The Journal of Computer Assisted Tomography

26/06/2025

Superior Performance of Synchronized Percutaneous Microwave Ablation and Immediate Percutaneous Biopsy for Highly Suspected Malignant Pulmonary Ground-Glass Nodules: Objective:

In recent years, experience has been accumulated in microwave ablation (MWA) of ground-glass nodules (GGNs). The goal of this retrospective study was to explore the feasibility, safety, and efficacy of synchronized computed tomography (CT)-guided MWA combined with intraoperative percutaneous biopsy (PB) for the treatment of highly suspected malignant GGNs.

Methods:

From January 2021 to February 2025, 93 patients with highly suspected malignant GGNs underwent MWA and PB. Forty-one patients in group A were treated with sequential low power MWA-PB-radical MWA in one session. Fifty-two patients in group B were treated with staged procedures. The pathologic diagnostic results and pathology positive diagnosis rate were evaluated. The technical success, complete ablation rate, and complications were analyzed. The total operative time, irradiation dose, hospitalization time, and hospitalization expenses were compared between the 2 groups.

Results:

The technical success rate of both groups was 100%. The complete ablation rates of group A and group B were 100% and 98.1%, respectively (P>0.05). The positive pathologic diagnosis rate of group A was 90.2% (37/41). The incidence of pneumothorax and intrapulmonary hemorrhage was lower in group A than in group B (29.3% vs. 50.0%, P=0.04; 17.1% vs. 61.5%, P

cutaneous biopsy (PB) for the treatment of highly suspected malignant GGNs. Methods: From January 2021 to February 2025, 93 patients with highly suspected malignant GGNs underwent MWA and PB. Forty-one patients in group A were treated with sequential low power MWA-PB-radical MWA in one session. Fift...

26/06/2025

Hepatobiliary Tumor Board: A Multidisciplinary Review of Challenging Cases: Multidisciplinary case conferences have been shown to improve patient outcomes. However, such case conferences may be unavailable in some settings. This multidisciplinary discussion of 4 challenging hepatobiliary cases was presented at the 2023 Society of Advanced Body Imaging Annual Meeting in Dallas, TX. The cases include an “imaging occult” pancreatic tumor, a large pancreatic mass, an intraductal biliary mass, and a polypoid intraluminal gallbladder mass.

allas, TX. The cases include an “imaging occult” pancreatic tumor, a large pancreatic mass, an intraductal biliary mass, and a polypoid intraluminal gallbladder mass....

26/06/2025

The Diagnostic Value of 18F-FDG PET in Parkinson Disease Based on Voxel Analysis: Purpose:

To evaluate the accuracy of statistical parametric mapping (SPM) and Scenium in the differential diagnosis of Parkinson disease (PD) and atypical Parkinsonian syndromes based on 18F-fluoro-deoxy-glucose (18F-FDG) imaging, and to explore the application of these 2 software programs in analyzing patients with Parkinson disease of varying severity, as well as to construct and evaluate the metabolic profiles of PD patients using Scenium.

Methods:

A total of 64 patients with Parkinsonian syndrome who met the diagnostic criteria were included in this study. PET images were used for disease diagnosis with SPM and Scenium based on diagnostic charts, and the diagnostic accuracy of both software programs was assessed through consistency analysis. Meanwhile, an in-depth analysis was performed to compare the sensitivity, specificity, positive predictive value, and negative predictive value of the 2 software programs. In addition, Scenium was used to construct a diagnostic model for PD.

Results:

SPM demonstrated greater accuracy in distinguishing between PD and APS, with a significantly higher Kappa value (K_spm=0.704) compared with Scenium (K_scenium=0.440). The sensitivity and specificity of SPM were 82.5% and 91.7%, respectively. Further, a PD diagnostic model was constructed by incorporating PET parameters from the contralateral central region and basal ganglia, achieving a diagnostic accuracy of 82.9%.

Conclusions:

SPM can more accurately differentiate the diagnosis of Parkinson disease from atypical Parkinson syndrome compared with Scenium.

analyzing patients with Parkinson disease of varying severity, as well as to construct and evaluate the metabolic profiles of PD patients using Scenium. Methods: A total of 64 patients with Parkinsonian syndrome who met the diagnostic criteria were included in this study. PET images were used for di...

26/06/2025

Varied Symptomatology and Computed Tomography Analysis of Coral Reef Aorta: Exploring the Symptom-location Relationship: Purpose:

To describe the clinical manifestations of coral reef aorta (CRA), determine the common locations of CRA on CT, and assess the relationship between lesion location and clinical symptoms.

Materials and Methods:

Keyword detection in CT reports at a single institution between 2008 and 2021 revealed 27 patients with CRA. Aortic segments were grouped by relation to the aortic branches. Patient’s characteristics, cardiovascular risk factors, treatments, and outcomes were collected from the medical record.

Results:

Median age was 63.7 (IQR: 58.1–70.6). Of the total, 77.8% (21/27) were females. The most common risk factors were hypertension (23/27) and smoking (24/27). Diabetes was present in 4/27, 14.8%. All CRAs were at the level of the celiac trunk or distal. The most common symptom was claudication (9/27), but 8/27 were asymptomatic. Approximately 74% of the CRAs were superior to the inferior mesenteric artery (20/27).

Claudication was significantly more common in patients with CRA inferior to the inferior renal artery (iRA, 8/13, 61.5%) than those with the CRA superior to the iRA (including iRA) (2/14, 14.3%; P = 0.018). Pulmonary edema was seen in 2/5 patients with CRA between the superior renal artery and iRA compared with none when the CRA was located in other segments (P = 0.043).

Conclusion:

Nearly all patients with CRA had a history of hypertension and smoking, and the majority were female. The most common CRA segment was distal to the iRA, which was associated with claudication. The CRA involving the renal arteries was associated with recurring pulmonary edema.

26/06/2025

Combining the Qualitative and Quantitative Parameters of Dual-layer Detector Spectral Computed Tomography to Predict Intracranial Hemorrhage in Acute Ischemic Stroke Patients After Mechanical Thrombectomy: Aim:

To investigate the predictive value of combining qualitative and quantitative parameters from dual-layer spectral detector CT (DLCT) in identifying intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) in patients with acute ischemic stroke and large vessel occlusion (AIS-LVO).

Materials and Methods:

This retrospective study consecutively enrolled 120 patients with AIS-LVO who underwent MT, followed by DLCT performed 3 hours postprocedure. After applying the inclusion and exclusion criteria, 30 patients were included in the final analysis. Two radiologists independently assessed the presence of high-density areas (HDA) on noncontrast DLCT images. Qualitative imaging signs and quantitative parameters were subsequently obtained through observation and measurement of HDAs. Follow-up CT examinations conducted during hospitalization were reviewed for ICH development. The sensitivity and specificity of the DLCT parameters for early ICH diagnosis were calculated, and the diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis.

Results:

Fifty-five HDAs were detected on DLCT images from 30 patients. Follow-up noncontrast CT confirmed the development of ICH in 19/55 (34.5%) HDAs. Univariate analysis revealed significant differences in the mass effect, low-density edema zone, the median maximum CT value, the median cross-sectional area, the median maximum iodine concentration, the median relative iodine concentration, and the median Z-effective value between the ICH and non-ICH groups were significantly different (P < 0.05). Multivariate logistic regression identified low-density edema zone and the relative iodine concentration as independent predictors, which were incorporated into a combined diagnostic model. ROC analysis revealed an area under the curve (AUC) of 0.901 (95% CI: 0.807–0.994) for ICH prediction, with a sensitivity of 89.5% and specificity of 80.6%.

Conclusions:

The combination of qualitative and quantitative DLCT parameters demonstrated excellent predictive performance for identifying ICH after MT in patients with AIS-LVO.

Materials and Methods: This retrospective study consecutively enrolled 120 patients with AIS-LVO who underwent MT, followed by DLCT performed 3 hours postprocedure. After applying the inclusion and exclusion criteria, 30 patients were included in the final analysis. Two radiologists independently as...

26/06/2025

Neuroimaging Applications of Photon-counting CT: Photon-counting computed tomography (PCCT) is a new imaging technology that has advanced diagnostic imaging by offering improved spatial and contrast resolution as well as novel spectral imaging capabilities. Unlike conventional CT, which uses energy-integrating detectors, PCCT employs photon-counting detectors that directly measure individual photon energies, enabling applications such as virtual monochromatic imaging (VMI) and material decomposition. These innovations allow for artifact reduction, better visualization of fine anatomic structures, and improved diagnostic accuracy, all while reducing radiation dose. This review explores select applications of PCCT in neuroimaging, focusing on the brain, temporal bone, and spine. In the brain, we discuss how PCCT demonstrates superior performance for evaluating aneurysms, metallic prostheses, and vessel stenosis, offering enhanced visualization of vascular structures and minimizing artifacts. For temporal bone imaging, we review assessment of both complex anatomy and potentially subtle pathologies such as otosclerosis, as well as visualization of implants like cochlear devices and their intricate components. In spinal imaging, we explore how PCCT improves precise detection of causes of cerebrospinal fluid leaks, improves localization of tiny vessels such as the artery of Adamkiewicz and spinal dural arteriovenous fistulas, and reduces metal artifacts associated with postoperative hardware. PCCT addresses limitations of conventional CT while unlocking new diagnostic possibilities across neuroimaging applications. As clinical adoption of PCCT grows, ongoing research and development will refine imaging protocols and expand its utility. The accumulating evidence underscores PCCT’s transformative potential to improve diagnostic confidence in neuroimaging and beyond.

nting detectors that directly measure individual photon energies, enabling applications such as virtual monochromatic imaging (VMI) and material decomposition. These innovations allow for artifact reduction, better visualization of fine anatomic structures, and improved diagnostic accuracy, all whil...

26/06/2025

A Pilot Study to Assess Pancreatic Adenocarcinoma Treatment Response With Iodine Density From Photon Counting CT: Objective:

To assess photon counting CT iodine density as a marker of histopathologic treatment response after neoadjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma.

Materials and Methods:

A retrospective PACS search identified 21 pancreatic ductal adenocarcinoma patients [14 men; mean (SD) age: 64 (10) y] who underwent neoadjuvant chemotherapy and pancreatic photon counting CT 2 months before resection from April 11, 2022 to February 2, 2024. The histopathologic treatment response grade was the reference standard. Freehand regions-of-interest measurements were drawn independently by 2 radiologists as large as possible within the mass on pancreatic parenchymal phase images. Attenuation, iodine density, and iodine density normalized to the aorta were recorded. Mann-Whitney U test was used to compare attenuation, iodine density, and normalized iodine density for responders (pathologic grade 1, 2) versus nonresponders (grade 3). Receiver operating characteristic curves were created, and optimal thresholds were determined with Youden’s index. A P

ents [14 men; mean (SD) age: 64 (10) y] who underwent neoadjuvant chemotherapy and pancreatic photon counting CT 2 months before resection from April 11, 2022 to February 2, 2024. The histopathologic treatment response grade was the reference standard. Freehand regions-of-interest measurements were....

26/06/2025

Quantifying the Performance of Enhanced Radiation Output, Dual-Source CT Relative to Traditional CT in Patients With Severe Obesity: Objective:

In CT imaging of severely obese patients, demanding clinical tasks like liver imaging may be constrained by scanner radiation output limits. This may impose an unavoidable increase in image noise and loss of image quality. In such patients, scan parameters may be restricted, leading to excessive x-ray tube heating and increased scan times that degrade exam and image consistency relative to other patients. In this study, the performance of dual-source (DS) CT with enhanced radiation output capacity was quantified relative to conventional single-source (SS) CT. The focus was on abdominopelvic imaging in severely obese patients (BMI >45 kg/m2).

Methods:

Abdominopelvic portal venous phase CT exams performed using DSCT were compared with exams using SSCT. General usage characteristics of the DSCT protocol were analyzed for >3000 exams over a 42-month period. More specifically, a total of 95 matched SS and DS scan pairs for the same patients were assessed in detail. The tube voltage, reconstruction method, and scanner platform were consistent in matched SS and DS scans, and changes in patient weight, diameter, and water equivalent diameter were

to excessive x-ray tube heating and increased scan times that degrade exam and image consistency relative to other patients. In this study, the performance of dual-source (DS) CT with enhanced radiation output capacity was quantified relative to conventional single-source (SS) CT. The focus was on a...

07/06/2025

The Predictive Value of Multiparameter Characteristics of Coronary Computed Tomography Angiography for Coronary Stent Implantation: Objective:

This study aims to evaluate the predictive value of multiparameter characteristics of coronary computed tomography angiography (CCTA) plaque and the ratio of coronary artery volume to myocardial mass (V/M) in guiding percutaneous coronary stent implantation (PCI) in patients diagnosed with unstable angina.

Methods:

Patients who underwent CCTA and coronary angiography (CAG) within 2 months were retrospectively analyzed. According to CAG results, patients were divided into a medical therapy group (n=41) and a PCI revascularization group (n=37). The plaque characteristics and V/M were quantitatively evaluated. The parameters included minimum lumen area at stenosis (MLA), maximum area stenosis (MAS), maximum diameter stenosis (MDS), total plaque burden (TPB), plaque length, plaque volume, and each component volume within the plaque. Fractional flow reserve (FFR) and pericoronary fat attenuation index (FAI) were calculated based on CCTA. Artificial intelligence software was employed to compare the differences in each parameter between the 2 groups at both the vessel and plaque levels.

Results:

The PCI group had higher MAS, MDS, TPB, FAI, noncalcified plaque volume and lipid plaque volume, and significantly lower V/M, MLA, and CT-derived fractional flow reserve (FFRCT). V/M, TPB, MLA, FFRCT, and FAI are important influencing factors of PCI. The combined model of MLA, FFRCT, and FAI had the largest area under the ROC curve (AUC=0.920), and had the best performance in predicting PCI.

Conclusions:

The integration of AI-derived multiparameter features from one-stop CCTA significantly enhances the accuracy of predicting PCI in angina pectoris patients, evaluating at the plaque, vessel, and patient levels.

ed with unstable angina. Methods: Patients who underwent CCTA and coronary angiography (CAG) within 2 months were retrospectively analyzed. According to CAG results, patients were divided into a medical therapy group (n=41) and a PCI revascularization group (n=37). The plaque characteristics and V/M...

07/06/2025

Fixed Versus Tailored Scan Delay for Pancreatic Phase Acquisition: Comparison of Scan Timing Adequacy: Purpose:

To compare the scan timing adequacy for the pancreatic phase between fixed and tailored scan delay in the pancreatic protocol CT with a bolus-tracking technique.

Materials and Methods:

This retrospective study included patients who underwent pancreatic protocol CT using a fixed scan delay of 20 s from January 2020 to November 2022 (conventional group) and those using a tailored scan delay from January 2023 to July 2024 (tailored group). Tailored scan delay was identified to be the same as the time from contrast injection to reaching to trigger threshold of 100 HU (TimeTRIG). The scan delay ratio (SDR) was calculated by dividing the scan delay by TimeTRIG. Two radiologists assessed the scan timing adequacy for the pancreatic phase and classified it into 3 categories: early, appropriate, and late. The SDR and scan timing adequacy were compared between the conventional and tailored groups.

Results:

This study involved 128 patients (75 men; median age, 71 y), including 63 and 65 in the conventional and tailored groups, respectively. The median SDR was significantly different between the two groups (1.2 and 1.0 in the conventional and tailored groups; P

can delay of 20 s from January 2020 to November 2022 (conventional group) and those using a tailored scan delay from January 2023 to July 2024 (tailored group). Tailored scan delay was identified to be the same as the time from contrast injection to reaching to trigger threshold of 100 HU (TimeTRIG)...

07/06/2025

Clinical and Magnetic Resonance Imaging Findings for Differentiating Nodular Fasciitis and Myxofibrosarcoma: Correlation With “Fascial Tail” Sign: Objective:

This study aimed to determine the characteristic clinical and magnetic resonance imaging (MRI) findings that can distinguish nodular fasciitis (NF) from myxofibrosarcoma (MFS) because they are sometimes difficult to differentiate due to the overlapping imaging findings, such as the “fascial tail” sign.

Methods:

Thirty patients with NF and 44 with MFS were included in this study. The following MRI features were evaluated: mass size, anatomical and compartmental location, presence and type of pseudo-capsule, degree of heterogeneity, presence, and length of the “fascial tail” sign, and presence of peritumoral edema. Using diffusion-weighted images (DWI), we determined the presence of diffusion restriction and measured the apparent diffusion coefficient (ADC) values. On dynamic contrast-enhanced (DCE) images, we obtained the values of Ktrans, Kep, Ve, iAUC, and time-concentration curves using Tissue 4D.

Results:

The patients with NF were significantly younger than those with MFS. The average sizes of MFS and NF were 6.27±3.74 and 3.03±1.81 cm, respectively. Linear logistic regression analysis revealed that age, recurrence, “fascial tail” length, peritumoral edema, enhancement heterogeneity, and Ve differed significantly between the NF and MFS groups. The length of “fascial tail,” contrast heterogeneity, and compartmental location were statistically significant factors influencing the recurrence.

Conclusions:

Older age (above 46 y), larger tumor size (>4 cm), peritumoral edema, enhancement heterogeneity, and longer “fascial tail” (>25 mm) are more frequently associated with MFS, while the functional MR imaging findings, except the Ve value (>0.417), showed no significant differences.

“fascial tail” sign. Methods: Thirty patients with NF and 44 with MFS were included in this study. The following MRI features were evaluated: mass size, anatomical and compartmental location, presence and type of pseudo-capsule, degree of heterogeneity, presence, and length of the “fascial tai...

05/06/2025

Current Issue: Improving Image Quality and Visualization of Hepatocellular Carcinoma in Arterial Phase Imaging Using Contrast Enhancement–Boost Technique: Objective:

This study aimed to evaluate the image quality and visualization of hepatocellular carcinoma (HCC) on arterial phase computed tomography (CT) using the contrast enhancement (CE)–boost technique.

Methods:

This retrospective study included 527 consecutive patients who underwent dynamic liver CT between June 2021 and February 2022. Quantitative and qualitative image analyses were performed on 486 patients after excluding 41 patients. HCC conspicuity was evaluated in 40 of the 486 patients with at least one HCC in the liver. Iodinated images obtained by subtracting nonenhanced images from arterial phase images were combined to generate CE-boost images. For quantitative image analysis, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured for the liver, pancreas, muscles, and aorta. For qualitative analysis, the overall image quality and noise were graded using a 3-point scale. Artifact, sharpness, and HCC lesion conspicuity were assessed using a 5-point scale. The paired-sample t test was used to compare quantitative measures, whereas the Wilcoxon signed-rank test was used to compare qualitative measures.

Results:

The mean SNR and CNR of the aorta, liver, pancreas, and muscle were significantly higher, and the image noise was significantly lower in the CE-boost images than in the conventional images (P

ynamic liver CT between June 2021 and February 2022. Quantitative and qualitative image analyses were performed on 486 patients after excluding 41 patients. HCC conspicuity was evaluated in 40 of the 486 patients with at least one HCC in the liver. Iodinated images obtained by subtracting nonenhance...