1
|
Dieckmeyer M, Sollmann N, Kupfer K, Löffler MT, Paprottka KJ, Kirschke JS, Baum T. Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose. Clin Neuroradiol 2023; 33:591-610. [PMID: 36862232 PMCID: PMC10449676 DOI: 10.1007/s00062-023-01271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
Collapse
Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Karina Kupfer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Karolin J. Paprottka
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Chen GZ, Luo S, Zhou CS, Zhang LJ, Lu GM. Digital subtraction CT angiography for the detection of posterior inferior cerebellar artery aneurysms: comparison with digital subtraction angiography. Eur Radiol 2017; 27:3744-3751. [PMID: 28289932 DOI: 10.1007/s00330-017-4771-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/18/2017] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of digital subtraction CT angiography (DS-CTA) in detecting posterior inferior cerebellar artery (PICA) aneurysms with digital subtraction angiography (DSA) as reference standard. METHODS A total of 115 patients, including 56 patients diagnosed with PICA aneurysms by CTA or DSA and 59 non-PICA-aneurysm patients were included in this retrospective study. All patients underwent DS-CTA and DSA. The site of PICA aneurysms and the pattern of haemorrhage were analysed. Sensitivity and specificity of DS-CTA without and with combining haemorrhage pattern in diagnosing PICA aneurysms were evaluated on a per patient and per aneurysm basis with DSA. RESULTS Of 115 patients, 56 patients (48.7%) had 61 PICA aneurysms (size range, 1.1-13.5 mm; mean size, 4.9 ± 2.8 mm) on DSA. The sensitivity and specificity in depicting PICA aneurysms were 89.3% and 96.6% on a per patient basis and 90.2% and 93.4% on a per aneurysm basis, while the corresponding values were 94.6% and 96.6% on a per patient basis and 95.1% and 93.4% on a per aneurysm basis when combining with haemorrhage site. CONCLUSION DS-CTA has a high sensitivity and specificity in detecting PICA aneurysms compared with DSA. It may be helpful for clinical diagnosis of PICA aneurysms to combine with haemorrhage sites. KEY POINTS • CT angiography has a good diagnostic performance in detecting PICA aneurysms. • The haemorrhage location is helpful to detect PICA aneurysms. • Digital subtraction CTA is a preferable diagnostic means for PICA aneurysms.
Collapse
Affiliation(s)
- Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Song Luo
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
| |
Collapse
|
3
|
Nagayama Y, Nakaura T, Tsuji A, Urata J, Furusawa M, Yuki H, Hirarta K, Oda S, Kidoh M, Utsunomiya D, Yamashita Y. Cerebral bone subtraction CT angiography using 80 kVp and sinogram-affirmed iterative reconstruction: contrast medium and radiation dose reduction with improvement of image quality. Neuroradiology 2017; 59:127-134. [DOI: 10.1007/s00234-016-1776-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
|
4
|
Zhao DL, Wan Y, Wang GK, Wang HB, Liang HW, Zhou HT, Gao L, Zhang JL. Evaluation of image quality in carotid and cerebrovascular disease: a comparative study between subtraction and routine computed tomography angiography. Echocardiography 2016; 33:1735-1740. [PMID: 27528234 DOI: 10.1111/echo.13326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Few data exist comparing the image quality and diagnostic accuracy of subtraction computed tomography (CT) angiography (SCTA) in carotid and cerebrovascular arteries with routine CT angiography (RCTA). PATIENTS AND METHODS In this study, 56 patients underwent 128-row CT angiography of these vessels with review by two radiologists using routine, nonsubtracted, and SCTA protocols. Comparisons were made using a 4-point subjective rating scale in all patients. Eighteen patients were examined with both SCTA and invasive digital subtraction angiography (DSA). The accuracy of SCTA and routine CTA reformations was assessed and compared by both patient-based and vessel-based analyses of intracranial aneurysms and intracranial and extracranial arterial stenotic lesions using DSA results as the reference standard. RESULTS Diagnostic accuracy in the adjacent skull base portion of the internal carotid artery (ICA) and reading time for cerebral aneurysms and vessel stenoses were obviously improved with SCTA protocol, but the accuracy in vertebro-basilar arteries was no different. The diagnostic accuracy in general was slightly increased compared with routine CTA. CONCLUSION Review of SCTA images is an effective means to remove bone close to vessels as seen on routine CTA and has good image quality and diagnostic accuracy. SCTA is superior to routine CTA in the visualization and diagnostic accuracy of adjacent skull base part of the ICA and decreases reading time for carotid and cerebrovascular arterial imaging.
Collapse
Affiliation(s)
- De-Li Zhao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong Wan
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guo-Kun Wang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hai-Bo Wang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong-Wei Liang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hai-Ting Zhou
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Gao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin-Ling Zhang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
5
|
Iyama Y, Nakaura T, Kidoh M, Kiyota N, Uemura S, Harada K, Yamashita Y. Effects of a high-pitch protocol and a hybrid iterative reconstruction algorithm on image quality of cerebral subtracted 3D CT angiography. Jpn J Radiol 2015; 33:687-93. [PMID: 26386575 DOI: 10.1007/s11604-015-0477-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/26/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the image quality and the radiation dose of 3D-computed tomography angiography (3D-CTA) with a high-pitch protocol and a hybrid iterative reconstruction (HIR). MATERIALS AND METHODS This was a prospective study and thirty patients were scanned at a 0.51-helical pitch with filtered back-projection (FBP, protocol-A), and 30 patients were scanned at a 0.91-helical pitch with FBP and HIR (protocol-B and C). The mean volume CT dose index (CTDI(vol)), image noise, and mean cerebral arterial and venous attenuation were compared between the three protocols. Two readers assessed image noise, arterial contrast and venous overlap. RESULTS The mean CTDI(vol) of protocol-B/C (38.9 mGy) was lower than that of protocol-A (49.7 mGy). Mean image noise of protocol-B [12.6 ± 1.3 Hounsfield units (HU)] was higher than that of protocol-A (10.3 ± 1.2 HU). There was no significant difference in arterial attenuation between protocol-A (327.5 ± 57.5 HU) and C (327.7 ± 59.4 HU). Venous attenuation of protocol-C (148.5 ± 50.4 HU) was lower than that of protocol-A (185.9 ± 50.6 HU). In qualitative analysis, the image noise of protocol-B was higher than that of protocol-A/C. Venous enhancement of protocol-B/C was more inconspicuous than that of protocol-A. CONCLUSIONS 3D-CTA with a high-pitch protocol and HIR can reduce radiation dose while decreasing venous enhancement and image noise to an adequate level for diagnosis.
Collapse
Affiliation(s)
- Yuji Iyama
- Diagnostic Radiology, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan. .,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Takeshi Nakaura
- Diagnostic Radiology, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan. .,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Naoto Kiyota
- Diagnostic Radiology, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.
| | - Shouzaburou Uemura
- Department of Neurosurgery, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.
| | - Kazunori Harada
- Department of Surgery, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan.
| |
Collapse
|
6
|
The value of cerebral CT angiography with low tube voltage in detection of intracranial aneurysms. BIOMED RESEARCH INTERNATIONAL 2015; 2015:876796. [PMID: 25710034 PMCID: PMC4331409 DOI: 10.1155/2015/876796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022]
Abstract
Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA) with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA) group and low voltage CTA (L-CTA) group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. With the results of 3D-DSA as “gold standard,” the sensitivity, specificity, and accuracy of C-CTA and L-CTA in diagnosis of aneurysms were calculated and compared with each other. Results. Compared with group C-CTA, the CT dose index volume (CTDIvol) of group L-CTA reduced by 35.65%. There were no significant differences between C-CTA and L-CTA groups regarding objective and subjective image qualities. The sensitivity, specificity, and accuracy of L-CTA in diagnosis of aneurysms were 95.16%, 99.72%, and 99.42%, respectively. There were no significant differences in sensitivity, specificity, and accuracy between the C-CTA and L-CTA groups. Conclusion. The value of cerebral CTA with 100 kV low tube voltage in detection of intracranial aneurysms is significant, and it should be recommended as a routine scan method.
Collapse
|