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Zhang D, Mu C, Zhang X, Yan J, Xu M, Wang Y, Wang Y, Xue H, Chen Y, Jin Z. Image quality comparison of lower extremity CTA between CT routine reconstruction algorithms and deep learning reconstruction. BMC Med Imaging 2023; 23:33. [PMID: 36800947 PMCID: PMC9940378 DOI: 10.1186/s12880-023-00988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/06/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND To evaluate the image quality of lower extremity computed tomography angiography (CTA) with deep learning-based reconstruction (DLR) compared to model-based iterative reconstruction (MBIR), hybrid-iterative reconstruction (HIR), and filtered back projection (FBP). METHODS Fifty patients (38 males, average age 59.8 ± 19.2 years) who underwent lower extremity CTA between January and May 2021 were included. Images were reconstructed with DLR, MBIR, HIR, and FBP. The standard deviation (SD), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), noise power spectrum (NPS) curves, and the blur effect, were calculated. The subjective image quality was independently evaluated by two radiologists. The diagnostic accuracy of DLR, MBIR, HIR, and FBP reconstruction algorithms was calculated. RESULTS The CNR and SNR were significantly higher in DLR images than in the other three reconstruction algorithms, and the SD was significantly lower in DLR images of the soft tissues. The noise magnitude was the lowest with DLR. The NPS average spatial frequency (fav) values were higher using DLR than HIR. For blur effect evaluation, DLR and FBP were similar for soft tissues and the popliteal artery, which was better than HIR and worse than MBIR. In the aorta and femoral arteries, the blur effect of DLR was worse than MBIR and FBP and better than HIR. The subjective image quality score of DLR was the highest. The sensitivity and specificity of the lower extremity CTA with DLR were the highest in the four reconstruction algorithms with 98.4% and 97.2%, respectively. CONCLUSIONS Compared to the other three reconstruction algorithms, DLR showed better objective and subjective image quality. The blur effect of the DLR was better than that of the HIR. The diagnostic accuracy of lower extremity CTA with DLR was the best among the four reconstruction algorithms.
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Affiliation(s)
- Daming Zhang
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China
| | - Chunlin Mu
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China ,Department of Radiology, Beijing Sixth Hospital, Beijing, 100007 China
| | - Xinyue Zhang
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China
| | - Jing Yan
- Canon Medical Systems, Beijing, 100015 China
| | - Min Xu
- Canon Medical Systems, Beijing, 100015 China
| | - Yun Wang
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China
| | - Yining Wang
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China
| | - Huadan Xue
- grid.506261.60000 0001 0706 7839Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730 China
| | - Yuexin Chen
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, 100730, China.
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Arayapithak K, Suwannanon R, Hongsakul K. Popliteal artery branching variations on computed tomography angiography of 1542 lower limbs and its associated factors. Acta Radiol 2023; 64:874-880. [PMID: 35350850 DOI: 10.1177/02841851221088801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The identification of popliteal artery branching variation is of anatomical importance for surgical and endovascular procedures in the posterior region of the knee and below. PURPOSE To evaluate the variations and associated factors of popliteal artery branching by computed tomography angiography (CTA). MATERIAL AND METHODS CTA of the lower extremities of 1542 lower limbs in 771 patients (513 men and 258 women) were retrospectively reviewed to assess the popliteal artery branching patterns. The patient's sex, side of lower limbs, and population were recorded and evaluated for their association with popliteal artery branching patterns. P < 0.05 was considered to indicate statistical significance. RESULTS Variations in the branching of the popliteal artery were recorded in 9.3% of patients. The three most common variations were found to be hypoplastic-aplastic posterior tibial artery (PT) (3.6%), trifurcation (2.0%), and hypoplastic-aplastic anterior tibial artery (0.8%). A new pattern was detected in 2 (0.1%) cases, which were described as double PTs. Statistically significant differences were noted in the proportion of variation branching between the male and female groups (odds ratio = 1.52; 95% confidence interval = 1.07-2.16; P = 0.02). CONCLUSION The findings on popliteal variational branching patterns in the present study were in conformance to previous reports. Our study identified a novel variation of popliteal artery branching, which has not been mentioned in the literature so far. Sex was found to be an associated factor of branching variation.
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Affiliation(s)
- Karakkada Arayapithak
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ruedeekorn Suwannanon
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Automatic Plaque Removal Using Dual-Energy Computed Tomography Angiography: Diagnostic Accuracy and Utility in Patients with Peripheral Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101435. [PMID: 36295595 PMCID: PMC9609865 DOI: 10.3390/medicina58101435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This study aimed to evaluate the utility and accuracy of dual-energy automatic plaque removal (DE-APR) in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography (DSA) as the reference standard. Materials and Methods: We retrospectively analyzed 100 patients with PAD who underwent DE computed tomography angiography (DE-CTA) and DSA of the lower extremities. DE-CTA was used to generate APR subtracted images. In the three main arterial segments (aorto-iliac segment, femoro-popliteal segment, and below-the-knee segment), the presence or absence of hemodynamically significant stenosis (>50%) and calcification was assessed using the images. CTA data were analyzed using different imaging approaches (DE-standard reconstruction image (DE-SR), DE-APR maximum intensity projection image (APR), and DE-SR with APR). Results: For all segments evaluated, the sensitivity, specificity, and accuracy for detecting significant stenosis were 98.16%, 81.01%, and 89.58%, respectively, with DE-SR; 97.79%, 83.33%, and 90.56%, respectively, with APR; and 98.16%, 92.25%, and 95.20%, respectively, with DE-SR with APR. DE-SR with APR had greater accuracy than DE-SR or APR alone (p < 0.001 and p < 0.001, respectively). When analyzed based on vascular wall calcification, the accuracy of DE-SR with APR remained greater than 90% regardless of calcification severity, whereas DE-SR showed a considerable reduction in accuracy in moderate to severe calcification. In the case of APR, the degree of vascular wall calcification did not significantly influence the accuracy in the aorto-iliac and femoro-popliteal segments. DE-SR with APR achieved significantly higher diagnostic accuracy for all lower extremity segments in evaluating hemodynamically significant stenosis in patients with symptomatic PAD and transcended the impact of vascular wall calcification compared with DE-SR. Conclusions: APR demonstrated favorable diagnostic performance in the aorto-iliac and femoro-popliteal segments, exhibiting good agreement with DSA even in cases of moderate to severe vascular wall calcification.
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Zeiderman MR, Pu LLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma. BURNS & TRAUMA 2021; 9:tkab024. [PMID: 34345630 PMCID: PMC8324213 DOI: 10.1093/burnst/tkab024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/22/2021] [Indexed: 11/29/2022]
Abstract
The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally, the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review, the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.
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Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee L Q Pu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
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Notohamiprodjo S, Varasteh Z, Beer AJ, Niu G, Chen X(S, Weber W, Schwaiger M. Tumor Vasculature. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schwarcz TH, Gatz VL, Little S, Geddings CF. Arterial Duplex Ultrasound is the Most Cost-Effective, Noninvasive Diagnostic Imaging Modality before Treatment of Lower-Extremity Arterial Occlusive Disease. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670903300203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Multiple noninvasive imaging modalities (duplex ultrasound, magnetic resonance angiography, and computed tomographic angiography) are now available for diagnostic evaluation of lower-extremity arterial occlusive disease (LEOD). This study was performed to determine the effectiveness of duplex ultrasound as the primary diagnostic imaging test before endovascular treatment and to estimate the potential cost-savings compared with the use of other technologies. Methods The diagnostic evaluations of all patients treated for LEOD by a single vascular specialist between July 2004 and February 2008 were reviewed. The medical records were reviewed for the initial noninvasive diagnostic imaging study, type of intervention, and patency of revascularization. Medicare reimbursement rates (2007) for each imaging modality were used to compare costs of diagnostic testing. Results A total of 128 endovascular interventions were performed in 89 patients. Arterial duplex imaging was the primary and only diagnostic study performed prior to endovascular treatment in 108 (84%) of procedures. If preintervention magnetic resonance angiography or computed tomographic angiography had been used in these patients instead of duplex, the costs for diagnostic imaging alone would have increased by $96,064 and $44,762, respectively. Conclusion Arterial duplex ultrasound can be effectively used as the preferred modality for noninvasive imaging of LEOD, resulting in substantial cost savings.
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Affiliation(s)
| | - Vicki L. Gatz
- Lexington Surgeons, Vascular Laboratory, Lexington, Kentucky
| | - Stephen Little
- Lexington Surgeons, Vascular Laboratory, Lexington, Kentucky
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Computed tomographic arthrography of the normal dromedary camel carpus. Vet Comp Orthop Traumatol 2017; 29:188-94. [DOI: 10.3415/vcot-15-06-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
Abstract
SummaryThe aim of this prospective cadaveric study was to provide a detailed computed tomographic (CT) reference of the carpal joint in healthy dromedary camels. Twelve forelimbs of six apparently healthy camels were used. Computed tomographic imaging of 12 normal cadaveric camel carpal joints was performed before and after intra-articular administration of iodinated contrast medium. Transverse CT images were reconstructed in dorsal and parasagittal planes. The six carpal bones, the radial trochlea, and the proximal articular surface of the metacarpal bones were clearly visible on CT images with the bone setting window. Radiocarpal, carpometacarpal, transverse intercarpal, medial and lateral palmer intercarpal, middle intercarpal, accessory carpoulnar and medial and lateral collateral ligaments, carpal canal, joint capsule, and the extensor and flexor tendons were identified on CT images with the soft-tissue setting window. Postcontrast CT images provided better delineation of intercarpal ligaments, the capsular compartments and recesses. Results indicated that the osseous and the clinically important soft tissue structures of the dromedary camel carpal joint could be identified using CT and CT arthrography. The CT data of this study will serve as a basis for diagnosis of carpal problems in camels.
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Mishra A, Jain N, Bhagwat A. CT Angiography of Peripheral Arterial Disease by 256-Slice Scanner: Accuracy, Advantages and Disadvantages Compared to Digital Subtraction Angiography. Vasc Endovascular Surg 2017; 51:247-254. [PMID: 28478711 DOI: 10.1177/1538574417698906] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peripheral arterial occlusive disease (PAOD) may cause disabling claudication or critical limb ischemia. Multidetector computed tomography (CT) technology has evolved to the level of 256-slice CT scanners which has significantly improved the spatial and temporal resolution of the images. This has provided the capability of chasing the contrast bolus at a fast speed enabling angiographic imaging of long segments of the body. These images can be reconstructed in various planes and various modes for detailed analysis of the peripheral vascular diseases which helps in making treatment decision. PURPOSE The aim of this retrospective study was to compare the CT angiograms (CTAs) of all cases of PAOD done by 256-slice CT scanner at a tertiary care vascular center and comparing these images with the digital subtraction angiograms (DSAs) of these patients. MATERIALS AND METHODS The retrospective study included 53 patients who underwent both CTA and DSA at our center over a period of 3 years from March 2013 to March 2016. RESULTS The CTA showed high sensitivity (93%) and specificity (92.7%) for overall assessment of degree of stenosis in a vascular segment in cases of aortic and lower limb occlusive disease. The assessment of lesions of infrapopliteal segment was comparatively inferior (sensitivity 91.6%, accuracy 73.3%, and positive predictive value 78.5%), more so in the presence of significant calcification. The advantages of CTA were its noninvasive nature, ability to image large area of body, almost no adverse effects to the patients, and better assessment of vessel wall disease. However, the CTA assessment of collaterals was inferior with a sensitivity of only 62.7% as compared to DSA. Overall, 256-slice CTA provides fast and accurate imaging of vascular tree which can restrict DSA only in few selected cases as a problem-solving tool where clinico-radiological mismatch is present.
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Affiliation(s)
- Atul Mishra
- 1 Military Hospital (Cardio Thoracic Centre), Armed Forces Medical College, Pune, India
| | - Narendra Jain
- 1 Military Hospital (Cardio Thoracic Centre), Armed Forces Medical College, Pune, India
| | - Anand Bhagwat
- 2 Command Hospital (Southern Command), Armed Forces Medical College, Pune, India
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Demirtaş H, Parpar T, Değirmenci B, Kara M, Çelik AO, Umul A, Kayan M, Yılmaz Ö. Unenhanced 3D turbo spin echo MR angiography of lower extremity arteries: comparison with 128-MDCT angiography. Radiol Med 2016; 121:916-925. [PMID: 27573129 DOI: 10.1007/s11547-016-0678-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate the feasibility and diagnostic power of unenhanced 3D turbo spin echo MR angiography sequence (a technique based on subtraction of corresponding images acquired in diastole and systole, Syngo Native Space-Siemens healthcare) to identify peripheral artery disease (PAD). MATERIALS AND METHODS Thirty patients (619 arterial segments in total) suspected with PAD and who were assessed with lower extremity MDCT angiography were examined starting from the level of aortic bifurcation for both lower extremities by 3D native space MR angiography. Two readers assessed the image quality of native space MR angiography and number of lesions, their degrees of stenosis and localizations. The differences and compliance between the readers in the parameters assessed were investigated. RESULTS Out of 619 segments; Reader 1 considered 187 segments (30.2 %) and Reader 2 considered 177 segments (28.6 %) to have poor and inadequate MR image quality. When compared to CTA, sensitivity, specificity and diagnostic accuracy of native space MR angiography were calculated as 81.0, 83.1, 82.6 %, respectively, by Reader 1, while the same parameters were calculated as 69.9, 92.6, 84.9 %, respectively, by Reader 2. When the two readers were examined together, sensitivity, specificity, diagnostic accuracy were found to be 76.3, 88.1, 83.7 %, respectively, and the positive predictive value and negative predictive value was 70.3 and 89.9 %, respectively. A significantly better image quality was acquired with the age group below 50 years (p = 0.002). CONCLUSION Native space MR angiography technique can be used as the first-step imaging technique before contrast-enhanced examinations in young and middle age patients with suspected PAD and for patients with the risk of nephrogenic systemic fibrosis in chronic renal failure.
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Affiliation(s)
- Hakan Demirtaş
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey.
| | - Tuna Parpar
- Radiology Department, Hitit University Training and Research Hospital, Çorum, Turkey
| | - Bumin Değirmenci
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Mustafa Kara
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Ahmet Orhan Çelik
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Ayşe Umul
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Mustafa Kayan
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Ömer Yılmaz
- Radiology Department, School of Medicine, Suleyman Demirel University, Isparta, 32260, Turkey
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Demirtaş H, Değirmenci B, Çelik A, Umul A, Kara M, Aktaş A, Parpar T. Anatomic variations of popliteal artery: Evaluation with 128-section CT-angiography in 1261 lower limbs. Diagn Interv Imaging 2016; 97:635-42. [DOI: 10.1016/j.diii.2016.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/26/2022]
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Eid M, De Cecco CN, Schoepf UJ, Mangold S, Tesche C, Varga-Szemes A, Suranyi P, Stalcup S, Ball BD, Caruso D. The Role of MRI and CT in the Diagnosis of Atherosclerosis in an Aging Population. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Comparative study between multi-detector CT angiography and digital subtraction angiography in evaluation of peripheral arterial occlusive disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Molinari GJDP, Dalbem AMDO, Guillaumon AT. Avoiding pitfalls of intraoperative peripheral endovascular surgery with the aid of OsiriX: expanding the use of virtual fluoroscopy. Braz J Cardiovasc Surg 2014; 29:455-8. [PMID: 25372922 PMCID: PMC4412337 DOI: 10.5935/1678-9741.20140094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022] Open
Abstract
We have shown how the analysis of the angiotomography reconstruction through OsiriX program has assisted in endovascular perioperative programming. We presented its application in situations when an unexpected existence of metallic overlapping artifact (orthopedic osteosynthesis) compromised the adequate visualization of the arterial lesion during the procedure. Through manipulation upon OsiriX software, with assistance of preview under virtual fluoroscopy, it was possible to obtain the angles that would avoid this juxtaposition. These angles were reproduced in the C-arm, allowing visualization of the occluded segment, reducing the need for repeated image acquisitions and contrast overload, allowing the continuation of the procedure.
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Hellinger JC, Mendelson N, Pujata V, Kassam Z, Jahre C. CT Angiography: Essential for evaluating atherosclerotic cardiovascular disease. APPLIED RADIOLOGY 2014. [DOI: 10.37549/ar2094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Nicole Mendelson
- New York Cardiovascular Institute, Lenox Hill Radiology and Medical Imaging
| | - Varsha Pujata
- New York Cardiovascular Institute, Lenox Hill Radiology and Medical Imaging
| | - Zain Kassam
- New York Cardiovascular Institute, Lenox Hill Radiology and Medical Imaging
| | - Caren Jahre
- New York Cardiovascular Institute, Lenox Hill Radiology and Medical Imaging
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Adibi A, Krishnam MS, Dissanayake S, Plotnik AN, Mohajer K, Arellano C, Ruehm SG. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds. Eur Radiol 2014; 24:1586-93. [DOI: 10.1007/s00330-014-3174-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 11/27/2022]
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Radiation dose and image quality at high-pitch CT angiography of the aorta: intraindividual and interindividual comparisons with conventional CT angiography. AJR Am J Roentgenol 2013; 199:1402-9. [PMID: 23169737 DOI: 10.2214/ajr.12.8652] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate radiation dose and quantitative image quality parameters at high-pitch CT angiography (CTA) of the aorta compared with conventional CTA. MATERIALS AND METHODS We studied the examinations of 110 patients (65 men and 45 women; mean age ± SD, 64 ± 15 years) who had undergone CTA of the entire aorta on a second-generation dual-source CT system; 50 examinations were performed in high-pitch mode. The mean arterial attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) were calculated for the high-pitch CTA and conventional CTA groups. Radiation exposures were compared. RESULTS All studies were considered of diagnostic quality. At high-pitch CTA, the mean tube voltage and tube current-exposure time product were 118 ± 7 kV (SD) and 197 ± 78 mAs compared with 120 ± 1 kV and 258 ± 78 mAs, respectively, at conventional CTA (p < 0.05). The mean volume CT dose index, dose-length product, and effective dose were 8.1 ± 2.4 mGy, 561.1 ± 178.6 mGy × cm, and 9.6 ± 3.0 mSv at high-pitch CTA and 18.3 ± 7.7 mGy, 1162.6 ± 480.1 mGy × cm, and 19.8 ± 8.2 mSv at conventional CTA (p < 0.001). Attenuation was similar for both protocols, whereas significantly less contrast medium was injected for high-pitch CTA than for standard-pitch CTA (87.3 ± 16 mL vs 97.9 ± 16 mL, respectively; p < 0.01). The SNR and CNR were significantly lower in the high-pitch CTA examinations (p < 0.01), whereas the FOM was nonsignificantly higher. Twenty patients underwent both high-pitch CTA and conventional CTA, with a 45% reduction in radiation dose (p < 0.001). CONCLUSION High-pitch CTA of the aorta yields 45-50% reduction of radiation exposure as well as contrast medium savings with maintained vessel attenuation.
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Bashir MR, Weber PW, Husarik DB, Howle LE, Nelson RC. Improved aortic enhancement in CT angiography using slope-based triggering with table speed optimization: a pilot study. Int J Cardiovasc Imaging 2011; 28:1533-43. [PMID: 21898186 DOI: 10.1007/s10554-011-9945-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
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Abstract
OBJECTIVE The purpose of this article is to review the role of diagnostic imaging in the evaluation of women with diabetes. CONCLUSION Diabetic patients present a challenging population for the performance of various imaging studies and special considerations need to be made to obtain adequate studies. Imaging plays a significant role in assessing the multisystem morbidity of diabetes. Furthermore, diabetes in women may have some unique features and consequences and imaging studies can aid in the correct management of these patients.
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Holalkere NS, Matthes K, Kalva SP, Brugge WR, Sahani DV. 64-Slice multidetector row CT angiography of the abdomen: comparison of low versus high concentration iodinated contrast media in a porcine model. Br J Radiol 2010; 84:221-8. [PMID: 21081582 DOI: 10.1259/bjr/14535110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE In this study we aimed to assess the image quality and degree of vascular enhancement using low-concentration contrast media (LCCM) (300 mg I ml(-1)) and high-concentration contrast media (HCCM) (370 mg I ml(-1)) on 64-slice multidetector row CT (MDCT) abdominal CT angiography (CTA). In addition, we aimed to study the feasibility of using HCCM with a reduced total iodine dose. METHODS CTA of the abdomen on a 64-slice MDCT was performed on 15 anaesthetised pigs. Study pigs were divided into three groups of five each based on the iodine concentration and dose received: Group A (LCCM; 300 mg I ml(-1)), Group B (HCCM; 370 mg I ml(-1)) and Group C HCCM with 20% less iodine dose. The total iodine injected was kept constant (600 mg kg(-1)) in Groups A and B. Qualitative and quantitative analyses were performed to study and compare each group for image quality, visibility of the branch order of the superior mesenteric artery (SMA), artefacts, degree of enhancement in the aorta and main stem arteries and uniformity of enhancement in the aorta. Groups were compared using the analysis of variance test. RESULTS The image quality of 64-slice MDCT angiography was excellent with a mean score of 4.63 and confident visualisation of the third to fifth order branches of the SMA in all groups. Group B demonstrated superior vascular enhancement, as compared with Groups A and C (p≤0.05). Uniform aortic enhancement was achieved with the use of LCCM and HCCM with 20% less iodine dose. CONCLUSION 64-slice MDCT angiography of the abdomen was of excellent quality. HCCM improves contrast enhancement and overall CTA image quality and allows the iodine dose to be reduced.
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Affiliation(s)
- N-S Holalkere
- Boston Medical Center, Department of Radiology, Boston, MA 02118, USA.
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Sixty-Four Slice Multidetector Computed Tomographic Angiography in the Evaluation of Vascular Trauma. ACTA ACUST UNITED AC 2010; 68:96-102. [DOI: 10.1097/ta.0b013e318190c4ca] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Salman L, Maya ID, Asif A. Current concepts in the pathophysiology and management of arteriovenous access-induced hand ischemia. Adv Chronic Kidney Dis 2009; 16:371-7. [PMID: 19695505 DOI: 10.1053/j.ackd.2009.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The manifestations of hand ischemia because of an arteriovenous access can range from hand pain, tissue necrosis, and loss of the entire hand. Recent data have emphasized that multiple mechanisms (arterial steal, ie, retrograde flow, arterial stenosis, and arterial calcification) are responsible for inducing hand ischemia. Because any or a combination of the 3 mechanisms can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. A detailed history, physical examination, and differential diagnosis form the initial step in the management of distal hypoperfusion ischemic syndrome. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality should be based on this evaluation. In this article, we review the pathophysiology and present current strategies to ameliorate distal hypoperfusion ischemic syndrome.
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Fishman EK, Horton KM, Johnson PT. Multidetector CT and Three-dimensional CT Angiography for Suspected Vascular Trauma of the Extremities. Radiographics 2008; 28:653-65; discussion 665-6. [DOI: 10.1148/rg.283075050] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Increased Endovascular Interventions Decrease the Rate of Lower Limb Artery Bypass Operations without an Increase in Major Amputation Rate. Ann Vasc Surg 2008; 22:195-9. [DOI: 10.1016/j.avsg.2007.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 11/12/2007] [Accepted: 12/20/2007] [Indexed: 11/19/2022]
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MDCT angiography of peripheral arteries: technical considerations and impact on patient management. ACTA ACUST UNITED AC 2008; 17 Suppl 6:F5-15. [DOI: 10.1007/s10406-007-0223-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE The purpose of this study was to examine the results of computed tomography angiography (CTA) obtained in patients with high-energy tibial plafond fractures and assess if the information gleaned from CTA could be useful to the treating orthopedic surgeon. DESIGN Consecutive patient series. SETTING Level 2 trauma center. PATIENTS Consecutive patients treated between October 1, 2004 and June 31, 2006 for high-energy injury of the tibial plafond according to a protocol of early temporizing external fixation, CT, and elevation, followed by delayed reconstruction of the tibial plafond. INTERVENTION Addition of angiography to CT scan (CTA) in treatment protocol. MAIN OUTCOME MEASUREMENTS CTA abnormalities were identified and categorized to define the pattern of arterial lesions present. Characteristics of patients, injuries, treatments, and complications were evaluated and related to CTA findings. RESULTS CTA was performed at an average of 3 days postinjury in 25 consecutive patients treated for high-energy tibial plafond fractures. Abnormalities of the arterial tree of the leg were seen in 13 of 25 (52%) patients. One patient had 2 of 3 vessels notably injured. Fourteen arteries showed acute changes at the level of injury and 1 showed significant chronic atherosclerotic disease at the trifurcation. Acute arterial abnormalities included 7 arteries with complete occlusion, 2 with partial occlusion/diminished flow, and 5 with normal flow but with anatomic disturbances (4 tenting over and 1 entrapped by fracture fragments). Open fractures were associated with arterial abnormalities (P<0.05), but no other characteristics correlated with arterial injury. No patients had dye reactions or other problems relating to CTA. Patients with CTA-diagnosed vascular abnormalities were treated with more minimally invasive surgery than those without at the discretion of the surgeon, and no patients with vascular abnormalities had wound problems or infection. CONCLUSIONS In more than half of high-energy tibial plafond fractures, CTA identified significant abnormalities to the arterial tree of the distal leg. These injuries most commonly involved the anterior tibial artery and included a variety of lesions. CTA appears to be a safe and potentially useful tool for the assessment and preoperative planning of high-energy tibial plafond fractures.
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Abstract
Advances in vascular surgery have mirrored advances in diagnostic imaging. Indeed, the endovascular revolution has been made possible largely by advances in computed tomography, magnetic resonance imaging, and vascular ultrasound. As technology allows better noninvasive vascular diagnosis, conventional angiography, once the gold standard for the diagnosis of vascular disease, is now reserved largely for intervention. This article discusses the current state of vascular imaging. Specific emphasis is placed on the comparative clinical utility of different imaging modalities in the detection and management of vascular disease.
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Affiliation(s)
- Jason T Perry
- Division of General Surgery, Department of Surgery, Madigan Army Medical Center, 9400 Fitzsimmons Dr. Tacoma, WA 98431, USA.
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MDCT arteriographic spectrum in acute blunt peripheral trauma—a pictorial review. Emerg Radiol 2007; 15:91-7. [DOI: 10.1007/s10140-007-0687-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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Albrecht T, Foert E, Holtkamp R, Kirchin MA, Ribbe C, Wacker FK, Kruschewski M, Meyer BC. 16-MDCT Angiography of Aortoiliac and Lower Extremity Arteries: Comparison with Digital Subtraction Angiography. AJR Am J Roentgenol 2007; 189:702-11. [PMID: 17715120 DOI: 10.2214/ajr.07.2333] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to prospectively compare CT angiography (CTA) performed on a 16-MDCT scanner and digital subtraction angiography (DSA) in patients with peripheral arterial disease. SUBJECTS AND METHODS CTA and DSA were compared in 50 patients. CTA was independently evaluated by two blinded observers. DSA was evaluated by two additional blinded observers in consensus. Consensus DSA served as the reference standard for comparisons with CTA in terms of diagnostic quality, grading of stenoocclusive lesions, visualization of collaterals, impact on patient management, and time required for analysis. RESULTS No significant differences in diagnostic quality were observed between CTA and DSA above the ankle; both CTA observers noted significantly better visualization of pedal arteries (70 and 72 segments, respectively) than on DSA (57 segments). Of 958 stenoocclusive lesions on DSA, CTA observers 1 and 2 detected 933 and 929 lesions, respectively. Sensitivity and specificity for the detection of hemodynamically relevant (> 50%) lesions was 93.3% and 96.5% for observer 1 and 90.1% and 95.6% for observer 2. Collaterals were seen at 150 arterial levels on DSA compared with 97 and 92 levels on CTA (p < 0.05, both observers). Patient management decisions based on CTA were equivalent to those based on DSA in 49 of the 50 patients. CONCLUSION CTA is an effective noninvasive alternative to DSA for the evaluation of peripheral arterial disease.
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Affiliation(s)
- Thomas Albrecht
- Department of Radiology and Nuclear Medicine, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Germany.
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Ogasawara N, Komatsu S, Sato Y, Omori Y, Murakawa T, Ueda Y, Oyabu J, Fujisawa Y, Higashide T, Hirayama A, Kodama K. Evaluation of an occluded common iliac artery by multislice computed tomography: Plaque Map analysis as a guide for percutaneous transluminal angioplasty. Int J Cardiol 2007; 115:259-61. [PMID: 16764956 DOI: 10.1016/j.ijcard.2006.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 01/27/2006] [Indexed: 11/22/2022]
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Jiga LP, Ionac M. Microsurgery in infrapopliteal revascularization of lower limb. Ann Plast Surg 2007; 58:64-9. [PMID: 17197945 DOI: 10.1097/01.sap.0000250646.33887.f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lucian P Jiga
- Microsurgery Department, Timisoara University of Medicine and Pharmacy Victor Babes, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
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Mishra A, Bhaktarahalli JN, Ehtuish EF. Imaging of peripheral arteries by 16-row multidetector computed tomography angiography: a feasible tool? Eur J Radiol 2006; 61:528-33. [PMID: 17123762 DOI: 10.1016/j.ejrad.2006.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Revised: 10/10/2006] [Accepted: 10/11/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy of multidetector (16-row) computed tomography (MDCT) in imaging the upper and lower limb arterial tree in trauma and peripheral arterial occlusive disease (PAOD). METHODS Thirty-three patients underwent MDCT angiography (MDCTA) of the upper or the lower limb on 16-row MDCT scanner between November, 2004 and July, 2005. The findings were compared with the surgical outcome in cases with trauma and suspected arterial injuries or color Doppler correlation was obtained for patients of PAOD. RESULTS MDCTA allowed a comprehensive diagnostic work-up in all trauma cases with suspected arterial injuries. In the 23 cases of PAOD, MDCT adequately demonstrated the presence of stenosis or occlusion, its degree and extent, the presence of collaterals and plaques. CONCLUSION Our experience of CT angiography (CTA) with 16-row MDCT scanner has clearly demonstrated its efficacy as a promising, new, fast, accurate, safe and non-invasive imaging modality of choice in cases of trauma with suspected arterial injuries and as a useful screening modality in cases of PAOD for diagnosis and for grading.
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Affiliation(s)
- Anuj Mishra
- Department of Radiology, National Organ Transplant Program, Tripoli, Libyan Arab Jamahiriya, Libya.
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Leon C, Asif A. Arteriovenous access and hand pain: the distal hypoperfusion ischemic syndrome. Clin J Am Soc Nephrol 2006; 2:175-83. [PMID: 17699402 DOI: 10.2215/cjn.02230606] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
An ischemic hand in a hemodialysis patient is a serious condition. It causes significant pain and discomfort but also can lead to tissue necrosis and the eventual loss of digits and even the entire hand. Although stealing of blood away from the high-resistance forearm arteries into the low-resistance arteriovenous access generally is assumed to be the cause, a great majority of both wrist and elbow accesses demonstrate retrograde flow without any evidence of hand pain or ischemia. Consequently, demonstration of retrograde flow alone does not predict or indicate the existence of distal ischemia. In this context, the term "arterial steal syndrome" is a misnomer to indicate the presence of peripheral ischemia. Recent studies have shown that, in many cases, arterial stenotic lesions cause distal hypoperfusion and result in hand ischemia. In other cases, distal arteriopathy as a result of generalized vascular calcification and diabetes is the culprit. Because any or a combination of the three mechanisms (retrograde flow, stenotic lesions, and distal arteriopathy) can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. Treatment should start with a detailed history and physical examination to help rule out other (nonischemic) causes of hand pain. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality and procedure to apply should be based on this evaluation. This report reviews the pathophysiology and presents current strategies to ameliorate distal hypoperfusion ischemic syndrome.
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Affiliation(s)
- Carlos Leon
- Interventional Nephrology, Division of Nephrology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Anderson SW, Lucey BC, Varghese JC, Soto JA. Sixty-Four Multi-Detector Row Computed Tomography in Multitrauma Patient Imaging: Early Experience. Curr Probl Diagn Radiol 2006; 35:188-98. [PMID: 16949475 DOI: 10.1067/j.cpradiol.2006.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sixty-four multi-detector row computed tomography (64-MDCT) offers the possibility of increasing the application of CT in multitrauma imaging. 64-MDCT affords significant increases in imaging speed while allowing for subisotropic voxel slice thicknesses. We have recently installed two 64-MDCT scanners in our Level I trauma center. Our routine protocols using these new scanners are detailed. Additionally, this new technology has made possible several novel protocols. These include an increased use of CT angiography in trauma imaging. The acquisition speed and table lengths available with 64-MDCT allow for whole-body scout images. These scout images may be used to plan complex, multistep CT studies incorporating pelvic and extremity angiography, when indicated, into a single study. Imaging speeds afforded by 64-MDCT allow for imaging in any number of phases, over any area to be imaged, all with a single initial bolus of contrast. Image quality afforded by 64-MDCT allows for increasing roles of MPR and 3D reformations. These alternatives to axial images are currently used both for primary interpretation by our trauma radiologists as well as for communication and use by our clinical colleagues. Technical challenges presented by 64-MDCT include further increases in the number of images generated. Currently, datasets may exceed 4,000 images when angiography is included in routine trauma protocols. Radiation doses are also an ever present concern. With the opportunity to image from head to toe in seconds with submillimeter slice thicknesses, radiologists must be constantly vigilant in their efforts to limit radiation. Novel techniques such as automated dose modulation currently offer means of reducing radiation doses. Though several technical challenges are faced, 64-MDCT represents an evolution in multitrauma imaging.
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Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Division of Body Imaging, Boston University Medical Center, Boston, MA 02118, USA.
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