Objective
The aim of the study was to assess the performance and diagnostic value of a dual energy CT approach to reduce metal artefacts in subjects with metallic implants.
Methods
31 patients were ...examined in the area of their metallic implants using a dual energy CT protocol (filtered 140 kVp and 100 kVp spectrum, tube current relation: 3:1). Specific post-processing was applied to generate energies of standard 120 and 140 kVp spectra as well as a filtered 140 kVp spectrum with mean photon energies of 64, 69 and 88 keV, respectively, and an optimized hard spectrum of 95–150 keV. Image quality and diagnostic value were subjectively and objectively determined.
Results
Image quality was rated superior to the standard image in 29/31 high energy reconstructions; the diagnostic value was rated superior in 27 patients. Image quality and diagnostic value scores improved significantly from 3.5 to 2.1 and from 3.6 to 1.9, respectively. In several exams decisive diagnostic features were only discernible in the high energy reconstructions. The density of the artefacts decreased from −882 to −341 HU.
Conclusions
Dual Energy CT with specific postprocessing can reduce metal artefacts and may significantly enhance diagnostic value in the evaluation of metallic implants.
To determine the feasibility of computed tomography (CT)-based dynamic myocardial perfusion imaging for the detection of hemodynamically significant coronary artery stenosis, as defined with ...fractional flow reserve (FFR).
Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Subjects who were suspected of having or were known to have coronary artery disease underwent electrocardiographically triggered dynamic stress myocardial perfusion imaging. FFR measurement was performed within all main coronary arteries with a luminal narrowing of 50%-85%. Estimated myocardial blood flow (MBF) was derived from CT images by using a model-based parametric deconvolution method for 16 myocardial segments and was related to hemodynamically significant coronary artery stenosis with an FFR of 0.75 or less in a blinded fashion. Conventional measures of diagnostic accuracy were derived, and discriminatory power analysis was performed by using logistic regression analysis.
Of 36 enrolled subjects, 33 (mean age, 68.1 years ± 10 standard deviation; 25 76% men, eight 24% women) completed the study protocol. An MBF cut point of 75 mL/100 mL/min provided the highest discriminatory power (C statistic, 0.707; P <.001). While the diagnostic accuracy of CT for the detection of anatomically significant coronary artery stenosis (>50%) was high, it was low for the detection of hemodynamically significant stenosis (positive predictive value PPV per coronary segment, 49%; 95% confidence interval CI: 36%, 60%). With use of estimated MBF to reclassify lesions depicted with CT angiography, 30 of 70 (43%) coronary lesions were graded as not hemodynamically significant, which significantly increased PPV to 78% (95% CI: 61%, 89%; P = .02). The presence of a coronary artery stenosis with a corresponding MBF less than 75 mL/100 mL/min had a high risk for hemodynamic significance (odds ratio, 86.9; 95% CI:17.6, 430.4).
Dynamic CT-based stress myocardial perfusion imaging may allow detection of hemodynamically significant coronary artery stenosis.
The aim of this study was to assess the feasibility of a differentiation of iodine from other materials and of different body tissues using dual energy CT. Ten patients were scanned on a SOMATOM ...Definition Dual Source CT (DSCT; Siemens, Forchheim, Germany) system in dual energy mode at tube voltages of 140 and 80 kVp and a ratio of 1:3 between tube currents. Weighted CT Dose Index ranged between 7 and 8 mGy, remaining markedly below reference dose values for the respective body regions. Image post-processing with three-material decomposition was applied to differentiate iodine or collagen from other tissue. The results showed that a differentiation and depiction of contrast material distribution is possible in the brain, the lung, the liver and the kidneys with or without the underlying tissue of the organ. In angiographies, bone structures can be removed from the dataset to ease the evaluation of the vessels. The differentiation of collagen makes it possible to depict tendons and ligaments. Dual energy CT offers a more specific tissue characterization in CT and can improve the assessment of vascular disease. Further studies are required to draw conclusions on the diagnostic value of the individual applications.
To qualitatively and quantitatively compare virtual nonenhanced (VNE) data sets derived from dual-energy (DE) computed tomography (CT) with true nonenhanced (TNE) data sets in the same patients and ...to calculate potential radiation dose reductions for a dual-phase renal multidetector CT compared with a standard triple-phase protocol.
This prospective study was approved by the institutional review board; all patients provided written informed consent. Seventy one men (age range, 30-88 years) and 39 women (age range, 22-87 years) underwent preoperative DE CT that included unenhanced, DE nephrographic, and delayed phases. DE CT parameters were 80 and 140 kV, 96 mAs (effective). Collimation was 14 x 1.2 mm. CT numbers were measured in renal parenchyma and tumor, liver, aorta, and psoas muscle. Image noise was measured on TNE and VNE images. Exclusion of relevant anatomy with the 26-cm field of view detector was quantified with a five-point scale (0 = none, 4 = >75%). Image quality and noise (1 = none, 5 = severe) and acceptability for VNE and TNE images were rated. Effective radiation doses for DE CT and TNE images were calculated. Differences were tested with a Student t test for paired samples.
Mean CT numbers (+/- standard deviation) on TNE and VNE images, respectively, for renal parenchyma were 30.8 HU +/- 4.0 and 31.6 HU +/- 7.1, P = .29; liver, 55.8 HU +/- 8.6 and 57.8 HU +/- 10.1, P = .11; aorta, 42.1 HU +/- 4.1 and 43.0 HU +/- 8.8, P = .16; psoas, 47.3 HU +/- 5.6 and 48.1 HU +/- 9.3 HU, P = .38. No exclusion of the contralateral kidney was seen in 50 patients, less than 25% was seen in 43, 25%-50% was seen in 13, and 50%-75% was seen in four. Mean image noise was 1.71 +/- 0.71 for VNE and 1.22 +/- 0.45 for TNE (P < .001); image quality was 1.70 HU +/- 0.72 for VNE and 1.15 HU +/- 0.36 for TNE (P < .0001). In all but three patients radiologists accepted VNE images as replacement for TNE images. Mean effective dose for DE CT scans of the abdomen was 5.21 mSv +/- 1.86 and that for nonenhanced scans was 4.97 mSv +/- 1.43. Mean dose reduction by omitting the TNE scan was 35.05%.
In patients with renal masses, DE CT can provide high-quality VNE data sets, which are a reasonable approximation of TNE data sets. Integration of DE scanning into a renal mass protocol will lower radiation exposure by 35%.
We present photometric redshift estimates for galaxies used in the weak lensing analysis of the Dark Energy Survey Science Verification (DES SV) data. Four model- or machine learning-based ...photometric redshift methods-annz2, bpz calibrated against BCC-Ufig simulations, skynet, and tpz-are analyzed. For training, calibration, and testing of these methods, we construct a catalogue of spectroscopically confirmed galaxies matched against DES SV data. The performance of the methods is evaluated against the matched spectroscopic catalogue, focusing on metrics relevant for weak lensing analyses, with additional validation against COSMOS photo-z's. From the galaxies in the DES SV shear catalogue, which have mean redshift 0.72 + or - 0.01 over the range 0.3 < z< 1.3, we construct three tomographic bins with means of z= {0.45,0.67,1.00}. These bins each have systematic uncertainties delta sub(z)<, ~ 0.05 in the mean of the fiducial skynet photo-z n(z). We propagate the errors in the redshift distributions through to their impact on cosmological parameters estimated with cosmic shear, and find that they cause shifts in the value of sigma sub(8) of approximately 3%. This shift is within the one sigma statistical errors on sigma sub(8) for the DES SV shear catalogue. We further study the potential impact of systematic differences on the critical surface density, capital sigma sub(crit), finding levels of bias safely less than the statistical power of DES SV data. We recommend a final Gaussian prior for the photo-z bias in the mean of n(z) of width 0.05 for each of the three tomographic bins, and show that this is a sufficient bias model for the corresponding cosmology analysis.
Tungsten oxide (WO3) thin films have been produced by KrF excimer laser (λ = 248 nm) ablation of bulk ceramic WO3 targets. The crystal structure, surface morphology, chemical composition, and ...structural stability of the WO3 thin films have been studied in detail. Characterization of freshly grown WO3 thin films has been performed using X-ray diffraction (XRD), atomic force microscopy (AFM), energy-dispersive X-ray spectroscopy (EDX), Raman spectroscopy (RS), transmission electron microscopy (TEM), and selected area electron diffraction (SAED) measurements. The results indicate that the freshly grown WO3 thin films are nearly stoichiometric and well crystallized as monoclinic WO3. The surface morphology of the resulting WO3 thin film has grains of ∼60 nm in size with a root-mean-square (rms) surface roughness of 10 nm. The phase transformations in the WO3 thin films were investigated by annealing in the TEM column at 30−500 °C. The phase transitions in the WO3 thin films occur in sequence as the temperature is increased: monoclinic → orthorhombic → hexagonal. Distortion and tilting of the WO6 octahedra occurs with the phase transitions and significantly affects the electronic properties and, hence, the electrochemical device applications of WO3.
The application of dielectrophoretic field-flow fractionation (depFFF) to the isolation of circulating tumor cells (CTCs) from clinical blood specimens was studied using simulated cell mixtures of ...three different cultured tumor cell types with peripheral blood. The depFFF method can not only exploit intrinsic tumor cell properties so that labeling is unnecessary but can also deliver unmodified, viable tumor cells for culture and/or all types of molecular analysis. We investigated tumor cell recovery efficiency as a function of cell loading for a 25 mm wide x 300 mm long depFFF chamber. More than 90% of tumor cells were recovered for small samples but a larger chamber will be required if similarly high recovery efficiencies are to be realized for 10 mL blood specimens used CTC analysis in clinics. We show that the factor limiting isolation efficiency is cell-cell dielectric interactions and that isolation protocols should be completed within ~15 min in order to avoid changes in cell dielectric properties associated with ion leakage.
Recipients of extended‐criteria donor (ECD) kidneys have poorer long‐term outcomes compared to standard‐criteria donor kidney recipients. We report 3‐year outcomes from a randomized, phase III study ...in recipients of de novo ECD kidneys (n = 543) assigned (1:1:1) to either a more intensive (MI) or less intensive (LI) belatacept regimen, or cyclosporine. Three hundred twenty‐three patients completed treatment by year 3. Patient survival with a functioning graft was comparable between groups (80% in MI, 82% in LI, 80% in cyclosporine). Mean calculated GFR (cGFR) was 11 mL/min higher in belatacept‐treated versus cyclosporine‐treated patients (42.7 in MI, 42.2 in LI, 31.5 mL/min in cyclosporine). More cyclosporine‐treated patients (44%) progressed to GFR <30 mL/min (chronic kidney disease CKD stage 4/5) than belatacept‐treated patients (27–30%). Acute rejection rates were similar between groups. Posttransplant lymphoproliferative disorder (PTLD) occurrence was higher in belatacept‐treated patients (two in MI, three in LI), most of which occurred during the first 18 months; four additional cases (3 in LI, 1 in cyclosporine) occurred after 3 years. Tuberculosis was reported in two MI, four LI and no cyclosporine patients. In conclusion, at 3 years after transplantation, immunosuppression with belatacept resulted in similar patient survival, graft survival and acute rejection, with better renal function compared with cyclosporine. As previously reported, PTLD and tuberculosis were the principal safety findings associated with belatacept in this study population.
Three‐year results from the BENEFIT‐EXT study confirm the durability of the renal function benefits of belatacept over time compared to cyclosporine, while providing comparable 3‐year patient/graft survival and balancing risks associated with belatacept in recipients of extended criteria donor kidneys.
We use the new Type Ia supernovae discovered by the Sloan Digital Sky Survey-II supernova survey, together with additional supernova data sets as well as observations of the cosmic microwave ...background and baryon acoustic oscillations to constrain cosmological models. This complements the standard cosmology analysis presented by Kessler et al. in that we discuss and rank a number of the most popular nonstandard cosmology scenarios. When this combined data set is analyzed using the MLCS2k2 light-curve fitter, we find that more exotic models for cosmic acceleration provide a better fit to the data than the Delta *LCDM model. For example, the flat Dvali-Gabadadze-Porrati model is ranked higher by our information-criteria (IC) tests than the standard model with a flat universe and a cosmological constant. When the supernova data set is instead analyzed using the SALT-II light-curve fitter, the standard cosmological-constant model fares best. This investigation of how sensitive cosmological model selection is to assumptions about, and within, the light-curve fitters thereby highlights the need for an improved understanding of these unresolved systematic effects. Our investigation also includes inhomogeneous Lemaitre-Tolman-Bondi (LTB) models. While our LTB models can be made to fit the supernova data as well as any other model, the extra parameters they require are not supported by our IC analysis. Finally, we explore more model-independent ways to investigate the cosmic expansion based on this new data set.
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