Performance of four dual-energy CT platforms for abdominal imaging: a task-based image quality assessment based on phantom data.

OBJECTIVES: To compare the spectral performance of dual-energy CT (DECT) platforms using task-based image quality assessment based on phantom data. MATERIALS AND METHODS: Two CT phantoms were scanned on four DECT platforms: fast kV-switching CT (KVSCT), split filter CT (SFCT), dual-source CT (DSCT), and dual-layer CT (DLCT). Acquisitions on each phantom were performed using classical parameters of abdomen-pelvic examination and a CTDIvol at 10 mGy. Noise power spectrum (NPS) and task-based transfer function (TTF) were evaluated from 40 to 140 keV of virtual monoenergetic images. A detectability index (d') was computed to model the detection task of two contrast-enhanced lesions as function of keV. RESULTS: The noise magnitude decreased from 40 to 70 keV for all DECT platforms, and the highest noise magnitude values were found for KVSCT and SFCT and the lowest for DSCT and DLCT. The average NPS spatial frequency shifted towards lower frequencies as the energy level increased for all DECT platforms, smoothing the image texture. TTF values decreased with the increase of keV deteriorating the spatial resolution. For both simulated lesions, higher detectability (d' value) was obtained at 40 keV for DLCT, DSCT, and SFCT but at 70 keV for KVSCT. The detectability of both simulated lesions was highest for DLCT and DSCT. CONCLUSION: Highest detectability was found for DLCT for the lowest energy levels. The task-based image quality assessment used for the first time for DECT acquisitions showed the benefit of using low keV for the detection of contrast-enhanced lesions. KEY POINTS: • Detectability of both simulated contrast-enhanced lesions was higher for dual-layer CT for the lowest energy levels. • The image noise increased and the image texture changed for the lowest energy levels. • The detectability of both simulated contrast-enhanced lesions was highest at 40 keV for all dual-energy CT platforms except for fast kV-switching platform.

Impact of iterative reconstructions on image quality and detectability of focal liver lesions in low-energy monochromatic images.

PURPOSE: To assess the impact of iterative reconstructions on image quality and detectability of focal liver lesions in low-energy monochromatic images from a Fast kV-Switching Dual Energy CT (KVSCT) platform. METHODS: Acquisitions on an image-quality phantom were performed using a KVSCT for three dose levels (CTDIvol:12.72/10.76/8.79 mGy). Raw data were reconstructed for five energy levels (40/50/60/70/80 keV) using Filtered Back Projection (FBP) and four levels of ASIR (ASIR30/ASIR50/ASIR70/ASIR100). Noise power spectrum (NPS) and task-based transfer function (TTF) were measured before computing a Detectability index (d') to model the detection task of liver metastasis (LM) and hepatocellular carcinoma (HCC) as function of keV. RESULTS: From 40 to 70 keV, noise-magnitude was reduced on average by -68% ± 1% with FBP; -61% ± 3% with ASIR50 and -52% ± 6% with ASIR100. The mean spatial frequency of the NPS decreased when the energy level decreased and the iterative level increased. TTF values at 50% decreased as the energy level increased and as the percentage of ASIR increased. The detectability of both lesions increased with increasing dose level and percentage of ASIR. For the LM, d' peaked at 70 keV for all reconstruction types, except for ASIR70 at 12.72 mGy and ASIR100, where d' peaked at 50 keV. For HCC, d' peaked at 60 keV for FBP and ASIR30 but peaked at 50 keV for ASIR50, ASIR70 and ASIR100. CONCLUSIONS: Using percentage of ASIR above 50% at low-energy monochromatic images could limit the increase of noise-magnitude, benefit from spatial resolution improvement and hence enhance detectability of subtle low contrast focal liver lesions such as HCC.

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions.

PURPOSE: To compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol. MATERIALS AND METHODS: Thirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3±14.4 (SD) years (range: 22-91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area. RESULTS: Dosimetric values were significantly reduced by -56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P<0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P<0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported. CONCLUSION: Semi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.

Dactylitis: A pictorial review of key symptoms.

Dactylitis refers to a global swelling of a finger or a toe giving it a clinical sausage-shape presentation. It is an extremely suggestive symptom as it guides the rheumatologist towards a shortlist of diagnoses. However, radiologists are less familiar with dactylitis. The aim of this review is to detail and illustrate the main causes of dactylitis using standard X-ray imaging, ultrasound, computed tomography and magnetic resonance imaging in order to make radiologists more familiar with this symptom by illustrating the various conditions that are associated with dactylitis including infection, peripheral spondyloarthritis, sarcoidosis, microcrystalline deposition, osteoid osteoma, and sickle cell disease.

Effect of tin filter-based spectral shaping CT on image quality and radiation dose for routine use on ultralow-dose CT protocols: A phantom study.

PURPOSE: The purpose of this study was to assess the impact of tin filter (TF) on X-ray beam quality, image quality and radiation dose and its suitability for routine use for chest and lumbar-spine/pelvis-hip ultralow-dose (ULD) CT examination protocols. MATERIALS AND METHODS: The X-ray beam quality was determined by measuring the half-value layer (HVL) and calculating the mean weighted energy for 100, 120, 150kVp (using standard filtration) and for 100 and 150kVp using TF (Sn100kVp and Sn150kVp, respectively). Acquisitions were performed on a phantom at four dose levels for each previously definedkVp. The mean attenuation (NCT), noise-power-spectrum (NPS) and task-based transfer function (TTF) were computed. The detectability index (d') was computed to model the detection of two lesions in spine and pelvic/hip examination and two for chest exploration. Image quality and detectability using a TF were assessed for two routinely used ULD protocols. RESULTS: The HVL and mean weighted energy increased using a TF for the same tube voltage. Using a TF for the same tube voltage changed NCT for bone and acrylic inserts, decreased the NPS peak without changing the NPS spatial frequency and increased the TTF values. The d' values were improved using a TF and with the dose increase. d' values of all modeled lesions were improved using Sn100kVp and Sn150kVp for the lumbar-spine/pelvis-hip and chest ULD protocols except for sclerotic bone lesion using Sn150kVp. CONCLUSION: The use of TF increases the X-ray beam quality and improves the image quality characteristics in phantom images, thus appearing as a promising tool for reducing dose and/or improving the image quality of ULD protocols.

Optimization of radiation dose for CT detection of lytic and sclerotic bone lesions: a phantom study.

OBJECTIVES: To determine the best compromise between low radiation dose and suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. METHODS: A phantom was scanned using the routine protocol (STD, 13 mGy) and six decreasing dose levels. Raw data were reconstructed using level 3 of iterative reconstruction (IR3) with 1-mm slice thickness for the STD protocol and highest IR levels with 3-mm slice thickness for the others. CTDIvol was used for radiation dose assessment. Quantitative criteria (noise power spectrum [NPS], task-based transfer function [TTF], and the detectability index [d']), as well as qualitative analysis, were used to compare protocols. NPS and TTF were computed using specific software (imQuest). d' was computed for two imaging tasks: lytic and sclerotic bone lesions. A subjective analysis was performed to validate the image quality obtained on the anthropomorphic phantom with the different dose values. RESULTS: Similar d' values were found for CTDIvol from 3 to 4 mGy with IR4 and from 1 to 2 mGy for IR5 compared with d' values using the STD protocol. Image quality was validated subjectively for IR4 but rejected for IR5 (image smoothing). Finally, for the same d', the dose was reduced by 74% compared with the STD protocol, with the CTDIvol being 3.4 mGy for the lumbar spine and for the pelvis. CONCLUSION: A dose level as low as 3.4 mGy, in association with high levels of IR, provides suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. KEY POINTS: • A CTDI volof 3.4 mGy, in association with high iterative reconstruction level, provides suitable image quality for the detection of lytic and sclerotic bone lesions, both at objective and subjective analysis. • Compared with the standard protocol, radiation dose can be reduced up to 74% for the lumbar spine and pelvis. • A task-based image quality assessment using  the detectability index represents an objective method for the assessment of image quality and bridges the gap between complex physical metrics and subjective image analysis.

Dietary fiber for pregnant sows: influence on sow physiology and performance during lactation.

This study was conducted to investigate the effects of feeding sows a bulky diet during gestation on their physiological and metabolic adaptations during the peripartum period, and to determine how these effects may relate to sow and piglet performances. From d 26 of gestation until farrowing, gilts were fed diets that contained 2.8 or 11.0% crude fiber (control and high-fiber diets, respectively, n = 9/group). Daily feed allowance provided the same amount of DE daily (33 MJ of DE/d). Throughout lactation, sows were allowed to consume a standard lactating sow diet ad libitum. Litters were standardized to 12 piglets beyond 48 h after birth. On d 105 of gestation, a jugular catheter was surgically implanted. Preprandial blood samples were collected from d 109 of gestation to the day after farrowing and on d 4, 18, and 26 of lactation. Meal tests and glucose tolerance tests were performed on d 109 of gestation and d 4 and 18 of lactation. During gestation, BW and backfat gain did not differ between treatment groups. During lactation, sows fed the high-fiber diet ate an average of 0.94 kg/d more than control sows (P < 0.02). Piglets born from sows fed the high-fiber diet grew faster than piglets from control sows (P = 0.03). Body weight and backfat losses did not differ between the 2 treatment groups. Sows fed the high-fiber diet during gestation had lesser concentrations of leptin before farrowing than control sows (P < 0.01). Leptin concentrations were negatively correlated with feed intake during lactation (P < 0.05). The prepartal increase in prolactin concentrations tended to be greater in sows fed the high-fiber diet than in control sows (P < 0.1). Preprandial concentrations of glucose, NEFA, lactate, and IGF-I fluctuated over time without significant treatment effect. Glucose half-life was shorter in late gestation than during both stages of lactation, but did not differ between sows in the 2 groups. In late gestation, the postprandial increases in glucose and insulin were delayed, and smaller, after a high-fiber meal than after a control meal. During lactation, glucose and insulin profiles after a standard meal did not differ between sows from treatment groups. In conclusion, the greater appetite of lactating sows fed a high-fiber diet during gestation does not seem related to changes in glucose and insulin metabolism and may be partly due to decreased secretion of leptin. The greater feed consumption was accompanied by a faster growth rate of piglets without sparing effect on maternal body reserves.

Dietary fibre for gestating sows: effects on parturition progress, behaviour, litter and sow performance.

In pig production, parturition progress is a key event for sow's reproductive performance, evaluated by piglet survival and piglets' performance. The aim of this study was to investigate the impact of feeding a high-fibre (HF) diet during gestation on parturition progress and reproductive performance of sows. Forty-two primiparous sows (Large-White × Landrace crossbred) were fed during gestation either a control diet (C diet; 2.40 kg/day, 3.2% crude fibre, in % of dry matter (DM)), or a HF diet (2.80 kg/day, 12.4% crude fibre, in % of DM). All sows received 33 MJ digestible energy per day. Continuous video recordings were done on the parturition day to determine postural changes (standing, sitting, lying) and behavioural activities (nesting behaviour, uterine contractions, restlessness, social behaviour towards piglets) during parturition. Duration of parturition and individual birth intervals were also measured. Piglets' growth was evaluated by weekly weighing from birth until weaning, at 26.5 days of age. Sows were weighed and backfat thickness was measured at mating, on day 105 of gestation, on the 1st day post partum, and at weaning. Durations of parturition and of birth intervals were not affected by the gestation diet and averaged 211 ± 12 min and 16.5 ± 0.9 min (mean ± s.e.), respectively. During the parturition progress, the gestation diet did not affect the frequency and the time devoted to postural and behavioural activities. Dietary treatment during gestation did not influence duration of gestation and weaning-to-oestrus interval, as well as litter size, and number of stillborn and weaned piglets. Piglet weight at birth did not differ between gestation dietary treatments but piglets nursed by HF sows showed a 13.5% greater growth rate during the 1st week of life (P < 0.01) and tended to be heavier at weaning (P = 0.06) compared with C piglets. The HF sows were leaner at the end of gestation (P < 0.05), but variations of sows' weight during gestation and lactation were not affected by the gestation diet. All sows lost the same amount of backfat thickness during lactation. During lactation, the average daily feed intake was not significantly affected by the gestation diet. This study shows that substituting a control diet for a HF diet during gestation has limited effects on farrowing progress and reproductive performance, but improved piglets' growth rate during the 1st week of life and tended to increase their live weight at weaning.

Intestinal development and growth performance of early-weaned piglets fed a low-threonine diet.

High dietary threonine extraction by the digestive tract suggests that threonine contributes to maintain gut integrity. The aims of this study were to investigate the intestine development and the growth performance of early-weaned piglets pair-fed either a control well-balanced (C: 9.3 g threonine/kg diet) or a low-threonine diet (LT: 6.5 g threonine/kg diet) for 2 weeks. As expected, LT piglets presented lower plasma free threonine compared with C piglets (118 v. 356 ± 12 µmol/l, P < 0.001). Dietary threonine supply altered neither growth performance nor growth of the intestine and of the other portal-drained viscera (stomach, spleen and pancreas). Nevertheless, villus height was reduced in the ileum of the LT piglets compared with C piglets (446 v. 714 ± 74 µm, P < 0.05). This was also associated with a decrease in crypt width (P < 0.05) and villus height-to-crypt depth ratio (P < 0.05). Whereas maltase and lactase activities did not change between the two groups, aminopeptidase nitrogen activity was decreased in the ileum of LT piglets (269 v. 374 ± 27 IU/mg protein, P < 0.05). The number of mucin-containing goblet cells was not modified in the ileum and in the proximal part of the large intestine of the LT piglets compared with the C piglets. In conclusion, despite no alteration of intestinal growth, villus hypotrophy associated with a reduction of aminopeptidase nitrogen activity suggest an alteration of the structure of the ileum in early-weaned piglets fed a diet supplying inadequate dietary threonine.