scholarly journals Virtual Non-Contrast versus True Non-Contrast Computed Tomography: Initial Experiences with a Photon Counting Scanner Approved for Clinical Use

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2377
Author(s):  
Julius Henning Niehoff ◽  
Matthias Michael Woeltjen ◽  
Kai Roman Laukamp ◽  
Jan Borggrefe ◽  
Jan Robert Kroeger
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Photon Counting ◽  
Routine Clinical Practice ◽  
Regions Of Interest ◽  
Clinical Use ◽  
Ct Scanner ◽  
Diagnostic Reliability ◽  
Quantitative Image

The present study evaluates the diagnostic reliability of virtual non-contrast (VNC) images acquired with the first photon counting CT scanner that is approved for clinical use by comparing quantitative image properties of VNC and true non-contrast (TNC) images. Seventy-two patients were retrospectively enrolled in this study. VNC images reconstructed from the arterial (VNCa) and the portalvenous (VNCv) phase were compared to TNC images. In addition, consistency between VNCa and VNCv images was evaluated. Regions of interest (ROI) were drawn in the following areas: liver, spleen, kidney, aorta, muscle, fat and bone. Comparison of VNCa and VNCv images revealed a mean offset of less than 4 HU in all tissues. The greatest difference between TNC and VNC images was found in spongious bone (VNCv 86.13 HU ± 28.44, p < 0.001). Excluding measurements in spongious bone, differences between TNC and VNCv of 10 HU or less were found in 40% (VNCa 36%) and differences of 15 HU or less were found in 72% (VNCa 68%) of all measurements. The underlying algorithm for the subtraction of iodine works in principle but requires adjustments. Until then, special caution should be exercised when using VNC images in routine clinical practice.

Pleuroparenchymal fibroelastosis-like lesions on chest computed tomography in routine clinical practice

2019 ◽  
Vol 37 (3) ◽  
pp. 230-236
Author(s):  
Hiromitsu Sumikawa ◽  
Takeshi Johkoh ◽  
Tae Iwasawa ◽  
Katsuyuki Nakanishi ◽  
Noriyuki Tomiyama
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Pleuroparenchymal Fibroelastosis ◽  
Chest Computed Tomography

scholarly journals Endovascular Thrombectomy for Stroke Effectiveness Study—An Audit From a Small Tertiary Care Center

2020 ◽  
Vol 71 (1) ◽  
pp. 63-67
Author(s):  
Karim Virani ◽  
Sherry Hu ◽  
Christine Christian ◽  
Wendy Simpkin ◽  
Stephen Phillips ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Routine Clinical Practice ◽  
Tertiary Care Center ◽  
Escape Trial ◽  
Endovascular Thrombectomy

Purpose: Endovascular thrombectomy (EVT) treatment for acute ischemic stroke is now recommended as a standard of care. However, implementing EVT in routine clinical practice poses many challenges, even in countries with advanced health-care systems. The aim of the current study is to delineate if EVT at our institution is an effective treatment for acute ischemic stroke. Methods: All patients who underwent EVT at our institution between December 2011 and July 2017 were retrospectively assessed from our prospective registry. Clinical and imaging (including the Alberta Stroke Program Early CT [ASPECT] score, single-phase computed tomography angiography, and computed tomography perfusion) criteria were utilized to determine EVT suitability. Primary outcomes included modified Rankin score (mRS) at 90 days and recanalization determined by the modified Treatment in Cerebral Infarction score. Effectiveness was assessed by comparing our cohort with patients receiving EVT in the ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke) trial. Results: Eighty-eight patients presented to our hospital after a median of 87 minutes last seen normal. Of these, median ASPECT score was 9. A majority (72%) also received intravenous alteplase. Successful recanalization (≥TICI 2b) was achieved in 79%. At 90 days, 48% (36/75) were functionally independent (mRS score of 0-2) and 28% (21/75) were disabled (mRS score of 3-5); 24% (18/75) died (mRS of 6) within 90 days. Conclusions: An audit of our initial experience with EVT for the treatment of acute ischemic stroke in a small tertiary care center yielded similar results compared to the ESCAPE trial, which is encouraging for implementing this treatment in routine clinical practice.

Clinical Use and Efficacy of Levetiracetam for Absence Epilepsies

2018 ◽  
Vol 34 (2) ◽  
pp. 94-98 ◽  
Author(s):  
Danielle Nolan ◽  
Shannon G. Lester ◽  
Stephanie M. Rau ◽  
Reneé A. Shellhaas
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Low Dose ◽  
Seizure Control ◽  
Absence Epilepsy ◽  
Routine Clinical Practice ◽  
Clinical Use ◽  
Epilepsy Treatment ◽  
Neurology Clinic ◽  
New Onset

Background: Levetiracetam is prescribed for a broad spectrum of seizure types but does not have a specific indication for absence epilepsy. We hypothesized that levetiracetam is commonly prescribed for children with absence epilepsies and evaluated the efficacy of this medication for absence epilepsy treatment in clinical practice. We also hypothesized that electroencephalographic (EEG) findings could help predict levetiracetam efficacy. Methods: We reviewed the charts of all patients treated for new-onset absence epilepsies at our pediatric neurology clinic between January 2011 and January 2016. Among 158 children diagnosed with absence epilepsies, 72 were treated with levetiracetam. Results: Levetiracetam was discontinued in 74% (n = 53/72) because of incomplete seizure control (59%, n = 35/72) and/or intolerable side effects (41%, n = 24/72) after a median 8.5 months (interquartile range 2, 17 months). Among patients for whom levetiracetam was effective, 44% (n = 8/18) had polyspikes on their initial EEG, versus 27% (n = 14/52) of patients for whom levetiracetam was discontinued ( P = .17). The maximal prescribed dose was lower for children in whom levetiracetam was effective (29 ± 13 mg/kg/d) than those for whom levetiracetam failed (42 ± 20 mg/kg/d; P = .005). Conclusion: In routine clinical practice, levetiracetam is often chosen for patients with absence seizures. However, only about one-quarter of children with absence epilepsy in this study became seizure free with levetiracetam. When effective, levetiracetam can control absence epilepsy at a relatively low dose. Lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.

Photon-counting detectors in computed tomography: from quantum physics to clinical practice

Der Radiologe ◽  
2021 ◽  
Author(s):  
E. Wehrse ◽  
L. Klein ◽  
L. T. Rotkopf ◽  
W. L. Wagner ◽  
M. Uhrig ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Quantum Physics ◽  
Photon Counting ◽  
Photon Counting Detectors

Computed tomography colonography in routine clinical practice

2003 ◽  
Vol 15 (12) ◽  
pp. 1323-1331 ◽  
Author(s):  
Teresa M Gallo ◽  
Giovanni Galatola ◽  
Mario Fracchia ◽  
Giuseppina Defazio ◽  
Francesca De Bei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Computed Tomography Colonography

Automated computed tomography (CT)-derived skeletal muscle mass determination as a significant prognostic factor in colorectal cancer patients using deep neural network model.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3534-3534
Author(s):  
Dongjin Seo ◽  
Han Sang Kim ◽  
Yu Rang Park
Keyword(s):  
Colorectal Cancer ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Deep Learning ◽  
Clinical Practice ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Routine Clinical Practice ◽  
Prognostic Impact ◽  
Baseline Bmi

3534 Background: Although recent evidence suggests skeletal muscle depletion predicts the survival of patients with cancer, the retrieval and manual measurement of the computed tomography (CT) images hinder clinical application in routine clinical practice. The advent of recent deep learning applications enables highly accurate noninvasive longitudinal evaluation of skeletal muscle mass (SMM) changes. Here, we evaluated the prognostic impact of DNN-measured skeletal muscle changes in colorectal cancer (CRC) patients. Methods: A total of 6,196 newly diagnosed CRC patients were analyzed in the Yonsei Cancer Registry Database between Jan 1, 2010, and Sep 30, 2020. SMM is measured by the Skeletal muscle index (SMI). The formula used was: L3 skeletal muscle cross-sectional area (cm2)/height2 (m2). Patients’ SMI patterns were grouped by difference ratio of initial and last SMI. Patients were also classified by BMI pattern with the result of K-means clustering. Association of baseline SMI, baseline body mass index (BMI), SMI changes, BMI changes, and demographic factors with overall survival (OS) were evaluated. Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test the predictive accuracy of survival models. Results: Fully automated UNet architecture-based deep learning algorithms were applied for the third lumbar transverse CT detection, skeletal muscle segmentation, and skeletal muscle area quantification in CRC patients undergoing abdominal CT between at the time of diagnosis and one year after the diagnosis. Baseline BMI distribution was 28% obese, 26% overweight, 42% normal weight, and 4% underweight. Patients in all SMI categories varied widely in BMI. Changes in SMI were categorized into three groups: SMI increase (33%), steady (45%), and decrease (22%) group. Similarly, BMI changes were categorized into three groups: BMI increase (24%), BMI stable (57%), and BMI decrease (19%) group. Low baseline SMI, low baseline BMI, SMI decrease, and BMI decrease were independently prognostic of survival. Intriguingly, BMI and SMI changes had a different prognostic impact in men and women. For women, the SMI increase group (hazard ratio [HR], 0.4; 95% CI, 0.3-0.7; P= 0.001) was associated with longer OS, while the SMI decrease group (HR, 1.2; 95% CI, 0.6-2.2; P= 0.619) was not associated with shorter OS, both compared with SMI steady group. Conclusions: Automated CT-derived SMM depletion had a negative prognostic impact independent of BMI and age in CRC patients. A noninvasive automatic deep learning algorithm provides a unique opportunity to apply to routine clinical practice and understand how and when cachexia impacts cancer prognosis.

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