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  • 1.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Jansson, Kjell
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review2016Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, nr 6, s. 1766-1774Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels.

    Methods: Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present.

    Results: Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %.

    Conclusions: Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain.

    Key points: • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

  • 2.
    Geijer, Mats
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Gunnlaugsson, Eirikur
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Götestrand, Simon
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Weber, Lars
    Department of Radiation Physics, Skåne University Hospital, Lund, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Radiology.
    Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly2017Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, nr 2, s. 491-497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.

    Methods: Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55-92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose-area product values.

    Results: For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51-0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm(2)) for the combined examination. The resulting effective dose was 0.87 mSv.

    Conclusion: Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.

    KEY POINTS:• Tomosynthesis helps evaluate the thoracic spine in the elderly. • Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73). • Significantly more vertebrae and significantly more fractures were seen with tomosynthesis. • Tomosynthesis took longer to evaluate than radiography. • There was a clear preference among all observers for tomosynthesis over radiography.

  • 3. Jansson, Margareta
    et al.
    Geijer, Håkan
    Örebro universitet, Institutionen för klinisk medicin.
    Persliden, Jan
    Örebro universitet, Institutionen för klinisk medicin.
    Andersson, Torbjörn
    Örebro universitet, Institutionen för klinisk medicin.
    Reducing dose in urography while maintaining image quality - a comparison of storage phosphor plates and a flat-panel detector2006Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 16, nr 1, s. 221-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The introduction of new flat-panel detector technology often forces us to accept too high dose levels as proposed by the manufacturers. We need a tool to compare the image quality of a new system with the accepted standard. The aim of this study was to obtain a comparable image quality for two systems-storage phosphor plates and a flat-panel system using intravenous urography (IVU) as a clinical model. The image quality figure was calculated using a contrast-detail phantom (CDRAD) for the two evaluated systems. This allowed us to set a dose for the flat-panel system that gave equivalent image quality to the storage phosphor plates. This reduced detector dose was used in an evaluation of clinical images to find out if the dose reduction from the phantom study indeed resulted in images of equal clinical image quality. The image quality was assessed using image criteria of the European guidelines for IVU with visual grading analysis. Equivalent image quality in image pairs was achieved at 30% of the dose. The CDRAD contrast-detail phantom makes it possible to find dose levels that give equal image quality using different imaging systems.

  • 4.
    Jendeberg, Johan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Alshamari, Muhammed
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Cierzniak, Bartosz
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage2017Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, nr 11, s. 4775-4785Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To determine how to most accurately predict the chance of spontaneous passage of a ureteral stone using information in the diagnostic non-enhanced computed tomography (NECT) and to create predictive models with smaller stone size intervals than previously possible.

    METHODS: Retrospectively 392 consecutive patients with ureteric stone on NECT were included. Three radiologists independently measured the stone size. Stone location, side, hydronephrosis, CRP, medical expulsion therapy (MET) and all follow-up radiology until stone expulsion or 26 weeks were recorded. Logistic regressions were performed with spontaneous stone passage in 4 weeks and 20 weeks as the dependent variable.

    RESULTS: The spontaneous passage rate in 20 weeks was 312 out of 392 stones, 98% in 0-2 mm, 98% in 3 mm, 81% in 4 mm, 65% in 5 mm, 33% in 6 mm and 9% in ≥6.5 mm wide stones. The stone size and location predicted spontaneous ureteric stone passage. The side and the grade of hydronephrosis only predicted stone passage in specific subgroups.

    CONCLUSION: Spontaneous passage of a ureteral stone can be predicted with high accuracy with the information available in the NECT. We present a prediction method based on stone size and location.

    KEY POINTS: • Non-enhanced computed tomography can predict the outcome of ureteral stones. • Stone size and location are the most important predictors of spontaneous passage. • Prediction models based on stone width or length and stone location are introduced. • The observed passage rates for stone size in mm-intervals are reported. • Clinicians can make better decisions about treatment.

  • 5.
    Jendeberg, Johan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Alshamari, Muhammed
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Prediction of spontaneous ureteral stone passage: Automated 3D-measurements perform equal to radiologists, and linear measurements equal to volumetric2018Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, nr 6, s. 2474-2483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To compare the ability of different size estimates to predict spontaneous passage of ureteral stones using a 3D-segmentation and to investigate the impact of manual measurement variability on the prediction of stone passage.

    METHODS: We retrospectively included 391 consecutive patients with ureteral stones on non-contrast-enhanced CT (NECT). Three-dimensional segmentation size estimates were compared to the mean of three radiologists' measurements. Receiver-operating characteristic (ROC) analysis was performed for the prediction of spontaneous passage for each estimate. The difference in predicted passage probability between the manual estimates in upper and lower stones was compared.

    RESULTS: The area under the ROC curve (AUC) for the measurements ranged from 0.88 to 0.90. Between the automated 3D algorithm and the manual measurements the 95% limits of agreement were 0.2 ± 1.4 mm for the width. The manual bone window measurements resulted in a > 20 percentage point (ppt) difference between the readers in the predicted passage probability in 44% of the upper and 6% of the lower ureteral stones.

    CONCLUSIONS: All automated 3D algorithm size estimates independently predicted the spontaneous stone passage with similar high accuracy as the mean of three readers' manual linear measurements. Manual size estimation of upper stones showed large inter-reader variations for spontaneous passage prediction.

    KEY POINTS:• An automated 3D technique predicts spontaneous stone passage with high accuracy.• Linear, areal and volumetric measurements performed similarly in predicting stone passage.• Reader variability has a large impact on the predicted prognosis for stone passage.

  • 6.
    Krauss, Wolfgang
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Neurology and Neurophysiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Margareta
    Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Conventional and synthetic MRI in multiple sclerosis: a comparative study2018Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, nr 4, s. 1692-1700Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To compare the assessment of patients with multiple sclerosis (MS) using synthetic and conventional MRI.

    MATERIALS AND METHODS: Synthetic and conventional axial images were prospectively acquired for 52 patients with diagnosed MS. Quantitative MRI (qMRI) was used for measuring proton density and relaxation times (T1, T2) and then, based on these parameters, synthetic T1W, T2W and FLAIR images were calculated. Image stacks were reviewed blindly, independently and in random order by two radiologists. The number and location for all lesions were documented and categorised. A combined report of lesion load and presence of contrast-enhancing lesions was compiled for each patient. Agreement was evaluated using kappa statistic.

    RESULTS: There was no significant difference in lesion detection using synthetic and conventional MRI in any anatomical region or for any of the three image types. Inter- and intra-observer agreements were mainly higher (p < 0.05) using conventional images but there was no significant difference in any specific region or for any image type. There was no significant difference in the outcome of the combined reports.

    CONCLUSION: Synthetic MR images show potential to be used in the assessment of MS dissemination in space (DIS) despite a slightly lower inter- and intra-observer agreement compared to conventional MRI.

    KEY POINTS:

    • Synthetic MR images may potentially be useful in the assessment of MS.

    • Examination times may be shortened.

    • Inter- and intra-observer agreement is generally higher using conventional MRI.

  • 7.
    Lidén, Mats
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Torbjörn
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Broxvall, Mathias
    Örebro universitet, Institutionen för naturvetenskap och teknik.
    Thunberg, Per
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Urinary stone size estimation: a new segmentation algorithm-based CT method2012Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 22, nr 4, s. 731-737Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The size estimation in CT images of an obstructing ureteral calculus is important for the clinical management of a patient presenting with renal colic. The objective of the present study was to develop a reader independent urinary calculus segmentation algorithm using well-known digital image processing steps and to validate the method against size estimations by several readers. Fifty clinical CT examinations demonstrating urinary calculi were included. Each calculus was measured independently by 11 readers. The mean value of their size estimations was used as validation data for each calculus. The segmentation algorithm consisted of interpolated zoom, binary thresholding and morphological operations. Ten examinations were used for algorithm optimisation and 40 for validation. Based on the optimisation results three segmentation method candidates were identified. Between the primary segmentation algorithm using cubic spline interpolation and the mean estimation by 11 readers, the bias was 0.0 mm, the standard deviation of the difference 0.26 mm and the Bland-Altman limits of agreement 0.0 +/- 0.5 mm. The validation showed good agreement between the suggested algorithm and the mean estimation by a large number of readers. The limit of agreement was narrower than the inter-reader limit of agreement previously reported for the same data. The size of kidney stones is usually estimated manually by the radiologist. An algorithm for computer-aided size estimation is introduced. The variability between readers can be reduced. A reduced variability can give better information for treatment decisions.

  • 8.
    Lidén, Mats
    et al.
    Örebro universitet, Hälsoakademin.
    Andersson, Torbjörn
    Örebro universitet, Institutionen för läkarutbildning.
    Geijer, Håkan
    Örebro universitet, Hälsoakademin.
    Making renal stones change size: impact of CT image post processing and reader variability2011Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 21, nr 10, s. 2218-2225Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives The objectives of this study were to quantify the impact of image post-processing parameters on the apparent renal stone size, and to quantify the intra- and inter-reader variability in renal stone size estimation. Methods Fifty CT datasets including a renal or ureteral stone were included retrospectively during a prospective inclusion period. Each of the CT datasets was post-processed in different ways regarding slice thickness, slice increment and window setting. In the first part of the study a single reader repeated size estimations for the renal stones using different post-processing parameters. In the intra-reader variability experiment one reader reported size estimations for the same images with a one-week interval. The inter-reader variability data were obtained from 11 readers reporting size estimations for the same renal stones. Results The apparent stone size differed according to image post-processing parameters with the largest mean differences seen with regard to the window settings experiment (1.5 mm, p < 0.001) and slice thickness (0.8 mm, p < 0.001). Changes in parameters introduced a bias and a pseudo-random variability. The inter-reader variability was considerably larger than the intra-reader variability. Conclusion Our results indicate a need for the standardisation of making measurements on CT images.

  • 9.
    Santoro, Aurelia
    et al.
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; C.I.G. Interdepartmental Centre "L. Galvani", Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Guidarelli, Giulia
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Ostan, Rita
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; C.I.G. Interdepartmental Centre "L. Galvani", Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Giampieri, Enrico
    Department of Physics, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Fabbri, Cristina
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; C.I.G. Interdepartmental Centre "L. Galvani", Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Bertarelli, Claudia
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Nicoletti, Claudio
    Department of Experimental and Clinical Medicine, Section of Anatomy, University of Florence, Florence, Italy; Gut Health Institute Strategic Programme, Quadram Institute Bioscience, Norwich, UK.
    Kadi, Fawzi
    Örebro universitet, Institutionen för hälsovetenskaper.
    de Groot, Lisette C. P. G. M.
    Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
    Feskens, Edith
    Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
    Berendsen, Agnes
    Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
    Brzozowska, Anna
    Department of Human Nutrition, WULS-SGGW, Warsaw, Poland.
    Januszko, Olga
    Department of Human Nutrition, WULS-SGGW, Warsaw, Poland.
    Kozlowska, Katarzyna
    Department of Human Nutrition, WULS-SGGW, Warsaw, Poland.
    Fairweather-Tait, Susan
    Norwich Medical School, University of East Anglia, Norwich, UK.
    Jennings, Amy
    Norwich Medical School, University of East Anglia, Norwich, UK.
    Meunier, Nathalie
    CHU Clermont-Ferrand, CRNH Auvergne, Clermont-Ferrand, France.
    Caumon, Elodie
    CHU Clermont-Ferrand, CRNH Auvergne, Clermont-Ferrand, France.
    Napoli, Alessandro
    Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.
    Mercatelli, Daniele
    Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
    Battista, Giuseppe
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Capri, Miriam
    Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; C.I.G. Interdepartmental Centre "L. Galvani", Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Franceschi, Claudio
    Institute of Neurological Sciences (IRCCS), Bologna, Italy.
    Bazzocchi, Alberto
    Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
    Gender-specific association of body composition with inflammatory and adipose-related markers in healthy elderly Europeans from the NU-AGE study2019Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 29, nr 9, s. 4968-4979Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim of this work was to examine the cross-sectional relationship between body composition (BC) markers for adipose and lean tissue and bone mass, and a wide range of specific inflammatory and adipose-related markers in healthy elderly Europeans.

    METHODS: A whole-body dual-energy X-ray absorptiometry (DXA) scan was made in 1121 healthy (65-79 years) women and men from five European countries of the "New dietary strategies addressing the specific needs of elderly population for a healthy aging in Europe" project (NCT01754012) cohort to measure markers of adipose and lean tissue and bone mass. Pro-inflammatory (IL-6, IL-6Rα, TNF-α, TNF-R1, TNF-R2, pentraxin 3, CRP, alpha-1-acid glycoprotein, albumin) and anti-inflammatory (IL-10, TGF-β1) molecules as well as adipose-related markers such as leptin, adiponectin, ghrelin, and resistin were measured by magnetic bead-based multiplex-specific immunoassays and biochemical assays.

    RESULTS: BC characteristics were different in elderly women and men, and more favorable BC markers were associated with a better adipose-related inflammatory profile, with the exception of skeletal muscle mass index. No correlation was found with the body composition markers and circulating levels of some standard pro- and anti-inflammatory markers like IL-6, pentraxin 3, IL-10, TGF-β1, TNF-α, IL-6Rα, glycoprotein 130, TNF-α-R1, and TNF-α-R2.

    CONCLUSIONS: The association between BC and inflammatory and adipose-related biomarkers is crucial in decoding aging and pathophysiological processes, such as sarcopenia. DXA can help in understanding how the measurement of fat and muscle is important, making the way from research to clinical practice.

    KEY POINTS: • Body composition markers concordantly associated positively or negatively with adipose-related and inflammatory markers, with the exception of skeletal muscle mass index. • No correlation was found with the body composition markers and circulating levels of some standard pro- and anti-inflammatory markers like IL-6, pentraxin 3, IL-10, TGF-β1, TNF-α, IL-6Rα, gp130, TNF-α-R1, and TNF-α-R2. • Skeletal muscle mass index (SMI) shows a good correlation with inflammatory profile in age-related sarcopenia.

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