Pesticides in Agricultural Soils: Major Findings from Various Monitoring Campaigns in Switzerland.

Synthetic pesticides are widely applied in modern agriculture, where they are used against diseases, pests, and weeds to secure crop yield and quality. However, their intensive application has led to widespread contamination of the environment, including soils. Due to their inherent toxicity, they might pose a risk to soil health by causing harm to non-target organisms and disrupting ecosystem services in both agricultural and other exposed soils. Following the Swiss National Action Plan on the reduction of pesticide risks, Agroscope has conducted several soil monitoring studies that are briefly presented here. All of them resort to different multi-residue trace analytical approaches to simultaneously quantify up to about 150 modern pesticides by either accelerated solvent, or Quick, Easy, Cheap, Efficient, Rugged, Safe (QuEChERS) extraction, followed by separation and detection with liquid chromatography-triple quadrupole mass spectrometry. While partly still in progress, our investigations led to the following major findings this far: Multiple pesticides are commonly present in soils, with individual concentrations in agricultural soils often reaching up to a few tens of µg/kg. Pesticide occurrence and concentrations in agricultural soils primarily depend on land use, land use history and cultivated crops. Pesticides can prevail much longer than predicted by their half-lives, and were found in soils even decades after conversion from conventional to organic farming. Corresponding residual fractions can be in the order of a few percent of the originally applied amounts. We further found negative associations of pesticide residues with the abundance of beneficial soil life, underpinning their potential risk to the fertility of agricultural soils. Traces of pesticides are also detected in soils to which they were never applied, indicating contamination, e.g., via spray drift or atmospheric deposition. These results confirm the general notion of both scientists and legislators that prospective risk assessments (RA; as executed during registration and use authorization) should be confirmed and adjusted by retrospective RA (e.g., by environmental monitoring studies of currently used compounds) to jointly lead to an overall reduced environmental risk of pesticides.

Geochemical Soil Atlas of Switzerland - Distribution of Toxic Elements.

Chemical elements such as copper and molybdenum are essential for animal and human health but may become toxic at elevated concentrations depending on the exposure and intake rate. Other elements such as mercury pose a threat to human health at already low concentrations. The soil acts as the main source of these elements for plant uptake and is thus driving accumulation along the food chain. However, in Switzerland, no nationwide information on elemental distributions in soils has existed up to now. The geochemical soil atlas of Switzerland will fill this gap by presenting the concentration ranges and the spatial distribution of 20 elements in the topsoil. In this summary, we present the methodological approaches and some main findings of the atlas with a focus on toxic elements as well as elements that can be or are toxic at higher concentrations.

A multi-residue method for trace analysis of pesticides in soils with special emphasis on rigorous quality control.

A multi-residue trace analytical method is presented to accurately quantify 146 currently used pesticides in (agricultural) soils with varying soil properties. Pesticides were extracted using an optimized quick, easy, cheap, effective, rugged, and safe (QuEChERS) approach and chemical analysis was carried out by liquid chromatography coupled to tandem mass spectrometry (triple quadrupole). Quantification was based on matrix-matched internal standards calibration, using 95 isotopically labeled analyte analogues. In contrast to the common approach of method validation using soils freshly spiked with analytes shortly before the extraction, our method is additionally validated via an in-house prepared partly aged soil, which contains all target pesticides and via agricultural field soils with native pesticide residues. The developed method is highly sensitive (median method limit of quantification: 0.2 ng/g), precise (e.g., median intra-day and inter-day method precision both ~ 4% based on field soils), and true ((i) quantified pesticide concentrations of the partly aged soil remained stable during 6 months, were close to the initially spiked nominal concentration of 10 ng/g, and thus can be used to review trueness in the future; (ii) median freshly spiked relative recovery: 103%; and (iii) participation in a ring trial: median z-scores close to one (good to satisfactory result)). Its application to selected Swiss (agricultural) soils revealed the presence of in total 77 different pesticides with sum concentrations up to 500 ng/g. The method is now in use for routine soil monitoring as part of the Swiss Action Plan for Risk Reduction and Sustainable Use of Plant Protection Products.

Predicting Penumbra Salvage and Infarct Growth in Acute Ischemic Stroke: A Multifactor Survival Game.

BACKGROUND: Effective treatment of acute ischemic stroke requires reperfusion of salvageable tissue. We investigated the predictors of penumbra salvage (PS) and infarct growth (IG) in a large cohort of stroke patients. METHODS: In the ASTRAL registry from 2003 to 2016, we selected middle cerebral artery strokes <24 h with a high-quality CT angiography and CT perfusion. PS and IG were correlated in multivariate analyses with clinical, biochemical and radiological variables, and with clinical outcomes. RESULTS: Among 4090 patients, 551 were included in the study, 50.8% male, mean age (±SD) 66.3 ± 14.7 years, mean admission NIHSS (±SD 13.3 ± 7.1) and median onset-to-imaging-time (IQR) 170 (102 to 385) minutes. Increased PS was associated with the following: higher BMI and lower WBC; neglect; larger penumbra; absence of early ischemic changes, leukoaraiosis and other territory involvement; and higher clot burden score. Reduced IG was associated with the following: non-smokers; lower glycemia; larger infarct core; absence of early ischemic changes, chronic vascular brain lesions, other territory involvement, extracranial arterial pathology and hyperdense middle cerebral artery sign; and higher clot burden score. When adding subacute variables, recanalization was associated with increased PS and reduced IG, and the absence of haemorrhage with reduced IG. Collateral status was not significantly associated with IG nor with PS. Increased PS and reduced IG correlated with better 3- and 12-month outcomes. CONCLUSION: In our comprehensive analysis, multiple factors were found to be responsible for PS or IG, the strongest being radiological features. These findings may help to better select patients, particularly for more aggressive or late acute stroke treatment.

Pesticide residues in agricultural soils in light of their on-farm application history.

The application of synthetic pesticides to agricultural fields for the protection of crops leads to the formation of residues in soils. While the short-term behavior of pesticide residues in soils after an application is generally known from laboratory and field studies required for authorization (prospective risk assessments), there is still a lack of in-situ observations that address their long-term fate. Long-term soil monitoring programs, with comprehensive site-specific records of pesticide application data, constitute an invaluable, complementary, retrospective exposure assessment tool to address this gap. Considering the pesticide applications over the past 10-15 years, this study assessed the occurrence of pesticides in agricultural soils of Switzerland and put their presence or absence, as well as their concentrations, in the context of their previous application. The results showed that pesticides could also be detected at sites without a connection to previous applications and that small residual mass fractions of pesticides, even of some non-persistent compounds, were found in soils, years or decades after their last application. This finding points to an environmental issue that may not be adequately captured in prospective risk assessment and calls attention to the need for comprehensive long-term recording and monitoring as a complementary retrospective exposure assessment.

The Swiss Approach - feasibility of a national low-dose CT lung cancer screening program.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths in Switzerland. Despite this, there is no lung cancer screening program in the country. In the United States, low-dose computed tomography (LDCT) lung cancer screening is partially established and endorsed by guidelines. Moreover, evidence is growing that screening reduces lung cancer-related mortality and this was recently shown in a large European randomized controlled trial. Implementation of a lung cancer screening program, however, is challenging and depends on many country-specific factors. The goal of this article is to outline a potential Swiss lung cancer screening program. FRAMEWORK: An exhaustive literature review on international screening models as well as interviews and site visits with international experts were initiated. Furthermore, workshops and interviews with national experts and stakeholders were conducted to share experiences and to establish the basis for a national Swiss lung cancer screening program. SCREENING APPROACH: General practitioners, pulmonologists and the media should be part of the recruitment process. Decentralisation of the screening might lead to a higher adherence rate. To reduce stigmatisation, the screening should be integrated in a "lung health check". Standardisation and a common quality level are mandatory. The PLCOm2012 risk calculation model with a threshold of 1.5% risk for developing cancer in the next six years should be used in addition to established inclusion criteria. Biennial screening is preferred. LUNG RADS and NELSON+ are applied as classification models for lung nodules. CONCLUSION: Based on data from recent studies, literature research, a health technology assessment, the information gained from this project and a pilot study the Swiss Interest Group for lung cancer screening (CH-LSIG) recommends the timely introduction of a systematic lung cancer screening program in Switzerland. The final decision is for the Swiss Cancer Screening Committee to make.

A Fetal Brain magnetic resonance Acquisition Numerical phantom (FaBiAN).

Accurate characterization of in utero human brain maturation is critical as it involves complex and interconnected structural and functional processes that may influence health later in life. Magnetic resonance imaging is a powerful tool to investigate equivocal neurological patterns during fetal development. However, the number of acquisitions of satisfactory quality available in this cohort of sensitive subjects remains scarce, thus hindering the validation of advanced image processing techniques. Numerical phantoms can mitigate these limitations by providing a controlled environment with a known ground truth. In this work, we present FaBiAN, an open-source Fetal Brain magnetic resonance Acquisition Numerical phantom that simulates clinical T2-weighted fast spin echo sequences of the fetal brain. This unique tool is based on a general, flexible and realistic setup that includes stochastic fetal movements, thus providing images of the fetal brain throughout maturation comparable to clinical acquisitions. We demonstrate its value to evaluate the robustness and optimize the accuracy of an algorithm for super-resolution fetal brain magnetic resonance imaging from simulated motion-corrupted 2D low-resolution series compared to a synthetic high-resolution reference volume. We also show that the images generated can complement clinical datasets to support data-intensive deep learning methods for fetal brain tissue segmentation.

MRI software for diffusion-perfusion mismatch analysis may impact on patients' selection and clinical outcome.

OBJECTIVE: Impact of different MR perfusion software on selection and outcome of patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO) treated by endovascular thrombectomy (EVT) is unclear. We aimed at comparing two commercial MRI software, semi-automated with unadjusted (method A) and adjusted mask (method B), and fully automated (method C) in this setting. METHODS: MRI from 144 consecutive AIS patients with anterior circulation LVO was retrospectively analysed. All diffusion- and perfusion-weighted images (DWI-PWI) were post-processed with the three methods using standard thresholds. Concordance for core and hypoperfusion volumes was assessed with Lin's test. Clinical outcome was compared between groups in patients who underwent successful EVT in the early and late time window. RESULTS: Mean core volume was higher and mean hypoperfusion volume was lower in method C than in methods A and B. In the early time window, methods A and B found fewer patients with a mismatch ratio ≤ 1.2 than method C (1/67 [1.5%] vs. 12/67 [17.9%], p = 0.0013). In the late time window, methods A and B found fewer patients with a mismatch ratio < 1.8 than method C (3/46 [6.5%] and 2/46 [4.3%] vs. 18/46 [39.1%], p ≤ 0.0002). More patients with functional independence at 3 months would not have been treated using method C versus methods A and B in the early (p = 0.0063) and late (p ≤ 0.011) time window. CONCLUSIONS: MRI software for DWI-PWI analysis may influence patients' selection before EVT and clinical outcome. KEY POINTS: • Method C detects fewer patients with favourable mismatch profile. • Method C might underselect more patients with functional independence at 3 months. • Software used before thrombectomy may influence patients' outcome.

Site and land-use associations of soil bacteria and fungi define core and indicative taxa.

Soil microbial diversity has major influences on ecosystem functions and services. However, due to its complexity and uneven distribution of abundant and rare taxa, quantification of soil microbial diversity remains challenging and thereby impeding its integration into long-term monitoring programs. Using metabarcoding, we analyzed soil bacterial and fungal communities at 30 long-term soil monitoring sites from the three land-use types arable land, permanent grassland, and forest with a yearly sampling between snowmelt and first fertilization over five years. Unlike soil microbial biomass and alpha-diversity, microbial community compositions and structures were site- and land-use-specific with CAP reclassification success rates of 100%. The temporally stable site core communities included 38.5% of bacterial and 33.1% of fungal OTUs covering 95.9% and 93.2% of relative abundances. We characterized bacterial and fungal core communities and their land-use associations at the family-level. In general, fungal families revealed stronger land-use associations as compared to bacteria. This is likely due to a stronger vegetation effect on fungal core taxa, while bacterial core taxa were stronger related to soil properties. The assessment of core communities can be used to form cultivation-independent reference lists of microbial taxa, which may facilitate the development of microbial indicators for soil quality and the use of soil microbiota for long-term soil biomonitoring.

Data-driven myelin water imaging based on T1 and T2 relaxometry.

Long acquisition times preclude the application of multiecho spin echo (MESE) sequences for myelin water fraction (MWF) mapping in daily clinical practice. In search of alternative methods, previous studies of interest explored the biophysical modeling of MWF from measurements of different tissue properties that can be obtained in scan times shorter than those required for the MESE. In this work, a novel data-driven estimation of MWF maps from fast relaxometry measurements is proposed and investigated. T1 and T2 relaxometry maps were acquired in a cohort of 20 healthy subjects along with a conventional MESE sequence. Whole-brain quantitative mapping was achieved with a fast protocol in 6 min 24 s. Reference MWF maps were derived from the MESE sequence (TA = 11 min 17 s) and their data-driven estimation from relaxometry measurements was investigated using three different modeling strategies: two general linear models (GLMs) with linear and quadratic regressors, respectively; a random forest regression model; and two deep neural network architectures, a U-Net and a conditional generative adversarial network (cGAN). Models were validated using a 10-fold crossvalidation. The resulting maps were visually and quantitatively compared by computing the root mean squared error (RMSE) between the estimated and reference MWF maps, the intraclass correlation coefficients (ICCs) between corresponding MWF values in different brain regions, and by performing Bland-Altman analysis. Qualitatively, the estimated maps appear to generally provide a similar, yet more blurred MWF contrast in comparison with the reference, with the cGAN model best capturing MWF variabilities in small structures. By estimating the average adjusted coefficient of determination of the GLM with quadratic regressors, we showed that 87% of the variability in the MWF values can be explained by relaxation times alone. Further quantitative analysis showed an average RMSE smaller than 0.1% for all methods. The ICC was greater than 0.81 for all methods, and the bias smaller than 2.19%. It was concluded that this work confirms the notion that relaxometry parameters contain a large part of the information on myelin water and that MWF maps can be generated from T1 /T2 data with minimal error. Among the investigated modeling approaches, the cGAN provided maps with the best trade-off between accuracy and blurriness. Fast relaxometry, like the 6 min 24 s whole-brain protocol used in this work in conjunction with machine learning, may thus have the potential to replace time-consuming MESE acquisitions.

Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer.

AIMS: To evaluate spectral photon-counting CT's (SPCCT) objective image quality characteristics in vitro, compared with standard-of-care energy-integrating-detector (EID) CT. METHODS: We scanned a thorax phantom with a coronary artery module at 10 mGy on a prototype SPCCT and a clinical dual-layer EID-CT under various conditions of simulated patient size (small, medium, and large). We used filtered back-projection with a soft-tissue kernel. We assessed noise and contrast-dependent spatial resolution with noise power spectra (NPS) and target transfer functions (TTF), respectively. Detectability indices (d') of simulated non-calcified and lipid-rich atherosclerotic plaques were computed using the non-pre-whitening with eye filter model observer. RESULTS: SPCCT provided lower noise magnitude (9-38% lower NPS amplitude) and higher noise frequency peaks (sharper noise texture). Furthermore, SPCCT provided consistently higher spatial resolution (30-33% better TTF10). In the detectability analysis, SPCCT outperformed EID-CT in all investigated conditions, providing superior d'. SPCCT reached almost perfect detectability (AUC ≈ 95%) for simulated 0.5-mm-thick non-calcified plaques (for large-sized patients), whereas EID-CT had lower d' (AUC ≈ 75%). For lipid-rich atherosclerotic plaques, SPCCT achieved 85% AUC vs. 77.5% with EID-CT. CONCLUSIONS: SPCCT outperformed EID-CT in detecting simulated coronary atherosclerosis and might enhance diagnostic accuracy by providing lower noise magnitude, markedly improved spatial resolution, and superior lipid core detectability.

Validating atlas-based lesion disconnectomics in multiple sclerosis: A retrospective multi-centric study.

The translational potential of MR-based connectivity modelling is limited by the need for advanced diffusion imaging, which is not part of clinical protocols for many diseases. In addition, where diffusion data is available, brain connectivity analyses rely on tractography algorithms which imply two major limitations. First, tracking algorithms are known to be sensitive to the presence of white matter lesions and therefore leading to interpretation pitfalls and poor inter-subject comparability in clinical applications such as multiple sclerosis. Second, tractography quality is highly dependent on the acquisition parameters of diffusion sequences, leading to a trade-off between acquisition time and tractography precision. Here, we propose an atlas-based approach to study the interplay between structural disconnectivity and lesions without requiring individual diffusion imaging. In a multi-centric setting involving three distinct multiple sclerosis datasets (containing both 1.5 T and 3 T data), we compare our atlas-based structural disconnectome computation pipeline to disconnectomes extracted from individual tractography and explore its clinical utility for reducing the gap between radiological findings and clinical symptoms in multiple sclerosis. Results using topological graph properties showed that overall, our atlas-based disconnectomes were suitable approximations of individual disconnectomes from diffusion imaging. Small-worldness was found to decrease for larger total lesion volumes thereby suggesting a loss of efficiency in brain connectivity of MS patients. Finally, the global efficiency of the created brain graph, combined with total lesion volume, allowed to stratify patients into subgroups with different clinical scores in all three cohorts.

Fetal Brain Biometric Measurements on 3D Super-Resolution Reconstructed T2-Weighted MRI: An Intra- and Inter-observer Agreement Study.

We present the comparison of two-dimensional (2D) fetal brain biometry on magnetic resonance (MR) images using orthogonal 2D T2-weighted sequences (T2WSs) vs. one 3D super-resolution (SR) reconstructed volume and evaluation of the level of confidence and concordance between an experienced pediatric radiologist (obs1) and a junior radiologist (obs2). Twenty-five normal fetal brain MRI scans (18-34 weeks of gestation) including orthogonal 3-mm-thick T2WSs were analyzed retrospectively. One 3D SR volume was reconstructed per subject based on multiple series of T2WSs. The two observers performed 11 2D biometric measurements (specifying their level of confidence) on T2WS and SR volumes. Measurements were compared using the paired Wilcoxon rank sum test between observers for each dataset (T2WS and SR) and between T2WS and SR for each observer. Bland-Altman plots were used to assess the agreement between each pair of measurements. Measurements were made with low confidence in three subjects by obs1 and in 11 subjects by obs2 (mostly concerning the length of the corpus callosum on T2WS). Inter-rater intra-dataset comparisons showed no significant difference (p > 0.05), except for brain axial biparietal diameter (BIP) on T2WS and for brain and skull coronal BIP and coronal transverse cerebellar diameter (DTC) on SR. None of them remained significant after correction for multiple comparisons. Inter-dataset intra-rater comparisons showed statistical differences in brain axial and coronal BIP for both observers, skull coronal BIP for obs1, and axial and coronal DTC for obs2. After correction for multiple comparisons, only axial brain BIP remained significantly different, but differences were small (2.95 ± 1.73 mm). SR allows similar fetal brain biometry as compared to using the conventional T2WS while improving the level of confidence in the measurements and using a single reconstructed volume.

Long-term stability of soil bacterial and fungal community structures revealed in their abundant and rare fractions.

Despite the importance of soil microorganisms for ecosystem services, long-term surveys of their communities are largely missing. Using metabarcoding, we assessed temporal dynamics of soil bacterial and fungal communities in three land-use types, i.e., arable land, permanent grassland, and forest, over five years. Soil microbial communities remained relatively stable and differences over time were smaller than those among sites. Temporal variability was highest in arable soils. Indications for consistent shifts in community structure over five years were only detected at one site for bacteria and at two sites for fungi, which provided further support for long-term stability of soil microbial communities. A sliding window analysis was applied to assess the effect of OTU abundance on community structures. Partial communities with decreasing OTU abundances revealed a gradually decreasing structural similarity with entire communities. This contrasted with the steep decline of OTU abundances, as subsets of rare OTUs (<0.01%) revealed correlations of up to 0.97 and 0.81 with the entire bacterial and fungal communities. Finally, 23.4% of bacterial and 19.8% of fungal OTUs were identified as scarce, i.e., neither belonging to site-cores nor correlating to environmental factors, while 67.3% of bacterial and 64.9% of fungal OTUs were identified as rare but not scarce. Our results demonstrate high stability of soil microbial communities in their abundant and rare fractions over five years. This provides a step towards defining site-specific normal operating ranges of soil microbial communities, which is a prerequisite for detecting community shifts that may occur due to changing environmental conditions or anthropogenic activities.

Discriminating cognitive motor dissociation from disorders of consciousness using structural MRI.

An accurate evaluation and detection of awareness after a severe brain injury is crucial to a patient's diagnosis, therapy, and end-of-life decisions. Misdiagnosis is frequent as behavior-based assessments often overlook subtle signs of consciousness. This study aimed to identify brain MRI characteristics of patients with residual consciousness after a severe brain injury and to develop a simple MRI-based scoring system according to the findings. We retrieved data from 128 patients and split them into a development or validation set. Structural brain MRIs were qualitatively assessed for lesions in 18 brain regions. We used logistic regression and support vector machine algorithms to first identify the most relevant brain regions predicting a patient's outcome in the development set. We next built a diagnostic MRI-based score and estimated its optimal diagnostic cut-off point. The classifiers were then tested on the validation set and their performance compared using the receiver operating characteristic curve. Relevant brain regions predicting negative outcome highly overlapped between both classifiers and included the left mesencephalon, right basal ganglia, right thalamus, right parietal cortex, and left frontal cortex. The support vector machine classifier showed higher accuracy (0.93, 95% CI: 0.81-0.96) and specificity (0.97, 95% CI: 0.85-1) than logistic regression (accuracy: 0.87, 95% CI: 0.73 - 0.95; specificity: 0.90, 95% CI: 0.75-0.97), but equal sensitivity (0.67, 95% CI: 0.24-0.94 and 0.22-0.96, respectively) for distinguishing patients with and without residual consciousness. The novel MRI-based score assessing brain lesions in patients with disorders of consciousness accurately detects patients with residual consciousness. It could complement valuably behavioral evaluation as it is time-efficient and requires only conventional MRI.

Environmental and Anthropogenic Factors Shape Major Bacterial Community Types Across the Complex Mountain Landscape of Switzerland.

Mountain areas harbor large climatic and geographic gradients and form numerous habitats that promote high overall biodiversity. Compared to macroorganisms, knowledge about drivers of biodiversity and distribution of soil bacteria in mountain regions is still scarce but a prerequisite for conservation of bacterial functions in soils. An important question is, whether soil bacterial communities with similar structures share environmental preferences. Using metabarcoding of the 16S rRNA gene marker, we assessed soil bacterial communities at 255 sites of a regular grid covering the mountainous landscape of Switzerland, which is characterized by close location of biogeographic regions that harbor different land-use types. Distribution of bacterial communities was mainly shaped by environmental selection, as revealed by 47.9% variance explained by environmental factors, with pH (29%) being most important. Little additional variance was explained by biogeographic regions (2.8%) and land-use types (3.3%). Cluster analysis of bacterial community structures revealed six bacterial community types (BCTs), which were associated to several biogeographic regions and land-use types but overall differed mainly in their preference for soil pH. BCT I and II occurred at neutral pH, showed distinct preferences for biogeographic regions mainly differing in elevation and nutrient availability. BCT III and IV differed only in their preferred soil pH. BCT VI occurred in most acidic soils (pH 3.6) and almost exclusively at forest sites. BCT V occurred in soils with a mean pH of 4 and differed from BCT VI in preference for lower values of organic C, total nitrogen and their ratio. Indicator species and bipartite network analyses revealed 3,998 OTUs associating to different levels of environmental factors and BCTs. Taxonomic classification revealed opposing associations of taxa deriving from the same phyla. The results revealed that pH, land-use type, biogeographic region, and nutrient availability were the main factors shaping bacterial communities across Switzerland. Indicator species and bipartite network analyses revealed environmental preferences of bacterial taxa. Combining information of environmental factors and BCTs yielded increased resolution of the factors shaping soil bacterial communities and provided an improved biodiversity framework. OTUs exclusively associated to BCTs provide a novel resource to identify unassessed environmental drivers.

Reduced-iodine-dose dual-energy coronary CT angiography: qualitative and quantitative comparison between virtual monochromatic and polychromatic CT images.

OBJECTIVES: To quantitatively evaluate the impact of virtual monochromatic images (VMI) on reduced-iodine-dose dual-energy coronary computed tomography angiography (CCTA) in terms of coronary lumen segmentation in vitro, and secondly to assess the image quality in vivo, compared with conventional CT obtained with regular iodine dose. MATERIALS AND METHODS: A phantom simulating regular and reduced iodine injection was used to determine the accuracy and precision of lumen area segmentation for various VMI energy levels. We retrospectively included 203 patients from December 2017 to August 2018 (mean age, 51.7 ± 16.8 years) who underwent CCTA using either standard (group A, n = 103) or reduced (group B, n = 100) iodine doses. Conventional images (group A) were qualitatively and quantitatively compared with 55-keV VMI (group B). We recorded the location of venous catheters. RESULTS: In vitro, VMI outperformed conventional CT, with a segmentation accuracy of 0.998 vs. 1.684 mm2, respectively (p < 0.001), and a precision of 0.982 vs. 1.229 mm2, respectively (p < 0.001), in simulated overweight adult subjects. In vivo, the rate of diagnostic CCTA in groups A and B was 88.4% (n = 91/103) vs. 89% (n = 89/100), respectively, and noninferiority of protocol B was inferred. Contrast-to-noise ratios (CNR) of lumen versus fat and muscle were higher in group B (p < 0.001) and comparable for lumen versus calcium (p = 0.423). Venous catheters were more often placed on the forearm or hand in group B (p < 0.001). CONCLUSION: In vitro, low-keV VMI improve vessel area segmentation. In vivo, low-keV VMI allows for a 40% iodine dose and injection rate reduction while maintaining diagnostic image quality and improves the CNR between lumen versus fat and muscle. KEY POINTS: • Dual-energy coronary CT angiography is becoming increasingly available and might help improve patient management. • Compared with regular-iodine-dose coronary CT angiography, reduced-iodine-dose dual-energy CT with low-keV monochromatic image reconstructions performed better in phantom-based vessel cross-sectional segmentation and proved to be noninferior in vivo. • Patients receiving reduced-iodine-dose dual-energy coronary CT angiography often had the venous catheter placed on the forearm or wrist without compromising image quality.

Fast and high-resolution myelin water imaging: Accelerating multi-echo GRASE with CAIPIRINHA.

PURPOSE: Although several MRI methods have been explored to achieve in vivo myelin quantification, imaging the whole brain in clinically acceptable times and sufficiently high resolution remains challenging. To address this problem, this work investigates the acceleration of multi-echo T2 acquisitions based on the multi-echo gradient and spin echo (GRASE) sequence using CAIPIRINHA undersampling and adapted k-space reordering patterns. METHODS: A prototype multi-echo GRASE sequence supporting CAIPIRINHA parallel imaging was implemented. Multi-echo T2 data were acquired from 12 volunteers using the implemented sequence (1.6 × 1.6 × 1.6 mm3 , 84 slices, acquisition time [TA] = 10:30 min) and a multi-echo spin echo (MESE) sequence as reference (1.6 × 1.6 × 3.2 mm3 , single-slice, TA = 5:41 min). Myelin water fraction (MWF) maps derived from both acquisitions were compared via correlation and Bland-Altman analyses. In addition, scan-rescan datasets were acquired to evaluate the repeatability of the derived maps. RESULTS: Resulting maps from the MESE and multi-echo GRASE sequences were found to be correlated (r = 0.83). The Bland-Altman analysis revealed a mean bias of -0.2% (P = .24) with the limits of agreement ranging from -3.7% to 3.3%. The Pearson's correlation coefficient among MWF values obtained from the scan-rescan datasets was found to be 0.95 and the mean bias equal to 0.11% (P = .32), indicating good repeatability of the retrieved maps. CONCLUSION: By combining a 3D multi-echo GRASE sequence with CAIPIRINHA sampling, whole-brain MWF maps were obtained in 10:30 min with 1.6 mm isotropic resolution. The good correlation with conventional MESE-based maps demonstrates that the implemented sequence may be a promising alternative to time-consuming MESE acquisitions.

Impact of CT venography added to CT pulmonary angiography for the detection of deep venous thrombosis and relevant incidental CT findings.

OBJECTIVES: To assess the additional diagnostic value of CT venography (CTV) simultaneously performed with CT pulmonary angiography (CTPA) in the context of thromboembolic disease for the detection of deep venous thrombosis (DVT) and other relevant incidental CT findings. MATERIALS AND METHODS: Retrospectively and consecutively, we included all patients referred to our emergency department within the last 24 months for suspected pulmonary embolism (PE) who underwent CTPA combined with CTV. Two radiologists blinded to clinical information and results independently analysed CTV images in the context of DVT of the lower extremities and other, unsuspected abdominal/pelvic findings. These latter were classified as relevant with therapeutic consequences or irrelevant. One radiologist reviewed patient clinical records. Inter-observer agreement for DVT detection was calculated. RESULTS: Of 696 patients, 119 had PE (17.1%) and 54 had DVT (7.8%), 16 (2.3%) of them without concomitant PE. Inter-observer agreement between the two readers was substantial (kappa = 0.78). CTV examinations led to diagnosis of relevant incidental abdominal/pelvic findings in 40 (5.7%) patients, including 11 with new malignant tumours, and 8 with progressive metastatic disease. The evaluated clinical and biological risk factors were not significantly associated with the presence of relevant incidental findings. CTV changed therapeutic management in 29 patients (4.3%): 15 had DVTs without PE, and 14 had abdominal/pelvic findings with therapeutic consequences. CONCLUSION: CTV simultaneously performed with CTPA offers limited incremental value for detecting DVT. It may reveal other relevant findings leading to therapeutic changes, but the low rate does not justify screening patients with suspected PE.

Neck-MRI experience for investigation of survived strangulation victims.

For the medicolegal evaluation of victims of survived strangulation, a neck-magnetic resonance imaging (MRI) can be performed for assessing lesions in the inner soft tissues (fat, muscles or lymph nodes, for example). In our institute, such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation. We retrospectively reviewed medicolegal reports from all victims examined during the test period. We extracted objective lesions (e.g. petechiae, bruising and abrasions) and reported clinical symptoms (e.g. vision disorder, dysphasia) from the reports. These findings were compared to those reported from the neck-MRI. In total, 112 victims were clinically examined after suspected strangulation. Eleven of these victims underwent an MRI examination of the neck. Eighty-four of the victims presented objective lesions during the clinical examination, with eight showing signs of both petechiae and bruising. Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI. Of 76 victims with bruising as the only objective finding, 66 victims described clinical symptoms. Of those 66 victims, seven were examined by MRI and two demonstrated lesions in MRI. When MRI was performed, relevant findings were detected in 45% of the cases. This leads to the suspicion that many more findings could have been detected in the other victims, if an MRI had been performed in those cases. Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful, and strict indications for its application should be established.