Influence of Gd-EOB-DTPA on proton-density fat fraction in the liver using chemical shift-encoded magnetic resonance imaging at 3-T.

Non-alcoholic fatty liver disease (NAFLD) and its advanced stage, non-alcoholic steatohepatitis (NASH), have become increasingly prevalent owing to the rise in metabolic syndromes. Accurate assessment of hepatic fat deposition and inflammation is crucial for diagnosing and managing NAFLD/NASH. We investigated the influence of Gd-EOB-DTPA, (EOB) on proton-density fat fraction (PDFF) measurements using chemical shift-encoded magnetic resonance imaging (CSE-MRI) at 3-T. In total, 431 patients who underwent EOB contrast-enhanced MRI were included. PDFF measurements were obtained from pre- and post-contrast CSE-MRI. Linear regression and Bland-Altman analyses were performed to assess the correlation and agreement between pre- and post-EOB PDFF measurements. Relative enhancement (RE) of the liver was calculated as an EOB uptake index. There was a significant decrease in PDFF following EOB administration compared with the pre-contrast values (P < 0.0001), which was observed across all PDFF ranges (< 10% and ≥ 10%). Linear regression analysis revealed high correlation between pre- and post-EOB PDFF measurements. Bland-Altman analysis indicated a small bias between pre- and post-EOB PDFF values. Subgroup analysis based on RE showed a significant difference in ΔPDFF between patients with high RE (> 120%) and those with lower RE levels. EOB administration resulted in a slight decrease in PDFF measurements obtained using CSE-MRI at 3-T. We were able to generalize and clarify that the PDFF of the liver on 3D CSE-MRI at 3-T was slightly decreased after EOB administration as we used a larger group of patients compared to previous studies.

The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome.

The purpose of the study was to investigate the relationship between diffusion tensor imaging (DTI) and the clinical classification of cubital tunnel syndrome (CuTS). Ten patients with CuTS (7 men and 3 women; mean age: 52.7 years) and 5 patients without ulnar neuropathy (2 men and 3 women; mean age: 38.0 years) were enrolled in this retrospective study. Fifteen patients were clinically classified into three groups: "Normal", "1 and 2A", and "2B and 3" by an orthopedic surgeon using the modified McGowan stages. DTI was acquired using a 3.0-T MRI. Fractional anisotropy (FA) of the ulnar nerve was measured in slices covering 20 mm proximal to 20 mm distal to ulnar sulcus. Median FA values in each group were compared by Kruskal-Wallis and Steel-Dwass test (P < 0.05). Five patients with CuTS were classified as "1 and 2A" and five patients as "2B and 3". The FA values, proximal 12 mm to the ulnar sulcus were 0.486 ± 0.117, 0.425 ± 0.166 and 0.298 ± 0.0386 in the "Normal", "1 and 2A" and "2B and 3" groups, respectively. The FA values of patients classified as "Normal" were significantly higher than those classified as "2B and 3" (P = 0.0326 in Steel-Dwass test). FA proximal to the ulnar sulcus might be associated to the modified McGowan stages for the clinical classification of CuTS.

The effects of mega-voltage CT scan parameters on offline adaptive radiation therapy.

TomoTherapy involves image-guided radiation therapy (IGRT) using Mega-voltage CT (MVCT) for each treatment session. The acquired MVCT images can be utilized for the retrospective assessment of dose distribution. The TomoTherapy provides 18 distinct imaging conditions that can be selected based on a combination of algorithms, acquisition pitch, and slice interval. We investigated the accuracy of dose calculation and deformable image registration (DIR) depending on MVCT scan parameters and their effects on adaptive radiation therapy (ART). We acquired image values for density calibration tables (IVDTs) under 18 different MVCT conditions and compared them. The planning CT (pCT) was performed using a thoracic phantom, and an esophageal intensity-modulated radiation therapy (IMRT) plan was created. MVCT images of the thoracic phantom were acquired under each of the 18 conditions, and dose recalculation was performed. DIR was performed on the MVCT images acquired under each condition. The accuracy of DIR, depending on the MVCT scan parameters, was compared using the mean distance to agreement (MDA) and Dice similarity coefficient (DSC). The dose distribution calculated on the MVCT images was deformed using deformed vector fields (DVF). No significant differences were observed in the results of the 18 IVDTs. The esophageal IMRT plan also showed a small dose difference. Regarding verifying the DIR accuracy, the MDA increased, and the DSC decreased as the acquisition pitch and slice interval increased. The difference between the dose distributions after dose mapping was comparable to that before DIR. The MVCT scan parameters had little effect on ART.

Non-Obese MAFLD Is Associated with Colorectal Adenoma in Health Check Examinees: A Multicenter Retrospective Study.

Colorectal adenoma is linked to metabolic dysfunction. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a precise definition and three subtypes, including non-obese MAFLD. We aimed to investigate the impact of MAFLD on the prevalence of colorectal adenoma by comparing it to non-alcoholic fatty liver disease (NAFLD) in health check-up examinees. This is a multicenter retrospective study. We enrolled 124 consecutive health check-up examinees who underwent colonoscopy. NAFLD and MAFLD were present in 58 and 63 examinees, respectively. Colorectal adenoma was diagnosed by biopsy. The impact of the MAFLD definition on the prevalence of colorectal adenoma was investigated by logistic regression, decision-tree, and random forest analyses. In logistic regression analysis, MAFLD was identified as the only independent factor associated with the presence of colorectal adenoma (OR 3.191; 95% CI 1.494-7.070; p = 0.003). MAFLD was also identified as the most important classifier for the presence of colorectal adenoma in decision-tree and random forest analyses (29 variable importance value). Among the three subtypes of MAFLD, non-obese MAFLD was the sole independent factor associated with the presence of colorectal adenoma (OR 3.351; 95% CI 1.589-7.262; p ≤ 0.001). Non-obese MAFLD was also the most important classifier for the presence of colorectal adenoma in decision-tree and random forest analyses (31 variable importance value). MAFLD, particularly non-obese MAFLD, is the most important factor associated with the presence of colorectal adenoma rather than NAFLD. Colonoscopy examination should be considered in patients with MAFLD, especially those who are non-obese.

[Effect of Reconstruction Technique for Metal Artifact Reduction in Computed Tomography by Changing Display Field of View].

We evaluated the effect of orthopedic-metal artifact reduction (O-MAR) for metal artifact in computed tomography with 73 simulated seeds for brachytherapy in different sizes of display field of view (DFOV) obtained by helical scan under the same clinical scan condition. The metal artifacts were analyzed with the Gumbel's method by changing DFOV sizes 80 mm, 160 mm, and 320 mm. Gumbel distribution, scale parameter (γ), and location parameter (ß) of the metal artifacts with O-MAR were compared with that of the metal artifacts with filtered back projection (FBP). In conclusion, it was considered that the effect of metal artifact reduction with O-MAR was influenced by DFOV size in this study. The reduction rates of scale parameter (γ) were 22.3%, 21.3%, and 10.0% in DFOV 80 mm, 160 mm, and 320 mm, respectively. The reduction rates of location parameter (ß) were 27.4%, 23.4 %, and 9.8%. Therefore, the effect of metal artifact reduction with O-MAR showed the tendency of increasing with decreasing DFOV size.

[Development of an automated method for analysis of Winston-Lutz test results using digital radiography and photostimulable storage phosphor].

Stereotactic radiosurgery (SRS) and radiotherapy (SRT) are intricate techniques that deliver a highly precise radiation dose to a localized target, usually a tumor. At our hospital, we perform SRS and SRT on brain tumors using a linear accelerator (linac) mounted with an external micro multi-leaf system. The Task Group TG-142 Report by the American Association of Physicists in Medicine recommends the coincidence of the radiation and mechanical isocenter to be within ±1 mm. The Winston-Lutz test is commonly used to verify the linac isocenter position: it has the advantages of being a simple method that uses a film or electronic portal imaging device (EPID). However, the film method requires a higher radiation dose, which makes it more time-consuming than the EPID method, and the results are highly dependent on the skills of the observer. The EPID method has certain advantages over the film method, but it has low resolution and can only be used for a few combinations of gantry and couch angles. This prompted us to develop an in-house-designed radiation receptor system based on digital radiography, using a photostimulable storage phosphor and automated analysis algorithm for Winston-Lutz test images using a template-matching technique based on cross-correlation coefficients. Our proposed method shows a maximum average absolute error of 0.222 mm (less than 2 pixels) for 0.5 mm and 1.0 mm displacement from the isocenter toward the inline and crossline directions. Our proposed method is thus potentially useful for verifying the Linac isocenter position with a small error and good reproducibility, as demonstrated by improved accuracy of evaluation.

Automated estimation of number of implanted iodine-125 seeds for prostate brachytherapy based on two-view analysis of pelvic radiographs.

Digital pelvic radiographs are used to identify the locations of implanted iodine-125 seeds and their numbers after insertion. However, it is difficult and laborious to visually identify and count all implanted seeds on the pelvic radiographs within a short time. Therefore, our purpose in this research was to develop an automated method for estimation of the number of implanted seeds based on two-view analysis of pelvic radiographs. First, the images of the seed candidates on the pelvic image were enhanced using a difference of Gaussian filter, and were identified by binarizing the enhanced image with a threshold value determined by multiple-gray level thresholding. Second, a simple rule-base method using ten image features was applied for false positive removal. Third, the candidates for the likely number of a multiply overlapping seed region, which may include one or more seeds, were estimated by a seed area histogram analysis and calculation of the probability of the likely number of overlapping seeds. As a result, the proposed method detected 99.9% of implanted seeds with 0.71 false positives per image on average in a test for training cases, and 99.2% with 0.32 false positives in a validation test. Moreover, the number of implanted seeds was estimated correctly at an overall recognition rate of 100% in the validation test using the proposed method. Therefore, the verification time for the number of implanted seeds could be reduced by the provision of several candidates for the likely number of seeds.

[Investigation of Region of Interest (ROI) for measurement of slice thickness in Computed Tomography (CT)].

We evaluated an appropriate region of interest (ROI) size for the measurement of full width at half maximum (FWHM) in the bead method (0.1 mm and 0.5 mm diameter; lead) and the microdisk method (0.05 mm thickness and 1.0 mm diameter; tungsten) using multislice computed tomography (CT). The FWHM of preset slice thicknesses 0.625 mm, 1.25 mm, 5.0 mm and 7.5 mm were measured by varying helical pitch, location of measurement [center and off-center of scan field of view (SFOV)] and ROI size, and they were compared with the tolerance stated in the Japanese Industrial Standards (JIS). It was conlcuded that the appropriate ROI size was influenced by preset slice thickness in this study. At the center of SFOV, measurements of FWHM were enabled within the tolerance of the JIS with small variations in all preset slice thicknesses if the ROI sizes were set between 0.4 times and equal to the size of the bead or microdisk indicating the maximum CT value in the series of CT images. At the off-center of SFOV, the tendency of increasing FWHM was confirmed, but it was shown that variations of the off-center in thicker slice thickness were larger regardless of helical pitch when the orbital synchronized helical scan technique was not used.

[Development of automatic analysis for dynamic renal function study using computed tomographic (CT) images].

Determination of the region of interest (ROI) for dynamic renal function has been highly discordant among operators because of the dependence on factors such as the rate of injection of radioactive medicines, constitution, and renal function. To simplify this problem, we developed a computer algorithm that provides automatic analysis for both localization of the kidney and automatic determination of ROIs using computed tomographic (CT) images. The bilateral kidneys were extracted from enhanced CT images, and the CT pixel size was adjusted to dynamic renal function images. The template-matching technique was used for these images, and the kidney renal location was analyzed on additional functional images constructed by dynamic renal function images. As a result, we were able to obtain time-activity curves of both renal function and quantified glomerular filtration rate (GFR). In conclusion, the computer algorithm we developed was considered to provide reliable results, apart from the variability among operators, because of its good reproducibility.

[Development of automatic analyses for star-shot images using computed radiography (CR)].

Recent progress in radiation therapy has been greatly enhanced in many facilities by the development of new machines for treatment, improved computer technology for radiotherapy treatment planning systems (RTPs), increased accuracy of radiation therapy such as stereotactic irradiation, and intensity-modulated radiation therapy (IMRT). Quality control (QC) of the isocenter, which has consisted of gantry rotation and limiting the radiation field, is important for greater accuracy of these radiation therapy technologies. Star-shot analyses using computed radiography (CR) for evaluation of the isocenter were employed in this study. Devices to support CR were created, and a method of automatically analyzing images obtained by the star-shot technique, which calculated the error (distance) from the isocenter and the incident beam angle, were developed. In terms of the accuracy of our method, the average maximum error was 0.33 mm (less than 2 pixels: 0.35 mm), the average absolute error and incident beam angle errors were 0.3 mm and 0.4 degrees at maximum and at one standard deviation (SD), respectively. In this study, the processing times were 16 sec at minimum, 152 sec at maximum, 18 sec at most frequencies, and 23.6 sec on average. In conclusion, it was considered that our newly developed method for analyzing star-shot images using CR enabled immediate, quantitative evaluation of the isocenter.

[Research on time-course differential imaging by bone scintigraphy].

The temporal image subtraction technique was applied to bone scintigraphy, using Photoshop (commercially available image processing software) and Morpher (public domain warping software). For the temporal subtraction images, 81 subtraction images (19 cases) were prepared by a method used to subtract the previous images from the current ones. Registration of the current and previous images was performed by manual operation using Photoshop, and warping was done using the warping function of Morpher. In addition, difference images prepared after correcting the distributions of radioactive isotopes of the current and previous images using the count of the pelvic region were also examined. Compared with manual operation, alignment of images by warping improved registration and reduced the generation of pseudo-images of subtraction images. The rate of identification of abnormal accumulation-enhanced regions and subjective evaluation by doctors was improved for warping more than for manual operation. Furthermore, abnormal hot regions, which are difficult to find in film images, could be found in three subtraction images. In addition, it was confirmed that abnormal hot regions become more visible in many cases by preparing subtraction images after correcting the count between images using the count of the pelvic region. Thus, it is suggested that the temporal image subtraction technique in bone scintigraphy enables more accurate observation of enhancement of or changes in abnormal hot regions, which will support diagnostic reading. It is considered that enhancement of or changes in abnormal hot regions will be more accurately understood through further detailed discussion in the future.

[Fundamental study of magnetization transfer contrast (MTC) effect: optimization of MT pulse condition using experimental phantom].

Magnetization transfer contrast (MTC) was evaluated by changing the off-set frequency and pulse intensity of MTC with the spoiled gradient echo (SPGR) sequence (T2*-weighted image) using an experimental phantom that included olive oil, protein, fiber, collagen, and pure water. The intensity of pure water reached a constant level just above the off-set frequency (1200 Hz) regardless of MT pulse power. The contrast-to-noise ratio (CNR) in each of the phantom materials was maximal at the MT pulse power of 2500 degrees (equivalent flip angle). The CNR and image noise obtained by body coil were inferior to those obtained with an extremity coil. In clinical application, the MTC effect on chondrosarcoma was higher (MT ratio, ROI-1:0.448, ROI-2:0.382) than those of other cases in this study. Since the image contrast was improved between the malignant fibrous histiocytoma (MFH, MT ratio, ROI-1:0.282, ROI-2:0.289) and peripheral tissues, extraskeletal extension could be observed more easily than without MTC imaging. In conclusion, the effects of MTC might be in providing useful information, in presuming composed tissues, differential diagnoses, and extent to the surrounding structures because of changing the image contrast to surrounding tissues corresponding to the rate of included bound water.

[Investigation of beam quality for digital chest radiography with RbBr:Tl(+) photostimulable storage phosphors].

Beam quality for digital chest radiography in digital radiography systems (DR systems) with RbBr:Tl(+) photostimulable storage phosphors was investigated. Measurements of overall Wiener spectrum (overall WS) and observer performance experiments by means of Scheffé's method of paired comparisons were performed under the same exposure (5.16x10(-7)C/kg) at the X-ray detector of DR systems (sampling distance: 175 micro m, 2,048x2,048 pixels, 12 bits, look-up table: THX2) with a phantom lung and metacryl plates. Overall WS values were indicated to be inferior at higher tube voltages. All of the overall WS values were greater than those of screen film systems (HGM/UR1:S/F) at radiographic density 0.50, which was considered the density of the mediastinum and the area below the diaphragm (low density area), and at radiographic densities 1.00 and 1.50, considered as lung, WS values of S/F were located between the overall WS values of 80 kV and 100 kV, and 120 kV and 140 kV, respectively. Evaluation of visibility including mediastinum, lung, and total were indicated to be superior at the lower tube voltages. In evaluation of the mediastinum, the base image, which was obtained by 100 kV tube voltage (effective energy: 46.0 kV) in this study, was not significant from 90 kV to 110 kV tube voltages (range, +/-10 kV), and in-lung and total evaluations were not significant from 90 kV to 120 kV (range, -10 kV to +20 kV), and from 80 kV to 120 kV (range, +/-20 kV) tube voltages by 99% confidence interval. In conclusion, optimal beam quality for digital chest radiography with RbBr:Tl(+) photostimulable storage phosphors was considered to be less than 110 kV tube voltage (effective energy, 47.9 keV) in 0.1 mm copper and 3.8 mm aluminum total filtration. In this case, the granularity in low-density areas were inferior to those of S/F systems but nearly equal to the middle and high-density areas of chest images, and exposure dose was 14.3% lower than that of the base image obtained by 100 kV (effective energy, 46.0 keV) tube voltage in this study.