Jimmy J. Mao, MD (1); Karen C. McCowen (1); Charles H. Choe (1)(1) Division of Endocrinology, Diabetes, and Metabolism, University of California San Diego, La Jolla, CA. Background: Over 80% of adrenal incidentalomas are benign adrenal cortical adenomas, of which 30-50% are found to have mild autonomous cortisol secretion (MACS). Bone fragility is a known complication of MACS. Clinical Case: A 57-year-old postmenopausal female with no prior history of fracture, venous thromboembolism, and atherosclerotic cardiovascular disease, was referred for incidental bilateral adrenal nodules. Body mass index was normal at 21 kg/m2, and no clinical stigmata of Cushing syndrome were noted on physical exam. Unenhanced computed tomography scan revealed a 4.6 cm right adrenal nodule and a 3.3 cm left adrenal nodule; both nodules measured less than -18 Hounsfield Units. Biochemical work-up for pheochromocytoma, primary aldosteronism, and non-classical congenital adrenal hyperplasia was negative. Evaluation for hypercortisolism revealed a morning cortisol of 20.3 mcg/dL (ref. 4-22 mcg/dL) with concurrent adrenocorticotropic hormone of &amp;lt;5 pg/mL (ref. 6-50 pg/mL), 24-hour urine free cortisol of 16.9 mcg (ref. 4-50 mcg), and midnight salivary cortisol of 0.07 mcg/dL (ref. &amp;lt;0.09 mcg/dL). A 1 mg dexamethasone suppression test measured on two separate occasions was elevated at 6.3 mcg/dL and 7.9 mcg/dL (ref. &amp;lt;1.8 mcg/dL). A subsequent 8 mg dexamethasone suppression test was also elevated at 6.1 mcg/dL (ref. &amp;lt;1.8 mcg/dL). The diagnosis of MACS was made. A bone mineral density (BMD) scan revealed T-scores at the right femoral neck, left femoral neck, and lumbar spine at -1.6, -1.3, and -0.8, respectively. Ten-year probability of major osteoporotic fracture and hip fracture were 8.3% and 1.0%, respectively. To reduce the risk for future fractures, the decision was made to proceed with adrenal vein sampling (AVS) in preparation for potential adrenalectomy. Conclusion: MACS is the most frequent hormonal abnormality in adrenal incidentalomas, with an estimated prevalence of 0.8-2 cases per 1000 persons. A previous prospective study found that surgical cure of unilateral MACS may lead to a substantial risk reduction (up to 15-fold) of future incident asymptomatic vertebral fractures. Additionally, the highest risk for clinical fracture in those with adrenal adenomas (either nonfunctional or with cortisol hypersecretion) appears to occur at 7-10 years after initial diagnosis. BMD does not perfectly correlate with fracture risk, so unilateral adrenalectomy (if lateralization is observed on AVS) and/or pharmacotherapy should be strongly considered in patients with an expected longevity of &amp;gt;10 years even with mild osteopenia and low fracture risk assessment tool scores. Presentation: Saturday, June 17, 2023

A new medical imaging postprocessing and interpretation concept to investigate the clinical relevance of incidentalomas: can we keep Pandora's box closed?

Incidental imaging findings (incidentalomas) are common, but there is currently no effective means to investigate their clinical relevance. To introduce a new concept to postprocess a medical imaging examination in a way that incidentalomas are concealed while its diagnostic potential is maintained to answer the referring physician's clinical questions. A deep learning algorithm was developed to automatically eliminate liver, gallbladder, pancreas, spleen, adrenal glands, lungs, and bone from unenhanced computed tomography (CT). This deep learning algorithm was applied to a separately held set of unenhanced CT scans of 27 patients who underwent CT to evaluate for urolithiasis, and who had a total of 32 incidentalomas in one of the aforementioned organs. Median visual scores for organ elimination on modified CT were 100% for the liver, gallbladder, spleen, and right adrenal gland, 90%-99% for the pancreas, lungs, and bones, and 80%-89% for the left adrenal gland. In 26 out of 27 cases (96.3%), the renal calyces and pelves, ureters, and urinary bladder were completely visible on modified CT. In one case, a short (<1 cm) trajectory of the left ureter was not clearly visible due to adjacent atherosclerosis that was mistaken for bone by the algorithm. Of 32 incidentalomas, 28 (87.5%) were completely concealed on modified CT. This preliminary technical report demonstrated the feasibility of a new approach to postprocess and evaluate medical imaging examinations that can be used by future prospective research studies with long-term follow-up to investigate the clinical relevance of incidentalomas.

Computed Tomography-Based Texture Analysis as a Predictor of Survival in Patients with T-Cell Lymphomas

Background: T-cell lymphomas constitute a heterogeneous group of hematological malignancies with global poor outcomes. Computed tomography (CT)-based texture analysis (CTTA) is a promising technique to predict the survival of these patients. Objectives: The present study aimed to investigate whether CTTA features on the pretreatment unenhanced CT scans of 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) examination can predict the survival of patients with T-cell lymphomas. Patients and Methods: In this retrospective cohort study, patients with T-cell lymphomas, undergoing pretreatment 18F-FDG PET/CT scan during 2008 - 2019, were included, and their clinical and biological characteristics were collected. The mean gray value, entropy, kurtosis, skewness, and standard deviation were derived from the pixel distribution histogram before and after spatial filtration at different anatomic scales in up to five lesions per patient, indicating a high focal uptake on 18F-FDG PET scan. A Lasso-penalized Cox regression analysis was performed to identify independent predictors of overall survival (OS), progression-free survival at 24 months (PFS24), and PFS. Results: A total of 23 patients (7 females and 16 males; median age, 69 years; age range, 33 - 86 years) were included in this study. The CTTA was performed for 60 lesions. The median OS and PFS were 391 days (range, 10 - 3,463 days) and 268 days (range, 10 - 2,321 days), respectively. No CT texture parameter was associated with PFS or PFS24. The standard deviation at a coarse filter scale was independently associated with a poor OS (hazard ratio [HR] = 1.009, confidence interval [CI]: 1.0012 - 1.016, P = 0.02). A value above 143 was associated with a poor prognosis with a specificity of 81%. Conclusion: The pretreatment CTTA-derived tumor standard deviation at a coarse filter scale may be a predictive biomarker of OS in patients with T-cell lymphomas.

De novo Stone Formation in Ureteric Stump Post-Nephrectomy

Introduction: The leftover ureteric stump after a simple nephrectomy is rarely symptomatic. Here, we report a unique case of ureteric stump stones that likely developed de novo and patients became symptomatic. Case Report: We report the case of a 53-year-old female, who had benign right nephrectomy for a nonfunctioning kidney 17 years ago and presented with three years history of recurrent urinary tract infections and right-side abdominal pain. A continuous unenhanced computed tomography scan confirmed the presence of multiple de novo stones in the leftover ureteric stump, which was successfully treated by an open transperitoneal ureteric stumpectomy. She was asymptomatic at 12 months post-operative follow-up. We describe problems of leftover ureteric stumps and the possible pathophysiology of the stones formation in this group of patients. Conclusion: Albeit rare, various symptoms and complications can develop in the leftover stump, including stumpitis, urinary tract infections, and calculi. Therefore, discussion with patients of ureteric stump complications is recommended.

Development and validation of a new equation based on plasma creatinine and muscle mass assessed by CT scan to estimate glomerular filtration rate: a cross-sectional study.

Inter-individual variations of non-glomerular filtration rate (GFR) determinants of serum creatinine, such as muscle mass, account for the imperfect performance of estimated GFR (eGFR) equations. We aimed to develop an equation based on creatinine and total lumbar muscle cross-sectional area measured by unenhanced computed tomography scan at the third lumbar vertebra. The muscle mass-based eGFR (MMB-eGFR) equation was developed in 118 kidney donor candidates (iohexol clearance) using linear regression. Validation cohorts included 114 healthy subjects from another center (51Cr-EDTA clearance, validation population 1), 55 patients with chronic diseases (iohexol, validation population 2), and 60 patients with highly discordant creatinine and cystatin C-based eGFR, thus presumed to have atypical non-GFR determinants of creatinine (51Cr-EDTA, validation population 3). Mean bias was the mean difference between eGFR and measured GFR, precision the standard deviation (SD) of the bias, and accuracy the percentage of eGFR values falling within 20% and 30% of measured GFR. In validation population 1, performance of MMB-eGFR was not different from those of CKD-EPICr2009 and CKD-EPICr2021. In validation population 2, MMB-eGFR was unbiased and displayed better precision than CKD-EPICr2009, CKD-EPICr2021 and EKFC (SD of the biases: 13.1vs 16.5, 16.8 and 15.9mL/min/1.73 m2). In validation population 3, MMB-eGFR had better precision and accuracy {accuracy within 30%: 75.0% [95% confidence interval (CI) 64.0-86.0] vs 51.5% (95% CI 39.0-64.3) for CKD-EPICr2009, 43.3% (95% CI 31.0-55.9) for CKD-EPICr2021, and 53.3% (95% CI 40.7-66.0) for EKFC}. Difference in bias between Black and white subjects was -2.1mL/min/1.73 m2 (95% CI -7.2 to 3.0), vs -8.4mL/min/1.73 m2 (95% CI -13.2 to -3.6) for CKD-EPICr2021. MMB-eGFR displayed better performances than equations based on demographics, and could be applied to subjects of various ethnic backgrounds.

Diagnosis of Metastatic Lymph Nodes in Patients With Hepatocellular Carcinoma Using Dual-Energy Computed Tomography.

Our study aimed to investigate the role of quantitative parameters derived from dual-energy computed tomography (DECT) in discriminating metastatic from nonmetastatic lymph nodes in hepatocellular carcinoma (HCC). Forty-two patients (34 males; mean age, 53.7 years) with HCC underwent unenhanced computed tomography scans and triple-phase DECT scans of the upper abdomen. A total of 72 suspected lymph nodes were resected, including 43 nonmetastatic and 29 metastatic lymph nodes. The maximum short-axis diameter of the lymph nodes, iodine concentration, normalized iodine concentration (NIC), and slope of the spectral curve were analyzed for the HCC primary lesions and the suspected lymph nodes. Lymph node metastasis was confirmed by pathologic examination. A maximum short-axis diameter of >10 mm had a sensitivity and a specificity of 75.9% (22/29) and 53.5% (23/43) in diagnosing metastatic lymph nodes. The iodine concentration, NIC, and slope of the spectral curve of the nonmetastatic lymph nodes were significantly higher than those of the primary HCC lesions and the metastatic lymph nodes (all P < 0.05). Among all the analyzed spectral parameters, the NIC in the arterial phase had the highest sensitivity and specificity of 88.4% and 86.2% in diagnosing metastatic lymph nodes. The arterial phase NIC of DECT has superior diagnostic performance than the traditional lymph node size in diagnosing metastatic lymph nodes in HCC.

Reliability of nephrolithometric nomograms in patients treated with minimally invasive percutaneous nephrolithotomy: A precision study

ObjectivesThe study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates (SFRs) and complication rates (CRs) in case of minimally invasive percutaneous nephrolithotomy (PNL). In the last decade, nomograms have been introduced to estimate the SFRs and CRs of PNL. However, no data are available regarding their reliability in case of utilization of miniaturized devices. Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score (GSS), the stone size, tract length, obstruction, number of involved calyces, and essence of stone (S.T.O.N.E.) nephrolithometry score and Clinical Research Office of the Endourological Society (CROES) score in patients treated with minimally invasive PNL. MethodsWe evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL. Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan. Patients demographics, SFRs, and CRs were reported and analyzed. Performances of nomograms were evaluated with the area under the curve (AUC). ResultsWe included 222 patients, the AUCs of GSS, CROES score, and S.T.O.N.E. nephrolithometry score were 0.69 (95% confidence interval [CI] 0.61–0.78), 0.64 (95% CI 0.56–0.73), and 0.62 (95% CI 0.52–0.71), respectively. Regarding SFRs, at multivariate binomial logistic regression, only the GSS had significance with an odds ratio of 0.53 (95% CI 0.31–0.95, p=0.04). We did not find significant correlation with complications, with only a trend for GSS. ConclusionThis is the first study evaluating nomograms in miniaturized PNL. They still show good reliability; however, our data showed lower performances compared to standard PNL. We emphasize the need of further studies to confirm this trend. A dedicated nomogram for minimally invasive PNL may be necessary.

Radiological Screening Methods in Deceased Organ Donation: An Overview of Guidelines Worldwide.

Organ transplantation is performed worldwide, but policies regarding donor imaging are not uniform. An overview of the policies in different regions is missing. This study aims to investigate the various protocols worldwide on imaging in deceased organ donation. An online survey was created to determine the current policies. Competent authorities were approached to fill out the survey based on their current protocols. In total 32 of the 48 countries approached filled out the questionnaire (response rate 67%). In 16% of the countries no abdominal imaging is required prior to procurement. In 50%, abdominal ultrasound (US) is performed to screen the abdomen and in 19% an enhanced abdominal Computed Tomography (CT). In 15% of the countries both an unenhanced abdominal CT scan and abdominal US are performed. In 38% of the countries a chest radiographic (CXR) is performed to screen the thorax, in 28% only a chest CT, and in 34% both are performed. Policies regarding radiologic screening in deceased organ donors show a great variation between different countries. Consensus on which imaging method should be applied is missing. A uniform approach will contribute to quality and safety, justifying (inter)national exchange of organs.

Nontarget Radiopaque Embolic Deposition during Prostatic Artery Embolization

This study evaluated detectable nontarget embolization (NTE) during prostatic artery embolization (PAE) and the safety and efficacy of using radiopaque particles in PAE. Ten patients aged >40 years with prostate glands of >50 mL and refractory lower urinary tract symptoms were analyzed. Unenhanced computed tomography scans at baseline and at 3 months after PAE, using 40–90-μm radiopaque spherical embolic beads, were compared to assess the NTE. Growth models evaluated changes from baseline to 3, 6, and 12 months in International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), quality of life (QoL), International Index of Erectile Function (IIEF), and postvoid residual (PVR). The IPSS, QoL, and Qmax improved at all time points (P < .05), with no trend in PVR or IIEF. Adverse events that occurred were minor. Radiographic NTE was seen in all patients, correlating at times with postprocedural symptoms (eg, rectal pain). Symptoms were not correlated with the NTE in some patients, whereas other patients remained asymptomatic despite NTE.

A New SteatoScore in the Evaluation of Non-Alcoholic Liver Disease in Oncologic Patients

PurposeThe aims of this study were to evaluate the reproducibility of a new multi-parametric steatoscore (new SteatoScore) in oncologic patients with non-alcoholic fatty liver disease (NAFLD) and to compare it with computed tomography (CT).Materials and MethodsFifty-one (31 men, 20 women) oncologic patients, with a mean age and weight of 63.9 years and 78.33 kg, respectively, were retrospectively enrolled in the study. Patients underwent ultrasound (US) and computed tomography (CT) examinations as part of their oncologic follow-up protocol. US examinations were performed by using a 3.5-MHz convex probe. During the US examination, three standardized clips were obtained in each patient. Two operators performed all measurements, one of whom repeated the processing twice in 1 year. Hepatic/renal ratio (HR), attenuation rate (AR), diaphragm visualization (DV), hepatic/portal vein ratio (HPV), and portal vein wall visualization (PVW) were acquired and calculated by using Matlab and inserted in a multi-parametric algorithm called new SteatoScore. On unenhanced CT scan, hepatic attenuation (HA), liver-spleen difference (L-S), and liver/spleen ratio (L/S) were measured by placement of a region of interest (ROI) within liver and spleen parenchyma, avoiding areas with vessels and biliary ducts.ResultsThe intra-observer variability was greater than the inter-observer one, with intraclass correlation coefficient (ICC) values of 0.94 and 0.97, respectively. Correlation between single US and CT parameters provided an agreement in no case exceeding 50%. New SteatoScore showed high reproducibility, and high coefficient of correlation with L-S (R = −0.64; p < 0.0001) and L/S (R = −0.62; p < 0.0001) at CT.ConclusionNew SteatoScore has a high reproducibility and shows a good correlation with unenhanced CT in evaluation of oncologic patients with NAFLD.

Movement of the superior mesenteric artery in patients with superior mesenteric artery syndrome: A case-reference study.

Superior mesenteric artery (SMA) syndrome is related to the reduction of the aortomesenteric angle on detailed imaging studies; i.e., an expert's ultrasonography or angiography. We aimed to test a simpler imaging finding of SMA syndrome. This cross-sectional case-reference study examined whether right movement of the SMA on unenhanced computed tomography (CT) is useful for the diagnosis of SMA syndrome. We reviewed hospital records of patients admitted in 2008-2018. Each case was matched to one non-case patient of the same age and sex. On unenhanced CT scans, we identified the shortest distance between the parallel line that passes through the center of the aorta to the line that bisects the spine and SMA. A negative number of the distance means that the SMA is on the left side of the above-described parallel line. There was a total of 14 cases and 14 non-cases (men, 57.1%) with mean age 78.7 years. Mean body mass index of cases and non-cases were 19.2 and 22.2kg/m2 , respectively. The more prevalent side of the SMA was the right side. The mean shortest distance was 10.5 mm in cases and 0.7 mm in non-cases (p for independent t test=0.043). For comparing the observations in SMA cases at several time points, the mean shortest distance at pre-onset was -2.7 mm, with a significant difference from that at onset (p for paired t test=0.030). In conclusion, right movement of the SMA diagnosed by unenhanced CT is associated with SMA syndrome.

Unenhanced computed tomography for non-invasive diagnosis of hepatic steatosis with low tube potential protocol.

Lowering kVp affects the image contrast and computed tomography (CT) attenuation values of low kVp CT is different from those of conventional 120-kVp scans. The purpose of this study is to determine the diagnostic performance and to establish the reference range of low-kVp unenhanced CT for the assessment of hepatic steatosis in liver transplantation donors using magnetic resonance (MR) spectroscopy as a reference standard. This retrospective study included 165 potential donors (male:female =114:51, 36.5±12.0 years old) who underwent 100-kVp single-slice unenhanced CT scan and MR spectroscopy. The difference between hepatic and splenic attenuation (CTL-S) and liver-to-spleen attenuation ratio (CTL/S) were calculated. Reference standard was the fat signal fraction measured by MR spectroscopy. Limits of agreement between CT measurements and the reference standard were calculated. Areas under receiver operating characteristic curves (AUROCs) of CTL-S and CTL/S were compared for the diagnosis of moderate to severe steatosis. Cut-off values of CTL-S and CTL/S that provided a balance between sensitivity and specificity and the highest specificity using the lower limit of the reference range were calculated. Eighty-seven subjects had a non-steatotic liver. Sixty-one subjects had mild steatosis and 17 subjects had moderate to severe steatosis based on MR spectroscopy. CTL-S and CTL/S values were negatively correlated with the fat signal fraction (P<0.001) and limits of agreement were -8.4% to 8.4% for CTL-S and -9.6% to 9.6% for CTL/S. AUROCs of CTL-S and CTL/S for diagnosing moderate to severe steatosis were 0.956 and 0.957, respectively. Cut-off values of CTL-S and CTL/S for diagnosis of moderate to severe steatosis by the Youden index were -0.5 HU for CTL-S and 0.99 for CTL/S. Reference ranges of non-steatotic liver were -6.90 to 31.40 HU for CTL-S and 0.89 to 1.77 for CTL/S. Using -6.9 HU for CTL-S and 0.89 for CTL/S as cut-off values, the sensitivity and specificity for diagnosing moderate to severe steatosis were 70.59% and 90.54% (CTL-S) and 76.47% and 90.54% (CTL/S), respectively. Measurements from a low-kVp unenhanced CT scan were negatively correlated with the degree of hepatic steatosis. Low-kVp unenhanced CT is a robust technique with reduced radiation exposure for diagnosing moderate to severe hepatic steatosis.

Visceral adipose tissue quality was associated with nonalcoholic fatty liver disease, independent of its quantity

Background and aimsNonalcoholic fatty liver disease (NAFLD) is a serious liver disease. Recent studies have shown that both visceral adipose tissue (VAT) quantity and density (as an indirect measure of quality) are associated with metabolic profiles. Therefore, we investigated the association between VAT quantity and quality, and the prevalence and incidence of NAFLD. Methods and resultsIn this cross-sectional, retrospective cohort study, the prevalence and incidence of NAFLD were analyzed in 627 and 360 middle-aged subjects, respectively. VAT was evaluated using an unenhanced computed tomography scan, while NAFLD was evaluated using ultrasonography. The VAT area was normalized to the square value of the subjects’ height in meters, the visceral fat area (VFA) index. The VAT density was described as the visceral fat density (VFD). The VFA index and VFD had an interaction effect on the prevalence of NAFLD (P = 0.0059). The VFA index (adjusted odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.07; P = 0.0145, per 1.0 cm2/m2) and the VFD (OR, 0.90; 95% CI, 0.84–0.96; P = 0.0026, per 1.0 Hounsfield unit [HU]) were independently associated with the prevalence of NAFLD. In our cohort, 36 subjects developed NAFLD. The VFD (adjusted hazards ratio [HR], 0.84; 95% CI, 0.77–0.91; P < 0.0001, per 1.0 HU) was independently associated with the incidence of NAFLD, whereas the VFA index was not. ConclusionBoth the VFA index and VFD were independently associated with NAFLD prevalence. The VFD might be more related to the incidence of NAFLD than the VFA index.