Background: Conventional deep-learning reconstruction (DLR) CT methods provide noise reduction but limited improvements in spatial resolution. Objective: To compare a novel super-resolution DLR (SR-DLR) algorithm and a hybrid iterative reconstruction (HIR) algorithm in terms of stent visualization and diagnostic performance for in-stent restenosis on coronary CTA using invasive coronary angiography (ICA) as the reference. Methods: This prospective study enrolled patients undergoing coronary CTA at 11 centers in China from September 2023 to November 2024. Participants underwent coronary CTA using a normal-resolution 320-row MDCT scanner with reconstruction of HIR and SR-DLR images. The final study sample included participants with a coronary stent who underwent ICA within 2 months after CTA. CNRstent, stent-lumen attenuation increase ratio (SAIR), and stent edge sharpness were calculated. Two radiologists (R1, R2) independently assessed stents for subjective image quality (1-5 scale; 5=highest quality), diagnostic confidence (1-5 scale; 5=greatest confidence), and in-stent restenosis (defined as ≥50% stenosis). HIR and SR-DLR were compared using ICA as the reference for in-stent restenosis. Results: The analysis included 73 participants (62 men, 11 women; mean age, 65.5±10.3 years) with 110 stents. SR-DLR, compared with HIR, showed greater CNRstent (44.0±20.1 vs 33.6±15.7), lower SAIR (0.44±0.36 vs 0.71±0.55), and greater edge sharpness (469±261 vs 221±130 HU/mm) (all p<.05). SR-DLR, compared with HIR, showed greater subjective image quality (both readers: median, 4 vs 3) and greater diagnostic confidence (both readers: median, 4 vs 3) (all p<.001). SR-DLR, compared with HR, showed greater accuracy for in-stent restenosis among all stents in per-stent analysis (R1: 89.1% vs 79.1%; R2: 88.2% vs 77.3%) and per-patient analysis (R1: 89.0% vs 79.5%; R2: 87.7% vs 72.6%) and among stents with diameter ≤3.0 mm in per-stent analysis (R1: 91.5% vs 81.4%; R2: 93.2% vs 81.4%) and per-patient analysis (R1: 90.7% vs 76.7%; R2: 93.0% vs 76.7%). Conclusions: SR-DLR, compared with HIR, yielded objective and subjective improvements in stent visualization, including differences attributable to reduced blooming artifacts, and greater diagnostic performance for in-stent restenosis. Clinical Impact: The novel SR-DLR algorithm improves the performance of coronary CTA obtained on conventional 320-row MDCT scanners and could support expanded use of CTA for stent evaluation.
1. Two additional cases of presumed, thorium-induced hemangioendothelioma of the liver are reported. 2. The angiographic pattern of large venous lakes conforms closely to the pathologic descriitions of this malignancy. 3. To our knowledge, angiography of the thorotrast (and vinyl chloride) liver, before the clinical evolution of malignancy, has not been recorded and may provide information of prognostic and therapeutic value. 4. Incidental identification of thorium deposits in the tissues of clinically healthy patients creates perplexing "inform and consent" problems. Presumably, these must be solved on an individual basis. 5. Because the use of thorotrast has been discontinued since the early 1950s, all physicians reviewing chest and abdominal roentgenograms should be aware of the characteristic appearance of human thorotrast deposits, especially in the liver, spleen and celiac lymph nodes. 6. The number of living thorotrast "carriers" and previous deaths from thorotrast related malignancy seems highly uncertain at this time.
A 7 year follow-up of 120 patients with malignant parotid cancers revealed parotidectomy to be an adequate procedure for low-grade, nonaggressive lesions. The addition of radiation therapy postoperatively will improve local and regional control of high-grade, aggressive lesions. Postoperative radiation therapy may also make the removal of the facial nerve unnecessary in certain clinical presentations.
The roentgenologic diagnosis and differentiation of mediastinal neurogenic tumors are possible on the chest roentgenogram as a rule. The soft tissue mass may be ill-defined and the tumor "ghost-like" in the case of primary neuroblastoma, but it is usually obvious in ganglioneuroma and metastatic disease. The presence of calcifications differentiates neurogenic tumors from other posterior mediastinal tumors of childhood. They are common in primary and rare in secondary disease. Rib erosions and displacement are striking in neuroblastoma (after a few months of age), more subtle in ganglioneuroma, and absent with secondary involvement. In 3 out of 7 posterior mediastinal neuroblastomas the diagnosis and treatment were delayed, as the adjacent rib changes were not appreciated for some time. "Dumbbell" shaped tumors are usually associated with vertebral changes and myelography is indicated even in the absence of neurologic deficit. Thoracic deformity and disability subsequent to laminectomy, radiation therapy, or both, are present in all survivors.
Permanent and removable interstitial implantation techniques using absorbable and unabsorbable sutures are described. Most of these techniques can be performed in the clinic easily and quickly with basic instruments: needle holder, needle book, and hemoclips. Specifically, Ir192 (74-4 day half life, 300-610 keV, and 6.0 cm. hvl in tissue) nylon ribbon and I125 (60 day half life, 27-35 keV, and 2.0 cm. hvl in tissue) Vicryl sutures are described. A major advantage of the I125 over the Ir192 see (other than the fact that it can be permanently implanted and needs less radiation protection) is that the patient does not remain highly radioactive for as long a period due to hte extremely low I125 energy and may be allowed to leave the hospital. Both nuclides have the advantage of a long shelf life, making their use practical and economically feasible.
Invasion of the esophagus by Candida albicans probably occurs more frequently than the reported cases suggest. The disease usually occurs following immunosuppression but may occur after antibiotic therapy. It is heralded by the sudden onset of severe pain and dysphagia, and recovery or death from dissemination may occur. Roentgenographically, impaired motility is much more prominent than disordered motility or spasm. Narrowing, a cobblestone epithelium, and later, erosions and ulcerations are seen. Antifungal agents are adequate therapy.
The navicular fat stripe (NFS) is a useful roentgenographic feature for evaluating traumatic wrist injury. A radiolucent stripe, cast by a thin collection of fat paralleling the lateral surface of the navicular bone, was seen in 96 percent of 400 normal wrists examined because of trauma. Obliteration or displacement of this line (positive NFS sign) is commonly present in acute fractures of the naviculum, radial styloid process, and proximal first metacarpus. A ositive NFS sign serves to alert the radiologist that an underlying fracture is likely. In particular, the NFS sign generally accompanies a navicular fracture.
Two unusual causes of bone defect in the finger are described. In one patient, erosion of the proximal phalanx was caused by a ring that eroded its way through the soft tissue and bone after an injury. In the other, a subungual wart caused a defect on the distal phalanx.
Congenital subglottic stenosis, which is life-threatening to the infant, can be diagnosed by the correlation of the clinical and the roentgenologic findings. The main clinical sign is the persistence of stridor from birth. The indicative roentgenologic finding is a symmetrical narrowing of the subglottic segment which is constant in form and length during the various phases of the respiratory cycle. Two cases are presented, one confirmed by postmortem examination and the other by endoscopy. The etiology of this condition and the differential diagnosis are discussed.
Transient candiomegaly and congestive heart failure associated with a clinical picture of hydrops fetalis were seen in 2 newborn infants.In both instances the placenta harbored large hemangiomas (chorioangiomas), which have been described as functioning large arteriovenous fistulae.It is almost certain that cardiomegaly under these circumstances is caused by systemic hypotension, increased vascular volume, and high output failure known to accompany other systemic arteriovenous shunts in the neonate, such as large cutaneous hemangiomas, hemangio-endotheliomas of the liver and arteriovenous aneurysm of the vein of Galen.Because of their location, chorioangiomas are associated with a more complex clinical syndrome, which frequently includes hydramnios.Chorioangiomas should be included in the differential diagnosis of neonatal cardiomegaly and maternal hydramnios.
Superior mesenteric arteriography can often demonstrate actively bleeding marginal ulcers. Five cases diagnosed by angiography are reported. Pitressin infusions of the superior mesenteric artery stopped bleeding permanently in two cases, transiently in two cases, and was not attempted in one case. Pitressin infusions of the superior mesenteric artery should be attempted before surgery is performed for bleeding marginal ulcers.
Radionuclide perfusion lymphangiography using /sup 99m/Tc-albumin requires a bipedal cannulation of peripheral lymphatics and may therefore be performed as an examination preliminary to standard Ethiodol lymphangiography. Experience in 13 dogs, including 2 with disseminated lymphosarcomas, and in a pilot series of 41 patients with various disorders, has shown the ability of this radionuclide technique to provide rapid gross visualization of lymph flow patterns and groups of nodes in the lymphatic chains of the extremities, the lateral pelvic walls, and the periaortic regions. In the 2 animals with generalized lymphosarcoma, and in the 21 patients in whom definitive pathologic or clinical proof of lymph node normality or involvement by tumor is now available, there have been no false negative radionuclide perfusion lymphangiograms. (auth)
Thirty-one cases of cystic adenomatoid malformation were reviewed at the Armed Forces Institute of Pathology.Of this group 15 had roentgenograms.The most common roentgen pattern is that of a multicystic lucent lesion with cyst expansion and mediastinal shift. The cyst walls are usually thick with some variation and are composed of small nonexpanded adenomatoid cysts, alveoli, blood vessels and atelectatic areas. These cysts commonly contain fluid at gross cutting and often demonstrate air-fluid levels on roentgenograms.Respiratory distress is related to the degree of lung involvement and expansion of the adenomatoid cysts.The roentgenologist and pediatrician play a significant role in patient management through accurate diagnosis, since infant survival depends on subsequent prompt surgical removal of the affected lung tissue.
