Fully automated deep learning powered calcium scoring in patients undergoing myocardial perfusion imaging

BACKGROUND To assess the accuracy of fully automated deep learning (DL) based coronary artery calcium scoring (CACS) from non-contrast computed tomography (CT) as acquired for attenuation correction (AC) of cardiac single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS AND RESULTS Patients were enrolled in this study as part of a larger prospective study (NCT03637231). In this study, 56 Patients who underwent cardiac SPECT-MPI due to suspected coronary artery disease (CAD) were prospectively enrolled. All patients underwent non-contrast CT for AC of SPECT-MPI twice. CACS was manually assessed (serving as standard of reference) on both CT datasets (n = 112) and by a cloud-based DL tool. The agreement in CAC scores and CAC score risk categories was quantified. For the 112 scans included in the analysis, interscore agreement between the CAC scores of the standard of reference and the DL tool was 0.986. The agreement in risk categories was 0.977 with a reclassification rate of 3.6%. Heart rate, image noise, body mass index (BMI), and scan did not significantly impact (p=0.09 - p=0.76) absolute percentage difference in CAC scores. CONCLUSION A DL tool enables a fully automated and accurate estimation of CAC scores in patients undergoing non-contrast CT for AC of SPECT-MPI

Characterization of hypermetabolic lymph nodes after SARS-CoV-2 vaccination using PET-CT derived node-RADS, in patients with melanoma

This study aimed to evaluate the diagnostic accuracy of Node Reporting and Data System (Node-RADS) in discriminating between normal, reactive, and metastatic axillary LNs in patients with melanoma who underwent SARS-CoV-2 vaccination. Patients with proven melanoma who underwent a 2-[$^{18}$F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[$^{18}$F]-FDG PET/CT) between February and April 2021 were included in this retrospective study. Primary melanoma site, vaccination status, injection site, and 2-[$^{18}$F]-FDG PET/CT were used to classify axillary LNs into normal, inflammatory, and metastatic (combined classification). An adapted Node-RADS classification (A-Node-RADS) was generated based on LN anatomical characteristics on low-dose CT images and compared to the combined classification. 108 patients were included in the study (54 vaccinated). HALNs were detected in 42 patients (32.8%), of whom 97.6% were vaccinated. 172 LNs were classified as normal, 30 as inflammatory, and 14 as metastatic using the combined classification. 152, 22, 29, 12, and 1 LNs were classified A-Node-RADS 1, 2, 3, 4, and 5, respectively. Hence, 174, 29, and 13 LNs were deemed benign, equivocal, and metastatic. The concordance between the classifications was very good (Cohen's k: 0.91, CI 0.86-0.95; p-value < 0.0001). A-Node-RADS can assist the classification of axillary LNs in melanoma patients who underwent 2-[$^{18}$F]-FDG PET/CT and SARS-CoV-2 vaccination

Opportunistic deep learning powered calcium scoring in oncologic patients with very high coronary artery calcium (≥ 1000) undergoing 18F-FDG PET/CT

Our aim was to identify and quantify high coronary artery calcium (CAC) with deep learning (DL)-powered CAC scoring (CACS) in oncological patients with known very high CAC (≥ 1000) undergoing 18F-FDG-PET/CT for re-/staging. 100 patients were enrolled: 50 patients with Agatston scores ≥ 1000 (high CACS group), 50 patients with Agatston scores < 1000 (negative control group). All patients underwent oncological 18F-FDG-PET/CT and cardiac SPECT myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin within 6 months. CACS was manually performed on dedicated non-contrast ECG-gated CT scans obtained from SPECT-MPI (reference standard). Additionally, CACS was performed fully automatically with a user-independent DL-CACS tool on non-contrast, free-breathing, non-gated CT scans from 18F-FDG-PET/CT examinations. Image quality and noise of CT scans was assessed. Agatston scores obtained by manual CACS and DL tool were compared. The high CACS group had Agatston scores of 2200 ± 1620 (reference standard) and 1300 ± 1011 (DL tool, average underestimation of 38.6 ± 26%) with an intraclass correlation of 0.714 (95% CI 0.546, 0.827). Sufficient image quality significantly improved the DL tool's capability of correctly assigning Agatston scores ≥ 1000 (p = 0.01). In the control group, the DL tool correctly assigned Agatston scores < 1000 in all cases. In conclusion, DL-based CACS performed on non-contrast free-breathing, non-gated CT scans from 18F-FDG-PET/CT examinations of patients with known very high (≥ 1000) CAC underestimates CAC load, but correctly assigns an Agatston scores ≥ 1000 in over 70% of cases, provided sufficient CT image quality. Subgroup analyses of the control group showed that the DL tool does not generate false-positives

Diagnostic Value of Fully Automated Artificial Intelligence Powered Coronary Artery Calcium Scoring from 18F-FDG PET/CT

OBJECTIVES The objective of this study was to assess the feasibility and accuracy of a fully automated artificial intelligence (AI) powered coronary artery calcium scoring (CACS) method on ungated CT in oncologic patients undergoing 18F-FDG PET/CT. METHODS A total of 100 oncologic patients examined between 2007 and 2015 were retrospectively included. All patients underwent 18F-FDG PET/CT and cardiac SPECT myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin within 6 months. CACS was manually performed on non-contrast ECG-gated CT scans obtained from SPECT-MPI (i.e., reference standard). Additionally, CACS was performed using a cloud-based, user-independent tool (AI-CACS) on ungated CT scans from 18F-FDG-PET/CT examinations. Agatston scores from the manual CACS and AI-CACS were compared. RESULTS On a per-patient basis, the AI-CACS tool achieved a sensitivity and specificity of 85% and 90% for the detection of CAC. Interscore agreement of CACS between manual CACS and AI-CACS was 0.88 (95% CI: 0.827, 0.918). Interclass agreement of risk categories was 0.8 in weighted Kappa analysis, with a reclassification rate of 44% and an underestimation of one risk category by AI-CACS in 39% of cases. On a per-vessel basis, interscore agreement of CAC scores ranged from 0.716 for the circumflex artery to 0.863 for the left anterior descending artery. CONCLUSIONS Fully automated AI-CACS as performed on non-contrast free-breathing, ungated CT scans from 18F-FDG-PET/CT examinations is feasible and provides an acceptable to good estimation of CAC burden. CAC load on ungated CT is, however, generally underestimated by AI-CACS, which should be taken into account when interpreting imaging findings

A Case Study of Low-Mass Star Formation

This article synthesizes observational data from an extensive program aimed toward a comprehensive understanding of star formation in a low-mass star-forming molecular cloud. New observations and published data spanning from the centimeter wave band to the near infrared reveal the high and low density molecular gas, dust, and pre-main sequence stars in L1551.Comment: 24 pages, 21 figures, ApJS accepte

Observations of T-Tauri Stars using HST-GHRS: I. Far Ultraviolet Emission Lines

We have analyzed GHRS data of eight CTTS and one WTTS. The GHRS data consists of spectral ranges 40 A wide centered on 1345, 1400, 1497, 1550, and 1900 A. These UV spectra show strong SiIV, and CIV emission, and large quantities of sharp (~40 km/s) H2 lines. All the H2 lines belong to the Lyman band and all the observed lines are single peaked and optically thin. The averages of all the H2 lines centroids for each star are negative which may indicate that they come from an outflow. We interpret the emission in H2 as being due to fluorescence, mostly by Ly_alpha, and identify seven excitation routes within 4 A of that line. We obtain column densities (10^12 to 10^15 cm^-2) and optical depths (~1 or less) for each exciting transition. We conclude that the populations are far from being in thermal equilibrium. We do not observe any lines excited from the far blue wing of Ly_alpha, which implies that the molecular features are excited by an absorbed profile. SiIV and CIV (corrected for H2 emission) have widths of ~200 km/s, and an array of centroids (blueshifted lines, centered, redshifted). These characteristics are difficult to understand in the context of current models of the accretion shock. For DR Tau we observe transient strong blueshifted emission, perhaps the a result of reconnection events in the magnetosphere. We also see evidence of multiple emission regions for the hot lines. While CIV is optically thin in most stars in our sample, SiIV is not. However, CIV is a good predictor of SiIV and H2 emission. We conclude that most of the flux in the hot lines may be due to accretion processes, but the line profiles can have multiple and variable components.Comment: 67 pages, 19 figures, Accepted in Ap

Observational Constraints on the Formation and Evolution of Binary Stars

We present a high spatial resolution UV to NIR survey of 44 young binary stars in Taurus with separations of 10-1000 AU. The primary results include: (1) The relative ages of binary star components are more similar than the relative ages of randomly paired single stars, supporting coeval formation. (2) Only one of the companion masses is substellar, and hence the apparent overabundance of T Tauri star companions relative to main-sequence star companions can not be explained by a wealth of substellar secondaries that would have been missed in main-sequence surveys. (3) Roughly 10% of T Tauri binary star components have very red NIR colors (K-L > 1.4) and unusually high mass accretion rates. This phenomenon does not appear to be restricted to binary systems, however, since a comparable fraction of single T Tauri stars exhibit the same properties. (4) Although the disk lifetimes of single stars are roughly equal to their stellar ages, the disk lifetimes of binary stars are an order of magnitude less than their ages. (5) The accretion rates for both single and binary T Tauri stars appear to be moderately mass dependent. (6) Although most classical T Tauri star binaries retain both a circumprimary and a circumsecondary disk, there are several systems with only a circumprimary disk. Together with the relative accretion rates, this suggests that circumprimary disks survive longer, on average, than circumsecondary disks. (7) The disk lifetimes, mass ratios, and relative accretion signatures of the closest binaries (10-100 AU) suggest that they are being replenished from a circumbinary reservoir with low angular momentum. Overall, these results support fragmentation as the dominant binary star formation mechanism.Comment: 67 pages including 11 figures, LaTeX2e, accepted for publication in Ap

The Hunt for Exomoons with Kepler (HEK): I. Description of a New Observational Project

Two decades ago, empirical evidence concerning the existence and frequency of planets around stars, other than our own, was absent. Since this time, the detection of extrasolar planets from Jupiter-sized to most recently Earth-sized worlds has blossomed and we are finally able to shed light on the plurality of Earth-like, habitable planets in the cosmos. Extrasolar moons may also be frequent habitable worlds but their detection or even systematic pursuit remains lacking in the current literature. Here, we present a description of the first systematic search for extrasolar moons as part of a new observational project called "The Hunt for Exomoons with Kepler" (HEK). The HEK project distills the entire list of known transiting planet candidates found by Kepler (2326 at the time of writing) down to the most promising candidates for hosting a moon. Selected targets are fitted using a multimodal nested sampling algorithm coupled with a planet-with-moon light curve modelling routine. By comparing the Bayesian evidence of a planet-only model to that of a planet-with-moon, the detection process is handled in a Bayesian framework. In the case of null detections, upper limits derived from posteriors marginalised over the entire prior volume will be provided to inform the frequency of large moons around viable planetary hosts, eta-moon. After discussing our methodologies for target selection, modelling, fitting and vetting, we provide two example analyses.Comment: 21 pages, 8 figures, 4 tables, accepted in Ap

Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery

Background: The purpose of the study was to characterize histological response to chemotherapy of hepatic colorectal metastases (HCRM), evaluate efficacy of different chemotherapies on histological response, and determine whether tumor regression grading (TRG) of HCRM predicts clinical outcome. Patients and methods: TRG was evaluated on 525 HCRM surgically resected from 181 patients, 112 pretreated with chemotherapy. Disease-free survival (DFS) and overall survival (OS) were correlated to TRG. Results: Tumor regression was characterized by fibrosis overgrowing on tumor cells, decreased necrosis, and tumor glands (if present) at the periphery of HCRM. With irinotecan/5-fluorouracil (5-FU), major (MjHR), partial (PHR), and no (NHR) histological tumor regression were observed in 17%, 13%, and 70% of patients, respectively. With oxaliplatin/5-FU, MjHR, PHR, and NHR were observed in 37%, 45%, and 18% of patients, respectively. Five patients, treated with oxaliplatin, had complete response in all their metastases. MjHR was associated with an improved 3-year DFS compared with PHR or NHR. MjHR and PHR were associated with an improved 5-year OS compared with NHR. Conclusion: Histological tumor regression of HCRM to chemotherapy corresponds to fibrosis overgrowth and not to increase of necrosis. TRG should be considered when evaluating efficacy of chemotherapy for HCRM. Histological tumor regression was most common among oxaliplatin-treated patients and associated with better clinical outcom