Can sufficient preoperative information of intracranial aneurysms be obtained by using 320-row detector CT angiography alone?

Abstract Purpose To determine whether sufficient pre-surgical treatment information of unruptured intracranial aneurysms can be obtained by using 320-row detector CT angiography (CTA) alone. Materials and methods We enrolled 40 consecutive patients with unruptured intracranial aneurysms. All patients were prospectively conducted to perform 320-detector CTA as the only preoperative modality. Two blinded readers independently assessed CTA images. Interobserver agreement and the agreement between CTA and surgical findings were determined by calculating the j coefficient. The referring neurosurgeons judged the usefulness of the information provided by CTA for treatment decisions. Results All patients had surgery without intraarterial digital subtraction angiography. Agreement between CTA and surgical findings was excellent for the aneurysm location (j = 1.0) and good for the shape (j = 0.71), neck (j = 0.74) and its relationship with adjacent branches (j = 0.71). Information obtained with 320-detector CTA was highly useful for surgical treatment in 37 of 40 (93 %) patients, although small perforators deriving from the aneurysm in 2 cases were not fully visualized on CTA images. Conclusion In most patients with unruptured intracranial aneurysms, sufficient pre-surgical treatment information can be obtained by using 320-detector CTA alone

Vertebral Tortuosity Is Associated With Increased Rate of Cardiovascular Events in Vascular Ehlers-Danlos Syndrome

Background Arterial tortuosity is associated with adverse events in Marfan and Loeys-Dietz syndromes but remains understudied in Vascular Ehlers-Danlos syndrome. Methods and Results Subjects with a pathogeni

Ultra-High-Resolution Computed Tomography of the Lung: Image Quality of a Prototype Scanner

Purpose: The image noise and image quality of a prototype ultra-high-resolution computed tomography (U-HRCT) scanner was evaluated and compared with those of conventional high-resolution CT (C-HRCT) scanners. Materials and Methods: This study was approved by the institutional review board. A U-HRCT scanner prototype with 0.25 mm × 4 rows and operating at 120 mAs was used. The C-HRCT images were obtained using a 0.5 mm × 16 or 0.5 mm × 64 detector-row CT scanner operating at 150 mAs. Images from both scanners were reconstructed at 0.1-mm intervals; the slice thickness was 0.25 mm for the U-HRCT scanner and 0.5 mm for the C-HRCT scanners. For both scanners, the display field of view was 80 mm. The image noise of each scanner was evaluated using a phantom. U-HRCT and C-HRCT images of 53 images selected from 37 lung nodules were then observed and graded using a 5-point score by 10 board-certified thoracic radiologists. The images were presented to the observers randomly and in a blinded manner. Results: The image noise for U-HRCT (100.87 ± 0.51 Hounsfield units [HU]) was greater than that for C-HRCT (40.41 ± 0.52 HU; P <.0001). The image quality of U-HRCT was graded as superior to that of C-HRCT (P <.0001) for all of the following parameters that were examined: margins of subsolid and solid nodules, edges of solid components and pulmonary ves sels in subsolid nodules, air bronchograms, pleural indentations, margins of pulmonary vessels, edges of bronchi, and interlobar fissures. Conclusion: Despite a larger image noise, the prototype U-HRCT scanner had a significantly better image quality than the C-HRCT scanners

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

Background and purposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] https://doi.org/10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals

コガタ ハイ ケッセツ ノ ケンシュツ オヨビ シツテキ シンダン ニ オケル ホウシャセンガクテキ ケンキュウ

1)We investigated the clinical efficacy ofDES technique using FPD chest radiography systems in the detection of smallpulmonary nodules. We also investigated the effect of virtual DES image using themassive-training artificial neural network (MTANN) which is a kind of artificialintelligence. 2)We investigated the accuracy andreproducibility of computer-aided volumetry (CAV) software for GGO nodules.Moreover, we evaluated the volume-doubling time (VDT) of histologically provedGGO nodules.①近年、flat-panel detector (FPD) X線装置に応用されたdual-energy subtraction (DES)技術を使用して、小型肺結節の検出能について検討した。また、人工知能の一種であるmassivetraining artificial neural network (MTANN)を応用したvirtual DES 技術の有用性についても検討した。②GGO 結節におけるコンピュータ支援３次元的体積測定の精度を検証し、続いてGGO 結節のvolume doubling time（VDT）について検討を行った

Computer-Aided Volumetry of Pulmonary Nodules Exhibiting Ground-Glass Opacity at MDCT

high-resolution CT may help in differential diagnosis. Because the doubling time of BAC is long (average, 457-813 days) With MDCT it is possible to scan a wide range, including areas containing pulmonary nodules, at a detector collimation of 0.500-0.625 mm in one breath-hold. This capability facilitates 3D evaluation of pulmonary nodules. In previous studies C a r d io p u lm o n a r y I m ag i ng • O r ig i n a l R e s e a rc h MATERIALS AND METHODS. To evaluate the accuracy of computer-aided volumetry software, we performed thin-section helical CT of a chest phantom that included simulated 3-, 5-, 8-, 10-, and 12-mm-diameter ground-glass opacity nodules with attenuation of -800, -630, and -450 HU. Three radiologists measured the volume of the nodules and calculated the relative volume measurement error, which was defined as follows: (measured nodule volume minus assumed nodule volume ÷ assumed nodule volume) × 100. Two radiologists performed two independent measurements of 59 nodules in humans. Intraobserver and interobserver agreement was evaluated with Bland-Altman methods. RESULTS. The relative volume measurement error for simulated ground-glass opacity nodules measuring 3 mm ranged from 51.1% to 85.2% and for nodules measuring 5 mm or more in diameter ranged from -4.1% to 7.1%. In the clinical study, for intraobserver agreement, the 95% limits of agreement were -14.9% and -13.7% and -16.6% to 15.7% for observers A and B. For interobserver agreement, these values were -16.3% to 23.7% for nodules 8 mm in diameter or larger. CONCLUSION. With computer-aided volumetry of ground-glass opacity nodules, the relative volume measurement error was small for nodules 5 mm in diameter or larger. Intraobserver and interobserver agreement was relatively high for nodules 8 mm in diameter or larger