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

这个项目是我实验室去年的主要工作。在临床应用方面，我们开发了高分辨率（UHR）CT和定量CT（qCT）技术，用于4种临床方案： 方案96-H-0100，LAM和其他罕见囊性肺疾病，PI Joel Moss，NHLBI肺分支， 迄今为止，327例患者接受了我们的UHR和/或qCT研究。该研究揭示了LAM患者中非常小的肺囊肿的存在和功能影响（1）;它发现囊肿的不同特征与肺的通气与扩散能力相关。这项工作在美国胸科学会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CT技术不断发展的二十年中，纵向qCT测量结果存在不一致性，这使得难以评估治疗对放射学异常的影响。为了解决这个问题，我们发起了与Hui Xues AI团队的合作，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图像分割可靠性的能力。 方案20-CC-0113，COVID-19对肺部的长期影响，PI Anthony Suffredini，NIH临床中心重症监护医学。在本方案中，迄今为止已有47例患者接受了我们的UHR和/或qCT研究。我们特别指出，即使在胸部CT正常化的患者中，3个月和6个月时DLCO持续低值也需要进一步讨论。因此，解读VA和KCO之间作为DLCO降低的因果因素对于推断潜在的肺结构变化与间质性异常或肺血管异常至关重要。(3)我们开发了一种全自动的方法来测量恢复正常的胸部CT患者的高分辨率胸部容积CT（HRCT）扫描中的小血管体积分数。我们在该患者队列的一个亚组中的初步研究结果在美国胸科学会2022年会议上发表（4）。我们随后完成了全面分析。我们目前正在准备一份报告我们结论的手稿。 方案19-CC-0070，采用方案类型光子计数CT对肾脏肿块进行高分辨率成像，PI Elizabeth Jones，NIH临床中心放射科。 24名患者在临床中心放射科的光子计数CT上使用我们的超高分辨率方案进行扫描。我们开发了成像协议，以优化该特定扫描仪上图像分辨率和组织对比度之间的平衡。对于每个患者扫描，我实验室的一名成员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的一篇论文中进行了报道，题为“光子计数CT在肾脏肿块表征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。 方案18-H-0108，遗传性疾病ACDC，PI Manfred Boehm，NHLBI转化血管医学。我们每年对ACDC患者进行超高分辨率下肢CT扫描，并开发了一种qCT程序来量化这些患者下肢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方法，以提高临床扫描仪的分辨率，超越硬件限制。它是一种混合CT系统，在标准临床扫描仪中集成了一个与患者身体接触的紧凑型光子计数探测器。我们开发了一种在线校准方法，以允许从探测器插入物的数据进行准确的图像重建，并融合来自探测器插入物和CT扫描仪探测器的图像。该方法报告在题为在线几何校准的混合CT系统的超高分辨率成像在断层扫描审查的手稿。预印本可在arxiv.org上获得。 引用 1. Matthew BP，Hasani AM，Chen Y-C，Pirooznia M，Stylianou M，Rollison SF，马查多TR，Quade NM，Jones AM，Julien-Williams P，Taveira-DaSilva A，Chen MY，Moss J，Wen H.淋巴管平滑肌瘤病中的超小肺囊肿损害扩散而不阻塞气流。CHEST 2021;160：199208. 2. 马修B p，Lebron A，Chen Y-C，Pirooznia M，Rollison S，Worthy T a.，琼斯，Julien-Williams P，Chen M y.，Moss J，Wen H.在淋巴管平滑肌瘤病患者中，肺囊肿的总表面积比基于体积的囊肿评分更好地预测一氧化碳的肺扩散能力。C103它只是IPF美国胸科学会; 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.欧洲呼吸学会关于COVID长期随访的声明。Eur Respir J 2022;60：. 4. Wen H，坎斯S m.，Huapaya J a.，Do H，Chen M y.，Malayeri A a.，Suffredini A f.定量CT扫描与具有清晰胸部CT的COVID-19确诊患者的肺弥散能力离散度相关。C30 LIFE LUNS COVID FUNCT RECOVERY OUTCOMES SARS-CoV2 Infect American Thoracic Society; 2022. 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.