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87 protocols using lightspeed ultra

1

Assessing Fatty Liver and Fibrosis via MDCT

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Fatty liver was assessed using multi-detector CT with 8-slice MDCT technology (LightSpeed Ultra, General Electric, Milwaukee, WI). A calibration phantom (Image Analysis, Lexington, KY, USA) with a water equivalent compound (CT-Water, Light Speed Ultra, General Electric, Milwaukee, WI, USA) and calcium hydroxyapatite at 0, 75, and 150 mg/cm3 was placed under each participant. Three areas from the liver and one from an external phantom were measured, and the average of the liver measures were then used to create liver/phantom ratios. NAFLD was defined as having a liver/phantom ratio ≤0.33, consistent with prior Framingham Heart Study publications20 .
Severity of liver fibrosis in individuals with NAFLD was estimated using clinical and serum markers recorded at exams 9 and 2 for Offspring- and 3rd generation cohorts, respectively, through the following NFS formula: NFS = −1.675 +0.037 × age [years] +0.094 × BMI [kg/m2] + 1.13 × impaired fasting glucose (IFG) or diabetes [yes = 1, no = 0] + 0.99 × AST/ALT ratio– 0.013 × platelet [x 109/L]– 0.66 × albumin g/dL) [10]. Participants were characterized into three categories based on the following, previously published cut-offs: NFS > 0.676 high probability advanced fibrosis (F3-F4), −1.455 < NFS ≤ 0.676 indeterminate probability of advanced fibrosis, and NFS < −1.455 as low probability of advanced fibrosis15 (link).
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2

Low-Dose CT Scans for Lung Texture Analysis

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All 77 individuals underwent at least two low-dose thin-section CT examinations. The mean number of CT examinations was 2.76±1.02 (range, 2 to 8), and the mean CT follow-up period was 227.5 days ±287.51 (range, 10–1528 days).
Thin-section low dose CTs used for visual analysis and texture analysis were performed using one of the following three scanners without intravenous contrast material injection; Sensation-16 (Siemens Medical Solutions, Forchheim, Germany; n = 57), Brilliance-64 (Phillips Medical Systems, Netherlands; n = 10), and Lightspeed Ultra (GE Medical Systems, Milwaukee, WI; n = 10) with 120 kVp, 40 mAs, pitch of 0.75–1.0, and collimation of 1–1.25 mm. Images were reconstructed using a medium sharp reconstruction algorithm with a thickness of 1–1.25 mm. CT scans were obtained for all patients in the supine position at full inspiration.
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3

Chest CT Imaging Protocols for Preoperative Evaluation

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Forty-nine patients underwent preoperative CT scans with 75–90 ml of nonionic iodinated contrast material (370 mg I/mL Iopromide; Ultravist 370; Bayer Shering Pharma AG, Berlin, Germany), while 4 underwent preoperative CT scans without contrast material. All CT examinations were performed using one of six available CT scanners: Sensation-16, Somatom Definition (Siemens Medical Systems, Erlangen, Germany), Brilliance-64, Ingenuity (Phillips Medical Systems, Best, The Netherlands), and Discovery CT750 HD, LightSpeed Ultra (GE Healthcare, Milwaukee, WI, USA). Scanning parameters for chest CT were as follows: detector collimation, 1.0–1.25 mm; beam pitch, 0.75–1.0; reconstruction slice thickness, 0.7–2.5 mm (0.7 mm (n = 1), 1.0 mm (n = 28), 1.25 mm (n = 22), 1.5 mm (n = 1), 2.5 mm (n = 1)); reconstruction interval, 1.0–1.25 mm; rotation time, 0.4–0.5 s; tube voltage, 120 kVp; tube current, 40–120 mAs; and reconstruction kernel, a sharp reconstruction algorithm. All CT scans were performed during patients’ inspiration in the supine position.
The mean time interval between preoperative CT scans and surgical resections was 13.91 ± 13.63 days (range, 1–58 days).
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4

Diagnostic Imaging of Suspected IPMN

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All patients who were diagnosed with suspected IPMN underwent MDCT using either the Brilliance 64 (Philips Medical Systems, Cleveland, OH, USA) or LightSpeed Ultra (GE Healthcare, Little Chalfont, UK). MRI (Magnetom Verio; Siemens Healthcare, Erlangen, Germany) or EUS was performed as required. The MPD and cyst diameter were measured at the maximal point, on the 3-mm-thick axial and coronal images of the portal venous phase, using a picture archiving and communication system (Marosis M-view; Marotech, Seoul, Korea). Each radiologic parameter was reviewed by one surgeon and one radiologist.
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5

Measuring Abdominal Adiposity via CT Scans

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We included three measures of abdominal adiposity: waist circumference; VAT; and SAT measured in the abdominal area. Waist circumference (inches) is considered the most reliable surrogate of visceral adiposity (36 (link)) and was measured by a trained professional applying an anthropometric tape at the level of the umbilicus, recording the reading at mid-inspiration with the participant breathing normally and rounding to the nearest 0.25 inches.(37 (link)) VAT (cm3) and SAT (cm3) volumes were calculated from CT scans of the abdomen as previously published.(38 (link)) Twenty-five consecutive 5 mm-thick slices using an 8-slice multidetector CT scanner (LightSpeed Ultra; General Electric, Milwaukee, WI) were obtained with participants lying in a supine position. A three-dimensional (3D) workstation tool (Aquarius 3D Workstation; TeraRecon Inc, San Mateo, CA) was used to evaluate CT slices for abdominal adipose tissue quantity and density. Trained technicians outlined the abdominal muscular wall manually, identifying a designated region of interest. Using a radiographic pixel threshold between −195 and −45 HU with center attenuation of −120 HU, SAT and VAT regions were automatically identified. Mean SAT and VAT volumes in cm3 were recorded as was attenuation in HU.
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6

4-Phase Liver CT Evaluation Protocol

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The 4P liver CT evaluation consisted of pre-contrast, arterial, portal and delayed phase. Patients were randomly allocated to one of the CT scanners with multi-detector (≥ 4) at our institution (MX 8000, Philips Healthcare, Bothell, WA, USA; Lightspeed Ultra, GE Healthcare, Waukesha, WI, USA; Sensation 16, Siemens Healthcare, Elrangen, Germany). The acquisition protocol was uniform regardless of the type of CT scanners. After scanning the pre-contrast phase, contrast media (1.5 mL/kg of Ultravist 370, Bayer-Schering Pharmaceuticals, Berlin, Germany) was injected at a rate of 2–4 mL/sec using a power injector (Multilevel CT, Medrad, Indianola, PA, USA) followed by saline flush. The arterial phase was obtained using the bolus tracking method, and the portal and delayed phases were obtained 70 and 180 seconds after contrast media injection, respectively. All scans were performed using standard kVp and automatic tube-current modulation for each vendor, when available.
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7

Quantifying Adipose Tissue Volumes via MDCT

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The details of the MDCT scan protocol and subsequent analyses have been described.16 (link),19 (link) Briefly, participants were placed in the supine position and assessed with 8‐slice MDCT (LightSpeed Ultra; General Electric). Adipose tissue was defined based on Hounsfield units (HU): window width, −195 to −45 HU; window center, −120 HU. Thoracic, pericardial, and visceral adipose depot volumes were measured with an offline workstation using a semiautomatic segmentation technique (Aquarius 3D Workstation; TeraRecon Inc). Pericardial fat was defined as adipose tissue located within the pericardium. Intrathoracic fat was defined as the total volume of fat within the thorax from the level of the right pulmonary artery to the diaphragm and the chest wall to the descending aorta, minus the volume of fat located within the pericardium. Visceral fat was defined as the total volume of fat within the abdominal wall as defined by the abdominal wall musculature, which was manually traced for all images. Inter‐reader reliability for pericardial fat (interclass correlation 0.95), total thoracic fat (interclass correlation 0.98), and visceral fat (interclass correlation 0.99) have been assessed as excellent.16 (link),19 (link)
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8

Quantifying Hepatic Steatosis Using CT Imaging

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Assessment of hepatic steatosis was standardized relative to a radiographic phantom during eight-slice multi-detector computed tomography (LightSpeed Ultra, General Electric, Milwaukee, WI).36 (link) Full details of the acquisition protocol have been previously published.36 (link) In brief, the mean Hounsfield units from three areas of the liver of at least 100 mm2 (intentionally avoiding blood vessels) was compared to a commercially available calibration control or “phantom,” which was present on all images. Lower values of the Liver:Phantom Ratio (LPR) correspond to more radiographic hepatic steatosis and have previously been shown to be associated with cardiometabolic risk factors.39 (link) Hepatic steatosis was defined as LPR ≤ 0.33 based on prior studies using the liver to spleen ratio.36 (link),39 (link) All image processing was overseen and reviewed by a single radiologist (UH) and has previously been demonstrated to have good inter- and intra-rater reliability.36 (link)
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9

Multimodal Imaging of Liver Steatosis

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Non-contrast chest CTs were obtained in the supine position in a single breath-hold on several CT platforms (Lightspeed Ultra, Lightspeed VCT, Discovery CT750HD, and Revolution, GE Healthcare; Somatom Definition Flash, Somatom Definition AS, Sensation Cardiac 64, and Force, Siemens Healthineers) using clinical acquisition protocols: 100 or 120 kVp, 106–663 mA, 0.600 mm (Siemens), 0.625 or 1.25 mm (GE) collimation, slice thickness 1.00–3.00 mm, and reconstruction kernels of B40f for Somatom Definition AS and Sensation Cardiac 64, I31f for Somatom Definition Flash, and standard for all GE scanners. Liver attenuation on CT was measured in HU on mediastinal window settings (width 350 HU; level 25 HU).
Multichannel MRI systems were used for all patients (1.5T: Avanto, Aera, and Sonata, Siemens Healthineers; and Signa HD and Optima 450w, GE Medical Systems or 3T: Skyra and Biograph mMR, Siemens Healthineers; and Discovery 750, GE Medical Systems) [27 ]. The liver MRI sequences and acquisition parameters followed clinical protocols. T1WI in- and out-of-phase imaging was performed in all cases and used to calculate the fat fraction percentage (FF).
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10

MDCT protocol for liver fat quantification

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The MDCT protocol (LightSpeed Ultra, General Electric, Milwaukee, WI, USA) has been previously described in detail.50 (link) In this protocol, twenty-five contiguous slices of 5mm thickness were obtained. A phantom calibration control (Image Analysis, Lexington, KY, US) was placed under each participant. Liver fat on MDCT was measured using a previously documented protocol.51 (link) Three measurements of at least 100mm2 were taken in the liver and averaged to determine the average liver fat attenuation measured in Hounsfield Units. The average liver fat attenuation was divided by the attenuation of the phantom to generate liver-phantom ratios (LPR). Hepatic steatosis was defined as LPR of less than or equal to 0.33 (sensitivity 70% specificity 98%).48 (link) As a continuous measure, the amount of liver fat increases as the LPR decreases.
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