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British Journal of Radiology [journal]
- Meta-analysis of CT-Guided Transthoracic Needle Biopsy for the Evaluation of Ground-Glass Opacity Pulmonary Lesions. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 23.:20140276.
Objectives: This meta-analysis is to determine the overall diagnostic yield of CT-guided TNB of GGO lesions. Methods: A MEDLINE search was performed using "ground-glass opacity" crossed with "core biopsy" and "needle biopsy." Test performance characteristics with the use of forest plots, summary receiver operating characteristic (SROC) curves, and bivariate random effects models were summarized. Adverse events, if reported, were recorded. Results: Our search identified 52 citations, of which six diagnostic studies evaluated 341 patients. Pooled specificity estimates were 0.94 (95% CI, 0.84-0.98) and sensitivity estimates were 0.92 (95% CI, 0.88-0.95), respectively. The positive likelihood ratio was 11.27 (95% CI, 4.2-30.6), the negative likelihood ratio was 0.1 (95% CI, 0.06-0.19), the diagnostic odds ratio was 131.38 (95% CI, 39.6-436.0), and the area under the curve was 0.97. Conclusion: Our data suggests that the CT-guided TNB is likely to be a useful tool for tissue diagnosis and may serve as an alternative for further patient management with GGO lesions. However, considering the limited studies and patients included, large scale studies are needed to verify these findings. Advances in knowledge: Some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. To our knowledge, our study is the first systematic analysis about CT-guided TNB of GGO lesions.
- Comparative study of hepatic venography using nonlinear-blending images, monochromatic images, and low-voltage images of dual-energy CT. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 23.:20140220.
Objective: To investigate the use of nonlinear-blending and monochromatic dual-energy computed tomography (DECT) images to improve the image quality of hepatic venography. Methods: Eighty-two patients undergoing abdominal DECT in the portal venous phase were enrolled. For each patient, 31 datasets of monochromatic images and seven datasets of nonlinear-blending images were generated. The datasets of the nonlinear-blending and monochromatic images with the best contrast-to-noise ratios (CNRs) for hepatic veins were selected and compared with the images obtained at 80 kVp and a simulated 120 kVp. The subjective image quality of the hepatic veins was evaluated using a 4-point scale. The image quality of the hepatic veins was analyzed using signal-to-noise ratio (SNR) and CNR values. Results: The optimal CNR between hepatic veins and the liver was obtained with the nonlinear-blending images. Compared with the other three groups, there were significant differences in the maximum CNR, the SNR, the subjective ratings, and the minimum background noise (P < 0.001). A comparison of the monochromatic and 80-kVp images revealed that the CNR and subjective ratings were both improved (P < 0.001). There was no significant difference in the CNR or subjective ratings between the simulated 120-kVp group and the control group (P = 0.09 and 0.053, respectively). Conclusions: The nonlinear-blending technique for acquiring DECT provided the best image quality for hepatic venography. Advances in knowledge: DECT can enhance the contrast of hepatic veins and the liver, potentially allowing the wider use of low-dose contrast agents for the CT examination of the liver.
- A planning target volume margin formula for hypofractionated intracranial stereotactic radiotherapy under cone-beam computed tomography image guidance with a six degrees of freedom robotic couch and a mouthpiece-assisted mask system: A preliminary study. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140240.
Objectives: A planning target volume (PTV) margin formula for hypofractionated intracranial stereotactic radiotherapy (SRT) has been proposed under cone-beam computed tomography (CBCT) image guidance with a six degrees of freedom (6-DOF) robotic couch. Methods: CBCT-based registration using a 6-DOF couch reportedly led to negligibly small systematic positioning errors, suggesting that each in-treatment positioning error during the treatment courses for the patients employing this combination was predominantly caused by a random Gaussian process. Under this assumption, an anisotropic PTV margin for each axis was formulated based on a Gaussian distribution model. Nineteen patients with intracranial lesions who underwent additional post-treatment CBCT were consecutively selected, to whom stereotactic hypofractionated radiotherapy was delivered by a linear accelerator equipped with a CBCT imager, a 6-DOF couch, and a mouthpiece-assisted mask system. Time-averaged patient positioning errors during treatment were estimated by comparing the post-treatment CBCT with the reference planning CT images. Results: It was suggested that each histogram of the in-treatment positioning error in each axis would approach each single Gaussian distribution with a mean of zero. The calculated PTV margins in the x, y, and z directions were 0.97 mm, 1.3 mm, and 0.88 mm, respectively. Conclusion: The empirical isotropic PTV margin of 2 mm used in our facility for intracranial SRT was consistent with the margin calculated by the proposed Gaussian model. Advances in knowledge: We have proposed a PTV margin formula for hypofractionated intracranial SRT under CBCT image guidance with a 6-DOF robotic couch.
- Current state of the art in brachytherapy treatment planning dosimetry algorithms. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140163.
Following literature contributions delineating the deficiencies introduced by the approximations of conventional brachytherapy dosimetry, different model based dosimetry algorithms have been incorporated to commercial systems for (192)Ir brachytherapy treatment planning. The calculation settings of these algorithms are preconfigured according to criteria established by their developers for optimizing computation speed versus accuracy. Their clinical use is hence straightforward. A basic understanding of these algorithms and their limitations is essential however for commissioning, as well as detecting differences from conventional algorithms, explaining their origin, assessing their impact, and maintaining global uniformity of clinical practice.
- Split-course accelerated, hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients - final results of randomized clinical trial. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140212.
Objectives: Evaluation of the efficacy and toxicity of split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced H&N cancer patients. Methods: We enrolled 101 patients, (39 in CHA-CHA and 37 in Conv. arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, seven days a week, using fd of 1.6 Gy to 64 Gy with an 8 day gap in midterm. Patients in the control (Conv.) arm group were irradiated with fd 2 Gy, 5 times a week to a TD of 72-74 Gy in the OTT 50-53 days. QOL and acute mucosal reaction were evaluated during RT. After RT we followed the treatment effect, QOL, PS and radiation adverse effects. For statistical analysis mainly a hierarchical multi-level modelling was used. Results: QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. in 30% of patients disease was controlled during FU. Tumor regression 1 year was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. Conclusions: Despite found differences, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated radiotherapy as a sole treatment for advanced H&N cancer patients. Advances in knowledge: Obtained results in context to published, support the notion that altered fractionations alone do not give an advantage for advanced H&N cancer patients.
- Embolisation of Percutaneous Transhepatic Portal Venous Access Tract with N-Butyl Cyanoacrylate. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140347.
Objectives: To evaluate the safety and feasibility of N-BCA embolisation of percutaneous transhepatic portal venous access tract, and to establish the appropriate technique. Methods: Forty consecutive patients underwent percutaneous transhepatic portal venous intervention for various reasons. Embolisation of percutaneous transhepatic portal venous access tract was performed after the procedure in all of the patients using N-BCA and Lipiodol® mixture. Immediate ultrasonography and fluoroscopy were performed to evaluate perihepatic haematoma formation and unintended embolisation of more than one segmental portal vein. Follow-up computed tomography was performed, and haemoglobin and haematocrit levels were checked to evaluate the presence of bleeding. Results: Immediate haemostasis was achieved in all of the patients, without development of perihepatic haematoma or unintended embolisation of more than one segmental portal vein. Complete embolisation of percutaneous access tract was confirmed in 39 out of 40 patients by computed tomography. Seven patients showed decreased haemoglobin and haematocrit levels. Other complications included mild pain at the site of embolisation and mild fever, which resolved after conservative management. Sixteen patients died during the follow-up period due to progression of the underlying disease. Conclusions: Embolisation of percutaneous transhepatic portal vein access tract with N-BCA is feasible and technically safe. With the appropriate technique, N-BCA can be safely used as an alternate embolic material since it is easy to use and inexpensive compared to other embolic materials. Advances in knowledge: This is the first study to investigate the efficacy of N-BCA for percutaneous transhepatic portal venous access tract embolisation.
- Application of contrast-enhanced ultrasonography in the diagnosis of skeletal muscle crush injury in rabbits. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140421.
Objectives: To explore the diagnostic value of quantitative contrast-enhanced ultrasonography (CEUS) for crush injury in the hind limb muscles of rabbits. Methods: A total of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 hours (n=56) or 4 hours (n=56) to induce muscle crush injury. Another 8 animals were not injured and served as normal controls. CEUS parameters such as peak intensity (PI), ascending slop (AS), descending slop (DS), and area under curve (AUC) were measured at 0.5 h, 2 h, 6 h, 24 h, 3 d, 7 d, 14 d after decompression. Results: Compared with the uninjured muscles, reperfusion of the injured muscles showed early and high enhancement in CEUS images. The time-intensity curve showed a trend of rapid-lift and gradual-drop. PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers. Rabbits of the 4-h compression group showed significantly higher PI and AUC values, and serum and tissue parameters, than the 2-h compression group at each time points. Conclusions: CEUS can effectively detect muscle crush injury and monitor dynamic changes of the injured muscles in rabbits. PI and AUC are promising diagnostic parameters for this disease. Advances in knowledge: CEUS might play an important role in the pre-hospital and bedside settings for the diagnosis of muscle crush injury.
- Pancreaticoduodenectomy: expected post-operative anatomy and complications. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20140050.
Pancreaticoduodenectomy is a complex, high risk surgical procedure performed for tumours of the pancreatic head and other periampullary structures. The rate of perioperative mortality has decreased in the last number of years but perioperative morbidity remains high. This pictorial review illustrates expected findings in early and late post-operative periods, including mimickers of pathology. It aims to familiarize radiologists with the imaging appearances of common and unusual postoperative complications. These are classified into early non-vascular complications such as delayed gastric emptying, postoperative collections, pancreatic fistulae and bilomas; late non-vascular complications, for example biliary strictures and hepatic abscesses; and vascular complications including haemorrhage and ischaemia. Options for minimally invasive image-guided management of vascular and non-vascular complications are discussed. Familiarity with normal anatomic findings is essential in order to distinguish expected post-operative change from surgical complications or recurrent disease. This review summarises the normal and abnormal radiological findings following pancreaticoduodenectomy.
- Accuracy of Lung Nodule Volumetry in Low-Dose CT with Iterative Reconstruction: An Anthropomorphic Thoracic Phantom Study. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 16.:20130644.
Objectives: The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. Methods: Eight artificial nodules (4 diameters: 5, 8, 10, and 12 mm; 2 CT densities: -630 HU which represents ground-glass nodule and +100 HU which represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30, and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). Results: APE of all nodules was significantly lower when IR was used with compared for FBP (7.5 ± 4.7% to 9.0 ± 6.9%, P < 0.001). Effect of IR was more pronounced for smaller nodules (P < 0.001). IR showed a significantly lower APE than FBP in ground-glass nodules (P < 0.0001), and the difference was more pronounced at the lowest tube current (11.8 ± 5.9% to 21.3 ± 6.1%, P < 0.0001). The effect of IR was most pronounced for ground-glass nodules in the lowest CT tube current. Conclusions: Lung nodule volumetry in low dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low dose CT when application of IR.
- A Prospective Comparison Study of Fast T1-Weghted Fluid Attenuation Inversion Recovery and T1-Weighted Turbo Spin Echo Sequence at 3Tesla in Degenerative Disease of the Cervical Spine. [JOURNAL ARTICLE]
- Br J Radiol 2014 Jul 10.:20140091.
Background and Purpose: This study compared T1 fluid attenuation inversion recovery (FLAIR) and T1 turbo spin echo (TSE) sequences for evaluation of cervical spine degenerative disease at 3T. Materials and Methods: Seventy-two patients (44 males, 28 females; mean age of 39 years, age range = 27 - 75 years) with suspected cervical spine degenerative disease were prospectively evaluated. Sagittal images of the spine were obtained using T1-FLAIR and T1-TSE sequences. Two experienced neuroradiologists compared the sequences qualitatively and quantitatively. Results: On qualitative evaluation, CSF nulling and contrast at cord-CSF, disc-CSF and disc-cord interfaces were significantly higher on fast T1-FLAIR images than on T1-TSE images (P < 0.001). No significant difference was seen between the sequences in evaluation of neural foramina and bone-disc interface. On quantitative evaluation, the SNRs of cord and CSF on fast T1-FLAIR images were significantly higher than those on T1-TSE images (P < 0.05). CNRs of cord to CSF on T1-FLAIR images were significantly higher compared to T1-TSE images (P < 0.05). CNRs of bone to disc for T1- weighted TSE images were significantly higher than T1-FLAIR images (P < 0.05). Conclusion: At 3T T1-FLAIR imaging is superior to T1-TSE for evaluating cervical spine degenerative disease, due to higher cord-CSF, disc-cord and disc-CSF contrast. However, intrinsic cord contrast is low on T1-FLAIR images. Advances in knowledge: T1FLAIR is more promising and sensitive than T1TSE for evaluation of degenerative spondyloarthropathy and may provide a foundation for development of MR protocols for early detection of degenerative and neoplastic diseases.