No abstract

SPIO-enhanced T2-weighted MR imaging was more accurate than nonenhanced T1-weighted and T2-weighted MR imaging and contrast-enhanced spiral CT for the detection of focal hepatic lesions. The combined analysis of nonenhanced and SPIO-enhanced images was more accurate in the characterization of focal hepatic lesions than was review of SPIO-enhanced images alone.

The aim of this study was to evaluate a computer-aided diagnosis (CAD) workstation with automatic detection of pulmonary nodules at low-dose spiral CT in a clinical setting for early detection of lung cancer. Eighty-eight consecutive spiral-CT examinations were reported by two radiologists in consensus. All examinations were reviewed using a CAD workstation with a self-developed algorithm for automatic detection of pulmonary nodules. The algorithm is designed to detect nodules with diameters of at least 5 mm. A total of 153 nodules were detected with at least one modality (radiologists in consensus, CAD, 85 nodules with diameter < 5 mm, 68 with diameter > or = 5 mm). The results of automatic nodule detection were compared to nodules detected with any modality as gold standard. Computer-aided diagnosis correctly identified 26 of 59 (38%) nodules with diameters > or = 5 mm detected by visual assessment by the radiologists; of these, CAD detected 44% (24 of 54) nodules without pleural contact. In addition, 12 nodules > or = 5 mm were detected which were not mentioned in the radiologist's report but represented real nodules. Sensitivity for detection of nodules > or = 5 mm was 85% (58 of 68) for radiologists and 38% (26 of 68) for CAD. There were 5.8+/-3.6 false-positive results of CAD per CT study. Computer-aided diagnosis improves detection of pulmonary nodules at spiral CT and is a valuable second opinion in a clinical setting for lung cancer screening despite of its still limited sensitivity.

The aim of this study was to investigate the relationship between cognitive impairment and cerebral metabolites in patients with anorexia nervosa (AN). N-acetylaspartate (NAA), creatine/phosphocreatine (Cr), choline-containing compounds, glutamate/glutamine (Glx) and myoinositol were measured by proton magnetic resonance spectroscopy (H-MRS) of the left prefrontal cortex. Compared with healthy controls, AN patients displayed a significantly poorer performance in verbal learning and in attentional and executive tasks. Performance in the divided attention task was correlated with NAA and Cr in the dorsolateral prefrontal cortex, while executive functioning and depressive symptomatology were associated with Glx levels in the anterior cingulate. Our results provide evidence for cognitive impairment in AN patients which is associated with cerebral metabolism in the prefrontal cortex.

Multidetector CT angiography offers high diagnostic accuracy-equivalent to that of DSA-in the detection of intracranial aneurysms. Also, the possibility of coil embolization can be reliably determined with multidetector CT angiography.

PurposeEvaluation of 15,000 computed tomography (CT) examinations to investigate if iterative reconstruction (IR) reduces sustainably radiation exposure. Method and MaterialsInformation from 15,000 CT examinations was collected, including all aspects of the exams such as scan parameter, patient information, and reconstruction instructions. The examinations were acquired between January 2010 and December 2012, while after 15 months a first generation IR algorithm was installed. To collect the necessary information from PACS, RIS, MPPS and structured reports a Dose Monitoring System was developed. To harvest all possible information an optical character recognition system was integrated, for example to collect information from the screenshot CT-dose report. The tool transfers all data to a database for further processing such as the calculation of effective dose and organ doses. To evaluate if IR provides a sustainable dose reduction, the effective dose values were statistically analyzed with respect to protocol type, diagnostic indication, and patient population. ResultsIR has the potential to reduce radiation dose significantly. Before clinical introduction of IR the average effective dose was 10.1±7.8mSv and with IR 8.9±7.1mSv (p*=0.01). Especially in CTA, with the possibility to use kV reduction protocols, such as in aortic CTAs (before IR: average14.2±7.8mSv; median11.4mSv /with IR:average9.9±7.4mSv; median7.4mSv), or pulmonary CTAs (before IR: average9.7±6.2mSV; median7.7mSv /with IR: average6.4±4.7mSv; median4.8mSv) the dose reduction effect is significant(p*=0.01). On the contrary for unenhanced low-dose scans of the cranial (for example sinuses) the reduction is not significant (before IR:average6.6±5.8mSv; median3.9mSv/with IR:average6.0±3.1mSV; median3.2mSv). ConclusionThe dose aspect remains a priority in CT research. Iterative reconstruction algorithms reduce sustainably and significantly radiation dose in the clinical routine. Our results illustrate that not only in studies with a limited number of patients but also in the clinical routine, IRs provide long-term dose saving.

Purpose:To investigate the parallel acquisition technique sensitivity encoding incorporating temporal filtering (TSENSE) with three saturation-recovery (SR) prepared pulse sequences (SR turbo fast low-angle shot [SR-Turbo-FLASH], SR true fast imaging with steady precession [SRTrueFISP], and SR-prepared segmented echo-planar-imaging [SR-segEPI]) for semiquantitative first-pass myocardial perfusion imaging. Materials and Methods:In blood-and tissue-equivalent phantoms the relationship between signal intensity (SI) and contrast-medium concentration was evaluated for the three pulse sequences. In volunteers, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and normalized upslopes (NUS) were calculated from signal-time curves (STC). Moreover, artifacts, image noise, and overall image quality were qualitatively evaluated.Results: Phantom data showed a 40% increased linear range of the relation between SI and contrast-medium concentration with TSENSE. In volunteers, TSENSE introduced significantly residual artifacts and loss in SNR and CNR. No differences were found for NUS values with TSENSE. SR-TrueFISP yielded highest SNR, CNR, and quality scores. However, in SR-True-FISP images, darkbanding artifacts were most pronounced. NUS values obtained with SR-TrueFISP were significantly higher and with SR-segEPI significantly lower than with SR-TurboFLASH. Conclusion:Semiquantitative myocardial perfusion imaging can significantly benefit from TSENSE due to shorter acquisition times and increased linearity of the pulse sequences. Among the three pulse sequences tested, SRTrueFISP yielded best image quality. SR-segEPI proved to be an interesting alternative due to shorter acquisition times, higher linearity and fewer dark-banding artifacts.

Mock circulatory loops (MCLs) are usually developed for assessment of ventricular assist devices and consist of abstracted anatomical structures represented by connecting tubing pipes and controllable actuators which could mimic oscillating flow processes. However, with increasing use of short-term peripheral mechanical support (extracorporeal life support [ECLS]) and the upcoming evidence of even counteracting flow processes between the failing native circulation and ECLS, MCLs incorporating the peripheral vascular system and preserved anatomical structures are becoming more important for systematic assessment of these processes. For reproducible and standardized fluid-mechanical studies using magnetic resonance imaging, Doppler ultrasound, and computational fluid dynamics measurements, we developed a MCL of the human circulation. Silicon-based life-sized dummies of the human aorta and vena cava (vascular module) were driven by paracorporeal pneumatic assist devices. The vascular module is placed in a housing with all arterial branches merging into peripheral resistance and compliances modules, and blood-mimicking fluid returns to the heart module through the venous dummy. Compliance and resistance chambers provide for an adequate simulation of the capillary system. Extracorporeal life support cannulation can be performed in the femoral and subclavian arteries and in the femoral and jugular veins. After adjusting vessel diameters using variable Hoffmann clamps, physiologic flow rates were achieved in the supraaortic branches, the renal and mesenteric arteries, and the limb arteries with physiologic blood pressure and cardiac output (4 L/min). This MCL provides a virtually physiologic platform beyond conventional abstracted MCLs for simulation of flow interactions between the human circulation and external circulation generated by ECLS.