1
|
Bae H, Lee JW, Jeong YJ, Hwang MH, Lee G. Increased Scan Speed and Pitch on Ultra-Low-Dose Chest CT: Effect on Nodule Volumetry and Image Quality. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1301. [PMID: 39202582 PMCID: PMC11356370 DOI: 10.3390/medicina60081301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: This study's objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who had lung nodules were included in this study. Standard-speed, standard-pitch (SSSP) ultra-low-dose CT and high-speed, high-pitch (HSHP) ultra-low-dose CT were obtained for all patients. Image noise was measured as the standard deviation of attenuation. One hundred and sixty-three nodules were identified and classified according to location, volume, and nodule type. Volume measurement of detected pulmonary nodules was compared according to nodule location, volume, and nodule type. Motion artifacts at the right middle lobe, the lingular segment, and both lower lobes near the lung bases were evaluated. Subjective image quality analysis was also performed. Results: The HSHP CT scan demonstrated decreased motion artifacts at the left upper lobe lingular segment and left lower lobe compared to the SSSP CT scan (p < 0.001). The image noise was higher and the radiation dose was lower in the HSHP scan (p < 0.001). According to the nodule type, the absolute relative volume difference was significantly higher in ground glass opacity nodules compared with those of part-solid and solid nodules (p < 0.001). Conclusion: Our study results suggest that HSHP ultra-low-dose chest CT scans provide decreased motion artifacts and lower radiation doses compared to SSSP ultra-low-dose chest CT. However, lung nodule volumetry should be performed with caution for ground glass opacity nodules.
Collapse
Affiliation(s)
- Heejoo Bae
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea (J.W.L.); (M.-H.H.)
| | - Ji Won Lee
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea (J.W.L.); (M.-H.H.)
| | - Yeon Joo Jeong
- Department of Radiology and Medical Research Institute, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Busan 50612, Republic of Korea;
| | - Min-Hee Hwang
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea (J.W.L.); (M.-H.H.)
| | - Geewon Lee
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea (J.W.L.); (M.-H.H.)
| |
Collapse
|
2
|
Pannenbecker P, Heidenreich JF, Huflage H, Gruschwitz P, Patzer TS, Weng AM, Grunz JP, Kunz AS, Bley TA, Petritsch B. The Best of Both Worlds: Ultra-high-pitch Pulmonary Angiography with Free-Breathing Technique by Means of Photon-Counting Detector CT for Diagnosis of Acute Pulmonary Embolism. Acad Radiol 2024:S1076-6332(24)00386-6. [PMID: 38969575 DOI: 10.1016/j.acra.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
RATIONALE AND OBJECTIVES To assess image quality and radiation dose of ultra-high-pitch CT pulmonary angiography (CTPA) with free-breathing technique for diagnosis of pulmonary embolism using a photon-counting detector (PCD) CT compared to matched energy-integrating detector (EID)-based single-energy CTPA. MATERIALS AND METHODS Fifty-one PCD-CTPAs were prospectively compared to 51 CTPAs on a third-generation dual-source EID-CT. CTPAs were acquired with an ultra-high-pitch protocol with free-breathing technique (40 mL contrast medium, pitch 3.2) at 140 kV (PCD) and 70-100 kV (EID). Iodine maps were reconstructed from spectral PCD-CTPAs. Image quality of CTPAs and iodine maps was assessed independently by three radiologists. Additionally, CT attenuation numbers within pulmonary arteries as well as signal-to-noise and contrast-to-noise ratios (SNR, CNR) were compared. Administered radiation dose was compared. RESULTS CT attenuation was higher in the PCD-group (all P < 0.05). CNR and SNR were higher in lobar pulmonary arteries in PCD-CTPAs (P < 0.05), whereas no difference was ascertained within the pulmonary trunk (P > 0.05). Image quality of PCD-CTPA was rated best by all readers (excellent/good image quality in 96.1% of PCD-CTPAs vs. 50.9% of EID-CTPAs). PCD-CT produced no non-diagnostic scans vs. three non-diagnostic (5.9%) EID-CTPAs. Radiation dose was lower with PCD-CT than with EID-CT (effective dose 1.33 ± 0.47 vs. 1.80 ± 0.82 mSv; all P < 0.05). CONCLUSION Ultra-high-pitch CTPA with free-breathing technique with PCD-CT allows for superior image quality with significantly reduced radiation dose and full spectral information. With the ultra-high pitch, only PCD-CTPA enables reconstruction of iodine maps containing additional functional information.
Collapse
Affiliation(s)
- Pauline Pannenbecker
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.).
| | - Julius F Heidenreich
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Henner Huflage
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Philipp Gruschwitz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Theresa S Patzer
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas M Weng
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Jan-Peter Grunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas S Kunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Thorsten A Bley
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Bernhard Petritsch
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.); Hospital Klagenfurt am Wörthersee, Department of Diagnostic and Interventional Radiology, Klagenfurt am Wörthersee, Austria (B.P.)
| |
Collapse
|
3
|
Tan S, Hamarati LB, Rajiah PS, Le Gal G, Ko JP, Stojanovska J. CTA of Acute Pulmonary Embolism: Best Practices. Semin Roentgenol 2022; 57:313-323. [DOI: 10.1053/j.ro.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/11/2022]
|
4
|
Farag A, Fielding J, Catanzano T. Role of Dual-energy Computed Tomography in Diagnosis of Acute Pulmonary Emboli, a Review. Semin Ultrasound CT MR 2022; 43:333-343. [PMID: 35738818 DOI: 10.1053/j.sult.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prompt diagnosis of pulmonary embolism is essential to avert morbidity and mortality. There are a number of diagnostic options for identification of a pulmonary embolism, including laboratory and imaging investigations. While computed tomography pulmonary angiography (CTPA) has largely supplanted nuclear medicine ventilation/perfusion studies, there remain significant limitations in the optimal performance of CTPA. Dual-energy computed tomography has the ability to overcome many of the limitations of standard of care CTPA, including rescue of poor contrast boluses and the ability to evaluate pulmonary perfusion defects.
Collapse
Affiliation(s)
- Ahmed Farag
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, MA
| | - Jordan Fielding
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, MA.
| |
Collapse
|
5
|
Degerstedt SG, Winant AJ, Lee EY. Pediatric Pulmonary Embolism: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:69-82. [PMID: 34836567 DOI: 10.1016/j.rcl.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In contrast with the algorithms and screening criteria available for adults with suspected pulmonary embolism, there is a paucity of guidance on the diagnostic approach for children. The incidence of pulmonary embolism in the pediatric population and young adults is higher than thought, and there is an urgent need for updated guidelines for the imaging approach to diagnosis in the pediatric population. This article presents an up-to-date review of imaging techniques, characteristic radiologic findings, and an evidence-based algorithm for the detection of pediatric pulmonary embolism to improve the care of pediatric patients with suspected pulmonary embolism.
Collapse
Affiliation(s)
- Spencer G Degerstedt
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
6
|
Gong H, Ren L, Hsieh SS, McCollough CH, Yu L. Deep learning enabled ultra-fast-pitch acquisition in clinical X-ray computed tomography. Med Phys 2021; 48:5712-5726. [PMID: 34415068 DOI: 10.1002/mp.15176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE In X-raycomputed tomography (CT), many important clinical applications may benefit from a fast acquisition speed. The helical scan is the most widely used acquisition mode in clinical CT, where a fast helical pitch can improve the acquisition speed. However, on a typical single-source helical CT (SSCT) system, the helical pitch p typically cannot exceed 1.5; otherwise, reconstruction artifacts will result from data insufficiency. The purpose of this work is to develop a deep convolutional neural network (CNN) to correct for artifacts caused by an ultra-fast pitch, which can enable faster acquisition speed than what is currently achievable. METHODS A customized CNN (denoted as ultra-fast-pitch network (UFP-net)) was developed to restore the underlying anatomical structure from the artifact-corrupted post-reconstruction data acquired from SSCT with ultra-fast pitch (i.e., p ≥ 2). UFP-net employed residual learning to capture the features of image artifacts. UFP-net further deployed in-house-customized functional blocks with spatial-domain local operators and frequency-domain non-local operators, to explore multi-scale feature representation. Images of contrast-enhanced patient exams (n = 83) with routine pitch setting (i.e., p < 1) were retrospectively collected, which were used as training and testing datasets. This patient cohort involved CT exams over different scan ranges of anatomy (chest, abdomen, and pelvis) and CT systems (Siemens Definition, Definition Flash, Definition AS+, Siemens Healthcare, Inc.), and the corresponding base CT scanning protocols used consistent settings of major scan parameters (e.g., collimation and pitch). Forward projection of the original images was calculated to synthesize helical CT scans with one regular pitch setting (p = 1) and two ultra-fast-pitch setting (p = 2 and 3). All patient images were reconstructed using the standard filtered-back-projection (FBP) algorithm. A customized multi-stage training scheme was developed to incrementally optimize the parameters of UFP-net, using ultra-fast-pitch images as network inputs and regular pitch images as labels. Visual inspection was conducted to evaluate image quality. Structural similarity index (SSIM) and relative root-mean-square error (rRMSE) were used as quantitative quality metrics. RESULTS The UFP-net dramatically improved image quality over standard FBP at both ultra-fast-pitch settings. At p = 2, UFP-net yielded higher mean SSIM (> 0.98) with lower mean rRMSE (< 2.9%), compared to FBP (mean SSIM < 0.93; mean rRMSE > 9.1%). Quantitative metrics at p = 3: UFP-net-mean SSIM [0.86, 0.94] and mean rRMSE [5.0%, 8.2%]; FBP-mean SSIM [0.36, 0.61] and mean rRMSE [36.0%, 58.6%]. CONCLUSION The proposed UFP-net has the potential to enable ultra-fast data acquisition in clinical CT without sacrificing image quality. This method has demonstrated reasonable generalizability over different body parts when the corresponding CT exams involved consistent base scan parameters.
Collapse
Affiliation(s)
- Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Liqiang Ren
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott S Hsieh
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
7
|
Petritsch B, Pannenbecker P, Weng AM, Veldhoen S, Grunz JP, Bley TA, Kosmala A. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. ROFO-FORTSCHR RONTG 2020; 193:427-436. [PMID: 33003244 DOI: 10.1055/a-1245-0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Comparison of dual-source dual-energy CT (DS-DECT) and split-filter dual-energy CT (SF-DECT) regarding image quality and radiation dose in patients with suspected pulmonary embolism. MATERIALS AND METHODS We retrospectively analyzed pulmonary dual-energy CT angiography (CTPA) scans performed on two different CT scanners in 135 patients with suspected pulmonary embolism (PE). Scan parameters for DS-DECT were 90/Sn150 kV (n = 68 patients), and Au/Sn120 kV for SF-DECT (n = 67 patients). The iodine delivery rate was 1400 mg/s in the DS-DECT group vs. 1750 mg/s in the SF-DECT group. Color-coded iodine distribution maps were generated for both protocols. Objective (CT attenuation of pulmonary trunk [HU], signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective image quality parameters (two readers [R], five-point Likert scale), as well as radiation dose parameters (effective radiation dose, size-specific dose estimations [SSDE]) were compared. RESULTS All CTPA scans in both groups were of diagnostic image quality. Subjective CTPA image quality was rated as good or excellent in 80.9 %/82.4 % (R1 / R2) of DS-DECT scans, and in 77.6 %/76.1 % of SF-DECT scans. For both readers, the image quality of split-filter iodine distribution maps was significantly lower (p < 0.05) with good or excellent ratings in only 43.3 %/46.3 % (R1 / R2) vs. 83.8 %/88.2 % for maps from DS-DECT. The HU values of the pulmonary trunk did not differ between the two techniques (p = n. s.), while both the SNR and CNR were significantly higher in the split-filter group (p < 0.001; p = 0.003). Both effective radiation dose (2.70 ± 1.32 mSv vs. 2.89 ± 0.94 mSv) and SSDE (4.71 ± 1.63 mGy vs. 5.84 ± 1.11 mGy) were significantly higher in the split-filter group (p < 0.05). CONCLUSION The split-filter allows for dual-energy imaging of suspected pulmonary embolism but is associated with lower iodine distribution map quality and higher radiation dose. KEY POINTS · The split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners.. · Compared to the assessed dual-source dual-energy system, split-filter dual-energy imaging of a suspected pulmonary embolism is associated with lower iodine distribution map quality and higher radiation dose.. · Both the split-filter and the dual-source scanner provide diagnostic image quality in CTPA.. CITATION FORMAT · Petritsch B, Pannenbecker P, Weng AM et al. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. Fortschr Röntgenstr 2021; 193: 427 - 436.
Collapse
Affiliation(s)
- Bernhard Petritsch
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
8
|
Al Hassan DA, Waheed KB, El Sirafy MN, Khattab MA, Al-Hammadi HI, Ibrahim MF, Arulanantham ZJ. Computed tomography pulmonary angiography using high-pitch dual-source scanner technology. Saudi Med J 2019; 40:230-237. [PMID: 30834417 PMCID: PMC6468199 DOI: 10.15537/smj.2019.3.23940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives: To compare use of ultra-fast high-pitch dual-source free-breathing computed tomography pulmonary angiogram (CTPA) with conventional standard-pitch single-source breath-hold CTPA. Methods: This retrospective comparative study was conducted in Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia from July 2016 to December 2017. Patients (N=130) were divided into 2 groups, each having 65 consecutive patients; Group-1 (single-source CT) and Group-2 (dual-source CT). Previously treated pulmonary embolism cases, pregnant patients and those with incomplete data were excluded. Image quality was subjectively assessed by 2 readers for adequacy of contrast opacification and pulmonary vessel outline, and presence of artifacts (breathing motion, cardiac pulsation, and contrast related). Scan acquisition times and radiation doses were also compared. Chi-square and t-test were used to determine association. Results: Improved image quality (optimal studies without artifacts 91%) was seen in Group-2 compared to Group-1 (optimal studies without artifacts 75.4%). Also, reduced scan time (1-2 sec.) and radiation dose (mean dose length product (DLP)-248 mGy-cm) were observed in Group-2 compared to Group-1 (scan time- 6.5 sec, mean DLP-375). Results were found significant (p<0.05). Conclusion: High-pitch dual-source CT with free-breathing yields better image quality, reduces image acquisition time and radiation doses.
Collapse
Affiliation(s)
- Donya A Al Hassan
- Department of Radiology, King Fahad Military Medical Complex,Prince Sultan Military College of Health Science, Dhahran, Kingdom of Saudi Arabia. E-mail.
| | - Khawaja B Waheed
- Radiology Department, King Fahad Military Medical Complex, Dhahran, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | |
Collapse
|
9
|
Bunch PM, Fulwadhva UP, Wortman JR, Primak AN, Madan R, Steigner ML, Sodickson AD. Motion Artifact Reduction From High-Pitch Dual-Source Computed Tomography Pulmonary Angiography. J Comput Assist Tomogr 2018; 42:623-629. [PMID: 29613990 DOI: 10.1097/rct.0000000000000736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare quantitative and qualitative measures of aortic, cardiac, and respiratory motion artifact between high-pitch dual-source (DS) and single-source (SS) computed tomography pulmonary angiography (CTPA) protocols. METHODS This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study retrospectively reviewed 80 non-electrocardiogram-gated CTPA examinations acquired with a second-generation DS system at 100 kVp following 50 mL iodinated contrast injection - 40 consecutive SS and 40 consecutive DS studies. Quantitative measures of aortic, left ventricular, and diaphragmatic motion were recorded as the maximal excursion of a structure's "double image," and 3 independent readers performed qualitative motion assessments. Pulmonary arterial contrast enhancement, image noise, and radiation dose metrics were recorded. Statistical analyses were performed with 1-way analysis of variance and Fisher exact test. RESULTS Dual source outperformed SS technique in both quantitative and qualitative measures of motion. Mean distances between motion-artifact double images were reduced with DS protocol at each location (all P ≤ 0.004), and DS examinations were more likely to receive an assessment of no motion in all locations (all P < 0.0001). The DS protocol demonstrated increases in contrast enhancement, although increased image noise resulted in lower enhancement to noise ratio. Mean radiation dose was 60% lower using the DS protocol. CONCLUSION High-pitch DS CTPA significantly reduces artifacts resulting from ascending aortic, cardiac, and diaphragmatic motion.
Collapse
|
10
|
Frellesen C, Wichmann JL, Tischendorf P, Scholtz JE, Beeres M, Vogl TJ, Bauer RW. High-pitch dual-source paranasal sinus CT in agitated patients with maxillofacial trauma: analysis of image quality, motion artifacts, and dose aspects. Acta Radiol 2018; 59:909-916. [PMID: 29105487 DOI: 10.1177/0284185117740931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Image quality benefits from high-pitch scanning in agitated patients by reducing acquisition time. Purpose To compare image quality and exposure parameters in patients with maxillofacial trauma on second- and third-generation dual-source computed tomography (DSCT). Material and Methods Four groups were compared. Group 1 was examined on second-generation DSCT (120 kV/50 mAs, pitch 3.0). The other three groups were examined on third-generation DSCT. Group 2 was scanned with 120 kV/50 mAs, pitch 2.2. Automated exposure control (AEC) was used in group 3 and group 4 with pitch factors of 2.2 and 3.0, respectively. Images of third-generation DSCT were reconstructed with iterative reconstruction (IR), of second-generation DSCT with filtered back-projection. CTDIvol, acquisition time, and image quality were compared. Results Thirty patients were included in each group. Average CTDIvol (2.76 ± 0.00 mGy, 2.66 ± 0.00 mGy, 0.74 ± 0.23 mGy, and 0.75 ± 0.17 mGy) was significantly lower on third-generation DSCT with AEC ( P < 0.001). Subjective image quality was rated worst in group 4 due to strong high-pitch artifacts, while in the remaining three groups it was rated good or very good with good inter-observer agreement (k > 0.64). Average acquisition time was significantly shorter with third-generation DSCT (0.47 s, 0.36 s, 0.38 s, 0.30 s; P < 0.001). Conclusion Third-generation DSCT yields faster acquisition times and substantial dose reduction with AEC. A pitch of 2.2 should be preferred, as it results in fewer artifacts. If AEC is used, latest IR ensures that diagnostic image quality is guaranteed.
Collapse
Affiliation(s)
- Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Martin Beeres
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University Frankfurt, Frankfurt am Main, Germany
- RNS, Private Radiology and Radiation Therapy Group, Wiesbaden, Germany
| |
Collapse
|
11
|
Atlı E, Akpınar E, Ünal E, Oğuz Sayan B, Haliloğlu M. The feasibility of high-pitch acquisition protocol for imaging of the pediatric abdomen by dual-source CT. Jpn J Radiol 2018; 36:437-443. [DOI: 10.1007/s11604-018-0744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/13/2018] [Indexed: 01/14/2023]
|
12
|
Cascio V, Hon M, Haramati LB, Gour A, Spiegler P, Bhalla S, Katz DS. Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients. Br J Radiol 2018; 91:20170956. [PMID: 29762047 DOI: 10.1259/bjr.20170956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.
Collapse
Affiliation(s)
- Vincent Cascio
- 1 Stony Brook University School of Medicine , Stony Brook, NY , USA.,2 Department of Radiology, NYU Winthrop, Stony Brook University School of Medicine , Mineola, NY , USA
| | - Man Hon
- 3 Interventional Radiology, NYU Winthrop, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Linda B Haramati
- 4 Division of Cardiothoracic Imaging, Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx, NY , USA
| | - Animesh Gour
- 5 Division of Pulmonaryand Critical Care Medicine, Department of Internal Medicine, NYU Winthrop , Mineola, NY , USA
| | - Peter Spiegler
- 1 Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Sanjeev Bhalla
- 6 Mallinckrodt Institute of Radiology, Washington University School of Medicine , St Louis, MO , USA
| | - Douglas S Katz
- 2 Department of Radiology, NYU Winthrop, Stony Brook University School of Medicine , Mineola, NY , USA
| |
Collapse
|
13
|
Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018; 8:225-243. [PMID: 30057872 DOI: 10.21037/cdt.2017.12.01] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Imaging plays an important role in the evaluation and management of acute pulmonary embolism (PE). Computed tomography (CT) pulmonary angiography (CTPA) is the current standard of care and provides accurate diagnosis with rapid turnaround time. CT also provides information on other potential causes of acute chest pain. With dual-energy CT, lung perfusion abnormalities can also be detected and quantified. Chest radiograph has limited utility, occasionally showing findings of PE or infarction, but is useful in evaluating other potential causes of chest pain. Ventilation-perfusion (VQ) scan demonstrates ventilation-perfusion mismatches in these patients, with several classification schemes, typically ranging from normal to high. Magnetic resonance imaging (MRI) also provides accurate diagnosis, but is available in only specialized centers and requires higher levels of expertise. Catheter pulmonary angiography is no longer used for diagnosis and is used only for interventional management. Echocardiography is used for risk stratification of these patients. In this article, we review the role of imaging in the evaluation of acute PE.
Collapse
Affiliation(s)
- Alastair J E Moore
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Wachsmann
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Murthy R Chamarthy
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lloyd Panjikaran
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Yuki Tanabe
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
14
|
Kaup M, Gruber-Rouh T, Scholtz JE, Albrecht MH, Bucher A, Frellesen C, Vogl TJ, Beeres M. Low-dose CT pulmonary angiography on a 15-year-old CT scanner: a feasibility study. Acta Radiol Open 2017; 5:2058460116684371. [PMID: 28286671 PMCID: PMC5330415 DOI: 10.1177/2058460116684371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) low-dose (LD) imaging is used to lower radiation exposure, especially in vascular imaging; in current literature, this is mostly on latest generation high-end CT systems. Purpose To evaluate the effects of reduced tube current on objective and subjective image quality of a 15-year-old 16-slice CT system for pulmonary angiography (CTPA). Material and Methods CTPA scans from 60 prospectively randomized patients (28 men, 32 women) were examined in this study on a 15-year-old 16-slice CT scanner system. Standard CT (SD) settings were 100 kV and 150 mAs, LD settings were 100 kV and 50 mAs. Attenuation of the pulmonary trunk, various anatomic landmarks, and image noise were quantitatively measured; contrast-to-noise ratios (CNR) and signal-to-noise ratios (SNR) were calculated. Three independent blinded radiologists subjectively rated each image series using a 5-point grading scale. Results CT dose index (CTDI) in the LD series was 66.46% lower compared to the SD settings (2.49 ± 0.55 mGy versus 7.42 ± 1.17 mGy). Attenuation of the pulmonary trunk showed similar results for both series (SD 409.55 ± 91.04 HU; LD 380.43 HU ± 93.11 HU; P = 0.768). Subjective image analysis showed no significant differences between SD and LD settings regarding the suitability for detection of central and peripheral PE (central SD/LD, 4.88; intra-class correlation coefficients [ICC], 0.894/4.83; ICC, 0.745; peripheral SD/LD, 4.70; ICC, 0.943/4.57; ICC, 0.919; all P > 0.4). Conclusion The LD protocol, on a 15-year-old CT scanner system without current high-end hardware or post-processing tools, led to a dose reduction of approximately 67% with similar subjective image quality and delineation of central and peripheral pulmonary arteries.
Collapse
Affiliation(s)
- Moritz Kaup
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Jan E Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Andreas Bucher
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Martin Beeres
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| |
Collapse
|
15
|
State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol 2016; 208:495-504. [PMID: 27897042 DOI: 10.2214/ajr.16.17202] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pulmonary CT angiography (CTA) is the imaging modality of choice in suspected acute pulmonary embolism (PE). Current pulmonary CTA techniques involve ever lower doses of contrast medium and radiation along with advanced postprocessing applications to enhance image quality, diagnostic accuracy, and provide added value in patient management. The objective of this article is to summarize these current developments and discuss the appropriate use of state-of-the-art pulmonary CTA. CONCLUSION Pulmonary CTA is well established as a fast and reliable means of excluding or diagnosing PE. Continued developments in CT system hardware and postprocessing techniques will allow incremental reductions in radiation and contrast material requirements while improving image quality. Advances in risk stratification and prognostication from pulmonary CTA examinations should further refine its clinical value while minimizing the potential harm from overutilization and overdiagnosis.
Collapse
|
16
|
Martini K, Meier A, Higashigaito K, Saltybaeva N, Alkadhi H, Frauenfelder T. Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism. Acad Radiol 2016; 23:1335-1341. [PMID: 27639625 DOI: 10.1016/j.acra.2016.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To prospectively compare high-pitch computed tomography (HPCT) under free breathing (FB) with standard-pitch CT (SPCT) under breath-hold (BH) for detection of pulmonary embolism (PE). MATERIALS AND METHODS One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signal-to-noise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated. RESULTS Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT. CONCLUSIONS HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained.
Collapse
Affiliation(s)
- K Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland.
| | - A Meier
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - K Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - N Saltybaeva
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - T Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| |
Collapse
|
17
|
High-pitch Helical Dual-source Computed Tomographic Pulmonary Angiography: Comparing Image Quality in Inspiratory Breath-hold and During Free Breathing. J Thorac Imaging 2016; 31:56-62. [PMID: 26447868 DOI: 10.1097/rti.0000000000000173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare qualitative and quantitative image parameters of dual-source high-pitch helical computed tomographic pulmonary angiography (CTPA) in breath-holding (BH) versus free-breathing (FB) patients. MATERIALS AND METHODS Ninety-nine consented patients (61 female individuals; mean age±SD, 49±18.7 y) were randomized into BH (n=45) versus FB (n=54) high-pitch helical CTPA. Patient characteristics and CTPA radiation doses were analyzed. Two readers assessed for pulmonary embolism (PE), transient interruption of contrast, and respiratory and cardiac motion. The readers used a subjective 3-point scale to rate the pulmonary artery opacification and lung parenchymal appearance. A single reader assessed mean pulmonary artery signal intensity, noise, contrast, signal to noise ratio, and contrast to noise ratio. RESULTS PE was diagnosed in 16% BH and 19% FB patients. CTPAs of both groups were of excellent or acceptable quality for PE evaluation and of similar mean radiation doses (1.3 mSv). Transient interruption of contrast was seen in 5/45 (11%) BH and 5/54 (9%) FB patients (not statistically significant, P=0.54). No statistically significant difference was noted in cardiac, diaphragmatic, and lung parenchymal motion. Lung parenchymal assessment was excellent in all cases, except for 5/54 (9%) motion-affected FB cases with acceptable quality (statistically significant, P=0.03). No CTPA was considered nondiagnostic by any of the readers. No objective image quality differences were noted between both groups (P>0.05). CONCLUSIONS High-pitch helical CTPA acquired during BH or in FB yields comparable image quality for the diagnosis of PE and lung pathology, with low radiation exposure. Only a modest increase in lung parenchymal artifacts is encountered in FB high-pitch helical CTPA.
Collapse
|
18
|
Taslakian B, Latson LA, Truong MT, Aaltonen E, Shiau MC, Girvin F, Alpert JB, Wickstrom M, Ko JP. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls. Eur J Radiol 2016; 85:2049-2063. [PMID: 27776659 DOI: 10.1016/j.ejrad.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/30/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.
Collapse
Affiliation(s)
| | - Larry A Latson
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Mylene T Truong
- Department of Radiology, University of Texas, MD Anderson Cancer Center, TX, USA.
| | - Eric Aaltonen
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Maria C Shiau
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Francis Girvin
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | | | - Maj Wickstrom
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| |
Collapse
|
19
|
Systematic Comparison of Reduced Tube Current Protocols for High-pitch and Standard-pitch Pulmonary CT Angiography in a Large Single-center Population. Acad Radiol 2016; 23:619-27. [PMID: 26905455 DOI: 10.1016/j.acra.2016.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/15/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES Benefits of iterative reconstruction (IR) algorithms combined with dose-reduction techniques have been shown at computed tomography pulmonary angiography (CTPA) in several medium to small patient collectives. In this study, we performed a systematic comparison of image quality to combinations of reduced tube current (RC) and IR for both standard-pitch (SP) single-source and high-pitch (HP) dual-source CTPA in a large, single-center population. MATERIALS AND METHODS Three hundred eighty-two consecutive patients (October 2010 through December 2012) received clinically indicated CTPA with one of four consecutively changed protocols: (1) HPSC: 180 mAs, weighted filtered back projection, pitch = 3; (2) HPRC: 90 mAs, IR, pitch = 3; (3) SPSC: 180 mAs, weighted filtered back projection, pitch = 1.2; and (4) HPRC: 90 mAs, IR, pitch = 1.2. Tube potential was 100 kV. Vascular attenuation and standardized signal-to-noise ratio (sSNR) were measured in the pulmonary trunk (sSNRPT) and on segmental artery level (sSNRS1, sSNRS10). Dose-length-product was recorded per series. Two independent investigators rated image quality. Kolmogorov-Smirnov test, Kruskal-Wallis test, and kappa statistics were used for statistical analysis. Median values are presented per group. RESULTS Image quality was consistent between all groups (observer 1: P = 0.118; observer 2: P = 0.122). Inter-reader consistency was very good (κ = 0.866, P < 0.001). Dose-length-product was significantly reduced in HP and RC groups (P < 0.001 for each; SPSC: 139.5 mGycm; HPRC: 92 mGycm; SPSC: 211 mGycm; HPRC: 137 mGycm). sSNR was comparable (sSNRPT overall: P = 0.052; sSNRS1 overall: P = 0.161; and sSNRS10 overall: P = 0.259). CONCLUSIONS Substantial dose reduction can be within a routine clinical setting without quantifiable loss of image quality either by HP pulmonary angiography or by a combination of IR and RC in either HP or SP acquisition.
Collapse
|
20
|
Lim HK, Ha HI, Hwang HJ, Lee K. Feasibility of high-pitch dual-source low-dose chest CT: Reduction of radiation and cardiac artifacts. Diagn Interv Imaging 2016; 97:443-9. [PMID: 26896374 DOI: 10.1016/j.diii.2016.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the radiation dose and image quality, focused mainly on cardiac pulsation artifact, between high-pitch low-dose chest computed tomography (HP-LDCT) and standard low-dose chest CT (LDCT). PATIENTS AND METHODS One hundred patients underwent HP-LDCT (50 patients) or LDCT (50 patients). Scan parameters were the same except for the pitch and gantry rotation time: 3.0 vs. 1.2 and 0.28s vs. 0.5s, respectively. Objective image noise at five regions and subjective image quality, such as noise, artifacts, cardiac pulsation artifacts, and overall diagnostic acceptability, were evaluated using a five-point scale. The significance level for all tests was set at P<0.05. RESULTS The dose-length products (DLPs) with HP-LDCT and LDCT were 90.2±4.3mGycm and 103.1±6.4mGycm, respectively (P<0.01). DLP of HP-LDCT showed a 13% reduction versus LDCT. Objective image noise was not significantly different. Cardiac pulsation artifacts showed a significant reduction on HP-LDCT (P<0.01). Other subjective image quality parameters of HP-LDCT were similar to those of LDCT. The overall diagnostic acceptability of HP-LDCT was better than that of LDCT (P<0.01). CONCLUSIONS HP-LDCT showed a 13% mean radiation dose reduction with no deterioration in image quality due to cardiac pulsation artifacts.
Collapse
Affiliation(s)
- H K Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
| | - H I Ha
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
| | - H J Hwang
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
| | - K Lee
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
| |
Collapse
|
21
|
Sabel BO, Buric K, Karara N, Thierfelder KM, Dinkel J, Sommer WH, Meinel FG. High-Pitch CT Pulmonary Angiography in Third Generation Dual-Source CT: Image Quality in an Unselected Patient Population. PLoS One 2016; 11:e0146949. [PMID: 26872262 PMCID: PMC4752234 DOI: 10.1371/journal.pone.0146949] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of high-pitch CT pulmonary angiography (CTPA) in 3rd generation dual-source CT (DSCT) in unselected patients. METHODS Forty-seven patients with suspected pulmonary embolism underwent high-pitch CTPA on a 3rd generation dual-source CT scanner. CT dose index (CTDIvol) and dose length product (DLP) were obtained. Objective image quality was analyzed by calculating signal-to-noise-ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality on the central, lobar, segmental and subsegmental level was rated by two experienced radiologists. RESULTS Median CTDI was 8.1 mGy and median DLP was 274 mGy*cm. Median SNR was 32.9 in the central and 31.9 in the segmental pulmonary arteries. CNR was 29.2 in the central and 28.2 in the segmental pulmonary arteries. Median image quality was "excellent" in central and lobar arteries and "good" in subsegmental arteries according to both readers. Segmental arteries varied between "excellent" and "good". Image quality was non-diagnostic in one case (2%), beginning in the lobar arteries. Thirteen patients (28%) showed minor motion artifacts. CONCLUSIONS In third-generation dual-source CT, high-pitch CTPA is feasible for unselected patients. It yields excellent image quality with minimal motion artifacts. However, compared to standard-pitch cohorts, no distinct decrease in radiation dose was observed.
Collapse
Affiliation(s)
- Bastian O. Sabel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Kristijan Buric
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Nora Karara
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Kolja M. Thierfelder
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Julien Dinkel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Wieland H. Sommer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Felix G. Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| |
Collapse
|
22
|
Liang T, McLaughlin P, Arepalli CD, Louis LJ, Bilawich AM, Mayo J, Nicolaou S. Dual-source CT in blunt trauma patients: elimination of diaphragmatic motion using high-pitch spiral technique. Emerg Radiol 2015; 23:127-32. [PMID: 26637401 DOI: 10.1007/s10140-015-1365-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/10/2015] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to compare diaphragmatic motion on dual-source high-pitch (DS-HP) and conventional single-source (SS) CT scans in trauma patients. Seventy-five consecutive trauma patients who presented to a level one trauma center over a 6-month period were scanned with a standardized whole body trauma CT protocol including both DS-HP chest (pitch = 2.1-2.5) and SS abdominal CT scans. Subjective analysis of diaphragmatic motion was performed by two readers using a four-point motion scale in seven regions of the diaphragm on coronal and axial slices. An overall confidence score to exclude a diaphragmatic tear was determined (1 to 10, 10: completely confident and 1: impossible to exclude). Wilcoxon rank sum tests were used for statistical analysis, and p < 0.05 was considered significant. Mean confidence score of 9.85 for DS-HP was significantly better than the mean score of 7.66 for SS images (p < 0.0001). Diaphragmatic motion scores and subjective diaphragmatic motion artifact on coronal and axial images were significantly better for DS-HP images in all areas when compared individually (p < 0.0001) and overall (p < 0.0001). Regions of DS-HP (99.2 %) were diagnostic, whereas only 87.0 % % regions on SS were. Complete agreement of motion scores was present in 92 % of cases, with moderate overall agreement for confidence to exclude a diaphragmatic tear (κ = 0.45). Dual-source high-pitch CT scanning is advantageous as it allows for significantly better evaluation of diaphragmatic structures by minimizing motion artifacts on images of freely breathing trauma patients.
Collapse
Affiliation(s)
- Teresa Liang
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Patrick McLaughlin
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Chesnal D Arepalli
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Luck J Louis
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Ana-Maria Bilawich
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - John Mayo
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
23
|
Where do we stand? Functional imaging in acute and chronic pulmonary embolism with state-of-the-art CT. Eur J Radiol 2015; 84:2432-7. [DOI: 10.1016/j.ejrad.2015.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023]
|
24
|
Coronary calcium screening with dual-source CT: reliability of ungated, high-pitch chest CT in comparison with dedicated calcium-scoring CT. Eur Radiol 2015; 26:1521-8. [DOI: 10.1007/s00330-015-3978-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
|
25
|
Kilic K, Erbas G, Ucar M, Akkan K, Tokgoz N, Arac M, Isik S. Determination of lowest possible contrast volume in computed tomography pulmonary angiography by using pulmonary transit time. Jpn J Radiol 2014; 32:90-7. [DOI: 10.1007/s11604-013-0274-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/15/2013] [Indexed: 01/28/2023]
|
26
|
High-pitch coronary CT angiography in dual-source CT during free breathing vs. breath holding in patients with low heart rates. Eur J Radiol 2013; 82:2217-21. [PMID: 24075783 DOI: 10.1016/j.ejrad.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 08/28/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) is usually performed during breath holding to reduce motion artifacts caused by respiration. However, some patients are not able to follow the breathing commands adequately due to deafness, hearing impairment, agitation or pulmonary diseases. The aim of this study was to evaluate the potential of high-pitch CCTA in free breathing patients when compared to breath holding patients. METHODS In this study we evaluated 40 patients (20 free breathing and 20 breath holding patients) with a heart rate of 60 bpm or below referred for CCTA who were examined on a 2nd generation dual-source CT system. Image quality of each coronary artery segment was rated using a 4-point grading scale (1: non diagnostic-4: excellent). RESULTS Mean heart rate during image acquisition was 52 ± 5 bpm in both groups. There was no significant difference in mean image quality, slightly favoring image acquisition during breath holding (mean image quality score 3.76 ± 0.32 in breath holding patients vs. 3.61 ± 0.45 in free breathing patients; p = 0.411). Due to a smaller amount of injected contrast medium, there was a trend for signal intensity to be slightly lower in free breathing patients, but this was not statistically significant (435 ± 123 HU vs. 473 ± 117 HU; p=0.648). CONCLUSION In patients with a low heart rate who are not able to hold their breath adequately, CCTA can also be acquired during free breathing without substantial loss of image quality when using a high pitch scan mode in 2nd generation dual-source CT.
Collapse
|
27
|
Bodelle B, Bauer RW, Holthaus L, Schulz B, Al-Butmeh F, Wichmann JL, Beeres M, Vogl TJ, Kerl JM. Dose and image quality of high-pitch dual source computed tomography for the evaluation of cervical lymph node status - comparison to regular 128-slice single source computed tomography. Eur J Radiol 2013; 82:e281-5. [PMID: 23414716 DOI: 10.1016/j.ejrad.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/31/2012] [Accepted: 01/09/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE A high-pitch dual-source CT (DSCT) was compared to a standard single-source CT protocol in terms of dose and image quality for malignant lymphoma staging. MATERIALS AND METHODS Data from 43 patients who underwent DSCT (group 1) of the neck for staging of malignant lymphoma and 40 patients who underwent regular single source CT (group 2) were investigated retrospectively. Volume CT dose index (CTDIvol), dose length product (DLP), background noise (BN), attenuation values, signal-to-noise-ratio (SNR), scan time, effective tube current-time product (eff. mAs), subjective diagnostic image quality and artifact burden were compared. RESULTS CTDIvol (5.5 ± 0.8 mGy vs. 12.4 ± 1.4 mGy), DLP (172 ± 27 mGycm vs. 344 ± 60 mGycm, p<0.0001), eff. mAs (98 ± 15 mAs vs. 183 ± 20 mAs, p<0.0001) and scan time (0.64 ± 0.05 s vs. 8.21 ± 0.72 s) were lower for group 1. BN was higher (p<0.001) for group 1 with a mean difference of 2.6 HU. SNR for sternocleidomastoid and pectoral muscle was lower (6.6-12.3 vs. 7.8-19.1) for group 1. Subjective image quality (1.55 ± 0.6 vs. 1.42 ± 0.5) and artifact burden (1.62 ± 1.0 vs. 1.57 ± 0.9) were not rated significantly different (p=0.47 and p=0.80) with a good inter-observer agreement (κ=0.59-0.90). CONCLUSION High-pitch DSCT allows reduction of patient dose for cervical lymphoma staging while diagnostic image quality is preserved.
Collapse
Affiliation(s)
- Boris Bodelle
- Goethe University of Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Lehnert T, Wrzesniak A, Bernhardt D, Ackermann H, Kerl JM, Vega-Higuera F, Vogl TJ, Bauer RW. Fully automated right ventricular volumetry from ECG-gated coronary CT angiography data: evaluation of prototype software. Int J Cardiovasc Imaging 2012; 29:489-96. [PMID: 22890796 DOI: 10.1007/s10554-012-0109-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
Enlargement and dysfunction of the right ventricle (RV) is a sign and outcome predictor of many cardiopulmonary diseases. Due to the complex geometry of the RV exact volumetry is cumbersome and time-consuming. We evaluated the performance of prototype software for fully automated RV segmentation and volumetry from cardiac CT data. In 50 retrospectively ECG-gated coronary CT angiography scans the endsystolic (RVVmin) and enddiastolic (RVVmax) volume of the right ventricle was calculated fully automatically by prototype software. Manual slice segmentation by two independent radiologists served as the reference standard. Measurement periods were compared for both methods. RV volumes calculated with the software were in strong agreement with the results from manual slice segmentation (Bland-Altman r = 0.95-0.98; p < 0.001; Lin's correlation Rho = 0.87-0.96, p < 0.001) for RVVmax and RVVmin with excellent interobserver agreement between both radiologists (r = 0.97; p < 0.001). The measurement period was significantly shorter with the software (153 ± 9 s) than with manual slice segmentation (658 ± 211 s). The prototype software demonstrated very good performance in comparison to the reference standard. It promises robust RV volume results and minimizes postprocessing time.
Collapse
Affiliation(s)
- Thomas Lehnert
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | | | | | | | | | | | | | | |
Collapse
|