scholarly journals EXPRESS: Optimizing CTEPH diagnosis and assessment using advancing imaging modalities

2021 ◽  
pp. 204589402110073
Author(s):  
Seth Kligerman ◽  
Albert Hsiao
Keyword(s):  
Computed Tomography ◽  
Structural Information ◽  
Imaging Techniques ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Imaging Study ◽  
Standard Technique ◽  
High Specificity ◽  
Imaging Modalities ◽  
Dual Energy Ct ◽  
Operability Assessment

Imaging is key to nearly all aspects of chronic thromboembolic pulmonary hypertension (CTEPH) including management for screening, assessing eligibility for pulmonary endarterectomy, and post-operative follow-up. While ventilation/perfusion (V/Q) scintigraphy, the gold standard technique for CTEPH screening, can have excellent sensitivity, it can be confounded by other etiologies of pulmonary malperfusion, and does not provide structural information to guide operability assessment. Conventional computed tomography pulmonary angiography (CTPA) has high specificity, though findings of CTEPH can be visually subtle and unrecognized. In addition, CTPA can provide morphologic information to aid in pre-operative workup and assessment of other structural abnormalities. Advances in computed tomography (CT) imaging techniques, including dual-energy CT (DECT) and spectral-detector CT allow for improved sensitivity and specificity in detecting CTEPH, comparable to that of V/Q scans. Furthermore, these advanced CT techniques, compared with conventional CT, provide additional physiologic data from perfused blood volume maps and improved resolution to better visualize distal CTEPH, an important consideration for balloon pulmonary angioplasty for inoperable patients. Electrocardiogram (ECG)-synchronized techniques in ECG-gated CT can also show further information regarding right ventricular function and structure. While the standard of care in the workup of CTEPH includes a V/Q scan, CTPA, direct catheter angiography, echocardiogram, and coronary angiogram, in the future a ECG-gated DECT angiography scan may enable a “one-stop” imaging study to guide diagnosis, operability assessment, and treatment decisions with less radiation exposure and cost than traditional CTEPH imaging modalities.

Imaging Modalities

Chest Imaging ◽  
2019 ◽  
pp. 7-11
Author(s):  
Melissa L. Rosado-de-Christenson
Keyword(s):  
Chest Radiography ◽  
Pulmonary Thromboembolism ◽  
Imaging Techniques ◽  
Imaging Study ◽  
Chest Ct ◽  
Imaging Modalities ◽  
Vascular Abnormalities ◽  
Contrast Enhanced ◽  
Lateral Chest ◽  
Fdg Pet Ct

The chapter titled imaging modalities describes various methods of imaging the thorax. Imaging of patients presenting with thoracic complaints typically begins with chest radiography. Ambulatory patients should undergo posteroanterior (PA) and lateral chest radiographs. Anteroposterior (AP) chest radiography should be reserved for debilitated, critically ill and traumatized patients. Special chest radiographic projections such as decubitus chest radiography may be employed for specific indications. Chest CT is the imaging study of choice for evaluating most abnormalities found on radiography. Contrast-enhanced chest CT is optimal for evaluation of vascular abnormalities, the hila and some mediastinal lesions. CT angiography is routinely employed in patients with suspected pulmonary thromboembolism or acute aortic syndromes. High-resolution chest CT is reserved for the evaluation of diffuse infiltrative lung disease and often includes expiratory and prone imaging. FDG PET/CT is increasingly employed in the assessment of patients with malignancy for the purposes of initial staging and post therapy re-staging of affected patients. Ventilation/perfusion scintigraphy is used in the assessment of pulmonary thromboembolism. Additional thoracic imaging techniques include: Fluoroscopy for evaluation of the diaphragm, and ultrasound for evaluation of the thyroid and the pleural space.

scholarly journals Comparison of Diagnostic Medical Sonography, Computed Tomography, Magnetic Resonance Imaging, and Contrast-Enhanced Ultrasound in the Investigation of Renal Lesions

2019 ◽  
Vol 36 (1) ◽  
pp. 37-44
Author(s):  
Jessica T. Prince
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Imaging Techniques ◽  
Imaging Modalities ◽  
Contrast Enhanced Ultrasound ◽  
Resonance Imaging ◽  
Renal Masses ◽  
Renal Lesions ◽  
Contrast Enhanced

This review explores the classification and evaluation of suspicious renal lesions across several radiologic imaging modalities. Diagnostic medical sonography (DMS), computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are the primary modalities used to investigate questionable lesions found within the kidneys. Renal masses may range from completely benign to malignant. They are classified based on many different features and characteristics. These lesions may be simple cystic, complex cystic, or solid in nature. Masses may also exhibit varying degrees of vascularity, septations, and calcifications. The discussed imaging modalities have varying strengths, limitations, and implications for use. Imaging techniques may be used independently or in conjunction to best diagnose and treat a patient with a suspicious renal mass. The aim of this review was to describe the diagnostic value of the imaging modalities (DMS, CT, MRI, and CEUS) and their role in the evaluation of suspicious renal lesions.

scholarly journals Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis

2020 ◽  
Vol 10 ◽  
pp. 39
Author(s):  
Ahmad Umar Khan ◽  
Sachin Khanduri ◽  
Zikra Tarin ◽  
Syed Zain Abbas ◽  
Mushahid Husain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Imaging Techniques ◽  
Ground Glass Opacity ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Pulmonary Tb

Objectives: The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings. Material and Methods: This cross-sectional study was conducted on 67 patients of 18–65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis. Results: On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV. Conclusion: The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

scholarly journals Bone Toolbox: Biomarkers, Imaging Tools, Biomechanics, and Histomorphometry

2018 ◽  
Vol 46 (5) ◽  
pp. 511-529 ◽  
Author(s):  
Aurore Varela ◽  
Jacquelin Jolette
Keyword(s):  
Computed Tomography ◽  
Bone Histomorphometry ◽  
Structural Changes ◽  
Imaging Techniques ◽  
Quantitative Computed Tomography ◽  
Biomechanical Testing ◽  
Drug Effects ◽  
Imaging Modalities ◽  
Micro Computed Tomography

Bone is a unique tissue with turnover, metabolic, and cellular activities that vary through development to aging and with a mineralized matrix in which the current state and the history of a bone coexist. Qualitative histopathology often lacks sensitivity to detect changes in bone formation, mineralization and resorption, which often requires chronic dosing to result in structural changes such as variation in bone mass and geometry. A large panel of modalities can be used to fully analyze the health of the skeleton, including biomarker evaluation in serum or urine, imaging techniques ranging from radiology to computed tomography, biomechanical testing, and undecalcified tissue processing with bone histomorphometry. The use of clinically relevant biomarkers provides an important noninvasive, sensitive, rapid, and real-time tool to monitor bone activity at the whole skeleton level when conducting safety assessments in a preclinical setting. Imaging modalities also allow in vivo longitudinal assessments with a powerful, noninvasive and clinically translatable tools to monitor drug effects. Different imaging modalities are used in the preclinical studies to evaluate the bone tissues: standard radiography, dual-energy X-ray absorptiometry, peripheral quantitative computed tomography (pQCT), micro-computed tomography, and high-resolution pQCT. Bone histomorphometry is an important tool that provides sensitive evaluation to detect effects of test articles on bone resorption, formation, mineralization, remodeling rates and growth to address a potential target- or class-related theoretical bone liability. Ultimately, the measurement of bone mechanical properties in pharmaceutical testing is critical to understand the potential effects of that pharmaceutical on bone health and fracture risk. Important considerations are required for including these different techniques in toxicology rodents and nonrodent studies, to actually integrate these into safety assessment.

scholarly journals State of the art in vivo imaging techniques for laboratory animals

2017 ◽  
Vol 51 (5) ◽  
pp. 465-478 ◽  
Author(s):  
David Tibor Lauber ◽  
András Fülöp ◽  
Tibor Kovács ◽  
Krisztián Szigeti ◽  
Domokos Máthé ◽  
...  
Keyword(s):  
Computed Tomography ◽  
In Vivo Imaging ◽  
State Of The Art ◽  
Imaging Techniques ◽  
Small Animal Imaging ◽  
Small Animal ◽  
Response To Therapy ◽  
Imaging Modalities ◽  
Animal Imaging

In recent decades, imaging devices have become indispensable tools in the basic sciences, in preclinical research and in modern drug development. The rapidly evolving high-resolution in vivo imaging technologies provide a unique opportunity for studying biological processes of living organisms in real time on a molecular level. State of the art small-animal imaging modalities provide non-invasive images rich in quantitative anatomical and functional information, which renders longitudinal studies possible allowing precise monitoring of disease progression and response to therapy in models of different diseases. The number of animals in a scientific investigation can be substantially reduced using imaging techniques, which is in full compliance with the ethical endeavours for the 3R (reduction, refinement, replacement) policies formulated by Russell and Burch; furthermore, biological variability can be alleviated, as each animal serves as its own control. The most suitable and commonly used imaging modalities for in vivo small-animal imaging are optical imaging (OI), ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and finally the methods of nuclear medicine: positron emission tomography (PET) and single photon emission computed tomography (SPECT).

scholarly journals Diagnosis of chronic thromboembolic pulmonary hypertension

2017 ◽  
Vol 26 (143) ◽  
pp. 160108 ◽  
Author(s):  
Deepa Gopalan ◽  
Marion Delcroix ◽  
Matthias Held
Keyword(s):  
Computed Tomography ◽  
Pulmonary Hypertension ◽  
Photon Emission ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical Signs ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Vasculature ◽  
Dual Energy Ct ◽  
Emission Computed Tomography ◽  
Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension. Rapid and accurate diagnosis is pivotal for successful treatment. Clinical signs and symptoms can be nonspecific and risk factors such as history of venous thromboembolism may not always be present. Echocardiography is the recommended first diagnostic step. Cardiopulmonary exercise testing is a complementary tool that can help to identify patients with milder abnormalities and chronic thromboembolic disease, triggering the need for further investigation. Ventilation/perfusion (V′/Q′) scintigraphy is the imaging methodology of choice to exclude CTEPH. Single photon emission computed tomography V′/Q′ is gaining popularity over planar imaging. Assessment of pulmonary haemodynamics by right heart catheterisation is mandatory, although there is increasing interest in noninvasive haemodynamic evaluation. Despite the status of digital subtraction angiography as the gold standard, techniques such as computed tomography (CT) and magnetic resonance imaging are increasingly used for characterising the pulmonary vasculature and assessment of operability. Promising new tools include dual-energy CT, combination of rotational angiography and cone beam CT, and positron emission tomography. These innovative procedures not only minimise misdiagnosis, but also provide additional vascular information relevant to treatment planning. Further research is needed to determine how these modalities will fit into the diagnostic algorithm for CTEPH.

scholarly journals Imaging as an Outcome Measure in Gout Studies: Report from the OMERACT Gout Working Group

2015 ◽  
Vol 42 (12) ◽  
pp. 2460-2464 ◽  
Author(s):  
Rebecca Grainger ◽  
Nicola Dalbeth ◽  
Helen Keen ◽  
Laura Durcan ◽  
N. Lawrence Edwards ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Working Group ◽  
Imaging Techniques ◽  
Joint Damage ◽  
Joint Inflammation ◽  
Imaging Modalities ◽  
Future Research ◽  
Measurement Instruments ◽  
Structural Joint ◽  
Magnetic Resonance Imaging Mri

Objective.The gout working group at the Outcome Measures in Rheumatology (OMERACT) 12 meeting in 2014 aimed to determine which imaging modalities show the most promise for use as measurement instruments for outcomes in studies of people with chronic gout and to identify the key foci for future research about the performance of these imaging techniques with respect to the OMERACT filter 2.0.Methods.During the gout session, a systematic literature review of the data addressing imaging modalities including plain radiography (XR), conventional computed tomography (CT), dual-energy computed tomography (DECT), magnetic resonance imaging (MRI), and ultrasound (US) and the fulfillment of the OMERACT filter 2.0 was presented.Results.The working group identified 3 relevant domains for imaging in gout studies: urate deposition (tophus burden), joint inflammation, and structural joint damage.Conclusion.The working group prioritized gaps in the data and identified a research agenda.

scholarly journals New Perspectives in Imaging of Uveal Melanoma

2021 ◽  
Author(s):  
Malgorzata Solnik ◽  
Natalia Paduszynska ◽  
Anna M. Czarnecka ◽  
Kamil J. Synoradzki ◽  
Yacoub A. Yousef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Uveal Melanoma ◽  
Single Photon ◽  
Imaging Techniques ◽  
Fundus Autofluorescence ◽  
Photon Emission ◽  
Imaging Modalities ◽  
Diagnostic Process ◽  
Emission Computed Tomography ◽  
Tumor Identification

Uveal melanoma is the most common primary intraocular malignancy in adults characterized by insidious onset and poor prognosis strongly associated with tumor size and the presence of distant metastases, most commonly in the liver. Contrary to most tumor identification, biopsy followed by pathological exam is not recommended in ophthalmic oncology. Therefore, early and non-invasive diagnosis is essential to enhance patients’ chances for early treatment possibilities. We reviewed imaging modalities currently used in the diagnosis of uveal melanoma, i.e., fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF). The principle of imaging techniques was briefly explained, along with their role in the diagnostic process and a summary of their advantages and limitations. Further, the experimental data and the advancements in imaging modalities were searched. We described their innovations, showed current usage and research, and explained the possibilities of utilizing them to diagnose uveal melanoma and their potential application in personalized medicine such as theranostics.

scholarly journals Depiction of mosaic perfusion in chronic thromboembolic pulmonary hypertension (CTEPH) on C-arm computed tomography compared to computed tomography pulmonary angiogram (CTPA)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sabine K. Maschke ◽  
Thomas Werncke ◽  
Cornelia L. A. Dewald ◽  
Lena S. Becker ◽  
Timo C. Meine ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Hypertension ◽  
Imaging Techniques ◽  
Intraclass Correlation ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Observer Agreement ◽  
Vascular Lesions ◽  
Pulmonary Angiogram ◽  
Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Arterial

AbstractTo evaluate mosaic perfusion patterns and vascular lesions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using C-Arm computed tomography (CACT) compared to computed tomography pulmonary angiography (CTPA). We included 41 patients (18 female; mean age 59.9 ± 18.3 years) with confirmed CTEPH who underwent CACT and CTPA within 21 days (average 5.3 ± 5.2). Two readers (R1; R2) independently evaluated datasets from both imaging techniques for mosaic perfusion patterns and presence of CTEPH-typical vascular lesions. The number of pulmonary arterial segments with typical findings was evaluated and the percentage of affected segments was calculated and categorized: < 25%; 25–49%; 50–75%; < 75% of all pulmonary arterial segments affected by thromboembolic vascular lesions. Inter-observer agreement was calculated for both modalities using the intraclass-correlation-coefficient (ICC). Based on consensus reading the inter-modality agreement (CACTcons vs. CTPAcons) was calculated using the ICC. Inter-observer agreement was excellent for central vascular lesions (ICC > 0.87) and the percentage of affected segments (ICC > 0.76) and good for the perceptibility of mosaic perfusion (ICC > 0.6) and attribution of the pattern of mosaic perfusion (ICC > 0.6) for both readers on CACT and CTPA. Inter-modality agreement was excellent for the perceptibility of mosaic perfusion (ICC = 1), the present perfusion pattern (ICC = 1) and central vascular lesions (ICC = 1). However, inter-modality agreement for the percentage of affected segments was fair (ICC = 0.50), with a greater proportion of identified affected segments on CACTcons. CACT demonstrates a high agreement with CTPA regarding the detection of mosaic perfusion. CACT detects a higher number of peripheral vascular lesions compared to CTPA.

scholarly journals Strategies for Site-Specific Radiolabeling of Peptides and Proteins

2021 ◽  
Author(s):  
Ingrid Dijkgraaf ◽  
Stijn M. Agten ◽  
Matthias Bauwens ◽  
Tilman M. Hackeng
Keyword(s):  
Computed Tomography ◽  
Molecular Imaging ◽  
Single Photon ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Imaging Modalities ◽  
Site Specific ◽  
Anatomical Imaging ◽  
Magnetic Resonance Imaging Mri

Although anatomical imaging modalities (X-ray, computed tomography (CT), magnetic resonance imaging (MRI)) still have a higher spatial resolution (0.1–1 mm) than molecular imaging modalities (single-photon emission computed tomography (SPECT), positron emission tomography (PET), optical imaging (OI)), the advantage of molecular imaging is that it can detect molecular and cellular changes at the onset of a disease before it leads to morphological tissue changes, which can be detected by anatomical imaging. During the last decades, noninvasive diagnostic imaging has encountered a rapid growth due to the development of dedicated imaging equipment for preclinical animal studies. In addition, the introduction of multimodality imaging (PET/CT, SPECT/CT, PET/MRI) which combines high-resolution conventional anatomical imaging with high sensitivity of tracer-based molecular imaging techniques has led to successful accomplishments in this exciting field. In this book chapter, we will focus on chemical synthesis techniques for site-specific incorporation of radionuclide chelators. Subsequently, radiolabeling based on complexation of a radionuclide with a chelator will be discussed, with focus on: diethylenetriaminepentaacetic acid (DTPA), 1,4,7,10-tetraazacyclododecane-tetraacetic acid (DOTA), 1,4,7-triazacyclononane-triacetic acid (NOTA), hexa-histidine (His-tag), and 6-hydrazinonicotinic acid (HYNIC) that allow the production of peptides labeled with 18F, 68Ga, 99mTc, and 111In – the currently most widely used isotopes.

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