Post-mortem computed tomography compared to medico-legal autopsy – pathologies in the torso and limbs

Publication date: Available online 15 December 2017
Source:Journal of Forensic Radiology and Imaging
Author(s): Adi Adelman, Margarita Vasserman, Gil Graziani, Chen Kugel, Karen Meir, Tali Bdolah-Abram, Alon Krispin
IntroductionPost-mortem computed tomography (PMCT) has become a routine part of post-mortem forensic evaluation in many institutes worldwide. Its added benefit to the traditional autopsy is indisputable, but its ability to detect different findings compared to those found in an autopsy has only been evaluated in a limited number of large scale studies.MethodsIn this retrospective study, we assessed the agreement between autopsy and PMCT, and their ability to detect pathological findings (by "Kappa" and "McNemar" scores, respectively), using all finding of both methods as reference standard. We included findings in the torso and the limbs extracted from autopsy and PMCT reports of 105 consecutive cases.ResultsThe level of agreement between autopsy and PMCT depends on the tissues, locations, and type of pathologies examined. Autopsy much better demonstrates bullet tracks (68/76 vs. 18/76, p<0.01) and stab wounds (22/25 vs. 11/25, p=0.013), while PMCT is more sensitive to shrapnel (86/121 vs. 37/121, p<0.001). PMCT better demonstrates fractures (259/344 vs. 222/344, p=0.012), especially in bones that are hard to access in autopsy, but is less sensitive to rib fractures (137/177 vs. 115/177, p=0.037). Parenchymal organ pathologies are not well demonstrated by PMCT (194/257 vs. 117/257, p=<0.001).ConclusionsShrapnel, foreign bodies, gas-related pathologies, pelvic fluid and fractures, excluding rib fractures, are detected more often by post-mortem CT. It is important to consider PMCT as a tool in the evaluation of specific tissues and organs, possibly providing solid answers, or at least directing the team in the performance of the autopsy.



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Low Tube Voltage and Iterative Model Reconstruction in Follow-up CT Angiography After Thoracic Endovascular Aortic Repair

Publication date: Available online 14 December 2017
Source:Academic Radiology
Author(s): Ping Hou, Xiangnan Feng, Jie Liu, Xiaopeng Wang, Yaojun Jiang, Leigang Dong, Jianbo Gao
Rationale and ObjectivesThis study aimed to investigate the feasibility of reducing radiation exposure and contrast medium (CM) dose in follow-up computed tomography angiography (CTA) after thoracic endovascular aortic repair (TEVAR) using low tube voltage and knowledge-based iterative model reconstruction (IMR).Materials and MethodsThirty-six patients that required follow-up CTA after TEVAR were included in this intra-individual study. The conventional protocol with standard tube voltage of 120 kVp and CM volume of 70 mL was applied in the first follow-up CTA of all the patients (control group A). The ultra-low CM dose protocol with low tube voltage of 80 kVp and weight-adapted CM volume of 0.4 mL/kg was utilized in the second follow-up CTA (study group B). Set A.FBP (group A filtered back-projection) contained images for group A that were reconstructed through FBP method. Three sets (B.FBP, B.HIR, and B.IMR) for group B were reconstructed using three methods, FBP, hybrid iterative reconstruction (HIR), and IMR, respectively. Objective measurements including aortic attenuations, image noise, contrast-to-noise ratios (CNRs), and figure of merit of CNR (FOMCNR), and subjective rating scores of the four image sets were compared.ResultsCompared to the images in set A.FBP, the images in set B.IMR had better quality in terms of equivalent attenuation values, equivalent subjective scores, lower noise, higher or equivalent CNRs, and higher FOMCNR. The quality of images in sets B.FBP and B.HIR was unacceptable. The radiation exposure and CM dose in group B were 1.94 mGy and 28 ± 5 mL, respectively, representing reductions of 77.6% (P < .001) and 60% (P < .001) as compared to those in group A.ConclusionsIn follow-up examinations after TEVAR, CTA with ultra-low radiation exposure and CM dose is feasible using low tube voltage and IMR for nonobese patients.



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Volumetric MRI in Neurofibromatosis Type 1 (NF1) Comes of Age to Help Determine Initiation and Monitoring of Targeted Therapies for Plexiform Neurofibromas

Publication date: Available online 13 December 2017
Source:Academic Radiology
Author(s): David Viskochil, Luke L. Linscott




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Essentials of Statistical Methods for Assessing Reliability and Agreement in Quantitative Imaging

Publication date: Available online 11 December 2017
Source:Academic Radiology
Author(s): Arash Anvari, Elkan F. Halpern, Anthony E. Samir
Quantitative imaging is increasing in almost all fields of radiological science. Modern quantitative imaging biomarkers measure complex parameters including metabolism, tissue microenvironment, tissue chemical properties or physical properties. In this paper, we focus on measurement reliability assessment in quantitative imaging. We review essential concepts related to measurement such as measurement variability and measurement error. We also discuss reliability study methods for intraobserver and interobserver variability, and the applicable statistical tests including: intraclass correlation coefficient, Pearson correlation coefficient, and Bland-Altman graphs and limits of agreement, standard error of measurement, and coefficient of variation.



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Understanding Patient Preference in Female Pelvic Imaging

Publication date: Available online 11 December 2017
Source:Academic Radiology
Author(s): Michelle D. Sakala, Ruth C. Carlos, Mishal Mendiratta-Lala, Elisabeth H. Quint, Katherine E. Maturen
Rationale and ObjectivesWomen with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity.Materials and MethodsInstitutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations.ResultsUsing Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] −1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI (P < .0001), but greater fear and anxiety both before (P < .0001) and during (P < .001) MRI, and greater mental (P = .02) and physical (P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = −0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = −0.28, P = .04) and sexual dysfunction (R = −0.30, P = .03) rated MRI more negatively.ConclusionWomen with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.



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Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings

Abstract

Smoking-related lung abnormalities are now an increasing public health concern. According to the findings of large-cohort studies, approximately 8% of smokers have interstitial lung abnormalities, which are associated with a relatively high risk of all-cause mortality. We reviewed the radiological and pathological findings of smoking-related interstitial lung diseases, such as respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia, and airspace enlargement with fibrosis. We have also discussed the histological basis of unclassifiable interstitial pneumonia in smokers, which exhibits airway-centered cystic lesions with fibrosis. A variety of radiological findings coexist in the lungs of a smoker. This overlapping of multiple pathological conditions might cause the radiological patterns of diseases to become unclassifiable. Therefore, diagnosis should be performed not on the basis of a single radiological finding, but in a comprehensive manner, by including clinical symptoms and disease behavior. Among interstitial abnormalities in smokers, the usual interstitial pneumonia (UIP) pattern is correlated with a worse prognosis than others. Basal-predominant subpleural reticulation is a clue for accurate diagnosis of UIP, which can be achieved by computer-aided quantitative analysis.

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Comment on “Epidermal growth factor receptor mutation predicts favorable outcomes in non-small cell lung cancer patients with brain metastases treated with stereotactic radiosurgery”, by Yang WC et al.

We read with great interest the article from Yang et al. named "Epidermal growth factor receptor mutation predicts favorable outcomes in non-small cell lung cancer patients with brain metastases treated with stereotactic radiosurgery" [1]. In this large retrospective review of 147 patients undergoing stereotactic radiosurgery (SRS) for brain metastasis (BM) of non-small cell lung cancer (NSCLC), the authors were able to conclude that the presence of an Epidermal Growth Factor Receptor mutation (EGFR) was associated with better outcomes compared to wild type (wt) EGFR.

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