Deep learning image reconstruction algorithm reduces image noise while alters radiomics features in dual-energy CT in comparison with conventional iterative reconstruction algorithms: a phantom study

Abstract Background To assess the improvement of image quality and diagnostic acceptance of thinner slice iodine maps enabled by deep learning image reconstruction (DLIR) in abdominal dual-energy CT (DECT). Methods This study prospectively included 104 participants with 136 lesions. Four series of iodine maps were generated based on portal-venous scans of contrast-enhanced abdominal DECT: 5-mm and 1.25-mm using adaptive statistical iterative reconstruction-V (Asir-V) with 50% blending (AV-50), and 1.25-mm using DLIR with medium (DLIR-M), and high strength (DLIR-H). The iodine concentrations (IC) and their standard deviations of nine anatomical sites were measured, and the corresponding coefficient of variations (CV) were calculated. Noise-power-spectrum (NPS) and edge-rise-slope (ERS) were measured. Five radiologists rated image quality in terms of image noise, contrast, sharpness, texture, and small structure visibility, and evaluated overall diagnostic acceptability of images and lesion conspicuity. Results The four reconstructions maintained the IC values unchanged in nine anatomical sites (all p &gt; 0.999). Compared to 1.25-mm AV-50, 1.25-mm DLIR-M and DLIR-H significantly reduced CV values (all p &lt; 0.001) and presented lower noise and noise peak (both p &lt; 0.001). Compared to 5-mm AV-50, 1.25-mm images had higher ERS (all p &lt; 0.001). The difference of the peak and average spatial frequency among the four reconstructions was relatively small but statistically significant (both p &lt; 0.001). The 1.25-mm DLIR-M images were rated higher than the 5-mm and 1.25-mm AV-50 images for diagnostic acceptability and lesion conspicuity (all P &lt; 0.001). Conclusions DLIR may facilitate the thinner slice thickness iodine maps in abdominal DECT for improvement of image quality, diagnostic acceptability, and lesion conspicuity. 

Deep learning image reconstruction generates thinner slice iodine maps with improved image quality to increase diagnostic acceptance and lesion conspicuity: a prospective study on abdominal dual-energy CT

To develop a noninvasive radiomics-based nomogram for identification of disagreement in pathology between endoscopic biopsy and postoperative specimens in gastric cancer (GC).This observational study recruited 181 GC patients who underwent pre-treatment computed tomography (CT) and divided them into a training set (n = 112, single-energy CT, SECT), a test set (n = 29, single-energy CT, SECT) and a validation cohort (n = 40, dual-energy CT, DECT). Radiomics signatures (RS) based on five machine learning algorithms were constructed from the venous-phase CT images. AUC and DeLong test were used to evaluate and compare the performance of the RS. We assessed the dual-energy generalization ability of the best RS. An individualized nomogram combined the best RS and clinical variables was developed, and its discrimination, calibration, and clinical usefulness were determined.RS obtained with support vector machine (SVM) showed promising predictive capability with AUC of 0.91 and 0.83 in the training and test sets, respectively. The AUC of the best RS in the DECT validation cohort (AUC, 0.71) was significantly lower than that of the training set (Delong test, p = 0.035). The clinical-radiomic nomogram accurately predicted pathologic disagreement in the training and test sets, fitting well in the calibration curves. Decision curve analysis confirmed the clinical usefulness of the nomogram.CT-based radiomics nomogram showed potential as a clinical aid for predicting pathologic disagreement status between biopsy samples and resected specimens in GC. When practicability and stability are considered, the SECT-based radiomics model is not recommended for DECT generalization.Radiomics can identify disagreement in pathology between endoscopic biopsy and postoperative specimen. 

/pdf/virtual-biopsy-using-ct-radiomics-for-evaluation-of-1kwzcc1v.pdf

Virtual biopsy using CT radiomics for evaluation of disagreement in pathology between endoscopic biopsy and postoperative specimens in patients with gastric cancer: a dual-energy CT generalizability study

<h2>Abstract</h2><h3>Objectives</h3> Robustness of radiomic features in physiological tissue is an important prerequisite for quantitative analysis of tumor biology and response assessment. In contrast to previous studies which focused on different tumors with mostly short scan-re-scan intervals, this study aimed to evaluate the robustness of radiomic features in cancer-free patients and over a clinically encountered inter-scan. <h3>Materials and methods</h3> Patients without visible tumor burden who underwent at least two portal-venous phase dual energy CT examinations of the abdomen between May 2016 and January 2020 were included, while macroscopic tumor burden was excluded based upon follow-up imaging for all patients (≥3 months). Further, patients were excluded if no follow-up imaging was available, or if the CT protocol showed deviations between repeated examinations. Circular regions of interest were placed and proofread by two board-certified radiologists (4 years and 5 years experience) within the liver (segments 3 and 6), the psoas muscle (left and right), the pancreatic head, and the spleen to obtain radiomic features from normal-appearing organ parenchyma using PyRadiomics. Radiomic feature robustness was tested using the concordance correlation coefficient with a threshold of 0.75 considered indicative for deeming a feature robust. <h3>Results</h3> In total, 160 patients with 480 repeated abdominal CT examinations (range: 2–4 per patient) were retrospectively included in this single-center, IRB-approved study. Considering all organs and feature categories, only 4.58 % (25/546) of all features were robust with the highest rate being found in the first-order feature category (20.37 %, 22/108). Other feature categories (grey level co-occurrence matrix, grey level dependence matrix, grey level run length matrix, grey level size zone matrix, and neighborhood gray-tone difference matrix) yielded an overall low percentage of robust features (range: 0 %-1.19 %). A subgroup analysis revealed the reconstructed field of view and the X-Ray tube current as determinants of feature robustness (significant differences in subgroups for all organs, p < 0.001) as well as the size of the region of interest (no significant difference for the pancreatic head with p = 0.135, significant difference with p < 0.001 for all other organs). <h3>Conclusion</h3> Radiomic feature robustness obtained from cancer-free subjects with repeated examinations using a consistent protocol and CT scanner was limited, with first order features yielding the highest proportion of robust features. 

Robustness of radiomic features in healthy abdominal parenchyma of patients with repeated examinations on dual-layer dual-energy CT

CT radiomic features reproducibility of virtual non-contrast series derived from photon-counting CCTA datasets using a novel calcium-preserving reconstruction algorithm compared with standard non-contrast series: focusing on epicardial adipose tissue.

To evaluate inter- and intra- scan mode and scanner repeatability and reproducibility of radiomics features within and between single-energy CT (SECT) and dual-energy CT (DECT).A standardized phantom with sixteen rods of clinical-relevant densities was scanned on seven DECT-capable scanners and three SECT-only scanners. The acquisition parameters were selected to present typical abdomen-pelvic examinations with the same voxel size. Images of SECT at 120 kVp and corresponding 120 kVp-like virtual monochromatic images (VMIs) in DECT which were generated according to scanners were analyzed. Regions of interest were drawn with rigid registrations to avoid variations due to segmentation. Radiomics features were extracted via Pyradiomics platform. Test-retest repeatability was evaluated by Bland-Altman analysis for repeated scans. Intra-scanner reproducibility for different scan modes was tested by intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC). Inter-scanner reproducibility among different scanners for same scan mode was assessed by coefficient of variation (CV) and quartile coefficient of dispersion (QCD).The test-retest analysis presented that 92.91% and 87.02% of the 94 assessed features were repeatable for SECT 120kVp and DECT 120 kVp-like VMIs, respectively. The intra-scanner analysis for SECT 120kVp vs DECT 120 kVp-like VMIs demonstrated that 10.76% and 10.28% of features were with ICC > 0.90 and CCC > 0.90, respectively. The inter-scanner analysis showed that 17.09% and 27.73% of features for SECT 120kVp were with CV < 10% and QCD < 10%, and 15.16% and 32.78% for DECT 120 kVp-like VMIs, respectively.The majority of radiomics features were non-reproducible within and between SECT and DECT.• Although the test-retest analysis showed high repeatability for radiomics features, the overall reproducibility of radiomics features within and between SECT and DECT was low. • Only about one-tenth of radiomics features extracted from SECT images and corresponding DECT images did match each other, even their average photon energy levels were considered alike, indicating that the scan mode potentially altered the radiomics features. • Less than one-fifth of radiomics features were reproducible among multiple SECT and DECT scanners, regardless of their fixed acquisition and reconstruction parameters, suggesting the necessity of scanning protocol adjustment and post-scan harmonization process. 

/pdf/robustness-of-ct-radiomics-features-consistency-within-and-2ycr9qjk.pdf

Robustness of CT radiomics features: consistency within and between single-energy CT and dual-energy CT

BACKGROUND
Diffusion-weighted imaging (DWI)-based virtual MR elastography (DWI-vMRE) in the assessment of breast lesions is still in the research stage.


PURPOSE
To investigate the usefulness of elasticity values on DWI-vMRE in the evaluation of breast lesions, and the correlation with the values calculated from shear-wave elastography (SWE).


STUDY TYPE
Prospective.


POPULATION/SUBJECTS
153 patients (mean age ± standard deviation: 55 ± 12 years) with 153 pathological confirmed breast lesions (24 benign and 129 malignant lesions).


FIELD STRENGTH/SEQUENCE
1.5-T MRI, multi-b readout segmented echo planar imaging (b-values of 0, 200, 800, and 1000 sec/mm2 ).


ASSESSMENT
For DWI-vMRE assessment, lesions were manually segmented using apparent diffusion coefficient (ADC0-1000 ) map, then the region of interests were copied to the map of shifted-ADC (sADC200-800 , sADC 200-1500 ). For SWE assessment, the shear modulus of the lesions was measured by US elastic modulus (μUSE ). Intraclass/interclass kappa coefficients were calculated to measure the consistency.


STATISTICAL TESTS
Pearson's correlation was used to assess the relationship between sADC and μUSE . A receiver operating characteristic analysis with the area under the curve (AUC) was performed to compare the diagnostic accuracy between benign and malignant breast lesions of sADC and μUSE . A P value <0.05 was considered statistically significant.


RESULTS
There were significant differences between benign and malignant breast lesions of μUSE (24.17 ± 10.64 vs. 37.20 ± 12.61), sADC200-800 (1.38 ± 0.31 vs. 0.97 ± 0.18 × 10-3  mm2 /sec), and sADC200-1500 (1.14 ± 0.30 vs. 0.78 ± 0.13 × 10-3  mm2 /sec). In all breast lesions, a moderate but significant correlation was observed between μUSE and sADC200-800 /sADC200-1500 (r = -0.49/-0.44). AUC values to differentiate benign from malignant lesions were as follows: μUSE , 0.78; sADC200-800 , 0.89; sADC200-1500 , 0.89.


DATA CONCLUSIONS
Both SWE and DWI-vMRE could be used for the differentiation of benign versus malignant breast lesions. Furthermore, DWI-vMRE with the use of sADC show relatively higher AUC values than SWE.


LEVEL OF EVIDENCE
4 TECHNICAL EFFICACY: Stage 2.

Diffusion-Weighted MRI-Based Virtual Elastography and Shear-Wave Elastography for the Assessment of Breast Lesions.

BACKGROUND
Quantitative diffusion metrics provide additional microstructural information of diseases. The robustness of quantitative diffusion metrics should be established before clinical application.


PURPOSE
To evaluate the variability and reproducibility of quantitative diffusion MRI metrics.


STUDY TYPE
Prospective.


POPULATION
14 volunteers (7 men; median age, range, 28, 26-59 years).


FIELD STRENGTH/SEQUENCE
3.0-T/Diffusion spectrum imaging.


ASSESSMENT
Brain MRI studies were performed four times per subject: involving different combinations of coil types and voxel sizes. Regions of interest of 13 brain anatomical sites were drawn by one observer twice and another observer once to allow interobserver and intraobserver reproducibility assessment. Twenty-five quantitative metrics were calculated using four diffusion models.


STATISTICAL TESTS
The variability was evaluated with coefficients of variation (CV), and quartile coefficient of dispersion (QCD). The reproducibility was assessed with intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC). Wilcoxon signed rank test was used to compare the influence of factors on robustness of quantitative diffusion metrics. A two-tailed P < 0.05 was considered statistically significant.


RESULTS
The variability of quantitative diffusion metrics showed CV of 2.4%-68.2%, and QCD of 0.6%-48.2%, respectively. The reproducibility of scans using 20-channel coils with voxels of 2 × 2 × 2 mm3 and 3 × 3 × 3 mm3 , respectively (ICC 0.03-0.84, CCC 0.03-0.84) was significantly worse than that of repeated scans using a 20-channel coil with a voxel size of 2 × 2 × 2 mm3 (ICC of 0.74-0.97, CCC 0.74-0.97) and that of scans using 20- and 64-channel coils, respectively, with a voxel size of 2 × 2 × 2 mm3 (ICC 0.59-0.95, CCC 0.59-0.95). The intraobserver reproducibility (ICC 0.49-0.94, CCC 0.49-0.94) was significantly better than the interobserver reproducibility (ICC 0.28-0.91, CCC 0.28-0.91).


DATA CONCLUSION
Our study indicated that the voxel size has a greater influence on the reproducibility of quantitative diffusion metrics than scan-rescans and coils. The reproducibility within one observer was higher than that between two observers.


EVIDENCE LEVEL
2 TECHNICAL EFFICACY: Stage 1.

Robustness of Quantitative Diffusion Metrics from Four Models: A Prospective Study on the Influence of Scan-Rescans, Voxel Size, Coils, and Observers.

Abstract Objective To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them. Methods We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool. Results Ten guidelines were included, with a median STAR score of 46.0 (range 28.5–61.5). The guidelines performed well in “Recommendations” domain (31/40, 78%), while poor in “Registry” (0/20, 0%) and “Protocol” domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) &lt; 30 mL/min/1.73 m 2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR &lt; 45 mL/min/1.73 m 2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means. Conclusion Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols. Critical relevance statement The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow. Key points • Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow. Graphical Abstract 

Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

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Robustness of CT radiomics features: consistency within and between single-energy CT and dual-energy CT

Diffusion-Weighted MRI-Based Virtual Elastography and Shear-Wave Elastography for the Assessment of Breast Lesions.

Robustness of Quantitative Diffusion Metrics from Four Models: A Prospective Study on the Influence of Scan-Rescans, Voxel Size, Coils, and Observers.

Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease