Ultra-high resolution CT and quantitative CT development and clinical applications

这个项目是我的实验室过去一年的主要工作。在临床应用方面，我们开发了超高分辨率(UHR)CT和定量CT(QCT)技术，用于4种临床方案： 方案96-H-0100，LAM和其他罕见的囊性肺疾病，PiJoel Moss，NHLBI肺科， 到目前为止，已有327名患者接受了我们的UHR和/或QCT研究。这项研究揭示了LAM患者中非常小的肺囊肿的存在和对功能的影响(1)；研究发现，囊肿的不同特征与肺的通气量和弥散量有关。这项研究已在美国胸科学会2022年会议上发表(2)，目前正在为《欧洲呼吸杂志》准备手稿。我们还发现，在20年来不断发展的CT技术中，纵向QCT测量存在不一致之处，这使得评估放射学异常治疗的效果变得困难。为了解决这个问题，我们发起了一个与Xue博士AI小组的合作，以评估深度学习神经网络算法在不同图像质量下提高自动肺部CT图像分割的可靠性的能力。 协议20-CC-0113，新冠肺炎在肺中的长期效应，皮安东尼·萨弗雷迪尼，美国国立卫生研究院临床中心重症监护医学。在这个方案中，到目前为止，有47名患者接受了我们的UHR和/或QCT研究。我们特别讨论了在3个月和6个月时DLCO持续低值的问题，即使在胸部CT正常化的患者中也是如此，这增加了进一步讨论的必要性。因此，破译VA和KCO之间的关系作为DLCO降低的原因，对于推断潜在的肺结构变化是至关重要的，无论是间质异常还是肺血管异常。(3)我们开发了一种全自动方法来测量正常胸部CT恢复患者的高分辨率容积CT(HRCT)扫描中的小血管体积分数。我们在该患者队列中的一个亚组中的初步发现在美国胸科学会2022年会议上公布(4)。我们随后完成了全面的分析。我们目前正在准备一份手稿来报告我们的结论。 协议19-CC-0070，使用协议类型光子计数CT对肾脏肿块进行高分辨率成像，Pi Elizabeth Jones，美国国立卫生研究院临床中心放射学。24名患者在临床放射中心的光子计数CT上使用我们的超高分辨率扫描方案进行扫描。我们开发了成像协议，以优化这台特殊扫描仪的图像分辨率和组织对比度之间的平衡。对于每一次患者扫描，我的实验室的一名成员都在现场执行扫描仪校准，协助扫描操作并执行部分图像重建。这项工作在《放射学》杂志上发表了一篇正在审阅的手稿，题为《光子计数CT在肾脏肿块定性中的可靠性和有效性的前瞻性初步研究》。我实验室的两名成员是合著者。 协议18-H-0108，遗传病ACDC，Pi Manfred Boehm，NHLBI转译血管医学。我们每年对ACDC患者进行超高分辨率的下肢CT扫描，并开发了一种QCT程序来量化这些患者小腿动脉钙化的进展或消退。 在技术开发方面，我们继续推进我们发明的一种方法，以提高临床扫描仪的分辨率，使其超越硬件限制。它是一种混合CT系统，结合了一个紧凑的光子计数探测器，放置在标准临床扫描仪中与患者身体接触。我们开发了一种在线校准方法，可以根据探测器插入的数据进行准确的图像重建，并融合来自探测器插入和CT扫描仪探测器的图像。该方法在一篇题为《用于超高分辨率成像的混合CT系统的在线几何校准》的手稿中被报道，该系统正在接受断层扫描的审查。预印本可在arxiv.org上找到。 参考文献 1.Matthew BP，Hasani AM，Chen Y-C，Pirooznia M，Stylianou M，Rollison SF，Machado Tr，Quade NM，Jones AM，Julien-Williams P，Taveira-DaSilva A，Chen My，Moss J，wen H。超小肺囊肿在不阻碍淋巴管肌瘤病气流的情况下阻碍扩散。《胸腔2021年》；第160页：199208页。 2.Matthew B p.，LeBron A，Chen Ye-C，Pirooznia M，Rollison S，Worthy Ta.，Jones Am.，Julien-Williams P，Chen My.，Moss J，Win H.在淋巴管肌瘤病患者中，肺囊肿总表面积比基于体积的囊肿评分更能预测肺一氧化碳弥散能力。C103《公正的IPF美国胸科学会》；2022年。P.A4894A4894.doi:10.1164/ajrccm-conference.2022.205.1_MeetingAbstracts.A4894. 3.Antoniou Km，Vasarmidi E，Russell A-M，Andrejak C，Crestani B，Delcroix M，Dinh-Xuan AT，Poletti V，Sverzellati N，Vitacca M，Witzenrath M，Tonia T，Swenvello A。欧洲呼吸学会关于COVID长期后续行动的声明。欧元报告J 2022；60：。 4.文和，坎特·S m.，华帕亚J a.，杜H，陈明义，Maleri A a.，Suffredini A f.胸部CT清晰的新冠肺炎康复者肺弥散能力的定量CT测量。C30生命肺COVID功能康复结果SARS-CoV2感染美国胸科学会；2022年。P.A3908A3908.doi:10.1164/ajrccm-conference.2022.205.1_MeetingAbstracts.A3908.

This project is the main effort of my lab for the last year. On the clinical application front, we developed ultrahigh resolution (UHR) CT and quantitative CT (qCT) technologies that are used in 4 clinical protocols: Protocol 96-H-0100, LAM and other rare cystic lung diseases, PI Joel Moss, NHLBI Pulmonary Branch, 327 patients have undergone our UHR and/or qCT study to date. The study uncovered the presence and functional impact of very small pulmonary cysts in LAM patients(1); it discovered that different characteristics of the cysts are associated with ventilation versus diffusion capacity of the lung. This work was presented at the American Thoracic Society 2022 meeting(2) and a manuscript is being prepared for European Respiratory Journal. We also found inconsistencies in longitudinal qCT measurements over two decades of evolving CT technology, which made it difficult to assess the effect of treatment on radiologic anomalies. To address the issue, we initiated a collaboration with Dr. Hui Xues AI group to evaluate the ability of deep-learning neural network algorithms to improve the reliability of automated lung CT image segmentation over diverse image quality. Protocol 20-CC-0113, COVID-19 long term effects in the lung, PI Anthony Suffredini, NIH Clinical Center Critical Care Medicine. In this protocol, 47 patients have undergone our UHR and/or qCT study to date. We specifically address the issue that the persistent low values of DLCO at 3 and 6 months, even in patients with normalised chest CT, raise the need for further discussion. Deciphering between VA and KCO as the causal factor for reduced DLCO is therefore critical to infer the underlying lung structural changes with either interstitial abnormalities or pulmonary vascular abnormalities.(3) We developed a fully automated method to measure the small blood vessel volume fraction in high-resolution volumetric chest CT (HRCT) scans of recovered patients with normalized chest CT. Our preliminary findings in a subgroup of this patient cohort was presented at the American Thoracic Society 2022 meeting(4). We subsequently finished the full analysis. We are currently preparing a manuscript to report our conclusion. Protocol 19-CC-0070, High-resolution imaging of renal masses with a protocol type photon-counting CT, PI Elizabeth Jones, NIH Clinical Center Radiology. 24 patients were scanned with our ultra-high resolution protocol on the photon-counting CT at Clinical Center Radiology. We developed the imaging protocol to optimize the balance between image resolution and tissue contrast on this particular scanner. For each patient scan a member of my lab was onsite to perform scanner calibration, assist with the scan operation and perform part of the image reconstruction. The work is reported in a manuscript under review at the journal Radiology, titled A Prospective Preliminary Study on the Reliability and Efficacy of Photon Counting CT in the Characterization of Renal Masses. Two members of my lab are co-authors. Protocol 18-H-0108, Genetic disease ACDC, PI Manfred Boehm, NHLBI Translational Vascular Medicine. We perform ultra-high resolution lower extremity CT scan on the ACDC patients on a yearly basis, and developed a qCT procedure to quantify the progression or regression of arterial calcification in the lower leg of these patients. On the technical development front, we continue to advance an approach we invented to improve resolution in clinical scanners beyond the hardware limit. It is a hybrid CT system that incorporates a compact photon-counting detector placed in contact with the patients body in a standard clinical scanner. We developed an online calibration method to allow accurate image reconstruction from the data of the detector insert and fusion of the images from the detector insert and CT scanners detector. The method is reported in a manuscript titled Online geometric calibration of a hybrid CT system for ultrahigh-resolution imaging under review at Tomography. Preprint is available at arxiv.org. References 1. Matthew BP, Hasani AM, Chen Y-C, Pirooznia M, Stylianou M, Rollison SF, Machado TR, Quade NM, Jones AM, Julien-Williams P, Taveira-DaSilva A, Chen MY, Moss J, Wen H. Ultra-Small Lung Cysts Impair Diffusion Without Obstructing Air Flow in Lymphangioleiomyomatosis. CHEST 2021;160:199208. 2. Matthew B p., Lebron A, Chen Y-C, Pirooznia M, Rollison S, Worthy T a., Jones A m., Julien-Williams P, Chen M y., Moss J, Wen H. Total Surface Area of Pulmonary Cysts Better Predicts the Diffusion Capacity of the Lung By Carbon Monoxide Than Volume-Based Cyst Score in Patients with Lymphangioleiomyomatosis. C103 ITS JUST IPF American Thoracic Society; 2022. p. A4894A4894.doi:10.1164/ajrccm-conference.2022.205.1_MeetingAbstracts.A4894. 3. Antoniou KM, Vasarmidi E, Russell A-M, Andrejak C, Crestani B, Delcroix M, Dinh-Xuan AT, Poletti V, Sverzellati N, Vitacca M, Witzenrath M, Tonia T, Spanevello A. European Respiratory Society statement on long COVID follow-up. Eur Respir J 2022;60:. 4. Wen H, Kanth S m., Huapaya J a., Do H, Chen M y., Malayeri A a., Suffredini A f. Quantitative CT Metrics Associated with the Dispersion in Diffusion Capacity of the Lung in Recovered Patients from COVID-19 with Clear Chest CTs. C30 LIFE LUNGS COVID Funct RECOVERY OUTCOMES SARS-CoV2 Infect American Thoracic Society; 2022. p. A3908A3908.doi:10.1164/ajrccm-conference.2022.205.1_MeetingAbstracts.A3908.