Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility.

Subtraction iodine imaging with area detector CT to improve tumor delineation and measurability of tumor size and depth of invasion in tongue squamous cell carcinoma

Purpose Tumor size and depth of invasion (DOI) are mandatory assessments for tumor classification in tongue cancer but are often non-assessable on CT due to dental artifacts. This study investigated whether subtraction iodine imaging (SII) would improve tumor delineation and measurability. Materials and methods Fifty-seven consecutive patients with tongue cancer, who underwent scanning with a 320-row area detector CT with contrast administration and were treated with surgical resection, were retrospectively evaluated. CT was reconstructed with single-energy projection-based metallic artifact reduction (sCT). SII was generated by subtracting the pre-contrast volume scans from the post-contrast volume scans using a high-resolution deformable registration algorithm. MRI scans were also evaluated for comparing the ability of measurements. Two radiologists visually graded the tumor delineation using a 5-point scale. Tumor size and DOI were measured wherever possible. The tumor delineation score was compared using the Wilcoxon signed-rank method. Spearman’s correlations between imaging and pathological measurements were calculated. Intraclass correlation coefficients of measurements between readers were estimated. Results The tumor delineation score was greater on sCT-plus-SII than on sCT alone (medians: 3 and 1, respectively; p < 0.001), with higher number of detectable cases observed with sCT-plus-SII (36/57 [63.2%]) than sCT alone (21/57 [36.8%]). Tumor size and DOI measurability were higher with sCT-plus-SII (29/57 [50.9%]) than with sCT alone (17/57 [29.8%]). MRI had the highest detectability (52/57 [91.2%]) and measurability (46/57 [80.7%]). Correlation coefficients between radiological and pathological tumor size and DOI were similar for sCT (0.83–0.88), sCT-plus-SII (0.78–0.84), and MRI (0.78–0.90). Intraclass correlation coefficients were higher than 0.95 for each modality. Conclusions SII improves detectability and measurability of tumor size and DOI in patients with oral tongue squamous cell carcinoma, thus increasing the diagnostic potential. SII may also be beneficial for cases unevaluable on MRI due to artifacts or for patients with contraindications to MRI.

Quantitative powder diffraction using a (2 + 3) surface diffractometer and an area detector

X-ray diffractometers primarily designed for surface X-ray diffraction are often used to measure the diffraction from powders, textured materials and fiber-texture samples in 2θ scans. Unlike in high-energy powder diffraction, only a fraction of the powder rings is typically measured, and the data consist of many detector images across the 2θ range. Such diffractometers typically scan in directions not possible on a conventional laboratory diffractometer, which gives enhanced control of the scattering vector relative to the sample orientation. There are, however, very few examples where the measured intensity is directly used, such as for profile/Rietveld refinement, as is common with other powder diffraction data. Although the underlying physics is known, converting the data is time consuming and the appropriate corrections are dispersed across several publications, often not with powder diffraction in mind. This paper presents the angle calculations and correction factors required to calculate meaningful intensities for 2θ scans with a (2 + 3)-type diffractometer and an area detector. Some of the limitations with respect to texture, refraction and instrumental resolution are also discussed, as is the kind of information that one can hope to obtain.

Multipurpose diffractometer for in situ X-ray crystallography of functional materials

Laboratory X-ray diffractometers play a crucial role in X-ray crystallography and materials science. Such instruments still vastly outnumber synchrotron facilities and are responsible for most of the X-ray characterization of materials around the world. The efforts to enhance the design and performance of in-house X-ray diffraction instruments benefit a broad research community. Here, the realization of a custom-built multipurpose four-circle diffractometer in the laboratory for X-ray crystallography of functional materials at Tel Aviv University, Israel, is reported. The instrument is equipped with a microfocus Cu-based X-ray source, collimating X-ray optics, four-bounce monochromator, four-circle goniometer, large (PILATUS3 R 1M) pixel area detector, analyser crystal and scintillating counter. It is suitable for a broad range of tasks in X-ray crystallography/structure analysis and materials science. All the relevant X-ray beam parameters (total flux, flux density, beam divergence, monochromaticity) are reported and several applications such as determination of the crystal orientation matrix and high-resolution reciprocal-space mapping are demonstrated. The diffractometer is suitable for measuring X-ray diffraction in situ under an external electric field, as demonstrated by the measurement of electric-field-dependent rocking curves of a quartz single crystal. The diffractometer can be used as an independent research instrument, but also as a training platform and for preparation for synchrotron experiments.

Exploring higher order images with Fe Kα-lines from relativistic disks: black hole spin determination and bias

We study the contributions to the relativistic Fe Kα line profile from higher order images (HOIs) produced by strongly deflected rays from the disk which cross the plunging region, located between the innermost stable circular orbit (ISCO) radius and the event horizon of a Kerr black hole. We investigate the characteristics features imprinted by the HOIs in the line profile for different black hole spins, disk emissivity laws and inclinations. We find that they extend from the red wing of the profile up to energies slightly lower than those of the blue peak, adding ∼0.4 − 1.3 per cent to the total line flux. The contribution to the specific flux is often in the ∼1 per cent to 7 per cent range, with the highest values attained for low and negative spin (a ≲ 0.3) black holes surrounded by intermediate inclination angle (i ∼ 40○) disks. We simulate future observations of a black hole X-ray binary system with the Large Area Detector of the planned X-ray astronomy enhanced X-ray Timing and Polarimetry Mission (eXTP) and find that the Fe Kα line profiles of systems accreting at ≲ 1 per cent the Eddington rate are affected by the HOI features for a range of parameters. This would provide evidence of the extreme gravitational lensing of HOI rays. Our simulations show also that not accounting for HOI contributions to the Fe Kα line profile may systematically bias measurements of the black hole spin parameter towards values higher by up to ∼0.3 than the inputted ones.

3D-CT Evaluation of Swallowing: Metrics of the Swallowing Response Using Swallowing CT

Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.

Correction to: Annular Flow in the Upper Esophageal Sphincter Demonstrated with Dynamic 320-row Area Detector Computed Tomography

A correction to this paper has been published: https://doi.org/10.1007/s00455-021-10282-8