Owing to recent advances in computing power, iterative reconstruction (IR) algorithms have become a clinically viable option in computed tomographic (CT) imaging. Substantial evidence is accumulating ...about the advantages of IR algorithms over established analytical methods, such as filtered back projection. IR improves image quality through cyclic image processing. Although all available solutions share the common mechanism of artifact reduction and/or potential for radiation dose savings, chiefly due to image noise suppression, the magnitude of these effects depends on the specific IR algorithm. In the first section of this contribution, the technical bases of IR are briefly reviewed and the currently available algorithms released by the major CT manufacturers are described. In the second part, the current status of their clinical implementation is surveyed. Regardless of the applied IR algorithm, the available evidence attests to the substantial potential of IR algorithms for overcoming traditional limitations in CT imaging.
Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation ...to identify features that allow for confirming or ruling out the intraplaque hemorrhage.
This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm
). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed.
A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had
values of .006, .0001, and .018, respectively).
The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.
Invasive coronary angiography (ICA) with measurement of fractional flow reserve (FFR) by means of a pressure wire technique is the established reference standard for the functional assessment of ...coronary artery disease (CAD) ( 1 , 2 ). Coronary computed tomographic (CT) angiography has emerged as a noninvasive method for direct assessment of CAD and plaque characterization with high diagnostic accuracy compared with ICA ( 3 , 4 ). However, the solely anatomic assessment provided with both coronary CT angiography and ICA has poor discriminatory power for ischemia-inducing lesions. FFR derived from standard coronary CT angiography (FFR
) data sets by using any of several advanced computational analytic approaches enables combined anatomic and hemodynamic assessment of a coronary lesion by a single noninvasive test. Current technical approaches to the calculation of FFR
include algorithms based on full- and reduced-order computational fluid dynamic modeling, as well as artificial intelligence deep machine learning ( 5 , 6 ). A growing body of evidence has validated the diagnostic accuracy of FFR
techniques compared with invasive FFR. Improved therapeutic guidance has been demonstrated, showing the potential of FFR
to streamline and rationalize the care of patients suspected of having CAD and improve outcomes while reducing overall health care costs ( 7 , 8 ). The purpose of this review is to describe the scientific principles, clinical validation, and implementation of various FFR
approaches, their precursors, and related imaging tests.
RSNA, 2017.
Mice deficient for SIRT6 exhibit a severely shortened lifespan, growth retardation, and highly elevated LINE1 (L1) activity. Here we report that SIRT6-deficient cells and tissues accumulate abundant ...cytoplasmic L1 cDNA, which triggers strong type I interferon response via activation of cGAS. Remarkably, nucleoside reverse-transcriptase inhibitors (NRTIs), which inhibit L1 retrotransposition, significantly improved health and lifespan of SIRT6 knockout mice and completely rescued type I interferon response. In tissue culture, inhibition of L1 with siRNA or NRTIs abrogated type I interferon response, in addition to a significant reduction of DNA damage markers. These results indicate that L1 activation contributes to the pathologies of SIRT6 knockout mice. Similarly, L1 transcription, cytoplasmic cDNA copy number, and type I interferons were elevated in the wild-type aged mice. As sterile inflammation is a hallmark of aging, we propose that modulating L1 activity may be an important strategy for attenuating age-related pathologies.
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•SIRT6 KO mice accumulate L1 cDNA, triggering interferon response via cGAS pathway•Wild-type aged mice accumulate L1 cDNA and display type I interferon response•Reverse-transcriptase inhibitors rescue type I interferon response and DNA damage•Reverse-transcriptase inhibitors extend lifespan and improve health of SIRT6 KO mice
Simon et al. show that LINE1 retrotransposon elements are derepressed in aged and progeroid mice. Cytoplasmic accumulation of LINE1 cDNA copies induced a type I interferon response, through the cGAS DNA sensing pathway, resulting in pathological inflammation. Inhibiting L1 replication significantly improved the health and lifespan of aged mice.
In this article, the authors discuss the technical background and summarize the current body of literature regarding virtual monoenergetic (VM) images derived from dual-energy CT data, which can be ...reconstructed between 40 and 200 keV. Substantially improved iodine attenuation at lower kiloelectron volt levels and reduced beam-hardening artifacts at higher kiloelectron volt levels have been demonstrated from all major manufacturers of dual-energy CT units. Improved contrast attenuation with VM imaging at lower kiloelectron volt levels enables better delineation and diagnostic accuracy in the detection of various vascular or oncologic abnormalities. Low-kiloelectron-volt VM imaging may be useful for salvaging CT studies with suboptimal contrast material delivery or providing additional information on the arterial vasculature obtained from venous phase acquisitions. For patients with renal impairment, substantial reductions in the use of iodinated contrast material can be achieved by using lower-energy VM imaging. The authors recommend routine reconstruction of VM images at 50 keV when using dual-energy CT to exploit the increased contrast properties. For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment.
Objectives
To evaluate the diagnostic performance of dual-energy computed tomography (DECT) with regard to its post-processing techniques, namely linear blending (LB), iodine maps (IM), and virtual ...monoenergetic (VM) reconstructions, in diagnosing acute pulmonary embolism (PE).
Methods
This meta-analysis was conducted according to PRISMA. A systematic search on MEDLINE and EMBASE was performed in December 2019, looking for articles reporting the diagnostic performance of DECT on a per-patient level. Diagnostic performance meta-analyses were conducted grouping study parts according to DECT post-processing methods. Correlations between radiation or contrast dose and publication year were appraised.
Results
Seventeen studies entered the analysis. Only lobar and segmental acute PE were considered, subsegmental acute PE being excluded from analysis due to data heterogeneity or lack of data. LB alone was assessed in 6 study parts accounting for 348 patients, showing a pooled sensitivity of 0.87 and pooled specificity of 0.93. LB and IM together were assessed in 14 study parts accounting for 1007 patients, with a pooled sensitivity of 0.89 and pooled specificity of 0.90. LB, IM, and VM together were assessed in 2 studies (for a total 144 patients) and showed a pooled sensitivity of 0.90 and pooled specificity of 0.90. The area under the curve for LB alone, and LB together with IM was 0.93 (not available for studies using LB, IM and VM because of paucity of data). Radiation and contrast dose did not decrease with increasing year of publication.
Conclusions
Considering the published performance of single-energy CT in diagnosing acute PE, either dual-energy or single-energy computed tomography can be comparably used for the detection of acute PE.
Key Points
• Dual-energy CT displayed pooled sensitivity and specificity of 0.87 and 0.93 for linear blending alone, 0.89 and 0.90 for linear blending and iodine maps, and 0.90 and 0.90 for linear blending iodine maps, and virtual monoenergetic reconstructions.
• The performance of dual-energy CT for patient management is not superior to that reported in literature for single-energy CT (0.83 sensitivity and 0.96 specificity).
• Dual-energy CT did not yield substantial advantages in the identification of patients with acute pulmonary embolism compared to single-energy techniques.
MYC is a highly pleiotropic transcription factor whose deregulation promotes cancer. In contrast, we find that Myc haploinsufficient (Myc+/–) mice exhibit increased lifespan. They show resistance to ...several age-associated pathologies, including osteoporosis, cardiac fibrosis, and immunosenescence. They also appear to be more active, with a higher metabolic rate and healthier lipid metabolism. Transcriptomic analysis reveals a gene expression signature enriched for metabolic and immune processes. The ancestral role of MYC as a regulator of ribosome biogenesis is reflected in reduced protein translation, which is inversely correlated with longevity. We also observe changes in nutrient and energy sensing pathways, including reduced serum IGF-1, increased AMPK activity, and decreased AKT, TOR, and S6K activities. In contrast to observations in other longevity models, Myc+/– mice do not show improvements in stress management pathways. Our findings indicate that MYC activity has a significant impact on longevity and multiple aspects of mammalian healthspan.
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•Reduction of Myc expression in mice promotes longevity•Lower Myc levels benefit multiple organs and physiological processes•Decreased Myc activity triggers changes in core nutrient and energy-sensing pathways•Lower Myc levels do not cause apparent changes in stress management pathways
Reduced expression of MYC increases lifespan in mice and benefits multiple aspects related to the aging process without apparent developmental trade-offs or changes in stress management pathways.
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