1
|
Meer E, Patel M, Chan D, Sheikh AM, Nicolaou S. Dual-Energy Computed Tomography and Beyond: Musculoskeletal System. Radiol Clin North Am 2023; 61:1097-1110. [PMID: 37758359 DOI: 10.1016/j.rcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Traditional monoenergetic computed tomography (CT) scans in musculoskeletal imaging provide excellent detail of bones but are limited in the evaluation of soft tissues. Dual-energy CT (DECT) overcomes many of the traditional limitations of CT and offers anatomical details previously seen only on MR imaging. In addition, DECT has benefits in the evaluation and characterization of arthropathies, bone marrow edema, and collagen applications in the evaluation of tendons, ligaments, and vertebral discs. There is current ongoing research in the application of DECT in arthrography and bone mineral density calculation.
Collapse
Affiliation(s)
- Emtenen Meer
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Mitulkumar Patel
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Chan
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan M Sheikh
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Cigarrán Sexto H, Calvo Blanco J, Fernández Suárez G. Spectral CT in Emergency. RADIOLOGIA 2023; 65 Suppl 1:S109-S119. [PMID: 37024225 DOI: 10.1016/j.rxeng.2022.11.002] [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: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 04/08/2023]
Abstract
Spectral CT technology is based on the acquisition of CT images with X-ray at 2 different energy levels which makes possible to distinguish between materials with different atomic numbers using their energy-dependent attenuation, even if those materials have similar density at conventional CT. This kind of technology has gained wide application due to the innumerable uses of their post-processing techniques, including virtual non-contrast images, iodine maps, virtual mono-chromatic images or mixed images without increasing radiation dose. There are several applications of spectral CT in Emergency Radiology that help in the detection, diagnosis and management of various pathologies such as differentiate haemorrhage from the underlaying causative lesion, diagnosis of pulmonary embolisms, demarcation of abscess, characterization of renal stones or reduction of artifacts. The purpose of this review is to provide the emergency radiologist a brief description of the main indications for spectral CT.
Collapse
|
3
|
Yu HS, Keraliya A, Chakravarti S, Uyeda JW. Multienergy Computed Tomography Applications. Radiol Clin North Am 2023; 61:23-35. [DOI: 10.1016/j.rcl.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
Menale S, Scheggi V, Giovacchini J, Marchionni N. Persistent respiratory failure after SARS-CoV-2 infection: The role of dual energy computed tomography. A case report. Radiol Case Rep 2022; 17:3179-3184. [PMID: 35784783 PMCID: PMC9236780 DOI: 10.1016/j.radcr.2022.05.031] [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: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background: COVID-19 disease is often complicated by respiratory failure, developing through multiple pathophysiological mechanisms, with pulmonary embolism (PE) and microvascular thrombosis as key and frequent components. Newer imaging modalities such as dual-energy computed tomography (DECT) can represent a turning point in the diagnosis and follow-up of suspected PE during COVID-19. Case presentation: A 78-year-old female presented to our internal medicine 3 weeks after initial hospitalization for COVID-19 disease, for recrudescent respiratory failure needing oxygen therapy. A computed tomography (CT) lungs scan showed a typical SARSCoV-2 pneumonia. Over the following 15 days, respiratory function gradually improved. Unexpectedly, after 21 days from symptom onset, the patient started complaining of breath shortening with remarkable desaturation requiring high-flow oxygen ventilation. CT pulmonary angiography and transthoracic echocardiography were negative for signs of PE. Thereby, Dual-energy CT angiography of the lungs (DECT) was performed and detected diffuse peripheral microembolism. After 2 weeks, a second DECT was performed, showing a good response to the anticoagulation regimen, with reduced extent of microembolism and some of the remaining emboli partially recanalized. Discussion: DECT is an emerging diagnostic technique providing both functional and anatomical information. DECT has been reported to produce a much sharper delineation of perfusion defects than pulmonary scintigraphy, using a significantly lower equivalent dose of mSv. We highlight that DECT is particularly useful in SARS-Cov-2 infection, in order to determine the predominant underlying pathophysiology, particularly when respiratory failure prolongs despite improved lung parenchymal radiological findings
Collapse
|
5
|
Virarkar MK, Vulasala SSR, Gupta AV, Gopireddy D, Kumar S, Hernandez M, Lall C, Bhosale P. Virtual Non-contrast Imaging in The Abdomen and The Pelvis: An Overview. Semin Ultrasound CT MR 2022; 43:293-310. [PMID: 35738815 DOI: 10.1053/j.sult.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Virtual non-contrast (VNC) imaging is a post-processing technique generated from contrast-enhanced scans using dual-energy computed tomography (DECT). It is generated by removing iodine from imaging acquired at multiple energies. Myriad clinical studies have shown its ability to diagnose the various abdominal and pelvic pathologies discussed in the article. VNC is also a problem-solving tool for characterizing incidentally detected lesions ("incidentalomas"), often decreasing the need for additional follow-up imaging. It also obviates the multiphase image acquisitions to evaluate hematuria, hepatic steatosis, aortic endoleaks, and gastrointestinal bleeding by generating image datasets from different tissue attenuation values. The scope of this article is to provide an overview of various applications of VNC imaging obtained by DECT in the abdomen and pelvis.
Collapse
Affiliation(s)
- Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mauricio Hernandez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
6
|
Odedra D, Narayanasamy S, Sabongui S, Priya S, Krishna S, Sheikh A. Dual Energy CT Physics-A Primer for the Emergency Radiologist. FRONTIERS IN RADIOLOGY 2022; 2:820430. [PMID: 37492677 PMCID: PMC10364985 DOI: 10.3389/fradi.2022.820430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/17/2022] [Indexed: 07/27/2023]
Abstract
Dual energy CT (DECT) refers to the acquisition of CT images at two energy spectra and can provide information about tissue composition beyond that obtainable by conventional CT. The attenuation of a photon beam varies depends on the atomic number and density of the attenuating material and the energy of the incoming photon beam. This differential attenuation of the beam at varying energy levels forms the basis of DECT imaging and enables separation of materials with different atomic numbers but similar CT attenuation. DECT can be used to detect and quantify materials like iodine, calcium, or uric acid. Several post-processing techniques are available to generate virtual non-contrast images, iodine maps, virtual mono-chromatic images, Mixed or weighted images and material specific images. Although initially the concept of dual energy CT was introduced in 1970, it is only over the past two decades that it has been extensively used in clinical practice owing to advances in CT hardware and post-processing capabilities. There are numerous applications of DECT in Emergency radiology including stroke imaging to differentiate intracranial hemorrhage and contrast staining, diagnosis of pulmonary embolism, characterization of incidentally detected renal and adrenal lesions, to reduce beam and metal hardening artifacts, in identification of uric acid renal stones and in the diagnosis of gout. This review article aims to provide the emergency radiologist with an overview of the physics and basic principles of dual energy CT. In addition, we discuss the types of DECT acquisition and post processing techniques including newer advances such as photon-counting CT followed by a brief discussion on the applications of DECT in Emergency radiology.
Collapse
Affiliation(s)
- Devang Odedra
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Sabarish Narayanasamy
- Department of Radiology, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States
| | - Sandra Sabongui
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Sarv Priya
- Department of Radiology, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States
| | - Satheesh Krishna
- Department of Medical Imaging, Mount Sinai Hospital, and Women's College Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adnan Sheikh
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
7
|
Son H, Grigovich M, McCabe BE. Non-tumorous diseases of the sternum and its articulations: At the front gate of the chest. Curr Probl Diagn Radiol 2021; 51:628-638. [PMID: 34393035 DOI: 10.1067/j.cpradiol.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Abnormalities of the sternal and peri-sternal regions are commonly seen in clinical practice and may be one of the important causes of chest pain particularly anterior chest wall pain. While reading computed tomography (CT) of the chest for evaluation of chest pain, the sternal region is either easily overlooked or its abnormality is often detected incidentally. This article will provide an overview of normal sternal anatomy and congenital variants as well as a variety of non-tumorous pathologic conditions of the sternum and adjacent joints, with emphasis on CT, to help radiologists, particularly thoracic radiologists, to make an accurate diagnosis in their daily practice. Non-tumorous abnormalities include trauma (fractures and dislocations), infection (osteomyelitis, septic arthritis), degenerative (osteoarthritis) and inflammatory conditions (rheumatoid arthritis, seronegative arthritides), and metabolic disorders (Paget's disease and renal osteodystrophy) as well as treatment related changes such as poststernotomy and its complications (dehiscence, nonunion) and postradiation changes of the sternum.
Collapse
Affiliation(s)
- Hongju Son
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401.
| | - Maria Grigovich
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401
| | - Bridgette E McCabe
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401
| |
Collapse
|
8
|
Zhou Q, Ke X, Man J, Zhang B, Wang F, Zhou J. Predicting Masaoka-Koga Clinical Stage of Thymic Epithelial Tumors Using Preoperative Spectral Computed Tomography Imaging. Front Oncol 2021; 11:631649. [PMID: 33842338 PMCID: PMC8029982 DOI: 10.3389/fonc.2021.631649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the utility of spectral computed tomography (CT) parameters for the prediction of the preoperative Masaoka-Koga stage of thymic epithelial tumors (TETs). Materials and Methods Fifty-four patients with TETs, aged from 37 to 73 years old, an average age of 55.56 ± 9.79 years, were included in the study.According to the Masaoka-Koga staging method, there were 19 cases of stage I, 15 cases of stage II, 8 cases of stage III, and 12 cases of stage IV disease. All patients underwent dual-phase enhanced energy spectral CT scans. Regions of interest (ROIs) were defined in sections of the lesion with homogeneous density, the thoracic aorta at the same level as the lesion, the outer fat layer of the lesion, and the anterior chest wall fat layer. The single-energy CT value at 40-140 keV, iodine concentration, and energy spectrum curve of all lesion and thoracic aorta were obtained. The energy spectrum CT parameters of the lesions, extracapsular fat of the lesions, and anterior chest wall fat in stage I and stage II were obtained. The energy spectrum CT parameters of the lesions, enlarged lymph nodes and intravascular emboli in the 3 groups were obtained. The slope of the energy spectrum curve and the normalized iodine concentration were calculated. Results In stage I lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the lesion and those of the fat outside the lesion and the anterior chest wall in the arteriovenous phase (P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was the opposite of that of the extracapsular fat. In stage II lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the anterior chest wall and those of the lesion and the fat outside the lesion in the arteriovenous phase(P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was consistent with that of the extracapsular fat. Distinction between stage I and II tumors be evaluated by comparing the energy spectrum curves of the mass and the extracapsular fat of the mass. The accuracy rate of is 79.4%. For stages III and IV, there was no significant difference in the slope of the energy spectrum curve of the tumor parenchyma, metastatic lymph node, and intravascular embolism (P>0.05). The energy spectrum curve of the tumor parenchyma was consistent with that of the enlarged lymph nodes and intravascular emboli. The two radiologists have strong consistency in evaluating TETs Masaoka-Koga staging, The Kappa coefficient is 0.873,(95%CI:0.768-0.978). Conclusion Spectral CT parameters, especially the energy spectrum curve and slope, are valuable for preoperative TET and can be used in preoperative staging prediction.
Collapse
Affiliation(s)
- Qing Zhou
- Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Xiaoai Ke
- Lanzhou University Second Hospital, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Jiangwei Man
- Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Zhang
- Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Furong Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Junlin Zhou
- Lanzhou University Second Hospital, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| |
Collapse
|
9
|
Gupta A, Kikano EG, Bera K, Baruah D, Saboo SS, Lennartz S, Hokamp NG, Gholamrezanezhad A, Gilkeson RC, Laukamp KR. Dual energy imaging in cardiothoracic pathologies: A primer for radiologists and clinicians. Eur J Radiol Open 2021; 8:100324. [PMID: 33532519 PMCID: PMC7822965 DOI: 10.1016/j.ejro.2021.100324] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Recent advances in dual-energy imaging techniques, dual-energy subtraction radiography (DESR) and dual-energy CT (DECT), offer new and useful additional information to conventional imaging, thus improving assessment of cardiothoracic abnormalities. DESR facilitates detection and characterization of pulmonary nodules. Other advantages of DESR include better depiction of pleural, lung parenchymal, airway and chest wall abnormalities, detection of foreign bodies and indwelling devices, improved visualization of cardiac and coronary artery calcifications helping in risk stratification of coronary artery disease, and diagnosing conditions like constrictive pericarditis and valvular stenosis. Commercially available DECT approaches are classified into emission based (dual rotation/spin, dual source, rapid kilovoltage switching and split beam) and detector-based (dual layer) systems. DECT provide several specialized image reconstructions. Virtual non-contrast images (VNC) allow for radiation dose reduction by obviating need for true non contrast images, low energy virtual mono-energetic images (VMI) boost contrast enhancement and help in salvaging otherwise non-diagnostic vascular studies, high energy VMI reduce beam hardening artifacts from metallic hardware or dense contrast material, and iodine density images allow quantitative and qualitative assessment of enhancement/iodine distribution. The large amount of data generated by DECT can affect interpreting physician efficiency but also limit clinical adoption of the technology. Optimization of the existing workflow and streamlining the integration between post-processing software and picture archiving and communication system (PACS) is therefore warranted.
Collapse
Key Words
- AI, artificial intelligence
- BT, blalock-taussig
- CAD, computer-aided detection
- CR, computed radiography
- DECT, dual-energy computed tomography
- DESR, dual-energy subtraction radiography
- Dual energy CT
- Dual energy radiography
- NIH, national institute of health
- NPV, negative predictive value
- PACS, picture archiving and communication system
- PCD, photon-counting detector
- PET, positron emission tomography
- PPV, positive predictive value
- Photoelectric effect
- SNR, signal to noise ratio
- SPECT, single photon emission computed tomography
- SVC, superior vena cava
- TAVI, transcatheter aortic valve implantation
- TNC, true non contrast
- VMI, virtual mono-energetic images
- VNC, virtual non-contrast images
- eGFR, estimated glomerular filtration rate
- kV, kilo volt
- keV, kilo electron volt
Collapse
Affiliation(s)
- Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Elias G Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Dhiraj Baruah
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Sachin S Saboo
- Department of Radiology, University Of Texas Health Science Center, San Antonio, TX, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert C Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kai R Laukamp
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
10
|
Thippeswamy PB, Rajasekaran RB. Imaging in polytrauma - Principles and current concepts. J Clin Orthop Trauma 2020; 16:106-113. [PMID: 33717944 PMCID: PMC7920130 DOI: 10.1016/j.jcot.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022] Open
Abstract
Imaging forms a crucial component in reducing mortality of polytraumatized patients by aiding appropriate diagnosis and guiding the emergency and definitive treatment. With the exponential expansion in the radiological armamentarium and introduction of protocols like Extended focused assessment with sonography for trauma (EFAST) and Whole body Computed tomography (WBCT), the role of imaging has considerably increased. Emergency imaging protocols should be done for rapid diagnosis of life-threatening injuries allowing simultaneous evaluation and resuscitation. Subsequent comprehensive imaging is essential to diagnose the often clinically missed injuries to reduce the overall morbidity. Imaging protocols must adapt to the patient's clinical scenario, which can be dynamically changing. Each trauma team should devise clear guidelines, protocols, and algorithms suitable for their center depending on the local availability of types of equipment and expertise. Radiologists must efficiently communicate and adopt patient-centered approach to ensure early appropriate care to these severely injured patients. Future research should involve multicentre studies to formulate the most appropriate imaging protocol in polytrauma to increase diagnostic accuracy and thereby reduce patient mortality.
Collapse
Affiliation(s)
- Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India,Corresponding author. Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, 641043, India.
| | | |
Collapse
|
11
|
Simonetti I, Verde F, Palumbo L, Di Pietto F, Puglia M, Scaglione M, Ragozzino A, Romano S. Dual energy computed tomography evaluation of skeletal traumas. Eur J Radiol 2020; 134:109456. [PMID: 33302030 DOI: 10.1016/j.ejrad.2020.109456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
Skeletal traumas are among the most common routine challenges faced by Emergency Radiologists, in particular in case of radiographically occult nondisplaced fractures or in case of soft tissue injuries. With the development of Dual Energy Computed Tomography (DECT) technology, new post-processing applications have gained a useful diagnostic role in many fields of musculoskeletal imaging including acute skeletal trauma imaging. In addition to conventional CT images, DECT allows for the generation of virtual calcium-suppressed images subtracting calcium from unenhanced CT images based on the fact that material attenuation varies at different energy levels. In this way, virtual-non-calcium (VNC) images can precisely characterize traumatic bone marrow edema in both axial and appendicular skeleton, facilitating prompt clinical decision, especially when magnetic resonance method is contraindicated or unavailable. Other DECT emerging applications in the trauma setting include metal artifact reduction and collagen mapping for the evaluation of injuries affecting ligament, tendon, and intervertebral disk. This review focuses on the basic principles of DECT and related post-processing algorithms, highlighting the current advantages and limitations of these new imaging advances in the Emergency Department related to skeletal traumas.
Collapse
Affiliation(s)
- Igino Simonetti
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
| | - Francesco Verde
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Luigi Palumbo
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
| | - Francesco Di Pietto
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, CE, Italy.
| | - Marta Puglia
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, CE, Italy.
| | - Alfonso Ragozzino
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
| | - Stefania Romano
- Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
| |
Collapse
|
12
|
Impact of Dual-Energy CT in the Emergency Department: Increased Radiologist Confidence, Reduced Need for Follow-Up Imaging, and Projected Cost Benefit. AJR Am J Roentgenol 2020; 215:1528-1538. [DOI: 10.2214/ajr.19.22357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
13
|
Building a dual-energy CT service line in abdominal radiology. Eur Radiol 2020; 31:4330-4339. [PMID: 33210201 DOI: 10.1007/s00330-020-07441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
As the access of radiology practices to dual-energy CT (DECT) has increased worldwide, seamless integration into clinical workflows and optimized use of this technology are desirable. In this article, we provide basic concepts of commercially available DECT hardware implementations, discuss financial and logistical aspects, provide tips for protocol building and image routing strategies, and review radiation dose considerations to establish a DECT service line in abdominal imaging. KEY POINTS: • Tube-based and detector-based DECT implementations with varying features and strengths are available on the imaging market. • Thorough assessment of financial and logistical aspects is key to successful implementation of a DECT service line. • Optimized protocol building and image routing strategies are of critical importance for effective use and seamless inception of DECT in routine clinical workflows.
Collapse
|
14
|
Duan X, Ananthakrishnan L, Guild JB, Xi Y, Rajiah P. Radiation doses and image quality of abdominal CT scans at different patient sizes using spectral detector CT scanner: a phantom and clinical study. Abdom Radiol (NY) 2020; 45:3361-3368. [PMID: 31587100 DOI: 10.1007/s00261-019-02247-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare radiation dose and image quality for abdominal CTs performed on a spectral detector CT (SDCT) and a comparable single-energy conventional CT scanner for patients of different sizes. METHODS Four semi-anthropomorphic phantoms were scanned on an SDCT (IQon, Philips Healthcare) and a comparable single-energy CT (iCT 256, Philips Healthcare) under matched scan parameters. Image noise and radiation dose were compared. For the HIPAA-compliant, IRB-approved retrospective cohort patient study, radiation dose was compared after adjusting for patient water equivalent diameter. Difference in subjective and objective image quality was assessed on a subset of 50 patients scanned on both scanners by two readers. RESULTS CTDIvol and noise from SDCT were higher than conventional CT for all phantoms, with a relative difference of 7.8% (range 5.3-14%) for radiation dose and average difference of 9.0% (range 5.5-11%) for noise. 718 SDCT and 937 conventional CT patients were included in the patient study. CTDIvol for SDCT patients tends to be lower for smaller patients (- 2%, 95% confidence interval (- 5%, - 0.2%) for 200 mm water equivalent diameter) and higher for larger patients compared to conventional CT (8%, (6%, 11%) for 400 mm). No difference was seen for subjective image quality, SNR, CNR, or image noise between the two scanners, except for higher image noise in the portal vein and higher signal in the aorta on SDCT. CONCLUSION Radiation dose for abdominal CT performed on SDCT is similar to the dose on a conventional CT for average size patients, lower for smaller patients, and slightly higher for larger patients. Image quality is similar between the two scanners.
Collapse
Affiliation(s)
- Xinhui Duan
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Lakshmi Ananthakrishnan
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jeffrey B Guild
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| |
Collapse
|
15
|
Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related systemic microangiopathy. Eur Radiol 2020; 31:1090-1099. [PMID: 32860146 PMCID: PMC7455509 DOI: 10.1007/s00330-020-07155-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 12/19/2022]
Abstract
Objectives There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction. Methods Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs). Results DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03). Conclusions We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies. Key Points • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients. Electronic supplementary material The online version of this article (10.1007/s00330-020-07155-3) contains supplementary material, which is available to authorized users.
Collapse
|
16
|
Yang SJ, Jeon JY, Lee SW, Jeong YM. Added value of color-coded virtual non-calcium dual-energy CT in the detection of acute knee fractures in non-radiology inexpert readers. Eur J Radiol 2020; 129:109112. [PMID: 32526668 DOI: 10.1016/j.ejrad.2020.109112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluated the added value of dual-energy CT (DECT) virtual non-calcium (VNCa) protocol on conventional CT in the detection of acute knee fractures in non-radiology inexpert readers. METHOD One hundred fifty-six patients (mean age, 51.97 years; age range, 17-86 years) with knee trauma, who underwent DECT and MRI within 3 days between April 2017 and October 2018, were retrospectively analyzed. Three readers (intern, 1st-year general surgery resident, 1st-year emergency medicine resident) independently analyzed CT alone and then with the additional color-coded DECT VNCa for fractures. A board-certified radiologist, analyzed CT and MRI series to define the reference standard. Sensitivity, specificity, and AUC were compared between the two reading sessions. RESULTS Fifty-seven patients had acute fractures and 99 had no fractures. Thirteen of 57 fractures were nondisplaced. The additional use of VNCa images significantly increased the mean AUC (reader 1: 0.813 vs. 0.919; reader 2: 0.842 vs. 0.930; reader 3: 0.837 vs. 0.921; P < 0.05). When only nondisplaced fractures included, the mean AUC was more increased in the combined analysis of CT and DECT VNCa (reader 1: 0.521 vs. 0.916; reader 2: 0.542 vs. 0.926; reader 3: 0.575 vs. 0.926; P < .01). Sensitivity increased by 15 %-20 % in total fracture group and by 69 %-77 % in nondisplaced fracture group over that with CT alone when both CT and DECT VNCa were used. Specificity did not differ significantly. CONCLUSIONS The additional use of color-coded DECT VNCa protocol to conventional CT improved diagnostic performance in detecting acute knee fractures for inexperienced non-radiology readers.
Collapse
Affiliation(s)
- Su Jeong Yang
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.
| | - Sheen-Woo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| |
Collapse
|
17
|
Shanbhogue KP, Pourvaziri A, Jeyaraj SK, Kambadakone A. Endoscopic and surgical treatment options for chronic pancreatitis: an imaging perspective. Abdom Radiol (NY) 2020; 45:1397-1409. [PMID: 31707437 DOI: 10.1007/s00261-019-02249-z] [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] [Indexed: 02/06/2023]
Abstract
Chronic pancreatitis is a chronic fibro-inflammatory syndrome characterized by chronic pancreatic inflammation leading to fibrosis and scarring. Patients with this multifactorial debilitating illness often require endoscopic or surgical intervention for treatment. Radiologists play a crucial role in pre-therapeutic workup as well as post-treatment imaging of chronic pancreatitis. This review summarizes the most common surgical and endoscopic treatment options that are currently available for chronic pancreatitis, including the implications on imaging.
Collapse
|
18
|
El Kayal N, Lennartz S, Ekdawi S, Holz J, Slebocki K, Haneder S, Wybranski C, Mohallel A, Eid M, Grüll H, Persigehl T, Borggrefe J, Maintz D, Heneweer C. Value of spectral detector computed tomography for assessment of pancreatic lesions. Eur J Radiol 2019; 118:215-222. [DOI: 10.1016/j.ejrad.2019.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023]
|
19
|
Li G, Huang W, Xu Q, Dong J, Cao Z, Wang D, Zou M, Lu G. Application value of dual-energy computed tomography spectrum curve combined with clinical risk factors in predicting adherent perinephric fat. Quant Imaging Med Surg 2019; 9:1421-1428. [PMID: 31559171 DOI: 10.21037/qims.2019.06.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Adherent perinephric fat (APF) is evaluated preoperatively with the Mayo adhesive probability (MAP) scoring system using conventional single form computed tomography (CT) images. An objective or quantitative indicator for predicting APF is urgently needed for clinical application. Methods Data obtained from 150 renal tumor patients with partial nephrectomy (PN) were used in the present study. Patients were divided into two groups based on the surgical results: an APF group (n=100) and a non-APF group (n=50). All patients had renal contrast-enhanced dual-energy CT (DECT) scan, and the data were brought into a post-processing workstation. Monoenergetic plus mode was adopted to analyze the spectrum curve of the region of interest (ROI). Logistic stepwise relapse investigation was utilized to analyze the related risk factors. The maximum Youden index was taken as the cut-off value. The sensitivity, specificity, accuracy, and 95% CI of the model were calculated. Results APF is related to patients' clinical characteristics of age, gender, BMI, smoking, tumor diameter, exophytic, and benign or malignant nature of the renal masses (P<0.05). The shape of the curve of ROI1 in the APF group was different from that of the ROI4 in the non-APF group, and the curve slope of K1 (-0.21±0.47) was different from that of K4 (-1.30±0.14) (P<0.001). Statistical analysis showed that the slope K was solely retained in the model index. The best cut-off point for the K value was -0.95. The AUC of the cut-off point was 0.97 (95% CI: 0.96-0.99). Conclusions The DECT spectrum curve performed well in predicting APF, and the curve slope K can be used as an objective quantitative indicator.
Collapse
Affiliation(s)
- Guan Li
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Wei Huang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Qinmei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Jie Dong
- Department of Urology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Zhiqiang Cao
- Department of Urology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Di Wang
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Mingyu Zou
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Guangming Lu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| |
Collapse
|
20
|
Si-Mohamed S, Dupuis N, Tatard-Leitman V, Rotzinger D, Boccalini S, Dion M, Vlassenbroek A, Coulon P, Yagil Y, Shapira N, Douek P, Boussel L. Virtual versus true non-contrast dual-energy CT imaging for the diagnosis of aortic intramural hematoma. Eur Radiol 2019; 29:6762-6771. [PMID: 31264015 DOI: 10.1007/s00330-019-06322-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether virtual non-contrast (VNC) images derived from contrast dual-layer dual-energy computed tomography (DL-DECT) images could replace true non-contrast (TNC) images for aortic intramural hematoma (IMH) diagnosis in acute aortic syndrome (AAS) imaging protocols by performing quantitative as well as qualitative phantom and clinical studies. MATERIALS AND METHODS Patients with confirmed IMH were included retrospectively in two centers. For in vitro imaging, a custom-made phantom of IMH was placed in a semi-anthropomorphic thorax phantom (QRM GmbH) and imaged on a DL-DECT at 120 kVp under various conditions of patient size, radiation exposure, and reconstruction modes. For in vivo imaging, 21 patients (70 ± 13 years) who underwent AAS imaging protocols at 120 kVp were included. In both studies, contrast-to-noise ratio (CNR) between hematoma and lumen was compared using a paired t test. Diagnostic confidence (1 = non-diagnostic, 4 = exemplary) for VNC and TNC images was rated by two radiologists and compared. Effective radiation doses for each acquisition were calculated. RESULTS In both the phantom and clinical studies, we observed that the CNRs were similar between the VNC and TNC images. Moreover, both methods allowed differentiating the hyper-attenuation within the hematoma from the blood. Finally, we obtained equivalent high diagnostic confidence with both VNC and TNC images (VNC = 3.2 ± 0.7, TNC = 3.1 ± 0.7; p = 0.3). Finally, by suppressing TNC acquisition and using VNC, the mean effective dose reduction would be 40%. CONCLUSION DL-DECT offers similar performances with VNC and TNC images for IMH diagnosis without compromise in diagnostic image quality. KEY POINTS • Dual-layer dual-energy CT enables virtual non-contrast imaging from a contrast-enhanced acquisition. • Virtual non-contrast imaging with dual-layer dual-energy CT reduces the number of acquisitions and radiation exposure in acute aortic syndrome imaging protocol. • Dual-layer dual-energy CT has the potential to become a suitable imaging tool for acute aortic syndrome.
Collapse
Affiliation(s)
- Salim Si-Mohamed
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France.
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France.
| | - Nicolas Dupuis
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
- Anatomy Lab, Rockefeller Faculty, Lyon Est, Lyon, France
| | - Valérie Tatard-Leitman
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
| | - David Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital , Lausanne, Switzerland
| | - Sara Boccalini
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
| | - Matthias Dion
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
- Anatomy Lab, Rockefeller Faculty, Lyon Est, Lyon, France
| | | | | | - Yoad Yagil
- Global Advanced Technologies, CT, Philips, Haifa, Israel
| | - Nadav Shapira
- Global Advanced Technologies, CT, Philips, Haifa, Israel
| | - Philippe Douek
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
| | - Loic Boussel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
| |
Collapse
|
21
|
Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S. Dual-Energy CT in Evaluation of the Acute Abdomen. Radiographics 2019; 39:264-286. [DOI: 10.1148/rg.2019180087] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicolas Murray
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Kathryn E. Darras
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Frances E. Walstra
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Mohammed F. Mohammed
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Patrick D. McLaughlin
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Savvas Nicolaou
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| |
Collapse
|
22
|
Poststernotomy Complications: A Multimodal Review of Normal and Abnormal Postoperative Imaging Findings. AJR Am J Roentgenol 2018; 211:1194-1205. [DOI: 10.2214/ajr.18.19782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
23
|
How to Incorporate Dual-Energy Computed Tomography Into Your Neuroradiology Practice: Questions and Answers. J Comput Assist Tomogr 2018; 42:824-830. [PMID: 30371617 DOI: 10.1097/rct.0000000000000810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Dual-energy computed tomography (DECT) has many current and evolving applications in neuroradiology including material decomposition, improving conspicuity of iodinated contrast enhancement, and artifact reduction. However, there are multiple challenges in incorporating DECT into practice including hardware selection, postprocessing software requirements, technologist and physician training, and numerous workflow issues. This article reviews in a question-and-answer format common issues that arise when incorporating DECT into a busy neuroradiology practice.
Collapse
|
24
|
Abstract
Multidetector-row computed tomography (MDCT) can provide crucial information and rapid triage of emergency department patients with suspected acute coronary syndrome (ACS) or acute aortic syndrome (AAS). Coronary computed tomography angiography has high negative predictive value to rule out ACS, and MDCT is diagnostic for AAS and its variants. Optimization of acquisition technique and up-to-date knowledge of the pathophysiology of these conditions can improve study and interpretation quality for diagnosis of ACS or AAS.
Collapse
Affiliation(s)
- Avanti Gulhane
- Cardiovascular Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Harold Litt
- Cardiothoracic Imaging Division, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
25
|
Grams AE, Djurdjevic T, Rehwald R, Schiestl T, Dazinger F, Steiger R, Knoflach M, Gizewski ER, Glodny B. Improved visualisation of early cerebral infarctions after endovascular stroke therapy using dual-energy computed tomography oedema maps. Eur Radiol 2018; 28:4534-4541. [PMID: 29728814 PMCID: PMC6182745 DOI: 10.1007/s00330-018-5449-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim was to investigate whether dual-energy computed tomography (DECT) reconstructions optimised for oedema visualisation (oedema map; EM) facilitate an improved detection of early infarctions after endovascular stroke therapy (EST). METHODS Forty-six patients (21 women; 25 men; mean age: 63 years; range 24-89 years) were included. The brain window (BW), virtual non-contrast (VNC) and modified VNC series based on a three-material decomposition technique optimised for oedema visualisation (EM) were evaluated. Follow-up imaging was used as the standard for comparison. Contralateral side to infarction differences in density (CIDs) were determined. Infarction detectability was assessed by two blinded readers, as well as image noise and contrast using Likert scales. ROC analyses were performed and the respective Youden indices calculated for cut-off analysis. RESULTS The highest CIDs were found in the EM series (73.3 ± 49.3 HU), compared with the BW (-1.72 ± 13.29 HU) and the VNC (8.30 ± 4.74 HU) series. The EM was found to have the highest infarction detection rates (area under the curve: 0.97 vs. 0.54 and 0.90, p < 0.01) with a cut-off value of < 50.7 HU, despite slightly more pronounced image noise. The location of the infarction did not affect detectability (p > 0.05 each). CONCLUSIONS The EM series allows higher contrast and better early infarction detection than the VNC or BW series after EST. KEY POINTS • Dual-energy CT EM allows better early infarction detection than standard brain window. • Dual-energy CT EM series allow better early infarction detection than VNC series. • Dual-energy CT EM are modified VNC based on water content of tissue.
Collapse
Affiliation(s)
- Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Tanja Djurdjevic
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Rafael Rehwald
- Institute of Neurology, University College London, London, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Thomas Schiestl
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Dazinger
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
26
|
Tsai R, Raptis D, Raptis C, Mellnick VM. Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist. Abdom Radiol (NY) 2018; 43:1084-1093. [PMID: 29492608 DOI: 10.1007/s00261-018-1523-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Traumatic abdominal aortic injury (TAAI) is a severe complication of penetrating and blunt trauma with significant morbidity and mortality, particularly if diagnosis is delayed. In patients with life-threatening injuries, accurate and prompt diagnosis of TAAI can be made with computed tomography (CT). Once the diagnosis of TAAI is made, the radiologist should provide an accurate description of the aortic lesion and the extent of injury in order to guide management whether it be non-operative, open aortic repair, or endoluminal stent repair. The purpose of this article is to review the key imaging aspects of TAAI and to discuss how the key CT imaging findings affect clinical management.
Collapse
Affiliation(s)
- Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA.
| | - Demetrios Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Constantine Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| |
Collapse
|
27
|
Clinical Utility of Dual-Energy CT Analysis of Bone Marrow Edema in Acute Wrist Fractures. AJR Am J Roentgenol 2018; 210:842-847. [PMID: 29470155 DOI: 10.2214/ajr.17.18673] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
28
|
Razik A, Madhusudhan KS, Aggarwal A, Panwar R, Srivastava DN. Gastrointestinal Stromal Tumor of the Jejunum With Active Bleeding Demonstrated on Dual-Energy MDCT Angiography: A Case Report. Curr Probl Diagn Radiol 2017; 48:298-301. [PMID: 29169676 DOI: 10.1067/j.cpradiol.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 01/15/2023]
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and may occasionally present with acute gastrointestinal bleed (GIB). Multidetector computed tomography (MDCT) angiography is extremely useful in demonstrating the tumor as well as the presence of active hemorrhage, thereby guiding subsequent interventional or surgical management. We report a case of a 38-year-old man who presented with acute-onset melena and compensated shock, whose source of bleed remained elusive on endoscopy. MDCT angiography performed on a dual-energy scanner showed a jejunal tumor with active intraluminal contrast extravasation. The tumor was subsequently resected and the patient did well on follow-up. This was one of the few instances when MDCT angiography demonstrated active bleeding in a GIST and the first such case demonstrated on a dual-energy scanner.
Collapse
Affiliation(s)
- Abdul Razik
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Kumble S Madhusudhan
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Abhishek Aggarwal
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deep N Srivastava
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
29
|
Purcell YM, Kavanagh RG, Cahalane AM, Carroll AG, Khoo SG, Killeen RP. The Diagnostic Accuracy of Contrast-Enhanced CT of the Neck for the Investigation of Sialolithiasis. AJNR Am J Neuroradiol 2017; 38:2161-2166. [PMID: 28838906 DOI: 10.3174/ajnr.a5353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Sialolithiasis is a common benign pathology affecting the salivary glands but it is unclear if contrast-enhanced CT, which is commonly used for investigation of head and neck pathology, can identify calculi as accurately as noncontrast CT. The aim of this study was to assess the diagnostic accuracy of contrast-enhanced CT of the neck in the diagnosis of sialolithiasis compared with noncontrast CT of the neck used as the criterion standard. MATERIALS AND METHODS This was a retrospective, case-control study of 92 consecutive cases in 90 patients who underwent both noncontrast CT of the neck and contrast-enhanced CT of the neck in 2 tertiary referral centers from January 2011 to December 2015 for investigation of sialolithiasis. Axial 3-mm-section images were assessed by a fellowship-trained diagnostic neuroradiologist and diagnostic neuroradiology fellow in consensus. Blinded assessment of the contrast-enhanced CT of the neck was performed first, followed by noncontrast CT of the neck after a 2-week interval. The presence or absence of a stone and stone location and size were documented. Statistical analysis was undertaken to assess the agreement between CT protocols and calculate the sensitivity and specificity of contrast-enhanced CT of the neck. RESULTS Fifty calculi were identified on noncontrast CT of the neck in 31 cases; and 48 calculi, in 31 cases on contrast-enhanced CT of the neck. No calculi were identified in the remaining 61 cases. The sensitivity and specificity of contrast-enhanced CT of the neck in the detection of sialolithiasis was 96% (95% CI, 86.3%-99.5%) and 100% (95% CI, 94.1%-100%), respectively. The positive predictive value of contrast-enhanced CT of the neck was 100% (95% CI, 92.6%-100%), and the negative predictive value was 96.8% (95% CI, 89%-99.6%). The accuracy of contrast-enhanced CT of the neck in diagnosing the presence or absence of salivary calculi was 98%. CONCLUSIONS Contrast-enhanced CT of the neck is accurate in the detection of sialolithiasis, with no difference in diagnostic accuracy compared with noncontrast CT of the neck.
Collapse
Affiliation(s)
- Y M Purcell
- From the Departments of Radiology (Y.M.P., R.G.K., A.M.C., A.G.C., R.P.K.)
| | - R G Kavanagh
- From the Departments of Radiology (Y.M.P., R.G.K., A.M.C., A.G.C., R.P.K.)
| | - A M Cahalane
- From the Departments of Radiology (Y.M.P., R.G.K., A.M.C., A.G.C., R.P.K.)
| | - A G Carroll
- From the Departments of Radiology (Y.M.P., R.G.K., A.M.C., A.G.C., R.P.K.)
| | - S G Khoo
- Otolaryngology (S.G.K.), St. Vincent's University Hospital, Elm Park, Dublin, Ireland
- Departments of Otolaryngology (S.G.K.)
| | - R P Killeen
- From the Departments of Radiology (Y.M.P., R.G.K., A.M.C., A.G.C., R.P.K.)
- Radiology (R.P.K.), Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| |
Collapse
|
30
|
Kalisz K, Halliburton S, Abbara S, Leipsic JA, Albrecht MH, Schoepf UJ, Rajiah P. Update on Cardiovascular Applications of Multienergy CT. Radiographics 2017; 37:1955-1974. [DOI: 10.1148/rg.2017170100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
31
|
Khanduri S, Goyal A, Singh B, Chaudhary M, Sabharwal T, Jain S, Sharma H. The Utility of Dual Energy Computed Tomography in Musculoskeletal Imaging. J Clin Imaging Sci 2017; 7:34. [PMID: 28900555 PMCID: PMC5582533 DOI: 10.4103/jcis.jcis_46_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/11/2017] [Indexed: 12/27/2022] Open
Abstract
The objective of this article is to review the mechanisms, advantages and disadvantages of dual energy computed tomography (DECT) over conventional tomography (CT) in musculoskeletal imaging as DECT provides additional information about tissue composition and artifact reduction. This provides clinical utility in detection of urate crystals, bone marrow edema, reduction of beam hardening metallic artifact, and ligament and tendon analysis.
Collapse
Affiliation(s)
- Sachin Khanduri
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Aakshit Goyal
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Bhumika Singh
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mriganki Chaudhary
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Tushar Sabharwal
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shreshtha Jain
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Hritik Sharma
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| |
Collapse
|
32
|
Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, Aoki Y, Murayama S. CT and MR Imaging of Gynecologic Emergencies. Radiographics 2017; 37:1569-1586. [DOI: 10.1148/rg.2017160170] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Yuko Iraha
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Masahiro Okada
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Rin Iraha
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Kimei Azama
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Tsuneo Yamashiro
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Maho Tsubakimoto
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Yoichi Aoki
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Sadayuki Murayama
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| |
Collapse
|
33
|
Bassey B, Martinson M, Samadi N, Belev G, Karanfil C, Qi P, Chapman D. Multiple energy synchrotron biomedical imaging system. Phys Med Biol 2016; 61:8180-8198. [PMID: 27804925 DOI: 10.1088/0031-9155/61/23/8180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A multiple energy imaging system that can extract multiple endogenous or induced contrast materials as well as water and bone images would be ideal for imaging of biological subjects. The continuous spectrum available from synchrotron light facilities provides a nearly perfect source for multiple energy x-ray imaging. A novel multiple energy x-ray imaging system, which prepares a horizontally focused polychromatic x-ray beam, has been developed at the BioMedical Imaging and Therapy bend magnet beamline at the Canadian Light Source. The imaging system is made up of a cylindrically bent Laue single silicon (5,1,1) crystal monochromator, scanning and positioning stages for the subjects, flat panel (area) detector, and a data acquisition and control system. Depending on the crystal's bent radius, reflection type, and the horizontal beam width of the filtered synchrotron radiation (20-50 keV) used, the size and spectral energy range of the focused beam prepared varied. For example, with a bent radius of 95 cm, a (1,1,1) type reflection and a 50 mm wide beam, a 0.5 mm wide focused beam of spectral energy range 27 keV-43 keV was obtained. This spectral energy range covers the K-edges of iodine (33.17 keV), xenon (34.56 keV), cesium (35.99 keV), and barium (37.44 keV); some of these elements are used as biomedical and clinical contrast agents. Using the developed imaging system, a test subject composed of iodine, xenon, cesium, and barium along with water and bone were imaged and their projected concentrations successfully extracted. The estimated dose rate to test subjects imaged at a ring current of 200 mA is 8.7 mGy s-1, corresponding to a cumulative dose of 1.3 Gy and a dose of 26.1 mGy per image. Potential biomedical applications of the imaging system will include projection imaging that requires any of the extracted elements as a contrast agent and multi-contrast K-edge imaging.
Collapse
Affiliation(s)
- B Bassey
- Physics and Engineering Physics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | | | | | | | | |
Collapse
|
34
|
Noguchi K, Itoh T, Naruto N, Takashima S, Tanaka K, Kuroda S. A Novel Imaging Technique (X-Map) to Identify Acute Ischemic Lesions Using Noncontrast Dual-Energy Computed Tomography. J Stroke Cerebrovasc Dis 2016; 26:34-41. [PMID: 27639587 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/22/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND We evaluated whether X-map, a novel imaging technique, can visualize ischemic lesions within 20 hours after the onset in patients with acute ischemic stroke, using noncontrast dual-energy computed tomography (DECT). MATERIALS AND METHODS Six patients with acute ischemic stroke were included in this study. Noncontrast head DECT scans were acquired with 2 X-ray tubes operated at 80 kV and Sn150 kV between 32 minutes and 20 hours after the onset. Using these DECT scans, the X-map was reconstructed based on 3-material decomposition and compared with a simulated standard (120 kV) computed tomography (CT) and diffusion-weighted imaging (DWI). RESULTS The X-map showed more sensitivity to identify the lesions as an area of lower attenuation value than a simulated standard CT in all 6 patients. The lesions on the X-map correlated well with those on DWI. In 3 of 6 patients, the X-map detected a transient decrease in the attenuation value in the peri-infarct area within 1 day after the onset. CONCLUSIONS The X-map is a powerful tool to supplement a simulated standard CT and characterize acute ischemic lesions. However, the X-map cannot replace a simulated standard CT to diagnose acute cerebral infarction.
Collapse
Affiliation(s)
- Kyo Noguchi
- Departments of Radiology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan.
| | - Toshihide Itoh
- Department of Research & Collaboration, Siemens Healthcare, Tokyo, Japan
| | - Norihito Naruto
- Departments of Radiology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| | - Shutaro Takashima
- Department of Neurology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| | - Kortaro Tanaka
- Department of Neurology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| |
Collapse
|
35
|
Dual-energy CT shows brain ischemia and hyperbaric oxygen therapy efficacy in acute CO intoxication. Am J Emerg Med 2016; 34:1327.e3-4. [DOI: 10.1016/j.ajem.2015.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/24/2022] Open
|
36
|
Appearance and Frequency of Gas Interface Artifacts Involving Small Bowel on Rapid-Voltage-Switching Dual-Energy CT Iodine-Density Images. AJR Am J Roentgenol 2016; 206:301-6. [PMID: 26797356 DOI: 10.2214/ajr.15.14374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study is to describe the appearance and frequency of gas interface artifacts in the jejunum that may mimic severe bowel disease on iodine-density images generated from rapid-voltage-switching dual-energy CT (DECT) scans. MATERIALS AND METHODS Two readers retrospectively reviewed 108 consecutive abdominal rapid-voltage-switching DECT scans to record the presence of image artifacts in jejunal segments with different degrees of gaseous luminal filling, classified as full, partial, or absent. Readers viewed iodine-density images and corresponding 140-kVp and 65-keV virtual monochromatic images and classified the jejunal artifacts on iodine-density images as pseudostratified appearance of the bowel wall, pseudopneumatosis, pseudohyperenhancement, or pseudohypoenhancement. We correlated the presence of the artifacts with clinical features suggesting bowel disease. RESULTS Image artifacts were found in 91 of 108 scans (84.3%), appeared in 148 of 265 jejunal segments (55.8%), and included each type except for pseudohypoenhancement. Artifacts occurred exclusively when gas was present in the bowel lumen and were seen in 59 of 59 (100%) fully gas-distended segments, 89 of 98 (90.8%) partially gas-distended segments, and none of 108 gas-absent segments (p < 0.0001). In fully and partially gas-distended jejunal segments (n = 157), 148 (94.3%) segments had two or more artifacts. None of the patients was found to have clinical bowel-related injury on follow-up of medical records. CONCLUSION Pseudostratified appearance, pseudopneumatosis, and pseudohyperenhancement, but not pseudohypoenhancement, artifacts are common in gas-filled jejunal segments on iodine-density images generated from rapid-voltage-switching DECT scans and are not seen in the corresponding 140-kVp or 65-keV images. Knowledge of the appearance of such iodine-density image artifacts will avoid potential examination interpretation pitfalls.
Collapse
|
37
|
Haq AA, Restrepo CS, Lamus D, Ocazionez-Trujillo D, Vargas D. Thoracic venous injuries: an imaging and management overview. Emerg Radiol 2016; 23:291-301. [PMID: 26965007 DOI: 10.1007/s10140-016-1386-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating trauma whereas motor vehicle collisions are the leading cause of blunt trauma to the chest. Iatrogenic injuries, mostly from central venous catheter complications are being described in growing detail. Although these injuries are rare, they pose a diagnostic challenge as their clinical presentation does not substantially differ from that of arterial injury. Furthermore, the highly lethal nature of some of these injuries provides limited literature for review and probably underestimates their true incidence. The widespread use of multi-detector computed tomography (MDCT) has increased the detection rate of these lesions in hemodynamically stable patients that survive the initial traumatic event. In this article, we will discuss and illustrate various causes of injury to each vein and their supporting CT findings while briefly discussing management. The available literature will be reviewed for penetrating, blunt, and iatrogenic injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins.
Collapse
Affiliation(s)
- Aftab A Haq
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Daniel Lamus
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | | | - Daniel Vargas
- Department of Radiology, University of Colorado, Denver, CO, USA
| |
Collapse
|
38
|
Diagnosing poststernotomy mediastinitis in the ED. Am J Emerg Med 2016; 34:618-22. [DOI: 10.1016/j.ajem.2015.12.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022] Open
|
39
|
Ashton JR, West JL, Badea CT. In vivo small animal micro-CT using nanoparticle contrast agents. Front Pharmacol 2015; 6:256. [PMID: 26581654 PMCID: PMC4631946 DOI: 10.3389/fphar.2015.00256] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022] Open
Abstract
Computed tomography (CT) is one of the most valuable modalities for in vivo imaging because it is fast, high-resolution, cost-effective, and non-invasive. Moreover, CT is heavily used not only in the clinic (for both diagnostics and treatment planning) but also in preclinical research as micro-CT. Although CT is inherently effective for lung and bone imaging, soft tissue imaging requires the use of contrast agents. For small animal micro-CT, nanoparticle contrast agents are used in order to avoid rapid renal clearance. A variety of nanoparticles have been used for micro-CT imaging, but the majority of research has focused on the use of iodine-containing nanoparticles and gold nanoparticles. Both nanoparticle types can act as highly effective blood pool contrast agents or can be targeted using a wide variety of targeting mechanisms. CT imaging can be further enhanced by adding spectral capabilities to separate multiple co-injected nanoparticles in vivo. Spectral CT, using both energy-integrating and energy-resolving detectors, has been used with multiple contrast agents to enable functional and molecular imaging. This review focuses on new developments for in vivo small animal micro-CT using novel nanoparticle probes applied in preclinical research.
Collapse
Affiliation(s)
- Jeffrey R Ashton
- Department of Biomedical Engineering, Duke University, Durham NC, USA ; Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham NC, USA
| | - Jennifer L West
- Department of Biomedical Engineering, Duke University, Durham NC, USA
| | - Cristian T Badea
- Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham NC, USA
| |
Collapse
|
40
|
|
41
|
Berko NS, Dym RJ. Computed Tomographic Imaging of Renal and Ureteral Emergencies. Curr Probl Diagn Radiol 2015; 44:207-20. [DOI: 10.1067/j.cpradiol.2014.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
|