Correlation between Spectral CT Parameters and Ki67 Expression in Hepatocellular Carcinoma.

To explore the value of dual-energy spectral CT in distinguishing solitary pulmonary tuberculosis (SP-TB) from solitary lung adenocarcinoma (S-LUAD). A total of 246 patients confirmed SP-TB (n = 86) or S-LUAD (n = 160) were retrospectively included. Spectral CT parameters include CT40keV value, CT70keV value, iodine concentration (IC), water concentration (WC), effective atomic number (Zeff), and spectral curve slope (λ70keV). Data were measured during the arterial phase (AP) and venous phase (VP). Chi-square test was used to compare categorical variables, Wilcoxon rank-sum test was used to compare continuous variables, and a two-sample t-test was used to compare spectral CT parameters. ROC curves were used to calculate diagnostic efficiency. There were significant differences in spectral CT quantitative parameters (including CT40keV value [all P< 0.001] , CT70keV value [all P< 0.001], λ70keV [P< 0.001, and P = 0.027], Zeff [P =0.015, and P = 0.001], and IC [P =0.002, and P = 0.028]) between the two groups during the AP and VP. However, WC (P = 0.930, and P = 0.823) was not statistically different between the two groups. The ROC curve analysis showed that the AUC in the AP and VP was 90.9% (95% CI, 0.873-0.945) and 83.4% (95% CI, 0.780-0.887), respectively. The highest diagnostic performance (AUC, 97.6%; 95% CI, 0.961-0.991) was achieved when all spectral CT parameters were combined with clinical variables. Dual-energy spectral CT has a significant value in distinguishing SP-TB from S-LUAD.

ObjectivesThis study aimed to investigate the ability of quantitative parameters of dual-energy computed tomography (DECT) and nodule size for differentiation between lung cancers and benign lesions in solid pulmonary nodules.Materials and MethodsA total of 151 pathologically confirmed solid pulmonary nodules including 78 lung cancers and 73 benign lesions from 147 patients were consecutively and retrospectively enrolled who underwent dual-phase contrast-enhanced DECT. The following features were analyzed: diameter, volume, Lung CT Screening Reporting and Data System (Lung-RADS) categorization, and DECT-derived quantitative parameters including effective atomic number (Zeff), iodine concentration (IC), and normalized iodine concentration (NIC) in arterial and venous phases. Multivariable logistic regression analysis was used to build a combined model. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity.ResultsThe independent factors for differentiating lung cancers from benign solid pulmonary nodules included diameter, Lung-RADS categorization of diameter, volume, Zeff in arterial phase (Zeff_A), IC in arterial phase (IC_A), NIC in arterial phase (NIC_A), Zeff in venous phase (Zeff_V), IC in venous phase (IC_V), and NIC in venous phase (NIC_V) (all P < 0.05). The IC_V, NIC_V, and combined model consisting of diameter and NIC_V showed good diagnostic performance with AUCs of 0.891, 0.888, and 0.893, which were superior to the diameter, Lung-RADS categorization of diameter, volume, Zeff_A, and Zeff_V (all P < 0.001). The sensitivities of IC_V, NIC_V, and combined model were higher than those of IC_A and NIC_A (all P < 0.001). The combined model did not increase the AUCs compared with IC_V (P = 0.869) or NIC_V (P = 0.633).ConclusionThe DECT-derived IC_V and NIC_V may be useful in differentiating lung cancers from benign lesions in solid pulmonary nodules.

Background: This study proposed to quantitatively assess the value of spectral CT imaging parameters in differentiating different pathological types of lung cancer. Methods: Eighty five patients with lung cancer (66 non-mucinous adenocarcinomas, 7 Squamous cell carcinomas, 8 small cell carcinomas, 1 mucinous adenocarcinoma, 1 sarcomatoid carcinoma, 1 carcinoid, 1 large cell carcinoma) underwent CT plain scan, contrast enhanced CT scans in arterial phase (a) and venous phase (v) with spectral imaging mode on a GE Revolution Xtream CT scanner. The Spectral CT Imaging parameters: Iodine concentrations (IC) of lesion in arterial phase (ICLa) and venous phase (ICLv), Normalized IC (NICa/NICv)-normalized to the IC in the aorta, slope of the spectral HU curve (λHUa/λHUv) and monochromatic CT number (CT40keVa/CT40keVv, CT70keVa/CT70keVv) enhancement on 40 keV and 70 keV images were calculated. The One-way ANOVA or Kruskal-Wallis test was used to compare quantitative parameters among lung squamous carcinoma, small cell carcinoma and lung adenocarcinoma groups, Bonferroni method was used to correct P value for multiple comparisons. Results: Among the different pathological types of lung cancers, these quantitative parameters of spectral CT imaging CT70keVa has significant difference. The CT70keVa of lung adenocarcinoma was lower than small cell carcinoma (P = 0.048) and squamous cell carcinoma (P = 0.039), respectively. And these CT40keVa, CT70keVa/CT70keVv parameters of lung adenocarcinoma was lower than non-adenocarcinomas (P &lt; 0.05). However, there was no significant difference in spectral CT parameters between small cell lung cancer and squamous cell lung cancer, small cell lung cancer and non-small cell carcinoma (P &gt; 0.05). Conclusion: Spectral CT parameters may be of value in distinguishing different pathological types of lung cancer.

Spectral CT Imaging in the Differential Diagnosis of Small Bowel Adenocarcinoma From Primary Small Intestinal Lymphoma

To investigate the usefulness of computed tomographic (CT) spectral imaging parameters in differentiating small (≤3 cm) hepatic hemangioma (HH) from small hepatocellular carcinoma (HCC), with or without cirrhosis, during the late arterial phase (AP) and portal venous phase (PVP). This prospective study was institutional review board approved, and written informed consent was obtained from all patients. The authors examined 49 patients (39 men, 10 women; 65 lesions) with CT spectral imaging during the AP and the PVP. Twenty-one patients had HH; nine, HCC with cirrhosis; and 19, HCC without cirrhosis. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PVP (ie, iodine concentration difference [ICD]) and the lesion-to-normal parenchyma ratio (LNR) were calculated. Two readers qualitatively assessed lesion types on the basis of conventional CT characteristics. Sensitivity and specificity were compared between the qualitative and quantitative studies. The two-sample t test was performed to compare quantitative parameters between HH and HCC. Normalized iodine concentrations (NICs) and LNRs in patients with HH differed significantly from those in patients with HCC and cirrhosis and those in patients with HCC without cirrhosis: Mean NICs were 0.47 mg/mL ± 0.24 (standard deviation) versus 0.23 mg/mL ± 0.10 and 0.23 mg/mL ± 0.08, respectively, during the AP and 0.83 mg/mL ± 0.38 versus 0.47 mg/mL ± 0.86 and 0.52 mg/mL ± 0.11, respectively, during the PVP. Mean LNRs were 5.87 ± 3.36 versus 2.56 ± 1.10 and 2.29 ± 0.87, respectively, during the AP and 2.01 ± 1.33 versus 0.96 ± 0.16 and 0.93 ± 0.26, respectively, during the PVP. The mean ICD for the HH group (1.37 mg/mL ± 0.84) was significantly higher than the mean ICDs for the HCC-cirrhosis (0.33 mg/mL ± 0.29) (P < .001) and HCC-no cirrhosis (0.82 mg/mL ± 0.99) (P = .03) groups. The combination of NIC and LNR had higher sensitivity and specificity compared with those of conventional qualitative CT image analysis during individual and combined phases. Use of spectral CT with fast tube voltage switching may increase the sensitivity for differentiating small hemangiomas from small HCCs in two-phase scanning.

Background: Laryngeal cancer stage is essential for determining the appropriate treatment strategies and evaluating prognosis for laryngeal carcinoma, which is based primarily on laryngeal cartilage invasion or not. However, there was no optimal means to confirm whether cartilage was being invaded before operation. With dual-energy CT development, it provided a new potential approach for laryngeal cartilage invasion diagnosis. Objectives: To evaluate the clinical value of dual-energy computed tomography with iodine overlay images and spectrum curve in the quantitative analysis of laryngeal cartilage invasion in patients with laryngeal carcinoma. Patients and Methods: Dual-source dual-energy CT was performed for one hundred and twenty patients with confirmed diagnosis of laryngeal carcinoma by surgical pathology (56 cases with laryngeal cartilage invasion and 64 cases without invasion). The mean CT attenuation values of laryngeal cartilage and the tumor in routine scan, arterial and venous phases was measured and cartilage invasion was considered to be present with asymmetric sclerotic changes, erosion, lysis and extralaryngeal tumor spread with iodine overlay images and routine scan images. Moreover, the sensitivity and specificity were analyzed. The slope of spectral curve and iodine concentration of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage were compared between arterial phase and venous phase. Furthermore, the receiver operating characteristic (ROC) curve of mean CT attenuation value, the slope of spectral curve and iodine concentration were made comparative analysis. Results: The mean CT attenuation values of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage had significant difference among the routine scan, arterial phase and venous phase (P < 0.05). The sign of asymmetric sclerotic changes had no significant difference between iodine overlay images and routine scan images (the same specificity and sensitivity, 77.8% and 52.6%, respectively). However, the signs of erosion, lysis and extralaryngeal tumor spread had significant difference. The specificity and sensitivity of iodine overlay images were superior to that of the routine scan images in the three signs (specificity and sensitivity of erosion: 92.3% vs. 61.5%, and 86.7% vs. 60.0%, respectively; lysis: 82.4% vs. 69.2%, and 81.8% vs. 66.7%, respectively; extralaryngeal tumor spread: 90.9% vs. 68.3%, and 100% vs. 63.5% respectively). The slope of spectral curve and iodine concentration of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage showed significant difference (P < 0.05). The iodine concentration of the tumor was higher than invaded laryngeal cartilage. The area under the curve (AUC) value of mean CT attenuation value in routine scan, arterial phase and venous phase were 0.064, 0.265, and 0.192, respectively. The AUC value of the slope of spectral curve in arterial phase was 0.970 and its selected cutoff was considered as 1.09. In this cutoff point, the diagnostic indices including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88.9%, 100%, 100%, and 82.6%, respectively, while the AUC value of the slope of spectral curve in venous phase was 0.944 and its selected cutoff was considered as 0.95. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV, NPV, positive likelihood ratio (PLR), negative likelihood ration (NLR) were 81.5%, 96.3%, 91.7%, 77.3%, 7.76, and 19.30, respectively. The AUC value of the slope of iodine concentration in arterial phase was 0.995 and its selected cutoff was considered as 1.05. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV and NPV were 92.6%, 100%, 95.8%, and 100%, respectively. Moreover, the AUC value of the slope of iodine concentration in venous phase was 0.905 and its selected cutoff was considered as 0.75. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV, NPV, PLR, and NLR were 77.8%, 88.9%, 91.3%, 82.6%, 7.00, and 24.5, respectively. Conclusion: Dual-energy CT can provided a new potential approach for laryngeal cartilage invasion diagnosis in order to guide the selection of optimal operation plan and improve the prognosis.

This study aimed to investigate whether there is a correlation between quantitative parameters of dual-energy computed tomography (DECT) and the relative expression of HIF-1&#945; in patients with non-small cell lung cancer (NSCLC) to preliminarily explore the value of DECT in evaluating the hypoxia of tumor microenvironment and tumor biological behavior and provide more information for the treatment of NSCLC. This retrospective research included 36 patients with pathologically confirmed NSCLC who underwent dual-energy enhanced CT scans. The quantitative parameters of DECT were analyzed, including iodine concentration, water concentration, the CT values corresponding to 40keV, 70keV, 100keV, and 130keV in arterial and venous phases, and the normalized iodine concentration and the slope of the energy spectrum curve were calculated. Postoperative specimens underwent HIF immunohistochemical staining by two pathologists. Spearman correlation analysis was adopted as the statistical methodology. The data were analyzed by SPSS26.0 statistical software. Water concentration (r=0.659, P&#60;0.001 and r= 0.632, P&#60;0.001, the CT values corresponding to 100keV (r=0.645, P&#60;0.001 and r= 0.566, P&#60;0.001) and 130keV (r=0.687, P&#60;0.001 and r= 0.682, P&#60;0.001) in arterial and venous phases, and CT value of 70keV in arterial phase (r=0.457, P=0.005) were positively correlated with HIF-1&#945; expression level. There was no correlation among iodine concentration, standardized iodine concentration, CT value of 40keV, λHU, and HIF-1&#945; expression in arterial and venous levels (P >0.05). The quantitative parameters of DECT have a certain correlation with HIF-1&#945; expression in NSCLC. Moreover, it has been demonstrated that DECT can be used to predict hypoxia in tumor tissues and the prognosis of lung cancer patients.

BackgroundAccurate preoperative diagnosis of pathological grades in T1-sized lung adenocarcinoma (LUAD) is crucial for clinical decision-making. The study aimed to investigate the value of dual-energy computed tomography (DECT) in distinguishing pathological grades in newly diagnosed LUAD lesions ≤3 cm in size.MethodsFrom October 2018 to January 2022, 137 patients with 161 pathologically confirmed LUAD lesions (≤3 cm) having received DECT were retrospectively enrolled with clinical information collected (low-grade: high-grade =41:120). CT values of monochromatic images at 40–140 keV, effective atomic number (Zeff), and iodine concentration of lesion (ICl) on plain, arterial phase (AP), and venous phase (VP) images were measured. Iodine concentration difference (ICD), normalized iodine concentration (NIC), and slope of the spectral curve (λHU) were further calculated. Difference tests and multiple stepwise regression were utilized to predict grades. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy of the clinical model, spectral model, and combined model.ResultsThere were significant differences in CT values of 40–140 keV and Zeff between these two groups for the plain, AP, and VP images (all P<0.001), but not in ICl, ICD, NIC, and λHU (all P>0.05). Stepwise regression showed that CT40keV on plain spectral CT, CT140keV on AP, and CT140keV on VP are independently significant factors. The combined model achieved the best performance [area under the curve (AUC) =0.825], which significantly outperformed the clinical model (AUC =0.772, P=0.03), but not the spectral CT model (AUC =0.774, P=0.07).ConclusionsIn addition to clinical features, single-energy CT values hold the potential to differentiate the pathological grade of T1-size LUAD.

Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer (GC), but traditional imaging methods have some limitations in preoperative evaluation. In recent years, energy spectrum computed tomography (CT) multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail display. To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion (LVI) and nerve invasion (PNI) in GC patients. Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023, including 46 males and 16 females aged 36-71 (57.5 ± 9.1) years, were retrospectively collected. The patients were divided into a positive group (42 patients) and a negative group (20 patients) according to the presence of LVI/PNI. The CT values (CT40 keV, CT70 keV), iodine concentration (IC), and normalized IC (NIC) of lesions in the upper energy spectrum CT images of the arterial phase, venous phase, and delayed phase 40 and 70 keV were measured, and the slopes of the energy spectrum curves [K (40-70)] from 40 to 70 keV were calculated. Arterial phase combined parameter, venous phase combined parameters (VP-ALLs), and delayed phase association parameters were calculated for patients with late-stage disease. The differences in the energy spectrum parameters between the positive and negative groups were compared, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated to measure the diagnostic efficiency of each parameter. In the delayed phase, the CT40 keV, CT70 keV, K (40-70), IC, NIC, and CT70 keV and the NIC in the upper arterial and venous phases of energy spectrum CT were greater in the LVI/PNI-positive group than in the LVI-negative group. The representative parameters for the arterial phase NIC were 0.14 ± 0.04 in the positive group and 0.12 ± 0.04 in the negative group. The venous phase NIC was 0.5 (0.5, 0.6) in the positive group and 0.4 (0.4, 0.5) in the negative group. Last, for the delayed phase NIC, it was 0.6 ± 0.1 in the positive group and 0.5 ± 0.1 in the negative group (all P values are less than 0.05). ROC curve analysis demonstrated that the diagnostic efficacy of each parameter during the venous stage was superior to that during the arterial and delayed stages. Furthermore, the diagnostic efficacy of the combined parameter throughout all three stages was superior to that of any single parameter. The AUC, sensitivity, and specificity of the optimal parameter, VP-ALL, were 0.931 (95% confidence interval: 0.872-0.990), 80.95%, and 95.00%, respectively. When assessing the condition of LVI and PNI (perineural invasion) in patients with GC prior to surgery, the ability to diagnose these conditions using venous stage parameters was superior to that using arterial stage and delayed stage parameters. Furthermore, the diagnostic accuracy of using a combination of parameters was better than that of using individual parameters alone.

Spectral CT for preoperative diagnosis of N2 station lymph node metastasis in solid T1 non-small cell lung cancer

BackgroundThe planification of radiation therapy (RT) for pancreatic cancer (PC) requires a dosimetric computed tomography (CT) scan to define the gross tumor volume (GTV). The main objective of this study was to compare the inter-observer variability in RT planning between the arterial and the venous phases following intravenous contrast.MethodsPANCRINJ was a prospective monocentric study that included twenty patients with non-metastatic PC. Patients underwent a pre-therapeutic CT scan at the arterial and venous phases. The delineation of the GTV was performed by one radiologist (gold standard) and two senior radiation oncologists (operators). The primary objective was to compare the Jaccard conformity index (JCI) for the GTVs computed between the GS (gold standard) and the operators between the arterial and the venous phases with a Wilcoxon signed rank test for paired samples. The secondary endpoints were the geographical miss index (GMI), the kappa index, the intra-operator variability, and the dose-volume histograms between the arterial and venous phases.ResultsThe median JCI for the arterial and venous phases were 0.50 (range, 0.17–0.64) and 0.41 (range, 0.23–0.61) (p = 0.10) respectively. The median GS-GTV was statistically significantly smaller compared to the operators at the arterial (p < 0.0001) and venous phases (p < 0.001), respectively. The GMI were low with few tumors missed for all patients with a median GMI of 0.07 (range, 0-0.79) and 0.05 (range, 0-0.39) at the arterial and venous phases, respectively (p = 0.15). There was a moderate agreement between the radiation oncologists with a median kappa index of 0.52 (range 0.38–0.57) on the arterial phase, and 0.52 (range 0.36–0.57) on the venous phase (p = 0.08). The intra-observer variability for GTV delineation was lower at the venous phase than at the arterial phase for the two operators. There was no significant difference between the arterial and the venous phases regarding the dose-volume histogram for the operators.ConclusionsOur results showed inter- and intra-observer variability in delineating GTV for PC without significant differences between the arterial and the venous phases. The use of both phases should be encouraged. Our findings suggest the need to provide training for radiation oncologists in pancreatic imaging and to collaborate within a multidisciplinary team.

To investigate the ability of CT texture analysis to assess and predict the expression statuses of E-cadherin, Ki67, VEGFR2 and EGFR in gastric cancers, the enhanced CT images of 139 patients with gastric cancer were retrospectively reviewed. The region of interest was manually drawn along the margin of the lesion on the largest slice in the arterial and venous phases, which yielded a series of texture parameters. Our results showed that the standard deviation, width, entropy, entropy (H), correlation and contrast from the arterial and venous phases were significantly correlated with the E-cadherin expression level in gastric cancers (all P < 0.05). The skewness from the arterial phase and the mean and autocorrelation from the venous phase were negatively correlated with the Ki67 expression level in gastric cancers (all P < 0.05). The width, entropy and contrast from the venous phase were positively correlated with the VEGFR2 expression level in gastric cancers (all P < 0.05). No significant correlation was found between the texture features and EGFR expression level. CT texture analysis, which had areas under the receiver operating characteristic curve (AUCs) ranging from 0.612 to 0.715, holds promise in predicting E-cadherin, Ki67 and VEGFR2 expression levels in gastric cancers.

PurposeTo compare the diagnostic performance of fast kV-switching dual-energy CT (DECT) parameters, including virtual monochromatic imaging (VMI) and iodine mapping, in the arterial and venous phases for detecting surgically confirmed acute small bowel ischemia (ASBI) in cases suspected as ASBI on conventional visual CT findings.Materials and methodsThirty-two patients with conventional visual CT findings suggesting possible or suspected ASBI caused by small bowel obstruction (SBO) were included. Two radiologists independently placed ten cursors on visually hypo-perfused bowel wall regions to measure CT values at 70 keV, 40 keV, and iodine quantity. Patients were categorized into surgically confirmed ASBI (n = 12) and non-confirmed ASBI (n = 20). ROC analysis assessed diagnostic performance, and inter-observer reliability was evaluated using intra-class correlation coefficients (ICC).ResultsFor both observers, the CT value at 40 keV and iodine quantity in the arterial phase, as well as iodine quantity in the venous phase, was significantly different between surgically confirmed ASBI and non-confirmed ASBI groups (p < 0.05). Iodine quantity consistently yielded the highest AUC among the evaluated parameters in each phase although the differences compared to 70-keV VMI were not statistically significant. The parameters in the arterial phase tended to demonstrate higher AUCs than those in the venous phase. Inter-observer agreement was moderate to substantial (ICC 0.585–0.741), while intra-observer agreement was substantial to almost perfect (ICC 0.733–0.940).ConclusionsDECT parameters, such as the CT value at 40-keV and the iodine quantity, were effective in differentiating surgically confirmed ASBI from non-confirmed ASBI in SBO cases with suspected ischemia. Iodine quantity showed the highest diagnostic performance among all evaluated parameters. Although the differences were not statistically significant, arterial phase parameters generally yielded higher AUCs than those in the venous phase, suggesting the potential utility of arterial phase DECT in the detection of ASBI.

Objectives To investigate the clinical significance of dual energy spectral CT (DESCT) in quantitatively differentiating peripheral lung cancers from pulmonary inflammatory masses.Methods Sixty patients with 35 lung cancers and 25 inflammatory masses underwent DESCT to get arterial phase (AP) images and venous phase (VP) images.Iodine concentrations in the central and peripheral zone of the masses were measured and normalized to the aorta as normalised iodine concentration (NIC).The difference of NIC between central and peripheral zone of the masses (dNIC) was calculated.The spectral attenuation curve was obtained automatically and the slope of curve (λHU) was also calculated in the two groups.The quantitative parameters was presented as M (Q1,Q3),and Wilcoxon signed rank test was used to compare above two independent samples.Receiver operating characteristic (ROC) curves were generated to calculate the sensitivity and specificity.Results NICs in the central zone of peripheral lung cancers were significantly lower than that of inflammatory masses:mean NICs were 0.03 (0,0.05) versus 0.12 (0.07,0.20) in AP,and 0.14 (0.12,0.19) versus 0.30 (0.21,0.57) in VP (Z=-4.14,-3.70,respectively,P＜0.01).While the dNIC values of lung cancers were significantly higher than that of inflammatory masses:dNIC values were 0.08 (0.05,0.11) versus 0.04 (-0.02,0.08) in AP,and 0.23 (0.17,0.34)versus 0.07 (-0.04,0.08) in VP(Z=-2.56,-4.00,respectively,P＜0.05).Mean λHU values of lung cancers were also lower than inflammatory masses:1.03 (0.67,1.67)versus 2.75 (1.61,3.19) in AP,and 1.58 (1.30,2.17) versus 3.25 (2.37,4.54) in VP (Z=-3.90,-4.42 respectively,P＜0.01).According to ROC curves,cutoff value of λHU =2.11 in VP had the highest sensitivity (89％) and specificity (91％) in differentiating peripheral lung cancers from inflammatory masses.Conclusions Contrast-enhanced dual energy spectral CT imaging with some quantitative parameters such as normalised iodine concentration,dNIC,and the slope of spectral attenuation curves may be a promising new method for differentiating peripheral lung cancers from inflammatory masses. Key words: Lung neoplasms; Pneumonia; Tomography,X-ray computed

Educational ExhibitAbstract No. 374 - Vascular compression syndromes for the interventional radiologist