Intramural duodenal hematoma: clinical course and imaging findings

Background: Intramural duodenal hematoma is a rare condition. Different imaging modalities are at hand for diagnosis. Purpose: To identify patients with intramural duodenal hematoma and report imaging findings and clinical courses. Material and Methods: Typical imaging patterns using ultrasound, computed tomography, and magnetic resonance imaging were carried out on 10 patients. Results: The mean patient age was 7.5 years. The average disease duration was 13 months. Clinical signs of improvement were observed within 16 days. Residues were still detectable at long-term follow-up. Conclusion: For patients with intramural duodenal wall hematoma, diagnosis should be considered early. Typical imaging findings should be known to ensure optimal treatment

MPI Phantom Study with A High-Performing Multicore Tracer Made by Coprecipitation

Magnetic particle imaging (MPI) is a new imaging technique that detects the spatial distribution of magnetic nanoparticles (MNP) with the option of high temporal resolution. MPI relies on particular MNP as tracers with tailored characteristics for improvement of sensitivity and image resolution. For this reason, we developed optimized multicore particles (MCP 3) made by coprecipitation via synthesis of green rust and subsequent oxidation to iron oxide cores consisting of a magnetite/maghemite mixed phase. MCP 3 shows high saturation magnetization close to that of bulk maghemite and provides excellent magnetic particle spectroscopy properties which are superior to Resovist® and any other up to now published MPI tracers made by coprecipitation. To evaluate the MPI characteristics of MCP 3 two kinds of tube phantoms were prepared and investigated to assess sensitivity, spatial resolution, artifact severity, and selectivity. Resovist® was used as standard of comparison. For image reconstruction, the regularization factor was optimized, and the resulting images were investigated in terms of quantifying of volumes and iron content. Our results demonstrate the superiority of MCP 3 over Resovist® for all investigated MPI characteristics and suggest that MCP 3 is promising for future experimental in vivo studies

Elasticity-based determination of isovolumetric phases in the human heart

<p>Abstract</p> <p>Background/Motivation</p> <p>To directly determine isovolumetric cardiac time intervals by magnetic resonance elastography (MRE) using the magnitude of the complex signal for deducing morphological information combined with the phase of the complex signal for tension-relaxation measurements.</p> <p>Methods</p> <p>Thirty-five healthy volunteers and 11 patients with relaxation abnormalities were subjected to transthoracic wave stimulation using vibrations of approximately 25 Hz. A <it>k</it>-space-segmented, ECG-gated gradient-recalled echo steady-state sequence with a 500-Hz bipolar motion-encoding gradient was used for acquiring a series of 360 complex images of a short-axis view of the heart at a frame rate of less than 5.2 ms. Magnitude images were employed for measuring the cross-sectional area of the left ventricle, while phase images were used for analyzing the amplitudes of the externally induced waves. The delay between the decrease in amplitude and onset of ventricular contraction was determined in all subjects and assigned to the time of isovolumetric tension. Conversely, the delay between the increase in wave amplitude and ventricular dilatation was used for measuring the time of isovolumetric elasticity relaxation.</p> <p>Results</p> <p>Wave amplitudes decreased during systole and increased during diastole. The variation in wave amplitude occurred ahead of morphological changes. In healthy volunteers the time of isovolumetric elasticity relaxation was 75 ± 31 ms, which is significantly shorter than the time of isovolumetric tension of 136 ± 36 ms (<it>P </it>< 0.01). In patients with relaxation abnormalities (mild diastolic dysfunction, <it>n </it>= 11) isovolumetric elasticity relaxation was significantly prolonged, with 133 ± 57 ms (<it>P </it>< 0.01), whereas isovolumetric tension time was in the range of healthy controls (161 ± 45 ms; <it>P </it>= 0.053).</p> <p>Conclusion</p> <p>The complex MRE signal conveys complementary information on cardiac morphology and elasticity, which can be combined for directly measuring isovolumetric tension and elasticity relaxation in the human heart.</p

Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse and 14 with corpuls cpr. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression

Quality Assessment of CEUS in Individuals with Small Renal Masses—Which Individual Factors Are Associated with High Image Quality?

Obesity and bowel gas are known to impair image quality in abdominal ultrasound (US). The present study aims at identifying individual factors in B-mode US that influence contrast-enhanced US (CEUS) image quality to optimize further imaging workup of incidentally detected focal renal masses. We retrospectively analyzed renal CEUS of focal renal masses <= 4 cm performed at our center in 143 patients between 2016 and 2020. Patient and lesion characteristics were tested for their influence on focal and overall image quality assessed by two experienced radiologists using Likert scales. Effects of significant variables were quantified by receiver operating characteristics (ROC) curve analysis with area under the curve (AUC), and combined effects were assessed by binary logistic regression. Shrunken kidney, kidney depth, lesion depth, lesion size, and exophytic lesion growth were found to influence focal renal lesion image quality, and all factors except lesion size also influenced overall image quality. Combination of all parameters except kidney depth best predicted good CEUS image quality showing an AUC of 0.91 (p < 0.001, 95%-CI 0.863-0.958). The B-mode US parameters investigated can identify patients expected to have good CEUS image quality and thus help select the most suitable contrast-enhanced imaging strategy for workup of renal lesions

Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis

Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (>20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI>1 or not measurable due to hypoperfusion as differentiator, p=0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent

Exploring Patterns of Dynamic Size Changes of Lesions after Hepatic Microwave Ablation in an In Vivo Porcine Model

Microwave ablation (MWA) is a type of minimally invasive cancer therapy that uses heat to induce necrosis in solid tumours. Inter- and post-ablational size changes can influence the accuracy of control imaging, posing a risk of incomplete ablation. The present study aims to explore post-ablation 3D size dynamics in vivo using computed tomography (CT). Ten MWA datasets obtained in nine healthy pigs were used. Lesions were subdivided along the z-axis with an additional planar subdivision into eight subsections. The volume of the subsections was analysed over different time points, subsequently colour-coded and three-dimensionally visualized. A locally weighted polynomial regression model (LOESS) was applied to describe overall size changes, and Student's t-tests were used to assess statistical significance of size changes. The 3D analysis showed heterogeneous volume changes with multiple small changes at the lesion margins over all time points. The changes were pronounced at the upper and lower lesion edges and characterized by initially eccentric, opposite swelling, followed by shrinkage. In the middle parts of the lesion, we observed less dimensional variations over the different time points. LOESS revealed a hyperbolic pattern for the volumetric changes with an initially significant volume increase of 11.6% (111.6% of the original volume) over the first 32 minutes, followed by a continuous decrease to 96% of the original volume (p < 0.05)

Comparison of low-contrast detectability between uniform and anatomically realistic phantoms—influences on CT image quality assessment

Objectives: To evaluate the effects of anatomical phantom structure on task-based image quality assessment compared with a uniform phantom background. Methods: Two neck phantom types of identical shape were investigated: a uniform type containing 10-mm lesions with 4, 9, 18, 30, and 38 HU contrast to the surrounding area and an anatomically realistic type containing lesions of the same size and location with 10, 18, 30, and 38 HU contrast. Phantom images were acquired at two dose levels (CTDIvol of 1.4 and 5.6 mGy) and reconstructed using filtered back projection (FBP) and adaptive iterative dose reduction 3D (AIDR 3D). Detection accuracy was evaluated by seven radiologists in a 4-alternative forced choice experiment. Results: Anatomical phantom structure impaired lesion detection at all lesion contrasts (p < 0.01). Detectability in the anatomical phantom at 30 HU contrast was similar to 9 HU contrast in uniform images (91.1% vs. 89.5%). Detection accuracy decreased from 83.6% at 5.6 mGy to 55.4% at 1.4 mGy in uniform FBP images (p < 0.001), whereas AIDR 3D preserved detectability at 1.4 mGy (80.7% vs. 85% at 5.6 mGy, p = 0.375) and was superior to FBP (p < 0.001). In the assessment of anatomical images, superiority of AIDR 3D was not confirmed and dose reduction moderately affected detectability (74.6% vs. 68.2%, p = 0.027 for FBP and 81.1% vs. 73%, p = 0.018 for AIDR 3D). Conclusions: A lesion contrast increase from 9 to 30 HU is necessary for similar detectability in anatomical and uniform neck phantom images. Anatomical phantom structure influences task-based assessment of iterative reconstruction and dose effects