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Biomedical subjects

Mathias Prokop

Publications and source records attributed to Mathias Prokop.

At least 37 records · Page 2Linked to original sources

MDCT for the diagnosis of acute pulmonary embolism.

With the advent of multidetector CT, pulmonary CT angiography (MD-CTPA) has substantially gained in spatial resolution and is the accepted method of choice to diagnose and rule out acute pulmonary embolism down to the subsegmental level. This article reviews means to optimize scanning technique and contrast injection protocols dependent on the scanner type used. It summarizes recent publications on the performance of MD-CTPA with special emphasis on the diagnostic accuracy, interpretation and clinical role of (isolated) peripheral emboli. Diagnostic algorithms are outlined that describe the role of CT in context with the pretest probability, the D-Dimer, lower limb sonography and scintigraphy.

Acute Disease↗

Cancer screening with CT: dose controversy.

Computed tomographic (CT) cancer screening has seen a steady increase in interest with the introduction of multislice scanners. While the potential benefits of screening are obvious, radiation dose may pose a long-term risk for the screened individual. This article will discuss the basis for radiation risk estimation and give an overview of the current dose controversy surrounding CT screening. Given the current evidence, a non-negligible radiation risk has to be postulated even at very low doses, but estimates depend heavily on the chosen mathematical model. Lung cancer risk is the most important factor in a screening population because it peaks in the time interval between 40 and 70 years of age. Substantial risks for lung cancer development from yearly screening CT examinations are currently discussed in the literature. Risks for colon cancer screening are less because of less frequent screening intervals. For both indications substantial dose reduction up to factors of 5-10 may be possible. Full-body screening remains critical when performed at regular intervals because of the large doses required and the direct exposure of the lungs. If performed in a dose-conscious fashion, individual risks with lung and colon cancer screening are very small, but estimated population risks are non-negligible.

Colorectal Neoplasms↗

Soft-copy reading of digital chest radiographs: effect of ambient light and automatic optimization of monitor luminance.

OBJECTIVE: We sought to evaluate whether soft-copy reading of simulated pulmonary chest lesions is influenced by ambient light and automatic optimization of cathode ray tube (CRT) monitor luminance. MATERIALS AND METHODS: Four types of simulated lesions (nodules, lines, micronodules, and patchy opacities) were superimposed over an anthropomorphic chest phantom. Lesion detection with soft-copy reading was assessed using a high-contrast grayscale 2K CRT monitor under the following conditions: (1) subdued lighting (<50 lux); (2) normal lighting conditions (450 lux) without, and (3) with a sensitivity modulation to automatically adjust the CRT luminance to the increased amount of ambient light. Reading data were analyzed according to receiver operating curve. Significance of differences was tested using an analysis of variance for repeated measures. RESULTS: Ambient room light of 450 lux did not significantly influence the detection of nodules and patchy opacities. However, bright ambient light significantly decreased detection of micronodules (0.60 vs. 0.74) and lines (0.52 vs. 0.66) relative to subdued lighting conditions. Automatic luminance adjustment could compensate the effect of ambient light for the micronodules (0.77) but not for the lines (0.53). CONCLUSION: Bright ambient light significantly decreases detection of small low-contrast structures. This may be partially but not completely compensated by an automatic luminance adaptation.

Data Display↗

Computed radiography and direct radiography: influence of acquisition dose on the detection of simulated lung lesions.

PURPOSE: We sought to evaluate the performance of dual-readout and single-readout computed radiography compared with direct radiography for detecting subtle lung abnormalities with a standard and a low-dose technique. MATERIALS AND METHODS: Posteroanterior radiographs of an anthropomorphic chest phantom were obtained with a single-readout storage phosphor radiography system (CRS, pixel size 200 microm), a dual-readout storage phosphor radiography system (CRD, pixel size 100 microm), and a direct detector (DR, pixel size 143 microm) at dose levels of 400 and 800 speed. Ten templates were superimposed to project 4 types of lesions over low- and high-attenuation areas, simulating nodules, micronodules, lines, and patchy opacities. Six radiologists evaluated 60 hard-copy images for the presence or absence of lesions. Statistical significance of differences was evaluated using receiver operating characteristic analysis and analysis of variance. RESULTS: For both low- and high-attenuation areas, CRD (Az = 0.85 and 0.66) was superior to CRS (Az = 0.75 and 0.58) for overall performance and all lesion subtypes (P < 0.05). DR (Az = 0.87 and 0.67) performed slightly better than CRD, being significant only for the detection of micronodules. Acquisition dose significantly affected only the detection of lines and micronodules, whereas the detection of nodules and patchy opacities was not significantly different with reduced exposure, regardless of the system used. CONCLUSION: The dual-readout CR system significantly outperformed the single-readout CR and almost equaled the performance of DR. Dose reduction was more critical for small-sized lesions (micronodules, lines) than for nodular or patchy opacifications and affected mainly the lesions in high attenuation areas.

Humans↗

Toward automated segmentation of the pathological lung in CT.

Conventional methods of lung segmentation rely on a large gray value contrast between lung fields and surrounding tissues. These methods fail on scans with lungs that contain dense pathologies, and such scans occur frequently in clinical practice. We propose a segmentation-by-registration scheme in which a scan with normal lungs is elastically registered to a scan containing pathology. When the resulting transformation is applied to a mask of the normal lungs, a segmentation is found for the pathological lungs. As a mask of the normal lungs, a probabilistic segmentation built up out of the segmentations of 15 registered normal scans is used. To refine the segmentation, voxel classification is applied to a certain volume around the borders of the transformed probabilistic mask. Performance of this scheme is compared to that of three other algorithms: a conventional, a user-interactive and a voxel classification method. The algorithms are tested on 10 three-dimensional thin-slice computed tomography volumes containing high-density pathology. The resulting segmentations are evaluated by comparing them to manual segmentations in terms of volumetric overlap and border positioning measures. The conventional and user-interactive methods that start off with thresholding techniques fail to segment the pathologies and are outperformed by both voxel classification and the refined segmentation-by-registration. The refined registration scheme enjoys the additional benefit that it does not require pathological (hand-segmented) training data.

Algorithms↗

Flat-panel-detector chest radiography: effect of tube voltage on image quality.

PURPOSE: To compare the visibility of anatomic structures in direct-detector chest radiographs acquired with different tube voltages at equal effective doses to the patient. MATERIALS AND METHODS: The study protocol was approved by the institutional internal review board, and written informed consent was obtained from all patients. Posteroanterior chest radiographs of 48 consecutively selected patients were obtained at 90, 121, and 150 kVp by using a flat-panel-detector unit that was based on cesium iodide technology and automated exposure control. Monte Carlo simulations were used to verify that the effective dose for all kilovoltage settings was equal. Five radiologists subjectively and independently rated the delineation of anatomic structures on hard-copy images by using a five-point scale. They also ranked image quality in a blinded side-by-side comparison. Average ranking scores were compared by using one-way analysis of variance with repeated measures. Data were analyzed for the entire patient group and for two patient subgroups that were formed according to body mass index (BMI). RESULTS: The visibility scores of most anatomic structures were significantly superior with the 90-kVp images (mean score, 3.11), followed by the 121-kVp (mean score, 2.95) and 150-kVp images (mean score, 2.80). Differences did not reach significance (P > .05) only for the delineation of the peripheral vessels, the heart contours, and the carina. This was also true for the subgroup of patients (n = 24) with a BMI greater than and the subgroup of patients (n = 24) with a BMI less than the mean BMI (26.9 kg/m(2)). At side-by-side comparison, the readers rated 90-kVp images as having superior image quality in the majority of image triplets; the percentage of 90-kVp images rated as "first choice" ranged from 60% (29 of 48 patients) to 90% (43 of 48 patients), with a median of 88% (42 of 48 patients), among the readers. CONCLUSION: Delineation of most anatomic structures and overall image quality were ranked superior in digital radiographs acquired with lower kilovoltage at a constant effective patient dose.

Aged↗

Detectability of small and flat polyps in MDCT colonography using 2D and 3D imaging tools: results from a phantom study.

OBJECTIVE: The objective of this phantom study was to determine the performance of MDCT colonography for the detection of small polyps under ideal imaging conditions and to determine the added value of 3D imaging when used as an adjunct to 2D imaging. MATERIALS AND METHODS: Thirty-six polypoid and 39 flat polyps (44 lesions, 2-5 mm; 31 lesions, 6-8 mm) were placed in three explanted segments of a thoroughly cleaned porcine colon (overall length, 4.5 m) that was distended with air and submerged in a water phantom. MDCT data sets with 4 x 1 mm collimation and 6-mm table feed were reconstructed every 0.7 mm with 1.25-mm effective slice width. The data were reviewed by three radiologists using 2D images in all three projections and with 3D volume-rendered images available as an adjunct to the 2D images. RESULTS: Additional 3D as a problem-solving tool significantly increased the overall sensitivity (96% vs 90%), decreased the total number of false-positive calls (n = 9 vs n = 5), and increased the diagnostic confidence level (p < 0.03) compared with 2D images alone. Small polyps less than or equal to 5 mm (89% vs 95%, p = 0.004) and flat polyps (82% vs 94%, p = 0.001) especially benefited from 3D. Sensitivity was generally higher for polypoid than for flat polyps (99% vs 94%, p = 0.041). CONCLUSION: Under phantom conditions, simulating an ideal clinical setup, MDCT colonography is not limited by spatial resolution and detects polyps less than or equal to 5 mm in size with high sensitivity and specificity. Additional 3D image tools improve diagnostic accuracy and reviewer confidence, especially for the detection of flat and small polyps.

Animals↗

Flat-panel display (LCD) versus high-resolution gray-scale display (CRT) for chest radiography: an observer preference study.

OBJECTIVE: Our objective was to compare cathode ray tube (CRT) display with liquid crystal display (LCD) for soft-copy viewing of chest radiographs in a clinical setting. MATERIALS AND METHODS: We displayed 80 posteroanterior digital chest radiographs side by side on a 5-megapixel CRT display and a 3-megapixel LCD. Gradation characteristics of both monitors were adjusted to DICOM display standards. Using a 4-point scale, seven radiologists ranked overall image quality and visibility of anatomic landmarks. Data analysis included Wilcoxon's rank sum test to assess the significance of preference for the different display modes and calculation of the percentage of images ranked equally by at least five of the seven radiologists. RESULTS: Wilcoxon's rank sum test found significant preferences (p < 0.001) for the CRT display for visualization of structures in low-attenuation areas of the thorax and for the LCD for visualization of structures in high-attenuation areas of the thorax. Overall image quality was ranked equal by at least five radiologists in 70% of cases, whereas for the remaining images a significant preference was found for the CRT display. CONCLUSION: We conclude that, under subdued ambient lighting conditions and without use of windowing, for most images the overall quality is equal with high-resolution CRT display and LCD. In images judged preferentially, we found a significant superiority for LCD for delineating mediastinal structures and for CRT display for delineating structures in the lung.

Computer Terminals↗

Contrast-enhanced MR Angiography of the renal arteries: blinded multicenter crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine.

PURPOSE: To prospectively and intraindividually compare 0.1 mmol/kg gadobenate dimeglumine with 0.2 mmol/kg gadopentetate dimeglumine for contrast material-enhanced magnetic resonance (MR) angiography of the renal arteries. MATERIALS AND METHODS: Institutional review board approval was granted by each of three participating centers. The study accorded with international standards for good clinical practice and Declaration of Helsinki and subsequent amendments. Patients gave written informed consent before enrollment. Patients (n = 34) underwent two MR angiographic examinations more than 48 hours but less than 12 days apart. Gadobenate dimeglumine followed by gadopentetate dimeglumine was administered in 18 patients; the order of administration was reversed in 16 patients. A 1.5-T MR imager was used with a phase-encoded three-dimensional spoiled breath-hold pulse sequence. Two blinded independent readers qualitatively assessed randomized subtracted maximum intensity projection images. A three-point scale for diagnostic quality (0, poor; 1a or 1p, moderate; and 2a or 2p, adequate [a and p refer, respectively, to absence and presence of vascular lesions]) was used to score each of nine segments of the abdominal aorta and both renal arteries (possible overall score, 18). Quantitative assessment (vessel signal-to-noise ratio [SNR], vessel-muscle contrast-to-noise ratio [CNR]) of source images was performed for regions of interest in supra-, juxta-, and infrarenal aorta segments and psoas muscle. Data were tested with analysis of variance for two-period crossover design. Interreader agreement was evaluated with Cohen kappa statistics. RESULTS: No difference in mean image quality between the two contrast agents was observed; scores for gadobenate dimeglumine and gadopentetate dimeglumine were 15.15 and 15.23 for reader 1 and 16.77 and 17.01 for reader 2. The order of contrast material administration likewise produced no quality differences: readers 1 and 2 reported scores of 14.4 +/- 4.2 (standard deviation) and 16.7 +/- 2.3, respectively, when gadobenate dimeglumine was given first, and 15.2 +/- 1.8 and 16.6 +/- 1.6, respectively, when gadopentetate dimeglumine was given first. Results of quantitative evaluation showed increasing SNR and CNR with gadobenate dimeglumine in segments at progressively lower levels of the aorta, but increases in SNR and CNR at the infrarenal aorta (48.3 vs 40.6 and 44.2 vs 36.4, respectively) were not significant (P = .05 for both). CONCLUSION: Gadobenate dimeglumine at a dose of 0.1 mmol/kg is comparable to gadopentetate dimeglumine at 0.2 mmol/kg for contrast-enhanced renal MR angiography.

Adult↗

Detectability of catheters on bedside chest radiographs: comparison between liquid crystal display and high-resolution cathode-ray tube monitors.

PURPOSE: To compare observer performance with a flat-panel liquid crystal display (LCD) monitor and with a high-resolution gray-scale cathode-ray tube (CRT) monitor in the detection of simulated support catheters on bedside chest radiographs. MATERIALS AND METHODS: The ethics committee did not require approval or patient informed consent when this study began. Because of a change in regulations, before images were acquired the nature of the study and procedures were explained to patients or their relatives, and consent was then obtained. A total of 131 catheter fragments (12-14 per radiograph) were superimposed over 10 anteroposterior bedside chest radiographs obtained with storage phosphor technology. Images were displayed on an LCD monitor (1536 x 2048 matrix) and a CRT monitor (2048 x 2560 matrix). Five radiologists independently located the catheter fragments and rated their confidence in detection with bright and subdued ambient light. A two-way analysis of variance and the Friedman test were used for statistical analysis. RESULTS: There was no significant difference for either display type with respect to correctly detected catheter fragments (mean sensitivity, 56.6% and 56.0% for the CRT and the LCD monitors, respectively, with bright light and 61.2% for both monitors with subdued light). With both display types, detection rate with bright light decreased significantly (P < .05). False-positive rates and confidence ratings were not significantly affected by monitor type or ambient light. CONCLUSION: In a study with simulation of clinical conditions, performance of the LCD monitor and high-resolution CRT monitor for detection of support catheters on bedside chest radiographs was equivalent. With both displays, detection performance was equally reduced with bright ambient light.

Aged↗

Comparison of liquid crystal versus cathode ray tube display for the detection of simulated chest lesions.

The purpose of the study was to compare the detection performance of a cathode ray tube (CRT) monitor versus a liquid crystal display (LCD) monitor for simulated subtle pulmonary lesions. Ten templates containing simulated lung lesions were superimposed on an anthropomorphic chest phantom. Posteroanterior radiographs were obtained using flat panel technology and were displayed on a CRT and an LCD monitor. Image processing and reading conditions were equivalent for both softcopy displays. Five observers assessed lesion detectability using receiver-operating characteristic (ROC) methodology. A multivariate test (Pillai trace) was used to test the significance of differences (P<0.05). The multivariate test revealed significantly different detection rates for the lesion types, but no significant difference between the two display modes. Detection performance for both monitors was higher for nodules and micro-nodules and lower for lines and patchy opacities. Analysis of lesion subgroups according to their location in lucent/obscured lung areas was also not statistically significant. Under ideal reading conditions, CRT and LCD displays perform equivalently for the detection of simulated subtle pulmonary lesions.

Data Display↗

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region.

As tissue dissections carried out on formaldehyde-fixed anatomical specimens demonstrate, the parasellar region (PSR), traditionally referred to as the cavernous sinus, is composed of three distinct compartments: orbital, pterygopalatine, and lateral sellar. The aim of our study was to identify and measure these compartments in the living and to describe the topography of their adipose body tissues. For this purpose data sets of 35 patients, who had undergone thin-section multislice computed tomography (CT), were examined using 3D-reconstruction software. The pterygopalatine and orbital compartments of the PSR could be identified in the images by their adipose bodies. We provide more exacting measurements of their size than have been presented in earlier studies. Furthermore, we include data about the uni- and bilateral presence of the single compartments and analyze the topography of the adipose tissue bodies in the orbital apex region. Our quantitative data and topographical descriptions confirm the compartmentalization concept of the PSR, allow for correct interpretation of CT scans of the orbital apex and anterior PSR, and provide baseline information for individual planning of surgical and radiological interventions.

Adipose Tissue↗

Comparison of an automatic versus a semiautomatic mode for gray-scale adaptation for digital chest radiography.

PURPOSE: To compare image quality of digital chest radiographs using 2 modes of gradation adjustment. METHODS: We compared image quality and visualization of anatomic landmarks of 50 chest radiographs after digital processing using a semiautomatic mode with a fixed gamma of 2.6 and an automatic mode with individual gamma adaptation. RESULTS: The mean gamma was significantly higher (P < 0.001) with the automatic mode (3.0 vs. 2.6, respectively). Patient constitution had no impact on the automatically adapted gamma for PA but showed a significant correlation (P < 0.001) for lateral images. For PA, there was a preference (P < 0.016) of the semiautomatic mode in heavier patients whereas no difference was seen in slim patients. For the lateral projection, there was a general preference (P = 0.001) of the automatic mode. CONCLUSION: For PA radiographs, the semiautomatic mode provides superior results for heavier patients without compromising the quality in slim patients. For lateral radiographs, the automatic mode provides generally superior results.

Adult↗

Skeletal applications for flat-panel versus storage-phosphor radiography: effect of exposure on detection of low-contrast details.

PURPOSE: To compare exposure requirements for similar detection performance with flat-panel detectors and the most recent generation of storage-phosphor plates in the simulated scatter of typical skeletal radiographic examinations. MATERIALS AND METHODS: A contrast-detail test object was covered with varying thicknesses of acrylic to simulate skeletal exposure conditions in the wrist, knee, and pelvis. Three series were obtained with increasing thicknesses of a simulated soft-tissue layer (5, 10, and 20 cm) and increasing tube voltage (50, 70, and 90 kVp). A fourth series was obtained with exposure conditions adapted to the phantom instructions (75 kVp). Images were acquired with a flat-panel detector (cesium iodide scintillator) and storage-phosphor plates at five exposure levels (speed class range, 100-1,600). Five readers evaluated 84 images to determine the threshold contrast of 12 lesion diameters (range, 0.25-11.1 mm). Statistical significance of differences between the two digital systems was assessed with two-way analysis of variance. RESULTS: A linear relationship was found between the number of detected lesions and the logarithm of exposure (R(2) > 0.98 for all series). On average, the flat-panel system required 45% less exposure than did the phosphor plates when 20-cm-thick acrylic was superimposed on the test object. Differences in exposure requirements were smaller with decreasing thicknesses of simulated soft-tissue layers and lower tube voltages (39% at 10 cm and 70 kVp, and 17% at 5 cm and 50 kVp). All differences were statistically significant. CONCLUSION: Flat-panel radiography provides improved contrast detectability and a potential for exposure reduction compared with those with storage-phosphor radiography. The best performance was achieved with conditions comparable to those for radiography of the trunk and lowest for conditions that simulate radiography of the extremities.

Bone and Bones↗

Misdiagnosis of pulmonary embolism in patients with allergic reaction--the importance of prior probability of disease.

Because pulmonary embolism (PE) and its treatment carry substantial risk of morbidity and mortality, accurate diagnosis is essential. We report two cases with allergic reactions, in which PE was suggested by routine ECG and D-dimer elevation and strengthened by spiral CT. Therapy with low-molecular-weight heparin was initiated and long-term anticoagulation was considered. As their histories did not reveal any predisposing factor to PE, the cases were re-evaluated. Elevation of D-dimer was now attributed to allergic reaction, ECG abnormalities were considered as constitutional, and findings from spiral CT attributed to breathing artifacts and partial-volume effects. The diagnosis of PE was therefore rejected and anticoagulant treatment discontinued without sequelae. These cases show the importance of determining clinical probability before ordering further diagnostic tests and critical interpretation of test results suggestive of PE, based on prior probability of the disease.

Adult↗

Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: a computed tomography study.

OBJECTIVE: To quantify the effect of superimposed high-frequency jet ventilation on lung recruitment in adult patients with acute lung injury. DESIGN AND SETTING: Prospective clinical study in the intensive care unit of a university teaching hospital. PATIENTS: Eight adults suffering from acute lung injury with a mean lung injury score of 2.6+/-0.6 and pronounced atelectasis in at least two lung quadrants. The cause was either pneumonia ( n=5) or postoperative sepsis ( n=3). INTERVENTIONS: Superimposed high-frequency jet ventilation was initiated in patients following a mean of 4.4+/-1.7 days of conventional ventilation. Before and 4 h after the start of superimposed high-frequency jet ventilation differential lung volumes were determined by volumetry using computed tomography. MEASUREMENTS AND RESULTS: Superimposed high-frequency jet ventilation significantly increased the lung volume of every patient due to alveolar recruitment. This was achieved despite lower peak inspiratory pressures and higher PaO(2)/FIO(2) ratios than with conventional ventilation. CONCLUSIONS: Treatment with superimposed high-frequency jet ventilation for 4 h resulted in rapid alveolar recruitment in dependent lung areas, improved gas exchange, and better arterial oxygenation. It offers an effective and advantageous alternative to conventional ventilation for ventilatory management of respiratory insufficient patients.

Adult↗

Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up.

Propionibacterium acnes (P. acnes) is suspected to be involved in the pathophysiology of SAPHO syndrome, since it has been isolated repeatedly through open surgical bone biopsy. This study demonstrates the role of MRI in identifying inflamed bone areas in patients with SAPHO syndrome and the role of CT-guided bone biopsies in obtaining samples from these areas for microbiological and histopathological investigations, thus obviating open surgery. Fourteen consecutive patients with SAPHO syndrome were investigated by MRI to identify acute inflammatory changes in hyperostotic periarticular bone. The CT-guided biopsies for microbiological investigations were taken from the areas identified. Patients positive for P. acnes were started on long-term antibiotic therapy according to antibiotic susceptibility. On MRI the inflammatory changes appeared as hyperintense areas on fat-saturated T2 fast-spin-echo (FSE) images and showed signal increase on fat-saturated T1 SE images after Gd-DTPA. With MR localization CT-guided bone biopsies yielded P. acnes in 8 patients. No bacteria could be isolated from the remaining 6 patients. Acute inflammatory bone changes in SAPHO syndrome are well localized by MRI. With MR localization, CT-guided bone biopsies offer a minimally invasive alternative to open surgery in the detection of. P. acnes leading to the institution of a specific antibiotic therapy.

Acquired Hyperostosis Syndrome↗