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OBJECTIVE. Previous advances over filtered back projection (FBP) have incorporated model-based iterative reconstruction. The purpose of this study was to characterize the latest advance in image reconstruction, that is, deep learning. The focus was on applying characterization results of a deep learning approach to decisions about clinical CT protocols. MATERIALS AND METHODS. A proprietary deep learning image reconstruction (DLIR) method was characterized against an existing advanced adaptive statistical iterative reconstruction method (ASIR-V) and FBP from the same vendor. The metrics used were contrast-to-noise ratio, spatial resolution as a function of contrast level, noise texture (i.e., noise power spectra [NPS]), noise scaling as a function of slice thickness, and CT number consistency. The American College of Radiology accreditation phantom and a uniform water phantom were used at a range of doses and slice thicknesses for both axial and helical acquisition modes. RESULTS. ASIR-V and DLIR were associated with improved contrast-to-noise ratio over FBP for all doses and slice thicknesses. No dose or contrast dependencies of spatial resolution were observed for ASIR-V or DLIR. NPS results showed DLIR maintained an FBP-like noise texture whereas ASIR-V shifted the NPS to lower frequencies. Noise changed with dose and slice thickness in the same manner for ASIR-V and FBP. DLIR slice thickness noise scaling differed from FBP, exhibiting less noise penalty with decreasing slice thickness. No clinically significant changes were observed in CT numbers for any measurement condition. CONCLUSION. click here In a phantom model, DLIR does not suffer from the concerns over reduction in spatial resolution and introduction of poor noise texture associated with previous methods.OBJECTIVE. The goal of this study was to evaluate radiologic and clinical factors associated with overall survival of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy (HAIC). MATERIALS AND METHODS. This single-center retrospective study included 180 patients with advanced hepatocellular carcinoma who underwent HAIC with a 5-fluorouracil (250-500 mg/m2 for 5 hours) plus cisplatin (10-20 mg/m2 for 1-2 hours) regimen via an implantable port system. Survival curves were generated by the Kaplan-Meier method and compared by log-rank tests. Factors associated with overall survival were evaluated with Cox proportional hazard models. RESULTS. The median overall survival time was 7.6 months (95% CI, 6.1-9.1), and the objective response rate was 15%. In multivariate analysis, infiltrative tumor growth (hazard ratio [HR], 1.002; p = .03) and rimlike arterial enhancement (HR, 3.040; p less then .001) were pretreatment radiologic factors associated with reduced overall survival. No early response to treatment (HR, 2.064-6.491) and higher Child-Pugh class (HR, 2.010-2.815) were strong prognostic factors of poor outcome. Treatment with three or more HAIC cycles (HR, 0.371; p = .001) and high-dose HAIC (HR, 0.447; p less then .001) were favorable for increased overall survival. CONCLUSION. Infiltrative tumor growth and rimlike arterial enhancement in pre-treatment imaging studies were associated with poor prognosis, and better early radiologic response and preserved liver function reserve were strong indicators of prolonged survival. Recognizing these radiologic and clinical predictors may help optimize care of patients with hepatocellular carcinoma.OBJECTIVE. Knowledge of normal testicular 18F-FDG PET/CT (FDG PET/CT) SUVs is crucial for accurate examination interpretation. The objective of this study was to establish normal testicular SUV ranges among adult men receiving health care in North America. MATERIALS AND METHODS. A retrospective review of an institutional electronic database identified adult men undergoing pretreatment clinical FDG PET/CT examinations from March 15, 2013, through March 15, 2018. An FDG PET/CT image review of 700 testicles in 350 male patients was performed. Data collected included testicular SUVmax, SUVmean, and visual PET pattern of uptake. RESULTS. Testicular SUVmean and SUVmax values (mean ± SD) by age group were as follows 3.1 ± 0.7 and 3.8 ± 0.9 for the age group of 18-30 years; 3.2 ± 0.6 and 4.0 ± 0.8, 31-40 years; 3.1 ± 0.4 and 3.8 ± 0.5, 41-50 years; 3.0 ± 0.5 and 3.7 ± 0.7, 51-60 years; 2.9 ± 0.5 and 3.5 ± 0.7, 61-70 years; 2.8 ± 0.5 and 3.5 ± 0.7, 71-80 years; and 2.6 ± 0.5 and 3.3 ± 0.6, more than 80 years. A statistically significant difference exists between age groups for testicular SUVmean (p ≤ .001) and SUVmax (p less then .001), with SUVs peaking in the 4th decade of life and subsequently declining with age. A small but significant negative correlation exists between blood glucose level and testicular SUVmean (r = -0.12). CONCLUSION. This study reports the largest currently known cohort of SUVs in normal testicles and may guide clinical interpretation of testicular FDG activity. Discrepancies in normal SUVs may exist because of differences in patient demographics and PET technology.OBJECTIVE. The objective of our study was to provide insight on the diagnostic validity of cardiac CTA (CCTA) to identify obstructive coronary artery disease (CAD) and patients who require urgent intervention, compared with those who require same-admission coronary catheterization (CC), and to help elucidate the necessity of a 24/7 CCTA service. MATERIALS AND METHODS. We retrospectively reviewed 658 consecutive CCTA examinations performed of emergency department (ED) patients who presented with acute chest pain from October 1, 2013, to February 28, 2018. Patients were categorized by CAD severity on CCTA. Using same-admission CC as the reference standard, we assessed CCTA's validity to identify obstructive disease using PPV, NPV, sensitivity, and specificity and CCTA's validity to identify patients who require urgent intervention. The added value of the CCTA findings of subendocardial hypoattenuation and wall motion abnormality was evaluated. CCTA examinations were categorized on the basis of the time of day when scanning was performed. RESULTS. The PPV, NPV, and sensitivity of CCTA to diagnose obstructive CAD were 0.87, 0.79, and 0.95, respectively. Nine percent of the scanned patients underwent percutaneous coronary intervention (PCI) or were referred for urgent coronary artery bypass grafting (CABG). The presence of obstructive CAD on CCTA has a PPV of 0.73 to identify patients deemed to be at higher acute coronary syndrome (ACS) risk to warrant urgent PCI or CABG. Wall motion abnormality increased the PPV to 1.0; subendocardial attenuation increased the PPV to 0.9. The NPV and sensitivity were 0.89 and 0.97, respectively. Of the CCTA examinations, 54% were performed outside regular working hours. Of the patients who received urgent interventions, 62% underwent CCTA examinations performed outside regular working hours. CONCLUSION. CCTA provides high correlation with CC, helps identify individuals with high ACS risk, and is further strengthened by functional analysis; 24/7 CCTA service is warranted.
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