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

National Heart, Lung, And Blood Institute

Investigators

Linked publications, trials & patents

Abstract

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.