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Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities., (© 2023. The Author(s).)

Purpose: To investigate the efficacy of virtual monochromatic spectral computed tomography imaging (VMI) in the preoperative evaluation for intraductal spread of breast cancer., Materials and Methods: Twenty-four women who underwent spectral CT and were pathologically diagnosed with ductal carcinoma with a ≥ 2-cm noninvasive component were retrospectively enrolled in Group 1. Twenty-two women with 22 lesions pathologically diagnosed with ductal carcinoma in situ or microinvasive carcinoma were enrolled in Group 2. We compared the contrast-to-noise ratios (CNRs) of the lesions on conventional 120-kVp CT images and 40-keV VMIs in Group 1. Two board-certified radiologists measured the maximum diameters of enhancing areas on 120-kVp CT, 40-keV VMI, and MRI in Group 2 and compared with histopathological sizes., Results: The quantitative assessment of Group 1 revealed that the mean ± SD of the CNRs in the 40-keV images were significantly greater than those in the 120-kVp images (5.5 ± 1.9 vs. 3.6 ± 1.5, p < 0.0001). The quantitative assessment of Group 2 demonstrated that the lesion size observed in the conventional 120-kVp CT images by both readers was significantly underestimated as compared to the histopathological size (p = 0.017, 0.048), whereas both readers identified no significant differences between the lesion size measured on 40-keV VMI and the histopathological data. In a comparison with MRI, 40-keV VMI provided measurement within a 10-mm error range in more lesions as compared to the conventional 120-kVp CT., Conclusion: VMI improves the evaluation of intraductal spread and is useful for the preoperative evaluations of breast cancer., (© 2023. The Author(s).)

Objective: A phantom for diffusion-weighted imaging is required to standardize quantitative evaluation. The objectives were to develop a phantom simulating various cell densities and to evaluate repeatability., Materials and Methods: The acrylic fine particles with three different diameters were used to simulate human cells. Four-degree cell density components were developed by adjusting the volume of 10-μm particles (5, 20, 35, and 50% volume, respectively). Two-degree components to simulate cell edema were also developed by adjusting the diameter without changing number (17% and 40% volume, respectively). Spearman's rank correlation coefficient was used to find a significant correlation between apparent diffusion coefficient (ADC) and particle density. Coefficient of variation (CV) for ADC was calculated for each component for 6 months. A p value < 0.05 represented a statistically significance., Results: Each component (particle ratio of 5, 17, 20, 35, 40, and 50% volume, respectively) presented ADC values of 1.42, 1.30, 1.30, 1.12, 1.09, and 0.89 (× 10 -3 mm 2 /s), respectively. A negative correlation (r =  - 0.986, p < 0.05) was observed between ADC values and particle ratio. CV for ADC was less than 5%., Discussion: A phantom simulating the diffusion restriction correlating with cell density and size could be developed.

Purpose: To evaluate the detectability of AKA on aortic computed tomography angiography (CTA) using ultra-high-resolution computed tomography (UHRCT)., Materials and Methods: Twenty-eight patients were enrolled. They underwent aortic CTA with UHRCT (UHRCTA) and had previously undergone aortic conventional CTA (CCTA). The injection protocol of UHRCTA was the same as that of CCTA. The bolus tracking technique was used. UHRCTA images were reconstructed with adaptive iterative dose reduction (strong) and with forward-projected model-based iterative reconstruction solution. The matrix size and slice thickness on UHRCT were 1024 and 0.25 mm, respectively, and those on conventional CT were 512 and 0.5 or 0.67 mm, respectively. The UHRCTA and CCTA images were visually compared by using four scales. A score of 4 or 3 indicated that the AKA was assessable. In this instance, the contrast-to-noise ratios of each UHRCTA were measured. The exposure dose and signal-to-noise ratios were also investigated., Results: The AKA visualization scores obtained with UHRCTA with forward-projected model-based iterative reconstruction solution were significantly higher than those with adaptive iterative dose reduction (p = 0.018) and CCTA (p = 0.0024)., Conclusion: UHRCT can contribute to the better visualization of the AKA on aortic CTA.

Objectives: It is necessary to standardize the examination procedure and diagnostic criteria of diffusion tensor imaging (DTI). Thus, the purpose of this study was to examine the reproducibility of measurements using a standardization phantom composed of different fibre materials with different fibre densities (FDs) for the evaluation of fractional anisotropy (FA) derived from DTI., Materials and Methods: Two types of fibre materials wrapped in heat-shrinkable tubes were used as fibre phantoms. We designed fibre phantoms with three different FDs of each fibre material. The standardization phantom was examined using DTI protocol six times a day, and each examination session was repeated once a month for 7 consecutive months. Fibre tracking was performed by setting regions of interest in the FA map, and FA was measured in each fibre phantom. Coefficients of variation (CVs) were used to evaluate the inter-examination reproducibility of FA values. Furthermore, Bland-Altman plots were used to evaluate the intra-operator reproducibility of FA measurements., Results: All CVs for each fibre phantom were within 2% throughout the 7-month study of repeated DTI sessions. The high intra-operator reproducibility of the FA measurement was confirmed., Discussion: High reproducibility of measurements using a standardization phantom for the evaluation of FA was achieved.

To investigate the performance of second-generation 320-row computed tomographic (CT) angiography (CTA) in detecting coronary arteries and identify factors influencing visibility of the coronary arteries in infants with complex congenital heart disease (CHD). Data of 60 infants (aged 0-2 years, median 2 months) with complex CHD who underwent examination using 320-row CTA with low-dose prospective electrocardiogram-triggered volume target scanning were reviewed. The coronary arteries of each infant were assessed using a 0-4-point scoring system based on the number of coronary segments with a visible course. Clinical parameters, the CT value in the ascending aorta, image noise, and the radiation dose were subjected to univariate and multivariate analyses. The mean coronary score for all examinations was 2.6 ± 1.5 points. The mean attenuation in the ascending aorta was 306.7 ± 66.2 HU and the mean standard deviation was 21.7 ± 4.4. The mean effective radiation dose was 1.27 ± 0.39 mSv. Multivariate regression analysis showed significant correlations between coronary score and body weight (p < 0.05) and between coronary score and the CT value in the ascending aorta (p < 0.02). Second-generation 320-row CTA with prospective electrocardiogram-triggered volume target scanning and hybrid iterative reconstruction allows good visibility of the coronary arteries in infants with complex CHD. Body weight and the CT value in the ascending aorta are important factors influencing the visibility of the coronary arteries in infants.

To investigate the effect of breath-holding on left-to-right shunts in patients with a secundum atrial septal defect (ASD). Thirty-five consecutive patients with secundum ASDs underwent right heart catheterization and invasive oximetry. Phase-contrast magnetic resonance imaging (MRI) was performed for the main pulmonary artery and ascending aorta. All measurements were obtained during free breathing (FB) (quiet breathing; no breath-hold), expiratory breath-hold (EBH), and inspiratory breath-hold (IBH). Pulmonary circulation flow (Qp) and systemic circulation flow (Qs) were calculated by multiplying the heart rate by the stroke volume. Measurements during FB, EBH, and IBH were compared, and the differences compared to invasive oximetry were evaluated. There were significant differences among the measurements during FB, EBH, and IBH for Qp (FB, 7.70 ± 2.68; EBH, 7.18 ± 2.34; IBH, 6.88 ± 2.51 l/min); however, no significant difference was found for Qs (FB, 3.44 ± 0.74; EBH, 3.40 ± 0.83; IBH, 3.40 ± 0.86 l/min). There were significant differences among the measurements during FB, EBH, and IBH for Qp/Qs (FB, 2.38 ± 1.12; EBH, 2.24 ± 0.95; IBH, 2.14 ± 0.97). Qp/Qs during FB and EBH correlated better with Qp/Qs measured by invasive oximetry than did IBH. The limit of agreement was smaller for EBH than for FB and IBH. In patients with secundum ASDs, Qp/Qs significantly decreased with breath-holding. The accuracy of the Qp/Qs measurement by MRI compared with invasive oximetry during EBH was higher than during FB and IBH.