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Tripathy TP, Patel R, Chandel K, Mukund A. Utility of Dual-Energy CT in Abdominal Interventions. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0041-1740475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an emerging CT technique based on data acquisition at two different settings. Various postprocessing techniques generate different sets of images, each with unique advantages. With DECT, it is possible to obtain virtual unenhanced images from monochromatic reconstructions and attenuation maps of different elements, thereby improving the detection and characterization of a variety of lesions. Presently, DECT is widely used to evaluate pulmonary embolism, characterize abdominal masses, determine the composition of urinary calculi, and detect tophi in gout. CT angiography is an essential prerequisite for endovascular intervention. DECT allows a better quality of angiographic images with a lesser dose of contrast. Various postprocessing techniques in DECT also help in a better evaluation of response to locoregional therapy. Virtual noncontrast images and iodine map differentiate residual or recurrent tumors from intrinsically hyperdense materials. Superior metallic artifact reduction allows better evaluation of vascular injuries adjacent to bony fractured fragments or previously deployed embolization coils. In addition to metal artifacts reduction, virtual monochromatic spectral imaging could further mitigate metal artifacts during CT-guided biopsy, providing an improved depiction of lesions and safe and versatile access for long puncture pathways. This article reviews and illustrates the different applications of DECT in various abdominal interventions. Familiarity with the capabilities of DECT may help interventional radiologists to improve their practice and ameliorate patient care.
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Affiliation(s)
- Tara Prasad Tripathy
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Ranjan Patel
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
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Shin DH, Song YS, Choi Y, Yoo WH, Kummel F, Park EH. Clumpy artifacts can be differentiated from tophi with DECT: comparison between gout-free and gouty patients. Br J Radiol 2022; 95:20210990. [PMID: 34767489 PMCID: PMC8722253 DOI: 10.1259/bjr.20210990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To accurately differentiate clumpy artifacts from tophi with foot and ankle DECT. METHODS AND MATERIALS In session 1, 108 clumpy artifacts from 35 patients and 130 tophi images from 25 patients were analyzed. Reviewers classified green pixelation according to anatomic location, shape (linear, stippled, angular, oval), and height and width ratio. In session 2, green pixelation confined to the tendon was evaluated (shape, height and width ratio, occupied area in the tendon, accompanied peritendinous green pixelation). RESULTS In session 1, while tophi were noted at various locations, almost all clumpy artifacts were located at the tendon (99%, p < 0.0001). Most clumpy artifacts were linear, stippled, and wide, while most tophi were angular and oval (p < 0.05). In session 2, the shape of green pixelation from clumpy artifacts and tophi was significantly different (p < 0.0001) and most clumpy artifacts occupied less than 50% of the tendon (p = 0.02), and most tophi were accompanied by peritendinous green pixelation (p < 0.0001). Univariant logistic regression showed that tophi were significantly correlated with peritendinous deposits, angular and oval shape, and more than 50% of the tendon (p < 0.05). CONCLUSION Clumpy artifacts can be differentiated from tophi in DECT. Clumpy artifacts typically are located in the tendon with a linear or stippled shape, wide, and less than 50% of a tendon's cross-section. Tophi, on the other hand, typically are oval, larger than 50% of the tendon's cross-section, and associated with adjacent peritendinous green pixelation. ADVANCES IN KNOWLEDGE Clumpy artifacts can be differentiated from tophi in image findings by their location and shape.
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Affiliation(s)
- Dong Han Shin
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, Pusan, Republic of Korea
| | | | | | - Florian Kummel
- SHS DI CT M&S PCMM, Siemens Healthcare GmbH, Forchheim, Germany
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Praël I, Wuest W, Heiss R, Wiesmueller M, Kopp M, Uder M, May MS. Dual-Energy Lung Perfusion in Portal Venous Phase CT-A Comparison with the Pulmonary Arterial Phase. Diagnostics (Basel) 2021; 11:diagnostics11111989. [PMID: 34829336 PMCID: PMC8620268 DOI: 10.3390/diagnostics11111989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE.
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Affiliation(s)
- Isabelle Praël
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Wolfgang Wuest
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
- Hospital Martha-Maria, 90491 Nürnberg, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Marco Wiesmueller
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Markus Kopp
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
| | - Matthias S. May
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
- Correspondence:
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Burke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT. Skeletal Radiol 2019; 48:605-613. [PMID: 30343440 DOI: 10.1007/s00256-018-3087-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose was to determine whether dual-energy CT (DECT), specifically the bone marrow setting of the virtual noncalcium (VNCa) algorithm, could be used to identify and accurately biopsy suspected bone malignancies that were visible on magnetic resonance imaging (MRI), nuclear bone scintigraphy, or positron-emission tomography/computed tomography (PET/CT), but occult on monoenergetic computed tomography (CT) by virtue of being either isodense or nearly isodense to surrounding normal bone. MATERIALS AND METHODS We present 4 cases in which DECT was used to detect various malignant bone lesions and was successfully used to direct percutaneous DECT-guided bone biopsies. RESULTS Two of the lesions were solid tumor metastases (breast and prostate carcinoma), whereas two others were hematological malignancies (leukemia and lymphoma). This technique enabled us to confidently and accurately direct the biopsy needle into the target lesion. CONCLUSION The authors demonstrate that the DECT VNCa bone marrow algorithm may be helpful in identifying isodense bone lesions of various histologies and may be used to guide percutaneous bone biopsies. This technique may help to maximize diagnostic yield, minimize the number of passes into the region of concern, and prevent patients from undergoing repeat biopsy.
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Affiliation(s)
- Michael C Burke
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Ankur Garg
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Jonathan M Youngner
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Swati D Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Imran M Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
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Kooraki S, Assadi M, Gholamrezanezhad A. Hot Topics of Research in Musculoskeletal Imaging. PET Clin 2019; 14:175-182. [DOI: 10.1016/j.cpet.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chatzaraki V, Tappero C, Thali MJ, Schweitzer W. Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT. Forensic Sci Med Pathol 2018; 14:484-496. [PMID: 30426338 DOI: 10.1007/s12024-018-0034-3] [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] [Accepted: 09/06/2018] [Indexed: 01/30/2023]
Abstract
During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon's bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon's bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon's bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon's bleedings are present.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Jeon JY, Lee SW, Jeong YM, Baek HJ. The effect of tube voltage combination on image artefact and radiation dose in dual-source dual-energy CT: comparison between conventional 80/140 kV and 80/150 kV plus tin filter for gout protocol. Eur Radiol 2018; 29:1248-1257. [PMID: 29987420 DOI: 10.1007/s00330-018-5622-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In dual-source CT, dual-energy (DE) performance is affected by various X-ray tube voltage combinations with and without tin filter (Sn). The purpose of this study was to assess the utility of the 80/150 Sn kV voltage combination in terms of image artefact and radiation dose for DECT gout protocol, compared with the conventional 80/140 kV. METHODS Seventy-four patients with suspected gout who underwent dual-source DECT examinations scanned at 80/140 kV (n = 37) and at 80/150 Sn kV (n = 37) were included. Patients' age, sex, and serum uric acid levels were matched between the two groups. The types and incidence of image artefacts and radiation dose were evaluated. RESULTS The 80/150 Sn kV group had significantly fewer patients with artefacts, compared to the 80/140 kV group [11 (30 %) of 37 vs 35 (94.6 %) of 37, p < 0.001]. Except for the motion artefact, the rest of the artefacts-skin, nail bed, submillimetre, motion, vascular, beam-hardening, clumpy artefact along tendon-were significantly less observed in the 80/150 Sn kV acquisitions. The dose-length product (DLP) and effective dose were significantly lower for the 80/150 Sn kV acquisitions compared with the 8s0/140 kV scans (DLP: 104.46 ± 10.66 mGy·cm vs 344.70 ± 56.39 mGy·cm, p < 0.001; effective dose: 1.04 ± 0.11 mSv vs 3.45 ± 0.56 mSv, p < 0.001). CONCLUSIONS The 80/150 Sn kV voltage combination in dual-source DECT system could be used as one of the artefact reduction methods while reducing radiation dose for gout protocol when compared to the conventional 80/140 kV. KEY POINTS • DECT has emerged as the leading modality for non-invasive diagnosis of gout. • Various X-ray tube voltage combinations are now feasible in dual-source DECT. • The 80/150 Sn kV acquisition could facilitate artefact reduction in gout protocol.
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Affiliation(s)
- Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 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, 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, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
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