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Sample records for 64-slice ct angiography

  1. Cardiac CT angiography after coronary artery surgery in children using 64-slice CT scan

    Marini, Davide; Agnoletti, Gabriella [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Brunelle, Francis [University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France); Sidi, Daniel; Bonnet, Damien [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Ou, Phalla [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France)], E-mail: phalla.ou@nck.aphp.fr

    2009-09-15

    Objective: The purpose of this study was to compare the diagnostic accuracy of 64-slice CT with that of invasive angiography in the detection of graft and/or coronary angioplasty stenosis in children who had undergone coronary artery surgery. Population and methods: Fifteen consecutive children (8 male and 7 female; age 9.2 {+-} 6.1 years) underwent 64-slice CT because of chest pain or ECG changes mean 4.8 {+-} 3.7 years after surgical coronary artery surgery; 10 patients had coronary angioplasty using a patch from the saphenous vein, four had mammary artery bypass, and one had saphenous vein bypass. Six main segments of the coronary arteries and all the bypass graft considered as a single segment were analyzed and compared with invasive angiography used as the reference standard. Results: CT correctly identified the four children with coronary angioplasty and mammary graft lesions that were confirmed by conventional angiography: one patient had a significant stenosis (>50% stenosis) at the mammary bypass graft anastomosis site; three other had non-significant stenosis (<50% stenosis) including a mild lesion of the saphenous vein patch in two patients and a mild lesion at the anastomosis site of the mammary bypass in one. All segments identified as normal by CT in the other 11 children were also found to be normal by conventional angiography. Conclusion: In centers expert in this technique, 64-slice CT scanning is a promising, rapid, and useful diagnostic technique for evaluating both coronary angioplasty and bypass graft lesions in children who had undergone coronary artery surge0008.

  2. Cardiac CT angiography after coronary artery surgery in children using 64-slice CT scan

    Objective: The purpose of this study was to compare the diagnostic accuracy of 64-slice CT with that of invasive angiography in the detection of graft and/or coronary angioplasty stenosis in children who had undergone coronary artery surgery. Population and methods: Fifteen consecutive children (8 male and 7 female; age 9.2 ± 6.1 years) underwent 64-slice CT because of chest pain or ECG changes mean 4.8 ± 3.7 years after surgical coronary artery surgery; 10 patients had coronary angioplasty using a patch from the saphenous vein, four had mammary artery bypass, and one had saphenous vein bypass. Six main segments of the coronary arteries and all the bypass graft considered as a single segment were analyzed and compared with invasive angiography used as the reference standard. Results: CT correctly identified the four children with coronary angioplasty and mammary graft lesions that were confirmed by conventional angiography: one patient had a significant stenosis (>50% stenosis) at the mammary bypass graft anastomosis site; three other had non-significant stenosis (<50% stenosis) including a mild lesion of the saphenous vein patch in two patients and a mild lesion at the anastomosis site of the mammary bypass in one. All segments identified as normal by CT in the other 11 children were also found to be normal by conventional angiography. Conclusion: In centers expert in this technique, 64-slice CT scanning is a promising, rapid, and useful diagnostic technique for evaluating both coronary angioplasty and bypass graft lesions in children who had undergone coronary artery surgery.

  3. Optimizing 64-slice spiral CT angiography in lower extremity arterial disease with individualized injection protocol

    Objective: To explore the optimal protocol of the 64-slice spiral CT angiography (CTA) in lower extremity arterial disease. Methods: Forty -eight patients with clinically suspected lower extremity arterial disease underwent GE LightSpeed VCT using individual and traditional injection protocols. The clinical value of CTA was evaluated using DSA as the standard reference. Results: Satisfactory images were obtained from 47 of 48 cases. Images fulfilling clinical diagnostic requirements after appropriate post -procession on workstation were obtained from 1 case. The image quality of the group with the individualized injection protocol was significantly superior to that of the group with the traditional image protocol. The sensitivity and specificity of CTA in detecting middle-grade and severe arterial stenosis were 86.1% and 86.6%, respectively. Conclusion: 64-slice spiral CT angiography is a reliable method for evaluating the lower extremity arterial disease, and is a more ideal method if using individualized injection protocol. (authors)

  4. The value of 64-slice CT angiography in diagnosing spinal vascular malformations

    Objective: To evaluate 64-slice CT angiography in diagnosing spinal vascular malformations. Methods: Fifteen patients, who were suggestive of spinal vascular malformations by clinical manifestation and MRI, underwent CT angiography with a 64-slice spiral CT (GE lightspeed VCT). DSA were performed later within 1 week in all the patients and four of them were treated with operation as well. We evaluated CTA images in displaying the lesions according to the following aspects: the type of malformation, lesion range, feeding artery, draining vein and possible fistula, and compared those details with DSA and operation findings. Results: All 15 patients acquired their final diagnosis by DSA and operation, which were intramedullary artefiovenous malformation in 6 cases, perimedullary artefiovenous fistula in 2, spinal dural arteriovenous fistula in 3 and Cobb syndrome in 4 cases. CTA was consistent with DSA in the classification of lesions and in the determination of the involved regions and it revealed the main feeding arteries and draining veins in all patients. CTA showed four arteriovenous fistulae confirmed by DSA, but it failed in a complex arteriovenous fistula. In Cobb syndrome patients, not only the intramedullary but also paravertebral and subcutenous vascular malformation could be clearly seen on CTA images. Conclusion: 64-slice CT angiography can be a preliminary method in spinal vascular malformation because it can determine the classification and reveal almost all the main lesions quickly, atraumatically. (authors)

  5. Diagnostic value of 64-slice CT angiography in coronary artery disease: A systematic review

    Purpose: To perform a systematic review of the diagnostic value of 64-multislice CT (MSCT) angiography in the detection of coronary artery disease (CAD) when compared to conventional coronary angiography. Materials and methods: A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 64-slice MSCT angiography with conventional coronary angiography in the detection of CAD were included. Diagnostic value of MSCT angiography compared to coronary angiography was compared and analysed at segment-, vessel- and patient-based assessment. Results: Fifteen studies met selection criteria and were included for analysis. Pooled sensitivity, specificity, positive predictive value and negative predictive value as well as 95% confidence interval (CI) were 97% (94 and 99%), 88% (79 and 97%), 94% (91 and 97%), and 95% (90 and 99%) for patient-based assessment; 92% (85 and 99%), 92% (85 and 99%), 78% (66 and 91%) and 98% (96 and 99%) for vessel-based assessment; 90% (85 and 94%), 96% (95 and 97%), 75%(68 and 82%) and 98% (98 and 99%) for segment-based assessment, respectively. No significant difference was found in the diagnostic accuracy of 64-slice CT in the detection of CAD when comparison was performed either among four main coronary arteries, or between proximal and middle or distal segments (p > 0.05). Conclusion: Our results showed that 64-slice CT angiography has a high-diagnostic value in the detection of CAD. Severe coronary artery calcification seems to be the major factor affecting the visualisation and assessment

  6. Preliminary evaluation of 64-slice spiral CT coronary angiography in patients with coronary artery disease

    Objective: To investigate the image quality and diagnostic accuracy using 64-slice spiral computed tomography (64-CTA) scanner in patients with suspected coronary artery disease. Methods: Sixty eight patients with chest pain or post PTCA underwent CT coronary angiography (CTA) and selected coronary angiography (SCA). The SCA results were served as 'gold standard' to evaluate the diagnostic accuracy of CTA, while the sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were calculated, respectively. Results: 64-slice spiral CT could clearly demonstrate the coronary arterial trunk and branchs with stenosis, calcifications abnormal orifise origination and bridge vascular disease; especially with high accuracy in revealing calcification and even with quantification. The sensitivity, specificity, PPV and NPV of the degree of stenosis more than 75% for coronary artery segments evaluated by CTA were significantly higher than those of the degree of stenosis less than 50% for coronary artery segments (P<0.01). Conclusion: CTA is a safe, simple and reliable noninvasive method for screening coronary artery disease in patients with chest pain. Moreover, 64-slice spiral CT could demonstrate not only the more delicate delineation of coronary arterial changes with 3D reconstruction and volume renderting but also the presence and quantity of calcium deposited on the vascular wall. (authors)

  7. Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation

    Carbone, Iacopo; Cannata, David; Algeri, Emanuela; Galea, Nicola; Napoli, Alessandro; Catalano, Carlo; Passariello, Roberto; Francone, Marco [Sapienza University of Rome, Department of Radiological, Onchological and Anatomopathological Sciences, Policlinico Umberto I, Rome (Italy); De Zorzi, Andrea [Bambino Gesu Hospital, Cardiology Division, Rome (Italy); Bosco, Giovanna; D' Agostino, Rita [Sapienza University of Rome, Unit of Paediatric Cardiology, Policlinico Umberto I, Rome (Italy); Menezes, Leon [University College of London, Institute of Nuclear Medicine, London (United Kingdom)

    2011-09-15

    Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. The study group comprised 12 patients (age 17.6 {+-} 2.9 years, mean{+-}SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6 {+-} 13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56 {+-} 0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n = 32), stenoses (n = 3) and occlusions (n = 9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures. (orig.)

  8. Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography

    Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria di Parma, Non-invasive Cardiovascular Imaging Unit, Department of Radiology, Parma (Italy); Maffei, Erica; Aldrovandi, Annachiara; Fusaro, Michele; Vignali, Luigi; Menozzi, Alberto [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Palumbo, Anselmo A. [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Malago, Roberto [University of Verona, Department of Radiology, Verona (Italy); La Grutta, Ludovico; Midiri, Massimo [University of Palermo, Department of Radiology, Palermo (Italy); Meiijboom, W.B.; Mollet, Nico R.A.; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Brambilla, Valerio; Coruzzi, Paolo [Don Gnocchi ONLUS, Cardiovascular Rehabilitation Unit, Parma (Italy); Kirchin, Miles A. [Bracco Imaging SpA, Worldwide Medical and Regulatory Affairs, Milan (Italy)

    2008-03-15

    We assessed the effect of intra-coronary attenuation on diagnostic accuracy using 64-slice computed tomography coronary angiography (CT-CA). We enrolled 170 patients with suspected coronary artery disease who underwent conventional coronary angiography (CA) and 64-slice CT-CA (100 ml of Iomeprol 400 mg I/ml at 4 ml/s). The study population was divided into two groups (85 patients each based on median attenuation of 326 HU) based on mean arterial attenuation; group 1 with low attenuation and group 2 with high attenuation. Diagnostic accuracy for the detection of significant coronary artery stenosis was determined for both groups using CA as reference standard. Overall, 163 significant stenoses were detected in 1,030 assessable coronary artery segments in group 1 compared with 160 significant stenoses in 1,020 assessable segments in group 2. The average intra-coronary attenuation was significantly (P < 0.05) higher for group 2 (388 {+-} 46 HU) compared with group 1 (291 {+-} 33 HU). The corresponding sensitivity and specificity values for detection of significant coronary artery stenosis were higher for group 2 (96.3% and 97.6%, respectively) than for group 1 (82.8% and 93.2%, respectively) and were more marked in distal coronary segments than in proximal segments. Higher intra-coronary attenuation on CT-CA results in greater diagnostic accuracy for detection of coronary artery stenosis. (orig.)

  9. Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography

    We assessed the effect of intra-coronary attenuation on diagnostic accuracy using 64-slice computed tomography coronary angiography (CT-CA). We enrolled 170 patients with suspected coronary artery disease who underwent conventional coronary angiography (CA) and 64-slice CT-CA (100 ml of Iomeprol 400 mg I/ml at 4 ml/s). The study population was divided into two groups (85 patients each based on median attenuation of 326 HU) based on mean arterial attenuation; group 1 with low attenuation and group 2 with high attenuation. Diagnostic accuracy for the detection of significant coronary artery stenosis was determined for both groups using CA as reference standard. Overall, 163 significant stenoses were detected in 1,030 assessable coronary artery segments in group 1 compared with 160 significant stenoses in 1,020 assessable segments in group 2. The average intra-coronary attenuation was significantly (P < 0.05) higher for group 2 (388 ± 46 HU) compared with group 1 (291 ± 33 HU). The corresponding sensitivity and specificity values for detection of significant coronary artery stenosis were higher for group 2 (96.3% and 97.6%, respectively) than for group 1 (82.8% and 93.2%, respectively) and were more marked in distal coronary segments than in proximal segments. Higher intra-coronary attenuation on CT-CA results in greater diagnostic accuracy for detection of coronary artery stenosis. (orig.)

  10. The clinical application of 64-slice spiral CT angiography in carotid artery bifurcation disease

    Objective: To explore the clinical value of 64-slice spiral CT angiography (CTA) in carotid stenosis and atherosclerotic plaque. Methods: 40 patients (80 carotid arteries) underwent CTA and DSA. These two examinations within one week. The results of CTA were compared with that of DSA, the sensitivity and specificity of CTA and DSA were figured out. Results: CTA performed well in the detection of mild (0% to 29%) carotid stenosis, as well as carotid occlusion, with values for sensitivity and specificity both near 100%. In determining that a stenosis was >50% by DSA measurement, CTA with a sensitivity, specificity of 89% and 91% respectively. While CTA was quite specific in identifying degrees of stenoses in either the 50% to 69% or the 70% to 99% ranges, in this task it was much less sensitive: 65% and 73% respectively. CTA can detect all kinds of ulcers while DSA can not. Conclusions: 64-slice CTA and DSA were correctly identified in detecting carotid stenosis. CTA could demonstrate ulcers associated with the carotid stenosis, hut DSA only show stenosis. (authors)

  11. 64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents

    Maintz, David; Seifarth, Harald; Rink, Michael; Oezguen, Murat; Heindel, Walter; Fischbach, Roman [University of Muenster, Department of Clinical Radiology, Muenster (Germany); Raupach, Rainer; Flohr, Thomas [Siemens Medical Solutions, Forchheim (Germany); Sommer, Torsten [University of Bonn, Department of Radiology, Bonn (Germany)

    2006-04-15

    The purpose of this study was to test a large sample of different coronary artery stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation, and image noise in 64-slice multidetector-row computed tomography (MDCT) in vitro and to provide a catalogue of currently used coronary artery stents when imaged with state-of the-art MDCT. We examined 68 different coronary artery stents (57 stainless steel, four cobalt-chromium, one cobalt-alloy, two nitinol, four tantalum) in a coronary artery phantom (vessel diameter 3 mm, intravascular attenuation 250 HU, extravascular density -70). Stents were imaged in axial orientation with standard parameters: 32x0.6 collimation, pitch 0.24, 680 mAs, 120 kV, rotation time 0.37 s. Four different image reconstructions were obtained with varying convolution kernels and section thicknesses: (1) soft, 0.6 mm, (2) soft, 0.75, (3) medium soft, 0.6, and (4) stent-optimized sharp, 0.6. To evaluate visualization characteristics of of the stent, the lumen diameter, intraluminal density and noise were measured. The high-resolution kernel offered significantly better average lumen visualization (57% {+-}10%) and more realistic lumen attenuation (222 HU {+-}66 HU) at the expense of increased noise (15.3 HU {+-}3.7 HU) compared with the soft and medium-soft CT angiography (CTA) protocol (p<0.001 for all). Stents with a lumen visibility of more than 66% were: Arthos pico, Driver, Flex, Nexus2, S7, Tenax complete, Vision (all 67%), Symbiot, Teneo (70%), and Radius (73%). Only ten stents showed a lumen visibility of less than 50%. Stent lumen visibility largely varies depending on the stent type. Even with the improved spatial resolution of 64-slice CT, a stent-optimized kernel remains beneficial for stent visualization when compared with the standard medium-soft CTA protocol. Using 64-slice CT and high-resolution kernel, the majority of stent products show a lumen visibility of more than 50% of the stent

  12. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

    Pugliese, Francesca; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Mollet, Nico R.A.; deFeyter, Pim J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Runza, Giuseppe [University of Palermo, Department of Radiology, Palermo (Italy); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy); Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Malagutti, Patrizia [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); University of Ferrara, Department of Cardiology, Ferrara (Italy); Cademartiri, Filippo [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy)

    2006-03-15

    Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as {>=} 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

  13. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

    Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

  14. Evaluation of peripheral artery stent with 64-slice multi-detector row CT angiography: Prospective comparison with digital subtraction angiography

    Li Xiaoming, E-mail: lixiaoming55@hotmail.co [Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Department of Radiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092 (China); Li Yuhua, E-mail: liyuhua2000@hotmail.co [Department of Radiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092 (China); Tian Jianming, E-mail: tianjianming1952@hotmail.co [Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Xiao Yi, E-mail: xiaoyi@188.co [Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Lu Jianping, E-mail: lujianping2000@hotmail.co [Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Jing Zaiping, E-mail: jingzaiping@hotmail.co [Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Sheng Jing, E-mail: shengjing1997@hotmail.co [Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433 (China); Edwin, Angela, E-mail: angiedwin@yahoo.co [Department of Emergency, 34 Military Hospital, Wilberforce Barracks, Republic of Sierra Leone Armed Forces, Freetown (Sierra Leone); Wu Fanghong, E-mail: fanghong.wu@siemens.co [Medical Solutions, Shanghai Branch, Siemens Ltd. (China)

    2010-07-15

    Purpose: To assess the accuracy of 64-slice multi-detector row computed tomography (MDCT) angiography in the evaluation of peripheral artery in-stent or peristent restenosis, with conventional digital subtraction angiography (DSA) as the reference standard. Materials and methods: Forty-one patients (30 men, 11 women; mean age, 69.8 {+-} 9.2 years) with symptomatic peripheral arterial occlusive disease after peripheral artery stenting (81 stented lesions) underwent both conventional DSA and 64-slice MDCT angiography. Each stent was classified as evaluable or unevaluable, and every stent was divided into three segments (proximal stent, stent body, and distal stent), resulting in 243 segments. For evaluation, stenosis was graded as follows: 1, none or slight stenosis (<25%); 2, mild stenosis (25-49%); 3, moderate stenosis (50-74%); 4, severe stenosis or total occlusion ({>=}75%). Two readers evaluated all CT angiograms with regard to narrowing of in-stent or peristent restenosis by consensus. Results were compared with findings of the DSA. Results: Of 81 stents, 62 (76.5%) were determined to be assessable. The metal artifact of the gold marker and motion artifact increased uninterpretability of the images of stents. Overall, 24 of 28 in-stent restenosis and 38 of 53 persistent restenosis were correctly detected by MDCT (85.7% and 71.7% sensitivity). In evaluable stents, 21 of 22 in-stent restenoses and 27 of 28 persistent restenosis were correctly detected (95.4% and 96.4% sensitivity). Additionally, as the grade of stenosis increases, the mean level of CT values in the stent lumina decreases linearly accordingly. Conclusion: 64-Slice MDCT has a high accuracy for the detection of significant in-stent or peristent restenosis of assessable stents in patients with peripheral artery stent implantation and therefore can be considered as a valuable noninvasive technique for stent surveillance.

  15. Evaluation of peripheral artery stent with 64-slice multi-detector row CT angiography: Prospective comparison with digital subtraction angiography

    Purpose: To assess the accuracy of 64-slice multi-detector row computed tomography (MDCT) angiography in the evaluation of peripheral artery in-stent or peristent restenosis, with conventional digital subtraction angiography (DSA) as the reference standard. Materials and methods: Forty-one patients (30 men, 11 women; mean age, 69.8 ± 9.2 years) with symptomatic peripheral arterial occlusive disease after peripheral artery stenting (81 stented lesions) underwent both conventional DSA and 64-slice MDCT angiography. Each stent was classified as evaluable or unevaluable, and every stent was divided into three segments (proximal stent, stent body, and distal stent), resulting in 243 segments. For evaluation, stenosis was graded as follows: 1, none or slight stenosis (<25%); 2, mild stenosis (25-49%); 3, moderate stenosis (50-74%); 4, severe stenosis or total occlusion (≥75%). Two readers evaluated all CT angiograms with regard to narrowing of in-stent or peristent restenosis by consensus. Results were compared with findings of the DSA. Results: Of 81 stents, 62 (76.5%) were determined to be assessable. The metal artifact of the gold marker and motion artifact increased uninterpretability of the images of stents. Overall, 24 of 28 in-stent restenosis and 38 of 53 persistent restenosis were correctly detected by MDCT (85.7% and 71.7% sensitivity). In evaluable stents, 21 of 22 in-stent restenoses and 27 of 28 persistent restenosis were correctly detected (95.4% and 96.4% sensitivity). Additionally, as the grade of stenosis increases, the mean level of CT values in the stent lumina decreases linearly accordingly. Conclusion: 64-Slice MDCT has a high accuracy for the detection of significant in-stent or peristent restenosis of assessable stents in patients with peripheral artery stent implantation and therefore can be considered as a valuable noninvasive technique for stent surveillance.

  16. The comparative study of 64-slices spiral CT angiography with DSA in lower extremity arterial occlusive diseases

    Objective: To study the clinical value of 64-slices spiral CTA with DSA comparatively in diagnosis of lower extremity arterial occlusive diseases. Methods: 31 patients with lower extremity arterial occlusive diseases underwent 64-slice spiral CT angiography of lower extremity arteries and they also underwent digital subtraction angiography (DSA)two weeks later. Reconstruction by maximum intensity projection (MIP), volume render (VR)and multiplanar reformatting (MPR)in working-station was undertaken comparing with the bolus chase DSA and traditional DSA for diagnostic accuracy. Results: The 216 arterial segments of lower extremity were selected, including 157 segments with consistent results in demonstrating degree of stenosis by both examinations. On CT angiography, 5 segmental stenosis were overestimated and 9 were underestimated. When stenosis of detected segments is more than 50%, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CTA were 98.21%, 96.15%, 97.22%, 96.49%, and 98.04%, respectively. Conclusion: 64-slices spiral CT angiography is an effective and reliable method for evaluating the lower extremity arterial occlusive diseases and may provide precious information for planning interventional therapy. (authors)

  17. The value of 64-slice spiral CT angiography based on pre-contrasted raw data in diagnosing pulmonary arteriovenous fistula

    Objective: To evaluate the value of 64-slice spiral CT angiography based on pre- contrasted raw data in diagnosing pulmonary arteriovenous fistula. Methods: 64-slice spiral CT plain scan and enhanced scan was performed in 16 patients with pulmonary arteriovenous fistula, pulmonary angiography based on pre-contrast and post-contrast raw data was performed respectively, including maximum intensity projection (MIP), shaded-surface display (SSD), and volume rendering (VR). According to the results of angiocardiography and surgical findings, comparson of the three methods was made in the display of PAVF in pre-contrast and post-contrast phase images. Results: 8 of the 16 PAVF cases were single lesion, 8 cases were multi-lesions. 30 PAVF lesions were found in all the patients. MIP, SSD and VR based on pre-contrast raw data displayed PAVF lesions in 20, 14, and 22, respectively. The combination of the 3 methods based on pre-contrast raw data could show 26 PAVF lesions. MIP, SSD, and VR based on post-contrast raw data displayed PAVF lesions in 24, 18, and 30, respectively. The combination of the 3 methods based on post-contrast raw data could show 30 PAVF lesions. Conclusion: 64-slice spiral CT angiography based on pre-contrasted raw data can clearly show the position, number, and shape of PAVF lesions, which is of great value in diagnosing PAVF. (authors)

  18. 64-Slice CT Angiography in the Detection of Intracranial Aneurysms: Comparison with DSA and Surgical Findings.

    Milošević Medenica, S; V Vućković, V; Prstojević, B

    2010-03-01

    The overall results of CT angiography on 64-slice MSCT published in the last five years are very close to results of DSA which is still a gold standard in the diagnosis of intracranial aneurysms. The aim of this study is to contribute to the confidence in reliability of this method and to try to answer the question of whether CTA should be used as the first diagnostic modality in patients with suspect intracranial aneurysms. In the period from October 2008 to August 2009 we diagnosed 118 aneurysms in 73 patients. We included in this study only those patients who underwent either DSA, surgical treatment or both after MSCTA, and the remainder of the above patients were not treated and are followed up, or died before treatment. So our group comprised 47 patients who were divided into two groups. The first group of 22 patients underwent DSA after MSCTA. We found 36 aneurysms in this group. One aneurysm was falsely positive compared to DSA, while 35 were in concordance with DSA. DSA revealed five aneurysms smaller than 4 mm not disclosed by MSCTA. The second group comprised 25 patients who were operated according to MSCTA findings only. There were 33 aneurysms in this group: 25 aneurysms were operated and surgical findings agreed with MSCTA. Eight aneurysms smaller than 4 mm were not operated and we do not have confirmation for them. In all false positive and false negative cases the misdiagnosed aneurysms were in fact 1-1.5 mm outpouchings that were not responsible for SAH. According to the available literature and our results, MSCTA has proved a very reliable method, simple and safe, competent to be used as a diagnostic modality of choice in the patients with SAH or suspect unruptured aneurysm. DSA should be used in cases of negative or uncertain findings on MSCTA, excluding cases of perimesencephalic SAH with negative MSCTA. The relative disadvantage of this method is its lower sensitivity in the detection of tiny outpouchings, especially in the infraclionid region

  19. Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography

    Cademartiri, Filippo; La Grutta, Ludovico; Malagò, Roberto; Alberghina, Filippo; Meijboom, Willem B.; Pugliese, Francesca; Maffei, Erica; Palumbo, Anselmo Alessandro; Aldrovandi, Annachiara; Fusaro, Michele; Brambilla, Valerio; Coruzzi, Paolo; Midiri, Massimo; Mollet, Nico R. A.; Krestin, Gabriel P

    2008-01-01

    The aim of our study was to assess the prevalence of variants and anomalies of the coronary artery tree in patients who underwent 64-slice computed tomography coronary angiography (CT-CA) for suspected or known coronary artery disease. A total of 543 patients (389 male, mean age 60.5 ± 10.9) were reviewed for coronary artery variants and anomalies including post-processing tools. The majority of segments were identified according to the American Heart Association scheme. The coronary dominanc...

  20. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to ''triage'' patients' treatment

    Agid, R.; Lee, S.K.; Willinsky, R.A.; Farb, R.I.; TerBrugge, K.G. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2006-11-15

    To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm. (orig.)

  1. Optimal scanning protocols of 64-slice CT angiography in coronary artery stents: An in vitro phantom study

    Purpose: The purpose of the study was to investigate the optimal scanning protocol of 64-slice CT angiography for assessment of coronary artery stents based on a phantom study. Materials and methods: Coronary stents with a diameter of 2.5 mm was implanted in thin plastic tubes with an inner diameter of 3.0 mm to simulate a coronary artery. The tubes were filled with iodinated contrast medium diluted to 178 HU, closed at both ends and positioned in a plastic container filled with vegetable oil (-70 to -100 HU). A series of scans were performed with a 64-slice CT scanner with the following protocols: section thickness: 0.67 mm, 1.0 mm, 1.5 mm, 2.0 mm, pitch value: 0.2, 0.3, 0.5 and reconstruction interval of 50% overlap of the section thickness. 2D axial and multiplanar reformatted images were generated to assess the visibility of stent lumen, while virtual intravascular endoscopy (VIE) was reconstructed to evaluate the artery wall and stent surface. Results: Our results showed that a scanning protocol of 1.0 mm slice thickness with a pitch of 0.3 produced acceptable images with best demonstration of the intrastent lumen and stent surface with minimal image noise or artifacts. In contrast, submillimeter scans with 0.67 mm resulted in moderate artifacts which affected visualization of the coronary lumen, in addition to the increased noise. When the section thickness increased to 1.5 mm and 2.0 mm, visualization of the artery wall and stent surface was compromised, although the intrastent lumen was still visible. Conclusion: Our in vitro study suggested that a scanning protocol of 1.0 mm section thickness with pitch of 0.3 is the optimal protocol for evaluation of coronary artery stents as it allows generation of acceptable images with better visualization of stent lumen, stent surface and coronary artery wall.

  2. Optimal scanning protocols of 64-slice CT angiography in coronary artery stents: An in vitro phantom study

    Almutairi, Abdulrahman Marzouq [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia); Sun Zhonghua [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia)], E-mail: z.sun@curtin.edu.au; Ng, Curtise [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia); Al-Safran, Zakariya A.; Al-Mulla, Abeer A.; Al-Jamaan, Abdulaziz I. [Department of Medical Imaging, King Fahad Specialist Hospital, Dammam (Saudi Arabia)

    2010-04-15

    Purpose: The purpose of the study was to investigate the optimal scanning protocol of 64-slice CT angiography for assessment of coronary artery stents based on a phantom study. Materials and methods: Coronary stents with a diameter of 2.5 mm was implanted in thin plastic tubes with an inner diameter of 3.0 mm to simulate a coronary artery. The tubes were filled with iodinated contrast medium diluted to 178 HU, closed at both ends and positioned in a plastic container filled with vegetable oil (-70 to -100 HU). A series of scans were performed with a 64-slice CT scanner with the following protocols: section thickness: 0.67 mm, 1.0 mm, 1.5 mm, 2.0 mm, pitch value: 0.2, 0.3, 0.5 and reconstruction interval of 50% overlap of the section thickness. 2D axial and multiplanar reformatted images were generated to assess the visibility of stent lumen, while virtual intravascular endoscopy (VIE) was reconstructed to evaluate the artery wall and stent surface. Results: Our results showed that a scanning protocol of 1.0 mm slice thickness with a pitch of 0.3 produced acceptable images with best demonstration of the intrastent lumen and stent surface with minimal image noise or artifacts. In contrast, submillimeter scans with 0.67 mm resulted in moderate artifacts which affected visualization of the coronary lumen, in addition to the increased noise. When the section thickness increased to 1.5 mm and 2.0 mm, visualization of the artery wall and stent surface was compromised, although the intrastent lumen was still visible. Conclusion: Our in vitro study suggested that a scanning protocol of 1.0 mm section thickness with pitch of 0.3 is the optimal protocol for evaluation of coronary artery stents as it allows generation of acceptable images with better visualization of stent lumen, stent surface and coronary artery wall.

  3. Bone Subtraction 3-Dimension CT Angiography Using 64-Slice Multidetector CT for the Evaluation of Steno-Occlusive Intra- and Extracranial Vascular Diseases: Comparison with Digital Subtraction Angiography

    Park, Sung Eun; Choi, Dae Seob; Shin, Hwa Seon; You, Jin Jong; Park, Mi Jung; Cho, Jae Min; Choi, Ho Cheol; Son, Seung Nam [Gyeongsang National University School of Medicine, Jinju (Korea, Republic of); Ryu, Jae Wook [Dept. of Radiology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2012-09-15

    To investigate the efficacy of bone subtraction CT angiography (BSCTA) for the evaluation of steno-occlusive intra- and extracranial vascular diseases. Fifty-six patients were examined using 64-slice multidetector CT and digital subtraction angiography (DSA). For BSCTA, both nonenhanced CT and enhanced CT angiography (CTA) data sets were obtained. The stenotic degree of each vascular segment was assessed and classified into 5 grades. With DSA as the standard, CTA images were compared. For the evaluation of the extracranial vessels, 370 arterial segments were analyzed, and the stenotic degree revealed by CTA and DSA agreed in 359 (97.0%). There was a significant correlation between CTA and DSA (Rs = 0.974). For depiction of {>=} 50% stenosis, the sensitivity, specificity, and diagnostic accuracy of BSCTA were 100%, 98.2%, and 98.6%, respectively. For the intracranial arteries, 1029 segments were analyzed, and CTA agreed with DSA in 966 (93.9%). There was a significant correlation between CTA and DSA for stenotic degree (Rs = 0.880). For the depiction of {>=} 50% stenosis, the sensitivity, specificity, and diagnostic accuracy of CTA were 100%, 95.8%, and 96.0%, respectively. In all 74 segments of disagreement, the degree of stenosis was overestimated on CTA. BSCTA is comparable to DSA for the evaluation of steno-occlusive intra- and extracranial vascular diseases. However, the stenotic degree tends to be overestimated on BSCTA, especially in cases of wall calcifications.

  4. Preliminary Reports on the Accuracy of Coronary CT-Angiography Using 64-slice Multi-slice Spiral CT (MSCT in Iran

    "A. Arjmand Shabestari

    2005-08-01

    Full Text Available Introduction & Background: Coronary artery disease (CAD is the leading cause of death in many western countries. Its prevalence and incidence among Irani-ans particularly in the urban areas are increasing. Ac-cording to the newest Tehran annual mortality re-port, the most common cause of death in Tehran is cardiovascular disease. Diagnostic gold standard in CAD is fluoroscopic coronary angiography (FCA us-ing catheterization. Nevertheless, it is an invasive method and in recent years, some non-invasive or less-invasive imaging modalities such as MRI and CT scans have been used to investigate CAD. One of the most attractive new methods in this regard is Coro-nary CT-Angiography (CCTA, which has gained considerable attention. Multi-slice spiral CT (MSCT scanners with simultaneous acquisition of multiple (up to 64 slices in less than half a second of gantry rotation time (in our study, 0.33 second, have be-come available, resulting in minimally-invasive coro-nary artery imaging. The purpose of this study is to determine the diagnostic accuracy of a new 64-slice MSCT scanner in the diagnosis of coronary artery and/or bypass grafts occlusion or hemodynamically significant stenosis. Parients & Methods: This investigation is underway in patients undergoing elective FCA. A 64-channel per rotation MSCT scanner (Somatom Sensation 64, Siemens Medical Systems, Forchheim, Germany, with 0.6 mm collimation, 0.33 second gantry rotation time and 120 KVp was used to perform CCTA. Ap-proximately 70-90 mL of a nonionic contrast medium was injected intravenously. All coronary artery seg-ments, according to American Heart Association (AHA classification & nomenclature system were analyzed. Patients who had undergone previous coronary artery bypass grafts (CABGs, or used coro-nary stents were enrolled in the study, as well. MSCT scans were carried out within 10 days of catheteriza-tion, and the most dramatically stenotic lesions were analyzed in CCTA by a semi

  5. Assessment of Grafts and Coronary Arteries with 64-slice Computer Tomography(CT) Angiography after Coronary Artery Bypass Surgery - our experiences

    Veljanovska, Lidija; Sokolov, V.; Milev, Ivan; Idrizi, Spend; Mitrev, Zan

    2008-01-01

    The use of 64 slice CT (GE Light-Speed VCT) in evaluation of pathway and patency of the grafts, distal anastomosis and native vascular net in patients (pts) after coronary artery bypass grafting (CABG).

  6. Optimisation of contrast medium volume and injection-related factors in CT pulmonary angiography: 64-slice CT study

    Uysal Ramadan, Selma [Ankara Training and Research Hospital, Department of Radiology, Ankara (Turkey); Ankara Training and Research Hospital, Cebeci, Ankara (Turkey); Kosar, Pinar; Sonmez, Iclal; Kosar, Ugur [Ankara Training and Research Hospital, Department of Radiology, Ankara (Turkey); Karahan, Sevilay [Hacettepe University, Department of Biostatistics, Faculty of Medicine, Ankara (Turkey)

    2010-09-15

    To compare the image quality of computed tomography pulmonary angiography (CTPA) obtained with the injection of various low doses of contrast medium (CM) with different injection-related factors. A total of 90 patients (42 females, 48 males; 54.3 {+-} 18.6 years) undergoing CTPA were included. Three CM protocols, each containing 30 patients, were created. Protocols 1, 2 and 3 consisted of a CM of 60 ml, 55 ml and 50 ml, and a bolus trigger level of 120 HU, 90 HU and 75 HU, respectively. Injection was uniphasic for protocols 1 and 2 (flow rate 5 ml/s), and biphasic for protocol 3 (flow rates 5 and 4 ml/s); with saline flushing afterwards. Enhancement was measured in three central and six peripheral pulmonary arteries. The mean attenuation value for pulmonary arteries was over 250 HU for all protocols. There was no difference between the attenuation levels with the protocols (p > 0.05). The percentage of pulmonary arteries exceeding optimal attenuation ({>=}250 HU) showed that protocols 2 and 3 were 90-100% successful (p < 0.05). The use of proper injection-related factors during CTPA, such as a low trigger level and a high flow rate with saline injection following a decreased CM volume (55 ml or 50 ml), will enable adequate pulmonary artery contrast enhancement. (orig.)

  7. Diagnostic Value of 64-Slice Dual-Source CT Coronary Angiography in Patients with Atrial Fibrillation: Comparison with Invasive Coronary Angiography

    We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib). The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses (≥ 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement. The mean heart rate was 89 ± 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement. 64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

  8. Diagnostic Value of 64-Slice Dual-Source CT Coronary Angiography in Patients with Atrial Fibrillation: Comparison with Invasive Coronary Angiography

    Zhang, Jian Jun; Liu, Tie; Feng, Yue; Wu, Wei Feng; Mou, Cai Yun; Zhai, Li Hao [Zhejiang Hospital, Hangzhou (China)

    2011-08-15

    We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib). The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses ({>=} 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement. The mean heart rate was 89 {+-} 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement. 64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

  9. The application of the reduced dosage of the contrast medium with saline flush in cerebral and carotid angiography with 64-slice spiral CT

    Objective: To utilize the reduced contrast dose with saline flush in cerebral and carotid angiography with 64-slice spiral CT. Methods: According to the contrast dose, 40 patients undergoing cerebral and carotid CTA examination were randomly divided into 2 groups, one group was treated with 50 ml contrast agent and 20 ml saline flush, the other group was administrated with 70 ml contrast agent. With double blindness method, the data were respectively evaluated and analyzed by two radiologists independently. Results: For the two radiologists, on the manifestation of carotid and cerebral arteries, the venous artefact and the CT value measurement aspects, the Kappa value was respectively 0.895, 0.814, 0.702, 0.836. By rank sum test, on the manifestation of carotid arteries aspect, the grading score of the two groups of radiologist A was respectively 1.3, l.2; and that of radiologist B was respectively 1.4, 1.2; the differences between the two groups of the two radiologists have no statistical significance(U=173, P>0.05; U=128, P>0.05). And on the manifestation of cerebral arteries aspect, the grading score of the two groups of radiologist A was respectively 1.4, l.2; and that of radiologist B was respectively 1.2, 1.2; the differences between two groups of the two radiologists both have no statistical significance (U=160, P>0.05; U=106, P>0.05). And on the artefacts produced by the high contrast densities in the right subclavian vein, brachiocephalic vein and vena cava, the grading score of the two groups of radiologist A was respectively 1.3, 2.1; and that of radiologist B was respectively 1.2, 1.9; the differences between the two groups of the two radiologists both have statistical significance (U=75, P0.05). The CT value of the arteries of the two groups from radiologist B was respectively 337.3, 329.5, 239.2, 192.8, 345.6, 341.2, 247.1, 210.5 HU; and the difference between the two groups has no statistical significance (t=0.233, P>0.05). Conclusion: On the CTA

  10. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography

    Combining the functional information of SPECT myocardial perfusion imaging (SPECT-MPI) and the morphological information of coronary CT angiography (CTA) may allow easier evaluation of the spatial relationship between coronary stenoses and perfusion defects. The aim of the present study was the validation of a novel software solution for three-dimensional (3D) image fusion of SPECT-MPI and CTA. SPECT-MPI with adenosine stress/rest 99mTc-tetrofosmin was fused with 64-slice CTA in 15 consecutive patients with a single perfusion defect and a single significant coronary artery stenosis (≥50% diameter stenosis). 3D fused SPECT/CT images were analysed by two independent observers with regard to superposition of the stenosed vessel onto the myocardial perfusion defect. Interobserver variability was assessed by recording the X, Y, Z coordinates for the origin of the stenosed coronary artery and the centre of the perfusion defect and measuring the distance between the two landmarks. SPECT-MPI revealed a fixed defect in seven patients, a reversible defect in five patients and a mixed defect in three patients and CTA documented a significant stenosis in the respective subtending coronary artery. 3D fused SPECT/CT images showed a match of coronary lesion and perfusion defect in each patient and the fusion process took less than 15 min. Interobserver variability was excellent for landmark detection (r = 1.00 and r = 0.99, p < 0.0001) and very good for the 3D distance between the two landmarks (r = 0.94, p < 0.001). 3D SPECT/CT image fusion is feasible, reproducible and allows correct superposition of SPECT segments onto cardiac CT anatomy. (orig.)

  11. 64层螺旋CT冠状动脉成像影响因素分析%Analysis of Influential Factors of 64-slice Spiral CT Coronary Angiography

    刘伟宾

    2011-01-01

    目的 探讨64层螺旋CT冠状动脉成像的质量影响因素.方法 回顾性分析514例行64层螺旋CT冠状动脉成像的影像资料.结果 根据图像评价方法,本组优321例,占62.5%;良138例,26.8%;差55例,占10.7%,认定为检查失败.127例ECG前瞻式门控扫描检查失败21例,占16.5%;387例回顾式门控扫描检查失败34例,占8.8%.检查时心率波动≤5/min 313例,7例失败,占2.2%;6~10/min 175例,23例检查失败,占13.1%;10~20/min 26例,25例检查失败,占96.2%.检查过程中37例屏气不好,32例检查失败,占86.5%;3例扫描过程中未能控制呛咳、呃逆,检查失败;53例冠状动脉搭桥术后复查者,1例因扫描范围不足而检查失败;3例过于肥胖,1例扫描参数过低而导致检查失败.结论 充分认识64层螺旋CT冠状动脉成像检查中影响成像质量的因素,争取患者最佳配合状态,方能获得更好的图像质量,提高诊断准确性.%Objective To discuss the influential factors of image quality of 64-slice spiral CT coronary angiography (CTCA). Methods The imaging data of 514 patients with coronary artery disease were retrospectively analyzed. Results According to image evaluation method, the results were excellent in 321 patients(62.5% ), good in 138 ( 26. 8% ) , and poor and regarded as failures in 55( 10.7% ). 127 patients underwent prospective electrocardiographic (ECG) gating, but failed in 21 patients (16.5%) ; 387 patients underwent retrospective ECG gating, and failed in 34 patients (8.8%). 313 patients had heart rate fluctuation ≤5 beats per minute( BPM), among whom, 7 (2.2%) failed in examination; 175 patients had heart rate from 6 BPM to 10 BPM, among whom, 23 (13.1%) failed in examination; 26 patients had heart rate from 10 BPM to 20 BPM,among whom, 25 failed in examination; 37 patients had poor breathholding, among whom, 32(86.5% )failed in examination.3 failed in examination due to incontrollable bucking and hiccup during the

  12. 64-slice CT imaging in a case of total anomalous pulmonary venous circulation

    For long, catheter angiography has been the investigation of choice for the diagnosis of congenital anomalies of the heart such as total anomalous pulmonary venous circulation (TAPVC). In the last few years, MRI and multislice CT scan have also been introduced for this purpose. We report a case where 64-slice CT scan was found very useful in the evaluation of TAPVC

  13. 64-slice spiral CT in the diagnosis of Caroli disease

    Objective: To investigate the value of 64-slice spiral CT in the diagnosis of Caroli disease. Methods: 64-slice spiral CT of 15 patients with histologically proven Caroli disease was reviewed. Results: All cases were polycystic or multi-tubular hypodensities in the livers communicating with intrahepatic bile ducts. There was no contrast enhancement. The central dot sign was detected on 2 patients. Of 12 patients with type I disease, ancillary findings included multiple hemangiomas and small cysts in the liver (2), bile duct stones (4), pneumobilia (3), and cholangitis (1). Of the remaining 3 patients with type II disease, two had liver cirrhosis and the other cholangitis with periportal fibrosis. Conclusion: 64 slice spiral CT with multiplanar reconstruction allows clear depiction of cystic liver lesions and their relationship with intrahepatic bile ducts. It is valuable in the diagnosis of Caroli disease. (authors)

  14. Infant Cardiac CT Angiography with 64-Slice and 256-Slice CT: Comparison of Radiation Dose and Image Quality Using a Pediatric Phantom

    Lee, Yi-Wei; Yang, Ching-Ching; Mok, Greta S. P.; Wu, Tung-Hsin

    2012-01-01

    Background The aims of this study were to investigate the image quality and radiation exposure of pediatric protocols for cardiac CT angiography (CTA) in infants under one year of age. Methodology/Principal Findings Cardiac CTA examinations were performed using an anthropomorphic phantom representing a 1-year-old child scanned with non-electrocardiogram-gated (NG), retrospectively electrocardiogram-gated helical (RGH) and prospectively electrocardiogram-gated axial (PGA) techniques in 64-slic...

  15. A study on the application of CT perfusion and CT angiography with 64-slice spiral CT in the evaluation of internal carotid artery and middle cerebral artery stenosis and occlusion

    Objective: To evaluate clinical application of combined cerebral CT perfusion (CTP) with head and neck CT angiography (CTA) using 64-slice spiral CT on the cerebral ischemia caused by the stenosis or occlusion of internal carotid artery (ICA) and middle cerebral artery (MCA). Methods: The sixty nine patients with unilateral or bilateral ICA and MCA stenosis or occlusion confirmed by digital subtraction angiography underwent head plain CT scan, cerebral CTP, and head and neck CTA using 64-slice spiral CT. Ten normal adults served as control. To discriminate the ischemic foci, the parameter maps of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTF) and time to peak (TTP) were obtained. Results: Among the patients with unilateral ICA stenosis or occlusion diagnosed by CTA, abnormal perfusion was found only in the watershed zone in 5 cases, both the MCA territory and the watershed zone were involved in 10 cases. Of 12 patients with severe unilateral ICA stenosis and occlusion, CBF values of the watershed zone in nonsymptmatic and symptomatic sides were(41±9) and (38±8) ml· 100 g-1·min-1 respectively (t=2.08, P>0.05), the MTT values were (5.2±1.1) and (10.9±2.6) s, respectively (t=7.24, P<0.01). Thirteen patients with severe bilateral ICA stenosis or occlusion diagnosed by CTA had perfusion abnormalities in the both the MCA territory and the watershed zone. Of 25 patients with unilateral MCA stenosis, 4 patients were normal in CT perfusion, 17 patients had perfusion abnormalities in MCA territory, and 4 patients had perfusion abnormalities in both MCA territory and the watershed zone. Twelve patients with severe bilateral MCA stenosis diagnosed by CTA had perfusion abnormalities in both the MCA territory and the watershed zone. Compared to normal control, the MTF and TTP were increased, the CBF was decreased, and the CBV in MCA territory and the watershed zone at the symptomatic side was increased. Conclusion: The combined examination

  16. Application of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation

    Yong-Shu Gao; Xing-Can Ma

    2015-01-01

    Objective:To explore the feasibility and effectiveness of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation.Methods:The 64 slice spiral CT image data of 125 patients after coronary artery stent implantation were collected, meanwhile, the image data of 25 patients underwent coronary angiography were also collected. The feasibility and accuracy of 64 slice spiral CT coronary artery stent imaging were comparatively analyzed. Results: The 64 slice spiral CT imaging quality with a stent diameter greater than 3.00 mm was significantly superior to that with a diameter of 2.25-3.00 mm. The CT imaging quality in the left main coronary artery and anterior descending artery was significantly higher than that in the left circumflex coronary artery. The CT imaging quality in the left main coronary artery was significantly higher than that in the right coronary artery. The CT reconstruction imaging quality in the drug coating stent was significantly superior to that in the bare metal stent. The sensitivity of 64 slice spiral CT was 100.00%, and the accuracy was 100.00%. In detecting the coronary artery with occlusion and stenosis (stent stenosis greater than 50%), the sensitivity was 90.00%, the false negative rate was 10.00%, and the positive predicative value was 100.00%.Conclusions:The effect of 64 slice spiral CT coronary imaging in evaluating the patency of coronary artery after stent implantation is highly consistent with that by coronary angiography, with a simple operation, less risk, and low cost, and thus, it can be completely taken as the imaging method in evaluating the patency of coronary artery after stent implantation.

  17. Application of 64 slice spiral CT angiography in subarachnoid hemorrhage%64层螺旋 CT 血管成像在自发性蛛网膜下腔出血中的应用

    韩璐璐; 张锡海; 张爱霞; 王俊英; 董乐

    2015-01-01

    目的:为了进一步提高临床对自发性蛛网膜下腔出血(SAH)的治疗效果,分析和探讨64层螺旋 CT血管成像在自发性 SAH 中的应用价值。方法按照随机双盲的原则抽取2014年1月-2015年1月治疗的38例考虑自发性 SAH 的患者作为研究对象,所有入组的患者均常规给予64层螺旋 CT 血管成像(CTA)及数字减影脑血管造影(DSA)检查,其中 CT 血管成像均应用最大密度投影(MIP)、容积再现技术(VR),通过和 DSA 结果对比分析 CTA 在发现自发性 SAH 中的病因诊断中的应用价值和意义。结果以 DSA 诊断结果作为评价标准,CTA 的诊断结果准确率和 DSA 相比较,差异亦无统计学意义(P ﹥0.05);而 CTA 组在诊断血管瘤大小方面和 DSA 诊断结果准确率和 DSA相比较示,差异无统计学意义(P ﹥0.05)。结论临床上在诊断自发性 SAH 的过程中应用64层螺旋 CT 血管成像,不仅简单、快捷和方便,而且有利于发现病因和提高诊断准确率,值得推广。%Objective To further improve the effectiveness of our hospital in terms of t spontaneous subarachnoid hemorrhage(SAH)and to reduce and prevent the occurrence probability of a variety of adverse events,analysis and discussion of the meaning and value of 64-slice CT angiography(CTA). Methods Selected 38 cases of patients with spontaneous sub-arachnoid hemorrhage(SAH)in our hospital from January 2014 to January 2015 according to the randomized double blind controlled principles as a study object,all patients with acute SAH underwent 64-slice CTA and digital subtraction angiography (DSA). Three-dimensional post-processing techniques including volume rendering( VR),maximum intensity projection (MIP),curved planar reformation(CPR)and multi-planar reconstruction(MPR)were underwent. Results Taking the DSA result as the standard,CTA diagnosis accuracy compared with DSA the difference between the two groups weren

  18. Low-dose ECG-gated 64-slices helical CT angiography of the chest: evaluation of image quality in 105 patients

    D' Agostino, A.G.; Remy-Jardin, M.; Khalil, C.; Remy, J. [University Center of Lille, Department of Thoracic Imaging, Hospital Calmette, Lille (France); Delannoy-Deken, V.; Duhamel, A. [University of Lille, Department of Medical Statistics, Lille (France); Flohr, T. [Siemens Medical, Research and Development Department, CT Division, Forchheim (Germany)

    2006-10-15

    interpolation artefacts was significantly linked to a low heart rate in affected patients. The overall image quality of CT scans was rated as diagnostic in 94 patients (89.5%) while 11 examinations (10.5%) were found to be partially nondiagnostic owing to the cyclic presence of severe interpolation artefacts, which can be compensated for by additional reconstructions at a different temporal window. In these cases, interpolation artefacts could have been avoided by reducing the pitch from 0.3 to 0.2 at the expense of increased patient dose. Low-dose ECG-gated CT angiograms of the chest can be obtained in routine clinical practice with 64-slice CT technology without altering the diagnostic value of CT scans. (orig.)

  19. The comparison of imaging quality between bolus-triggering and test-bolus technique used in 64-slice spiral CT angiography of lower extremity arteries

    Objective: To investigate the clinical value of multi-slice CT angiography (MSCTA) of lower limbs in patients with peripheral arterial occlusive disease (PAOD) using the test-bolus technique. Methods: Forty-four patients with PAOD were enrolled consecutively in the study. In group 1, 18 subjects underwent CTA by bolus triggering method and in group 2, 26 subjects underwent CTA by test-bolus technique. During scanning procedure in group 2 subjects, the bolus transit time to aorta (TAO), popliteal arteries (TPOP) and aorto-popliteal bolus transit time (Tt) were calculated through dynamic acquisition at their respective level and the delay time were immediately set as TAO and scan time as double Tt. Two independent senior attending physicians with training experience in interpreting CTA determined the quality of each arterial segment visualization based on 5 parameters (1. visible farthest branch, 2. clarity of vessels border, 3. presence of venous contamination, 4. grading of stenosis, 5. CT value at 4 arterial segments). Inter-observer agreement on imaging quality between readers was evaluated using Cohen's k statistic by calculating K values. χ2 test and t test were used to compare the quality of images in both groups. Results: In group 2 patients, a larger individual variation in transit time of the contrast to reach aorta was obserued [TAO=(17.1±2.6) s with a range of 12.0-22.0 s] and aorto-popliteal transit time [Tt=(14.8±5.5) s with a range of 8.0-24.0 s]. CTA of group 2 patients demonstrated better quality over group 1 patients' CTA, especifically in the infra-popliteal and foot area arteries. There was an excellent inter-observer agreement for group 2 patients (K>0.80) whereas in group 1 agreement in infra-popliteal segments for venous contamination (K value 0.60) and stenosis degree (K value 0.50) were not satisfactory enough. Group 1 patients were reported to have more severe stenosis in infra-popliteal and foot arteries (χ2=30.55 and 22.41, P<0

  20. Coronary artery imaging with 64-slice spiral CT in atrial fibrillation patients: initial experience

    Objective: To discuss the clinical value of coronary artery imaging using 64-slice spiral CT in patient with atrial fibrillation. Methods: The images of 31 patients with atrial fibrillation who underwent contrast-enhanced CT coronary angiography were evaluated. The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software. Ten patients additionally underwent conventional coronary angiography. The results of conventional coronary angiography were compared with CT coronary angiography of the 10 patients. Results: Image reconstruction was based on absolute timing. The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent, fine, moderate or poor. The image quality was excellent, fine, moderate and poor in 85, 41, 5, and 8 vessel segments respectively in patient group with heart rate between 47 beat per minent (bpm) and 69 bpm; and in 63, 16, 13, and 15 vessel segments respectively in patent group with heart rate between 70 bpm and 79 bpm;and in 46, 25, 23, and 24 vessel segments in patient group with heart rate between 80 bpm and 105 bpm. There was significant difference among the three patient groups (H=22.08, P<0.01). Comparison was carried out between CT angiographic findings and conventional angiographic findings of the 125 segments of the coronary arteries in the 10 patients who underwent conventional coronary angiography. The sensitivity and specificity of CT angiography for diagnosing vessel with significant coronary stenosis (≥50% narrowing) was 85.0% (17/20) and 95.2% (100/105), respectively. Positive predictive value was 77.3% (17/22), and negative predictive value was 97.1% (100/103). Coronary CTA underestimated the lesions of 3 vessel segments and overestimated the lesions of 5 vessel segments. Conclusion: Coronary artery imaging with 64-slice row CT had clinical value for patients with atrial fibrillation

  1. Detection of Postcoronary Stent Complication: Utility of 64-Slice Multidetector CT

    Alpa Bharati

    2012-01-01

    Full Text Available Coronary stent fracture is a known complication of coronary arterial stent placements. Multiple long-term risks are also associated with drug eluting stents. 64-slice multidetector CT (MDCT coronary angiography has been shown to detect poststent complications such as instent stenosis, thrombosis, stent migration and stent fractures. We report a case of stent fracture in a patient who underwent RCA stenting with associated RCA perforation and almost complete thrombosis of the RCA and peristent fibrinoid collection. This is a rare case of stent fracture with perforation of the RCA. The paper highlights the role of 64-row multidetector computed tomography (MDCT in evaluation of such poststent placement complications.

  2. 64排CT血管造影在动脉瘤性蛛网膜下腔出血的临床研究%Clinical research of 64-slice CT angiography in aneurysmal subarachnoid hemorrhage

    陈立朝; 许民辉; 邹咏文; 杨东虹; 张云东; 徐伦山; 张溢华

    2011-01-01

    目的:评估CT血管造影(CTA)在动脉瘤性蛛网膜下腔出血(SAH)病人中选择治疗策略的作用.方法:对231例动脉瘤性SAH病人行64排CTA检查.选择临床治疗方案,并通过DSA或外科手术验证CTA检查的准确性.结果:CTA检查与DSA或术中探查一致228例,CTA信息不充分2例,CTA漏诊1例;CTA检查的敏感性98.7%,特异性100%.根据CTA检查确定治疗方案228例(98.7%),其中采用血管内栓塞治疗141例,夹闭术87例;根据DSA检查,采用血管内栓塞治疗3例.结论:64排CTA能准确检测颅内动脉瘤及其特征,有助于选择治疗策略.%Objective To evaluate the clinical application of CT angiography (CTA) in making therapeutic strategy for patients with aneurysmal subarachnoid hemorrhage (SAH). Methods The 64-slice CTA examination was performed in 231 patients with aneurysmal SAH to select appropriate treatment strategies. CTA findings should be confirmed by DSA or surgical exploration. Results CTA findings were coincident with the findings by DSA or surgical exploration in 228 cases, CTA findings were insufficient in 2 cases, and missed diagnosis by CTA in 1 case. The sensitivity of CTA examination was 98.7% and specificity was 100%. The therapeutic measures were decided based on CTA in 228 cases (98.7%), including endovascular treatment in 141 cases, clipping of aneurysm in 87. Endovascular treatment was adopted based on DSA in 3 cases. Conclusions The 64-slice CTA as an accurate tool for detecting intracranial aneurysms is useful to decide therapeutic strategy.

  3. Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography

    Abdulla, Jawdat; Pedersen, Kasper; Budoff, Matthew;

    2012-01-01

    To determine via meta-analysis the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTA) for assessment of significant obstructive coronary artery stenosis at different coronary artery calcium score (CACS) levels. Data of 12,053 versus 5,890 segments, 906 versus 758 arter...

  4. Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot

    Objective: To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. Methods: Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. Results: All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. Conclusion: Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot

  5. Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot

    Wang Ximing [Tianjin Medical University, Tianjin City (China) and Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China)], E-mail: wxming369@163.com.cn; Wu Lebin [Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China); Sun Cong [Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China); Shandong University Medical College, Shandong Jinan 250012 (China); Liu Cheng [Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China); Chao, Bao-Ting [Shandong University Medical College, Shandong Jinan 250012 (China); Han Bo [Shandong Provincial Hospital Pediatric Department, Shandong, Jinan 250021 (China); Zhang Yunting [Tianjin Medical University, General Hospital MR Department, Tianjin City (China); Chen Haisong [Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China); Shandong University Medical College, Shandong Jinan 250012 (China); Li Zhenjia [Shandong Medical Imaging Research Institute, Jinan City, Shandong Province 250021 (China)

    2007-11-15

    Objective: To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. Methods: Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. Results: All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. Conclusion: Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.

  6. 64层螺旋CT血管成像诊断大脑中动脉成窗变异%CT Angiography Features of Fenestration Variation in the Middle Cerebral Artery Using 64-slice Multidetector Spiral CT

    袁飞; 刘银社; 常爱华; 赵军; 顾欣; 冯凯琳

    2011-01-01

    目的 探讨大脑中动脉成窗变异的发生率及CT血管成像(CTA)特征,提高对该血管变异的认识.资料与方法 2007年11月至2010年1月本院共有2734例患者行头颈联合64层CTA检查,其中14例确诊为大脑中动脉成窗.回顾性分析大脑中动脉成窗的发生率、部位、形态等CTA特征及其合并症.结果 (1)14例患者共15个大脑中动脉成窗,发生率为0.51%(14/2734).M1段近端成窗12个,占80%;M1段远端成窗2个,占13.3%,均由一支桥血管与M1段远端及M2段近端构成;M1段中部成窗1个,占6.7%.M1段近端成窗中,9个成窗位于大脑中动脉起始部,3个成窗由一支桥血管与M1和A1近端三支血管组成.(2)2个"窗"径较小者(<2 mm)呈孔状,13个"窗"径较大者中,10个分支粗细不等呈"OK"手势样,3个分支粗细大致相同呈"凸透镜"样.(3)1例合并基底动脉成窗,1例合并大脑后动脉成窗,1例合并永久三叉动脉,3例合并颅内其他动脉的动脉瘤.结论 CTA能快速、直观、准确地判断大脑中动脉成窗及其合并症,熟悉其CTA特征有助于指导临床制定合理的治疗方案,提高相应治疗中的安全性.%Objective To analyze the incidence and CT angiography(CTA) features of the fenestrations variation of middie eerebral artery, and to improve dignesis. Materials and Methods The imaging data of 2734 patients peeformed 64 slice CTA of the cranio cervical arteries in our hospital between November,2007 and January 2010 were evaluated retrospectively,and 14 of them were diagnosed as the fenestration variation of middle cerebral arteries. The incidence,location,morpholngical characteristics of the fenestration of middle cerebral artery and its coexisting abnormalities were analyzed. Results ( 1 ) 15 fenestrations variation of middle cerebral arteries in 14 patients were found,withh the incidence of 0.51% ( 14/2734 ). 80%( 12 fenestrations) were located at the proximal Mi segments,13.3% (2 fenestrations) at the distal

  7. Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography A systematic review and meta-analysis

    Abdulla, Jawdat; Asferg, Camilla Lundegaard; Kofoed, Klaus Fuglsang

    2011-01-01

    To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings. A systematic literature search and meta-analyses was con...

  8. Application of 64-slice spiral CT angiography in the diagnosis of tetralogy of fallot%64层螺旋CT血管造影在法洛四联症诊断中的应用

    陈红; 曹成瑛; 朱友义; 王生元; 罗焕; 周署泉

    2011-01-01

    目的:探讨64层螺旋CT血管造影(64-SCTA)诊断法洛四联症(tetralogy of Fallot,TOF)的应用价值.方法:回顾性分析23例TOF患者的64-SCTA诊断结果,并与心脏超声(UCG)和手术进行对比.结果:23例TOF患者经64-SCTA和UCG都能发现和准确诊断TOF的4种主要畸形,室间隔缺损大小、主动脉骑跨程度、右室流出道狭窄、右室前壁厚度以及主肺动脉内径的测量结果与手术结果比较均差异无统计学意义(均P>0.05);64-SCTA检出体肺侧支动脉血管6例,UCG仅检出1例,二者比较,差异有统计学意义(P<0.01).结论:64-SCTA能客观清晰地显示TOF的4种畸形,在心外大血管畸形诊断方面较UCG有明显的优势,是准确诊断TOF无创性检查的理想选择.%Objective!To evaluate the advantage and limitation of 64-slice spiral CT angiography (64-SCTA) in diagnosing tetralogy of fallot (TOF). Method:64-SCTA findings of 23 patients with TOF were retrospectively ana-lyzed comparatively with cardiac ultrasound and surgery. Result:Four major malformations of TOF could be accu-rately diagnosed by both 64-SCTA and cardiac ultrasound. There was no significant statistically difference (P> 0. 05) compared with that of surgery in evaluating the ventricular septal defect size, degree of aortic cross-riding, stenosis of right ventricular outflow, as well as internal diameter of main pulmonary, left and right pulmonary ar-tery, the right ventricular wall thickness were no significant statistically difference (P>0. 05) measured by 64-SC-TA and cardiac ultrasound, but 64-SCTA had more advantages than cardiac ultrasound in diagnosing the extracar-diac malformation (P<0. 01) , for the detection of lung body collateral arteries by 64-SCTA in 6cases, while only lease by cardiac ultrasound. Conclusion: Four major malformations of TOF could be objectively and clearly diag-nosed by 64-SCTA. In diagnosis of great extracardiac vessel malformations, 64-SCTA is significantly superior to UCG. 64

  9. Coronary artery imaging with 64-slice CT in atrial fibrillation patients: scanning method and post-processing techniques

    Objective: To discuss the clinical value of coronary artery imaging using 64-slice CT in patient with atrial fibrillation. Methods: All the cardiac volume data of 31 patients with atrial fibrillation were reconstructed using absolute time method. The images of 12 patients. The images of 31 patients who undeiwent contrast-enhanced CT coronary angiography were evaluated. The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software.. The results of conventional coronary angiography (CAG) of the 10 patients were compared with CT coronary angiography. Results: The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent, fine, moderate or poor. The image quality was excellent, fine, moderate and poor in 194(53.3%), 82(22.5%), 41(11.3%) and 47(12.9%) vessel segments. Comparison was carried out between CTA findings and CAG findings of the 125 segments of the coronary arteries in the 10 patients who underwent CAG. The sensitivity and specificity of CTA for diagnosing vessel with stenosis (≥ 50% narrowing) was 85%(17/20) and 95.2% (100/105). Conclusion: Coronary artery imaging using 64-slice CT is useful in patient with atrial fibrillation. (authors)

  10. Quantitative parameters of image quality in 64-slice computed tomography angiography of the coronary arteries

    We explored quantitative parameters of image quality in consecutive patients undergoing 64-slice multi-detector computed tomography (MDCT) coronary angiography for clinical reasons. Forty-two patients (36 men, mean age 61 ± 11 years, mean heart rate 63 ± 10 bpm) underwent contrast-enhanced MDCT coronary angiography with a 64-slice scanner (Siemens Sensation 64, 64 mmx 0.6 mm collimation, 330 ms tube rotation, 850 mAs, 120 kV). Two independent observers measured the overall visualized vessel length and the length of the coronary arteries visualized without motion artifacts in curved multiplanar reformatted images. Contrast-to-noise ratio was measured in the proximal and distal segments of the coronary arteries. The mean length of visualized coronary arteries was: left main 12 ± 6 mm, left anterior descending 149 ± 25 mm, left circumflex 89 ± 30 mm, and right coronary artery 161 ± 38 mm. On average, 97 ± 5% of the total visualized vessel length was depicted without motion artifacts (left main 100 ± 0%, left anterior descending 97 ± 6%, left circumflex 98 ± 5%, and right coronary artery 95 ± 6%). In 27 patients with a heart rate ≤65 bpm, 98 ± 4% of the overall visualized vessel length was imaged without motion artifacts, whereas 96 ± 6% of the overall visualized vessel length was imaged without motion artifacts in 15 patients with a heart rate >65 bpm (p < 0.001). The mean contrast-to-noise ratio in all measured coronary arteries was 14.6 ± 4.7 (proximal coronary segments: range 15.1 ± 4.4 to 16.1 ± 5.0, distal coronary segments: range 11.4 ± 4.2 to 15.9 ± 4.9). In conclusion, 64-slice MDCT permits reliable visualization of the coronary arteries with minimal motion artifacts and high CNR in consecutive patients referred for non-invasive MDCT coronary angiography. Low heart rate is an important prerequisite for excellent image quality

  11. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

    Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

    2010-11-15

    Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

  12. Assessment of extracranial-intracranial bypass patency with 64-slice multidetector computerized tomography angiography

    Extracranial-intracranial (EC/IC) bypass is a useful procedure for the treatment of cerebral vascular insufficiency or complex aneurysms. We explored the role of multidetector computed tomography angiography (MDCTA), instead of digital subtraction angiography (DSA), for the postoperative assessment of EC/IC bypass patency. We retrospectively analyzed a consecutive series of 21 MDCTAs from 17 patients that underwent 25 direct or indirect EC/IC bypass procedures between April 2003 and November 2007. Conventional DSA was available for comparison in 13 cases. MDCTA used a 64-slice MDCT scanner (Aquilion 64, Toshiba). The proximal and distal patencies were analyzed independently on MDCTA and DSA by a neuroradiologist and a neurosurgeon. The bypass was considered patent when the entire donor vessel was opacified without discontinuity from proximal to distal ends and was visibly in contact with the recipient vessel. MDCTA depicted the patency status in every patient. Bypasses were patent in 22 cases, stenosed in one, and occluded in two. DSA always confirmed the results of the MDCTA (sensitivity = 100%, 95% CI = 0.655-1.0; specificity 100%, 95% CI = 0.05-1.0). MDCTA is a non-invasive and accurate exam to assess the postoperative EC/IC bypass patency and is a promising technique in routine follow-up. (orig.)

  13. Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: A phantom study

    Objective: To measure the radiation dose from CT scans in an anthropomorphic phantom using a 64-slice MDCT, and to estimate the associated cancer risk. Materials and methods: Organ doses were measured with a 5-year-old phantom and thermoluminescent dosimeters. Four protocols; head CT, thorax CT, abdomen CT and pelvis CT were studied. Cancer risks, in the form of lifetime attributable risk (LAR) of cancer incidence, were estimated by linear extrapolation using the organ radiation doses and the LAR data. Results: The effective doses for head, thorax, abdomen and pelvis CT, were 0.7 mSv, 3.5 mSv, 3.0 mSv, 1.3 mSv respectively. The organs with the highest dose were; for head CT, salivary gland (22.33 mGy); for thorax CT, breast (7.89 mGy); for abdomen CT, colon (6.62 mGy); for pelvis CT, bladder (4.28 mGy). The corresponding LARs for boys and girls were 0.015-0.053% and 0.034-0.155% respectively. The organs with highest LARs were; for head CT, thyroid gland (0.003% for boys, 0.015% for girls); for thorax CT, lung for boys (0.014%) and breast for girls (0.069%); for abdomen CT, colon for boys (0.017%) and lung for girls (0.016%); for pelvis CT, bladder for both boys and girls (0.008%). Conclusion: The effective doses from these common pediatric CT examinations ranged from 0.7 mSv to 3.5 mSv and the associated lifetime cancer risks were found to be up to 0.16%, with some organs of higher radiosensitivity including breast, thyroid gland, colon and lungs.

  14. Clinical value of 64-slice spiral CT for classification of femoral neck fracture

    Objective: To evaluate the clinical application of 64-slice spiral CT for classification of femoral neck fracture. Methods: The survey was comprised of 46 patients with femoral neck fractures detected with plain radiographs and CT images. Cases were randomly presented in 2 formats: plain radiographs and CT. Garden classification was queried. Modification of garden classification (nondisplaced vs displaced) was taken to compare with plain radiographs and CT in the study. Results: The results of classification for plain radiographs were 2 cases of Garden Ⅰ, 10 cases of Ⅱ, 22 cases of Ⅲ, and 12 cases of Ⅳ. Those for CT were 1 cases of Garden Ⅰ, 4 cases of Ⅱ, 26 cases of Ⅲ, and 15 cases of Ⅳ. CT improved the accuracy of Garden Classification (P<0.05). Conclusion: Garden classification using CT images shows good conformation with results of surgery. 64-Slic CT is better plain radiographs for Garden classification of femoral neck fracture. (authors)

  15. 64排螺旋CT冠状动脉成像与冠状动脉造影对心肌桥诊断的比较研究%Diagnosis Comparison of Myocardial Bridge by 64-slice CT Coronary Angiography and Conventional Coronary Angiography

    施斌斌; 吴晶涛; 征锦; 叶靖; 王守安

    2012-01-01

    目的:比较64排螺旋CT冠状动脉成像(64 SCTCA)和冠状动脉造影(CAG)对心肌桥(MB)的诊断价值.方法:832例患者分别行64SCTCA扫描及CAG,观察有无MB及测量MB的长度、厚度、壁冠状动脉(MCA)狭窄程度等,并对结果进行对比研究.结果:64 SCTCA MB检出率为18.3%,CAG MB检出率为10.2%,两者比较差异有统计学意义(P<0.05).64 SCTCA与CAG对MB的狭窄程度及长度比较,差异也有统计学意义(P<0.05).结论:与CAG相比,64SCTCA对MB有较高的检出率,并能准确显示壁冠状动脉与心肌的解剖关系.%Objective To compare the clinical significance of 64-slice coronary CT angiography(64 SCTA) and conventional coronary angiography(CAG) for identification of myocardial bridge. Methods Eight hundred and thirty —two patients with suspected coronary artery disease underwent multi-detector row CT and conventional coronary angiography respectively.The prevalence, precise location, length, depth and concomitant atheromatous changes were evaluated. Results One hundred and sixty-five sites of MB were found in 152(18.3%, 152/832) of 832 patients with 64 SCTA, with MB detection rate of 10.2% by CAG, and the difference was statistically significant(P<0.05). There was also significant difference between 64 SCTCA and CAG for the degree and length of stenosis of the MB. Conclusion Compared with CAG, 64 SCTCA has a higher detection rate for MB, and can accurately show the relationship between mural coronary arteries and myocardial.

  16. Coronary ostial involvement in acute aortic dissection: detection with 64-slice cardiac CT.

    Ryan, E Ronan

    2012-02-01

    A 41-year-old man collapsed after lifting weights at a gym. Following admission to the emergency department, a 64-slice cardiac computed tomography (CT) revealed a Stanford Type A aortic dissection arising from a previous coarctation repair. Multiphasic reconstructions demonstrated an unstable, highly mobile aortic dissection flap that extended proximally to involve the right coronary artery ostium. Our case is an example of the application of electrocardiogram-gated cardiac CT in directly visualizing involvement of the coronary ostia in acute aortic dissection, which may influence surgical management.

  17. Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

    Palumbo, Anselmo Alessandro; Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular Imaging, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Maffei, Erica; Martini, Chiara [Azienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular Imaging, Department of Radiology and Cardiology, Parma (Italy); Tarantini, Giuseppe [University of Padua, Department of Cardiology, Padua (Italy); Di Tanna, Gian Luca; Berti, Elena; Grilli, Roberto [Regional Health Agency, Regione Emilia Romagna, Bologna (Italy); Casolo, Giancarlo [Ospedale Versilia, Department of Cardiology, Viareggio (Italy); Brambilla, Valerio [Don Gnocchi ONLUS, Cardiovascular Rehabilitation Unit, Parma (Italy); Cerrato, Marcella; Rotondo, Antonio [University of Naples, Department of Radiology, Naples (Italy); Weustink, Annick C.; Mollet, Nico R.A. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands)

    2009-09-15

    We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1-10, group 3: score 11-100, group 4: score 101-400, and group 5: score > 401. Diagnostic accuracy for the detection of significant ({>=}50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk. (orig.)

  18. Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

    We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1-10, group 3: score 11-100, group 4: score 101-400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk. (orig.)

  19. The value of multiplanar reconstruction using 64-slice CT myelography in cervical nerve root injury

    Objective: To study the diagnostic value of multi-direction adjusted multiplanar reconstruction (MPR) by 64-slice CT myelography (CTM) in diagnosing cervical nerve injury, and the possibility of the MPR to replace conventional myelography and CT direct-scanning axial images. Methods: Twenty-six patients with cervical nerve root injury were examined by conventional myelography and 64-slice CT using isotropic parameters. Then multi-direction MPR were performed to display nerve roots on coronal and sagittal planes besides axial images. Twenty-six patients were performed surgical operations and diagnosis were obtained. The coincident diagnosing rate with surgical operations results were compared statistically among multi-direction MPR, direct-scanning axial CT images, conventional myelography. The numbers of images were also compared between axial MPR and direct scanning axial CT images. Results: Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in 64-slice CT, which was found in 31 nerve roots. Indirect signs included: (1) Traumatic pseudomeningocele: 29 nerve roots showed the leak of Isovist into nerve root sheath, and extended into foramina; (2) Arachnoid cyst: 26 nerve roots clearly displays cystic distension in nerve root, which has low-density fine clew form septation from subarachnoid cavity and no nerve root in the cyst; (3) Deformity of the subarachnoid space: deformity of thecal sac, partially lack of Isovist into arachnoid space, which was found in 17 nerve roots. The coincident diagnosing rate of cervical nerve root injury by multi-direction adjusted coronal MPR imaging was 92.6% (50/54), which was higher than by axial CT (77.8%, 42/54) and conventional myelography (68.5%, 37/54), There was significant difference between the conventional myelography, direct-scanning axial CT, multi-direction MPR images (Kappa=0.686, 0.772, 0.920, respectively, P<0.05), the coronal MPR imaging was significantly

  20. The study of temporal bone scanning at low-dose with 64-slice spiral CT

    Objective: To study the rationality and possibility of 64 slice spiral CT in the examination of the temporal bone at low dose. Methods: The same CT technique and temporal bone mode as those for clinical CT were used, two cranium specimens (four ears) were scanned with Somatom Sensation 64-slice spiral CT at different mA (380, 300, 200, 160, 120, 80), and multi-planar reformation was performed. The CT dose index at different mA groups were measured by 10 em pencil ionization chamber and head dose phantom. Four anatomic structures on axial images (subarcuate fossa, tendon of tensor tympani, facial recess, etc), four anatomic structures on coronal images (scute, crista transversa, fenestra cochleae, etc) and six anatomic structures on double oblique images (malleus, incus, stirrup bone, upper bony semicircular, etc) were chosen to evaluate and grade the reformation images among different mA groups, and to determine the minimum mA value. Ten ears of five patients were used to test the validity of the minimum mA value. Results: CT radiation dose was significantly reduced flora (47.8 ± 2.7) to (20.1 ± 2.0) mGy (P<0.01) when mA decreased from 380 mA to 160 mA. No significant difference in displaying anatomic structures between the two mA protocols. Conclusion: it is a feasible borne temporal scanning method to decrease the radiation dose by decreasing mA appropriately. (authors)

  1. Comparison of digitally reconstructed radiographs (DRRs) generated from 4-slice and 64-slice helical CT scanners, a phantom study

    Full text: Digitally reconstructed radiographs (DRRs) are generated from CT data sets and playa vital role for verifying patient position for many radiotherapy treatments. The present study aimed to investigate the impact on the image quality of DRRs due to changes in the original CT data acquisition; specifically a 4-slice CT scanner and a 64-slice CT scanner have been considered. A specifically designed CT simulation phantom (Nuclear Associates Model 76--417) with test patterns to measure low contrast and modulation transfer function (MTF) was used to evaluate DRR characteristics for Siemens Somatom Sensation 4 and Sensation 64 CT scanners. The phantom was scanned as described in the manufacturer's manual, using the departmental protocol for head CT. The CT images were obtained with 120 kV, 300 mAs, a scanning and reconstruction pitch of I and collimation of I mm. Each of the test patterns from the DRRs was compared for the 4-slice and the 64-slice helical scans. Results The calculated relative MTF (RMTF) showed higher spatial resolution for DRRs generated from 64-slice scans compared with 4-slice scans, Fig. 1. The low contrast values for hole diameter patterns on the DRRs ranged from 0.01-8.04% for 64 slice scans and 0.06-6.15% for 4 slice scans.

  2. Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device

    Low yield of invasive coronary angiography and unnecessary coronary interventions have been identified as key cost drivers in cardiology for evaluation of coronary artery disease (CAD). This has fuelled the search for noninvasive techniques providing comprehensive functional and anatomical information on coronary lesions. We have evaluated the impact of implementation of a novel hybrid cadmium-zinc-telluride (CZT)/64-slice CT camera into the daily clinical routine on downstream resource utilization. Sixty-two patients with known or suspected CAD were referred for same-day single-session hybrid evaluation with CZT myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). Hybrid MPI/CCTA images from the integrated CZT/CT camera served for decision-making towards conservative versus invasive management. Based on the hybrid images patients were classified into those with and those without matched findings. Matched findings were defined as the combination of MPI defect with a stenosis by CCTA in the coronary artery subtending the respective territory. All patients with normal MPI and CCTA as well as those with isolated MPI or CCTA finding or combined but unmatched findings were categorized as ''no match''. All 23 patients with a matched finding underwent invasive coronary angiography and 21 (91%) were revascularized. Of the 39 patients with no match, 5 (13%, p < 0.001 vs matched) underwent catheterization and 3 (8%, p < 0.001 vs matched) were revascularized. Cardiac hybrid imaging in CAD evaluation has a profound impact on patient management and may contribute to optimal downstream resource utilization. (orig.)

  3. Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device

    Fiechter, Michael; Kaufmann, Philipp A. [University Hospital Zurich, Department of Radiology, Cardiac Imaging, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland); Ghadri, Jelena R.; Wolfrum, Mathias; Kuest, Silke M.; Pazhenkottil, Aju P.; Nkoulou, Rene N.; Herzog, Bernhard A.; Gebhard, Catherine; Fuchs, Tobias A.; Gaemperli, Oliver [University Hospital Zurich, Department of Radiology, Cardiac Imaging, Zurich (Switzerland)

    2012-03-15

    Low yield of invasive coronary angiography and unnecessary coronary interventions have been identified as key cost drivers in cardiology for evaluation of coronary artery disease (CAD). This has fuelled the search for noninvasive techniques providing comprehensive functional and anatomical information on coronary lesions. We have evaluated the impact of implementation of a novel hybrid cadmium-zinc-telluride (CZT)/64-slice CT camera into the daily clinical routine on downstream resource utilization. Sixty-two patients with known or suspected CAD were referred for same-day single-session hybrid evaluation with CZT myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). Hybrid MPI/CCTA images from the integrated CZT/CT camera served for decision-making towards conservative versus invasive management. Based on the hybrid images patients were classified into those with and those without matched findings. Matched findings were defined as the combination of MPI defect with a stenosis by CCTA in the coronary artery subtending the respective territory. All patients with normal MPI and CCTA as well as those with isolated MPI or CCTA finding or combined but unmatched findings were categorized as ''no match''. All 23 patients with a matched finding underwent invasive coronary angiography and 21 (91%) were revascularized. Of the 39 patients with no match, 5 (13%, p < 0.001 vs matched) underwent catheterization and 3 (8%, p < 0.001 vs matched) were revascularized. Cardiac hybrid imaging in CAD evaluation has a profound impact on patient management and may contribute to optimal downstream resource utilization. (orig.)

  4. In vitro imaging of coronary artery stents: Are there differences between 16- and 64-slice CT scanners?

    Purpose: To compare the performance of 64-slice with 16-slice CT scanners for the in vitro evaluation of coronary artery stents. Methods and materials: Twelve different coronary artery stents were placed in the drillings of a combined heart and chest phantom, which was scanned with a 16- and 64-slice CT scanner. Coronal reformations were evaluated for artificial lumen narrowing, intraluminal attenuation values, and false widening of the outer stent diameter as an indicator of artifacts outside the stent. Results: Mean artificial lumen narrowing was not significantly different between the 16- and 64-slice CT scanner (44% versus 39%; p = 0.408). The differences between the Hounsfield Units (HU) measurements inside and outside the stents were significantly lower (p = 0.001) with 64- compared to 16-slice CT. The standard deviation of the HU measurements inside the stents was significantly (p = 0.002) lower with 64- than with 16-slice CT. Artifacts outside the stents were not significantly different between the scanners (p = 0.866). Conclusion: Visualization of the in-stent lumen is improved with 64-slice CT when compared with 16-slice CT as quantified by significantly lesser intraluminal image noise and less artificial rise in intraluminal HU measurement, which is the most important parameter for the evaluation of stent patency in vivo

  5. Comparison of 64-slice computed tomography angiography and coronary angiography for the detection and assessment of coronary artery disease in patients with angina: A systematic review

    Background: Coronary artery disease (CAD) is the leading cause of death in Western countries. It presents itself in various ways, the commonest being angina. According to the Royal College of Radiologist referral guidelines, Coronary Angiography (CA) is currently the gold standard for diagnosis and evaluation of CAD. However, due to the invasive nature and expense of CA there is a perceived need for a primary non-invasive imaging modality to supersede it. Computed tomography angiography (CTA), utilising 64-slice technology, may be a less invasive alternative to CA. Aim: To consider the research evidence for the current gold standard diagnostic test for CAD. Specifically, which is more sensitive and specific for detecting CAD in patients with angina; 64-slice CTA or CA? Inclusion Criteria: Prospective, non-randomised control trials and diagnostic accuracy studies comparing 64-slice CTA and CA were included. Participants were adults with angina with suspected or known CAD. Method: An electronic search of the databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE and Science Direct, was conducted between January 2004 and April 2012. Secondary hand-searching of grey literature was undertaken. Two reviewers independently determined studies for inclusion, assessed quality, using SIGN50, and extracted data. Diagnostic value of 64-slice CTA and CA was compared and analysed at patient and segment level. Results: Ten studies were included in the critical review enrolling 1188 patients. At patient level sensitivity for 64-slice CTA ranged from 88% to 100%, specificity 64–92%, PPV 86–97% and NPV 76.9–100%. At segment level sensitivity for 64-slice CTA ranged from 73% to 100%, specificity 83–98%, PPV 47–90% and NPV 89–100% Conclusion: At both patient and segment level, 64-slice CTA is a highly sensitive and specific non-invasive alternative to CA for diagnosis of significant stenosis in patients with angina. For standalone diagnosis of CAD current research would

  6. Integrated cardio-thoracic imaging with ECG-Gated 64-slice multidetector-row CT: initial findings in 133 patients

    Salem, Randa; Remy-Jardin, Martine; Delhaye, Damien; Khalil, Chadi; Teisseire, Antoine; Remy, Jacques [Hospital Calmette, University Center of Lille, Department of Thoracic Imaging, LILLE cedex (France); Delannoy-Deken, Valerie; Duhamel, Alain [University of Lille, Place de Verdun, Department of Medical Statistics, LILLE cedex (France)

    2006-09-15

    The purpose of this study was to investigate the possibility of assessing the underlying respiratory disease as well as cardiac function during ECG-gated CT angiography of the chest with 64-slice multidetector-row CT (MDCT). One hundred thirty-three consecutive patients in sinus rhythm with known or suspected ventricular dysfunction underwent an ECG-gated CT angiographic examination of the chest without {beta}-blockers using the following parameters: (1) collimation: 32 x 0.6 mm with z-flying focal spot for the acquisition of 64 overlapping 0.6-mm slices (Sensation 64; Siemens); rotation time: 0.33 s; pitch: 0.3; 120 kV; 200 mAs; ECG-controlled dose modulation (ECG-pulsing) and (2) 120 ml of a 35% contrast agent. Data were reconstructed: (1) to evaluate the underlying respiratory disease (1-mm thick lung and mediastinal scans reconstructed at 55% of the R-R interval; i.e., ''morphologic scans'') and (2) to determine right (RVEF) and left (LVEF) ventricular ejection fractions (short-axis systolic and diastolic images; Argus software; i.e., ''functional scans''). The mean heart rate was 73 bpm (range: 42-120) and the mean scan time was 18.11{+-}2.67 s (range: 10-27). A total of 123 examinations (92%) had both lung and mediastinal images rated as diagnostic scans, whereas 10 examinations (8%) had non-diagnostic images altered by the presence of respiratory-motion artifacts (n=4) or cyclic artifacts related to the use of a pitch value of 0.3 in patients with a very low heart rate during data acquisition (n=6). Assessment of right and left ventricular function was achievable in 124 patients (93%, 95% CI: 88-97%). For these 124 examinations, the mean RVEF was 46.10% ({+-}9.5; range: 20-72) and the mean LVEF was 58.23% ({+-}10.88; range: 20-83). In the remaining nine patients, an imprecise segmentation of the right and left ventricular cavities was considered as a limiting factor for precise calculation of end-systolic and end

  7. Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT.

    Killeen, Ronan P

    2012-02-01

    To assess the contractility of accessory left atrial appendages (LAAs) using multiphasic cardiac CT. We retrospectively analyzed the presence, location, size and contractile properties of accessory LAAs using multiphasic cardiac 64-slice CT in 102 consecutive patients (63 males, 39 females, mean age 57). Multiplanar reformats were used to create image planes in axial oblique, sagittal oblique and coronal oblique planes. For all appendages with an orifice diameter >or= 10 mm, axial and sagittal diameters and appendage volumes were recorded in atrial diastole and systole. Regression analysis was performed to assess which imaging appearances best predicted accessory appendage contractility. Twenty-three (23%) patients demonstrated an accessory LAA, all identified along the anterior LA wall. Dimensions for axial oblique (AOD) and sagittal oblique (SOD) diameters and sagittal oblique length (SOL) were 6.3-19, 3.4-20 and 5-21 mm, respectively. All appendages (>or=10 mm) demonstrated significant contraction during atrial systole (greatest diameter reduction was AOD [3.8 mm, 27%]). Significant correlations were noted between AOD-contraction and AOD (R = 0.57, P < 0.05) and SOD-contraction and AOD, SOD and SOL (R = 0.6, P < 0.05). Mean diverticulum volume in atrial diastole was 468.4 +\\/- 493 mm(3) and in systole was 171.2 +\\/- 122 mm(3), indicating a mean change in volume of 297.2 +\\/- 390 mm(3), P < 0.0001. Stepwise multiple regression analysis revealed SOL to be the strongest independent predictor of appendage contractility (R(2) = 0.86, P < 0.0001) followed by SOD (R(2) = 0.91, P < 0.0001). Accessory LAAs show significant contractile properties on cardiac CT. Those accessory LAAs with a large sagittal height or depth should be evaluated for contractile properties, and if present should be examined for ectopic activity during electrophysiological studies.

  8. Measurement of scattered radiation in a volumetric 64-slice CT scanner using three experimental techniques

    Akbarzadeh, A; Ay, M R; Sarkar, S [Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Ghadiri, H [Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Zaidi, H [Division of Nuclear Medicine, Geneva University Hospital, CH-1211 Geneva (Switzerland)], E-mail: mohammadreza_ay@tums.ac.ir

    2010-04-21

    Compton scatter poses a significant threat to volumetric x-ray computed tomography, bringing cupping and streak artefacts thus impacting qualitative and quantitative imaging procedures. To perform appropriate scatter compensation, it is necessary to estimate the magnitude and spatial distribution of x-ray scatter. The aim of this study is to compare three experimental methods for measurement of the scattered radiation profile in a 64-slice CT scanner. The explored techniques involve the use of collimator shadow, a single blocker (a lead bar that suppresses the primary radiation) and an array blocker. The latter was recently proposed and validated by our group. The collimator shadow technique was used as reference for comparison since it established itself as the most accurate experimental procedure available today. The mean relative error of measurements in all tube voltages was 3.9 {+-} 5.5% (with a maximum value of 20%) for the single blocker method whereas it was 1.4 {+-} 1.1% (with a maximum value of 5%) for the proposed blocker array method. The calculated scatter-to-primary ratio (SPR) using the blocker array method for the tube voltages of 140 kVp and 80 kVp was 0.148 and 1.034, respectively. For a larger polypropylene phantom, the maximum SPR achieved was 0.803 and 6.458 at 140 kVp and 80 kVp, respectively. Although the three compared methods present a reasonable accuracy for calculation of the scattered profile in the region corresponding to the object, the collimator shadow method is by far the most accurate empirical technique. Nevertheless, the blocker array method is relatively straightforward for scatter estimation providing minor additional radiation exposure to the patient.

  9. 造影剂注射速率对64层螺旋CT冠状动脉血管成像质量的影响%Effect of contrast injection rates on immaging quality of coronary angiography taken by 64-slice spiral CT

    沈栋; 潘昌杰

    2011-01-01

    目的 研究造影剂注射速率对64层螺旋CT冠状动脉血管成像质量的影响.方法 120 例冠状动脉血管造影患者随机均分成三组,分别用4.5、5或5.5ml/s的速率注射等量造影剂.应用64层螺旋CT进行扫描;采用团注实验测定延迟时间;分别在左冠发出层面横断面图像选择感兴趣区测量升、降主动脉衰减值(HU),利用多平面重建技术(MPR)于离出口约1cm处的正交横断面图像测量心脏血管(左主干、前降支、回旋支及右冠状动脉)的衰减值.结果 升、降主动脉及心脏血管三组间对比衰减均有统计学意义(P<0.01).心脏血管对比衰减与体重(r=-0.722)、体重指数(BMI)(r=-0.599)明显相关(P<0.05).以5ml/s速率注射造影剂获得的图像质量优于其它两组(P<0.01).结论 在心脏CT血管造影(CTA)中在扫描条件及造影剂的碘浓度一致情况下,以5ml/s注射速率给予造影剂可以获得良好的血管增强效果.%Objective To study the effect of contrast injection rates on immaging quality of coronary angiography taken by 64-slice spiral CT (64-MSCT). Methods A total of 120 patients undergoing coronary angiography was equally randomized to 3 groups, in which the contrast injection was performed at the flow rates of 4. 5, 5, and 5. 5 ml/s, respectively. The 64-MSCT scanner and scanning protocols were the same for each group. The scanning delay of CT was determined with a bolus test technique. The attenuation in Hounsfield units(HU) achieved after each injection rate was determined at regions of interest(ROIs) placed at the 1 cm origin of coronary arteries measured by multiplanar reconstructions (MPR), which included the left main artery (LMA), left anterior descending artery(LAD), left circumfiex artery(LCX) and right coronary artery(RCA). All data were analyzed with one way ANOVA. The quality of the coronary artery images was evaluated and compared. Results The mean attenuation achieved at each aortic site was

  10. Calcium scoring using 64-slice MDCT, dual source CT and EBT : a comparative phantom study

    Groen, Jaap M.; Greuter, Marcel J. W.; Vliegenthart, R.; Suess, C.; Schmidt, B.; Zijlstra, F.; Oudkerk, M.

    2008-01-01

    Purpose Assessment of calcium scoring (Ca-scoring) on a 64-slice multi-detector computed tomography (MDCT) scanner, a dual-source computed tomography (DSCT) scanner and an electron beam tomography (EBT) scanner with a moving cardiac phantom as a function of heart rate, slice thickness and calcium de

  11. Optimization of individualized abdominal scan protocol with 64-slice CT scanner

    Objective: To explore an individualized abdominal scan protocol with a 64-slice CT scanner. Methods: From Sep. 2010 to Nov. 2010, one hundred consecutive patients, who underwent twice non-contrast-enhanced abdominal CT scans within 3 months, were enrolled in this study. For each patient, the tube current of 274 eff. mAs and 207 eff. mAs were applied respectively in the first and second abdominal scan. The imaging qualities of the two scans were evaluated retrospectively by 3 reviewers. All the individual variants,including height, weight, body mass index (BMI), the maximum transverse diameter, the anteroposterior diameter and the average maximum diameter of abdomen were recorded. A five-point scale was used for grading the image noise of eight organs, including abdominal aorta, portal vein, liver, spleen, gallbladder, pancreas, renal cortex and renal medulla. Diagnostic acceptability of CT images at three anatomic levels,including porta hepatis, pancreas and the upper pole of renal, was also evaluated by using a five-point scale. The noise value of abdominal aorta was defined as the standard deviation (SD) of CT values of aorta at the level of porta hepatis. Scatter diagram and Pearson correlation analysis were used for evaluating the linear relationship between the individual variants and the noise value of abdominal aorta, and multivariate linear regression analysis was used for evaluating the relevance between the individual variants and the noise value of aorta. Results: In this patients group, the average height was (164.6 ± 7.5) cm,the average weight was (64.3 ± 11.0) kg, the BMI was (23.7 ±3.3) kg/m2, the maximum transverse diameter of abdomen was (29.8 ± 2.3) cm, the anteroposterior diameter of abdomen was (23.1 ± 2.9) cm, and the average maximum diameter of abdomen was (26.5 ± 2.5) cm. Pearson correlation analysis showed significant positive linear correlation between the noise value of abdominal aorta (1 1.7 ± 3.0) and patients' weight (r=0

  12. Calcium scoring using 64-slice MDCT, dual source CT and EBT: a comparative phantom study

    Groen, Jaap M.; Greuter, Marcel J. W.; Vliegenthart, R.; Suess, C.; Schmidt, B.; Zijlstra, F.; Oudkerk, M.

    2007-01-01

    Purpose Assessment of calcium scoring (Ca-scoring) on a 64-slice multi-detector computed tomography (MDCT) scanner, a dual-source computed tomography (DSCT) scanner and an electron beam tomography (EBT) scanner with a moving cardiac phantom as a function of heart rate, slice thickness and calcium density. Methods and materials Three artificial arteries with inserted calcifications of different sizes and densities were scanned at rest (0 beats per minute) and at 50–110 beats per minute (bpm) w...

  13. Bouveret’s Syndrome: 64-Slice CT Diagnosis and Surgical Management—A Case Report

    Dinesh Sharma

    2012-01-01

    Full Text Available Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret’s syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT findings, and surgical management are discussed.

  14. Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

    Objective: Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance. Material and methods: A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study. Results: The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen. Conclusion: Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.

  15. Diagnostic performance of prospectively ECG triggered versus retrospectively ECG gated 64-slice computed tomography coronary angiography in a heterogeneous patient population

    Lehmkuhl, Lukas, E-mail: lukas.lehmkuhl@med.uni-leipzig.de [University of Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Struempellstrasse 39, D-04289 Leipzig (Germany); Herz, Franziska; Foldyna, Borek [University of Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Struempellstrasse 39, D-04289 Leipzig (Germany); Nagel, Hans Dieter [Dr. HD Nagel - Science and Technology for Radiology, Buchholz (Germany); Grothoff, Matthias; Nitzsche, Stefan [University of Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Struempellstrasse 39, D-04289 Leipzig (Germany); Thiele, Holger [University of Leipzig - Heart Center, Department for Cardiology (Germany); Mohr, Friedrich-Wilhelm [University of Leipzig - Heart Center, Department for Cardiovascular Surgery (Germany); Hindricks, Gerhard [University of Leipzig - Heart Center, Department for Cardiology (Germany); Gutberlet, Matthias [University of Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Struempellstrasse 39, D-04289 Leipzig (Germany)

    2011-11-15

    Objective: To compare diagnostic performance and applicability of prospectively versus retrospectively gated 64-slice computed tomography coronary angiography (pro-CTCA vs. retro-CTCA) in a heterogeneous patient population compared to invasive coronary angiography. Methods: 77 patients referred to an ECG-gated-CT of the chest were retrospectively included. Pro-CTCA was applied, whenever possible, alternatively retro-CTCA was performed. All coronary artery segments {>=}1.5 mm were analysed and image quality was assessed. Results: In 39 patients retro-CTCA and in 38 patients pro-CTCA was applied, mean heart rate (HR) was 69.5 {+-} 9.1 min{sup -1} and 62.8 {+-} 5.9, respectively. For a stenosis {>=}50% segment-based (patient-based) analysis revealed a sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of 97%, 98%, 71%, 100% (91%, 82%, 67%, 96%) using retro-CTCA and 94%, 97%, 75%, 99% (93%, 96%, 93%, 96%) using pro-CTCA. Sensitivity and NPV increased in the pro-CTCA group in patients with a HR < 65. Vessel-based analysis showed lower diagnostic performance for the right coronary artery (RCA) using pro-CTCA, which increased when HR < 65. Image quality did not differ significantly in both groups. Conclusions: Prospectively triggered CTCA in a heterogeneous patient group has a very high diagnostic accuracy and image quality, when used in HR {<=} 65. A low HR is of special importance for the evaluation of the RCA.

  16. Coronary artery imaging during preoperative CT staging: preliminary experience with 64-slice multidetector CT in 99 consecutive patients

    Delhaye, Damien; Remy-Jardin, Martine; Rozel, Celine; Remy, Jacques [University Center of Lille, Boulevard Jules Leclerc, Department of Thoracic Imaging, Hospital Calmette, Lille cedex (France); Dusson, Catherine; Wurtz, Alain [University Center of Lille, Department of Thoracic Surgery, Hospital Calmette, Lille cedex (France); Delannoy-Deken, Valerie; Duhamel, Alain [University of Lille, Department of Medical Statistics, Lille cedex (France)

    2007-03-15

    The purpose of this study was to evaluate the clinical feasibility of coronary artery imaging during routine preoperative 64-slice MDCT scans of the chest. Ninety-nine consecutive patients in sinus rhythm underwent a biphasic multidetector-row spiral CT examination of the chest without the administration of beta-blockers, including an ECG-gated acquisition over the cardiac cavities, followed by a non-gated examination of the upper third of the thorax. Data were reconstructed to evaluate coronary arteries and to obtain presurgical staging of the underlying disease. The percentage of assessable segments ranged from 65.4% (972/1,485) when considering all coronary artery segments to 88% (613/693) for the proximal and mid segments, reaching 98% (387/396) for proximal coronary artery segments. The 387 interpretable proximal segments included 97 (97%) LM, 99 (100%) LAD, 96 (97%) LCX and 95 (96%) RCA with a mean attenuation of 280.70{+-}52.93 HU. The mean percentage of assessable segments was significantly higher in patients with a heart rate {<=}80 bpm (n=48) than in patients with a heart rate greater than 80 bpm (n=35) (80{+-}11% vs. 72{+-}13%; P=0.0008). Diagnostic image quality was achieved in all patients for preoperative staging of the underlying disorder. The mean estimated effective dose was 12.06{+-}3.25 mSv for ECG-gated scans and 13.88{+-}3.49 mSv for complete chest examinations. Proximal and mid-coronary artery segments can be adequately evaluated during presurgical CT examinations of the chest obtained with 64-slice MDCT without the administration of {beta}-blockers. (orig.)

  17. Assessments of Coronary Artery Visibility and Radiation Dose in Infants with Congenital Heart Disease on Cardiac 128-slice CT and on Cardiac 64-slice CT.

    Cui, Y; Huang, M; Zheng, J; Li, J; Liu, H; Liang, C

    2016-01-01

    The aim of this study was to compare the coronary artery visibility and radiation dose in infants with CHD on cardiac 128-slice CT and on cardiac 64-slice CT. The images of 200 patients were analyzed in this study, 100 patients were selected randomly from a group of 789 infants (ECG-triggered axial scan, and 100 were selected randomly from 911 infants with CHD undergoing 64-slice CT retrospective ECG-gated spiral scan. The visibility of coronary artery segments was graded on a four-point scale. The coronary arteries were considered to be detected or visible when grade was 2 or higher. The visibility of the coronary artery segments and the radiation dose was compared between the two groups. Except for the rate of LM (96 vs. 99%), the detection rates of the total, LAD, LCX, RCA, and the proximal segment of the RCA in the 256-slice CT group were significantly higher than those in the 64-slice CT group (51.7, 53.33, 33.67, 53.33, and 99 vs. 34.8, 34.33, 18, 30.67, and 75%, respectively). The counts of visibility score (4/3/2/1) for the LM and the proximal segment of the RCA were 62/22/12/4 and 56/20/17/7, respectively, in the 128-slice CT group and 17/42/30/1 and 9/30/38/25, respectively, in the 64-slice CT group. There were significant differences, especially for score 4 and 3, between the two groups. The radiation dose in the 128-slice CT group was significantly decreased than those in the 64-slice CT group (CTDIvol 1.88 ± 0.51 vs. 5.61 ± 0.63 mGy; SSDE 4.48 ± 1.15 vs. 13.97 ± 1.52 mGy; effective radiation dose 1.36 ± 0.44 vs. 4.06 ± 0.7 mSv). With reduced radiation dose, the visibility of the coronary artery in infants with CHD via prospective ECG-triggered mode on a 128-slice CT is superior to that of the 64-slice CT using retrospective ECG-gated spiral mode. PMID:26271472

  18. Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes

    Jun Sung Moon

    2013-02-01

    Full Text Available BackgroundA 64-slice multidetector computed tomography (MDCT is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM.MethodsA total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years. We compared significant coronary stenosis (>50% luminal narrowing in MDCT with invasive coronary angiography (ICA by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.ResultsOf the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109 were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226 were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222, 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74, 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m2 and coronary calcium score did not also affect the diagnostic accuracy of MDCT.ConclusionThe 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

  19. Relationship between Willis circle variation and the occurrence of anterior and posterior communicaring artery aneurysms investigated by 64-slice CT angiography%CT血管成像评价颅内Willis环变异与前后交通动脉动脉瘤发生的关系

    王洪生; 徐新文; 王辉; 杨昭伟; 王鹏; 赵佩林; 王阳春

    2011-01-01

    目的 探讨大脑前动脉水平段(A1段)发育异常和胚胎型大脑后动脉与颅内前、后交通动脉动脉瘤形成的关系. 方法 回顾性分析216例64排CT血管成像(CTA)的资料.①将216例中CTA发现有前后交通动脉动脉瘤的126例,分为前交通动脉动脉瘤(ACoAA)组69例和后交通动脉动脉瘤(PCoAA)组57例,其余CTA检查无动脉瘤,但有头痛、头晕的90例患者,作为对照组.②分析动脉瘤的有无,动脉瘤的部位、形态、大小和瘤颈的宽度、瘤顶指向及瘤体与周围结构的关系等.③将判定结果与手术结果进行对照.④同时观察大脑前动脉A1段是否存在发育不良或缺如,是否存在胚胎型大脑后动脉. 结果 ①64排CTA共检出前、后交通动脉动脉瘤126例,其中ACoAA 69例,PCoAA57例,以DSA和手术为判断标准,64排CTA检出动脉瘤的敏感性和特异性均为100%.②ACoAA组中一侧A1段发育不良或缺如达81.7%,明显高于PCoAA组和对照组(P <0.05);PCoAA组中胚胎型大脑后动脉达56.1%,明显高于ACoAA组和对照组(P<0.05).结论 (1)64排CTA检出动脉瘤具有较高的敏感性和特异性;②一侧大脑前动脉Al段发育不良或缺如及胚胎型大脑后动脉与前、后交通动脉动脉瘤的发生密切相关.%Objective To investigate the relationship between the dysplasia of horizontal segment ( A1 segment) of anterior cerebral artery and the formation of anterior and posterior communicating artery aneurysms. Methods The data of 64-slice computed tomography angiography (CTA) of 216 patients were analyzed retrospectively. Of the 216 patients, CTA found 126 patients with aneurysm. They were di-vided into anterior communicating artery aneurysm ( ACoAA) group (n =69) and posterior communicating artery aneurysm (PCoAA)group (re =57). The other patients without aneurysm revealed by CTA but with headache and dizziness (n =90) were used as a control group. The presence or absence of aneurysm

  20. Clinical evaluation of 64-slice CT assessment of global left ventricular function using automated cardiac phase selection

    Left ventricular (LV) function provides prognostic information regarding the morbidity and mortality of patients. An automated cardiac phase selection algorithm has the potential to support the assessment of LV function with computed tomography (CT). This algorithm is clinically evaluated for 64-slice cardiac CT. Examinations of twenty consecutive patients were selected. Electrocardiogram gated contrast-enhanced CT was performed. Reconstructions were performed using an automated and a manual method, followed by the determination of the global LV function. Significances were tested using 2-sided Student's t-tests. Reduction in post processing time and storage capacity were estimated. A slightly smaller mean end-systolic volume was found with the automated method (52±18 ml vs 54±17 ml, p=0.02, r=0.99). The mean LV ejection fraction was slightly larger with the automated method (65±8% vs 64±8%, p=0.004, r=0.99). The estimated reduction in post processing time was maximal 5 min per patient with a potential 80% data storage reduction. Results of the automated phase selection algorithm are similar to the manual method. The automated tool reduces post processing time, reconstruction time and transfer time. (author)

  1. Radiation Exposure of Ovarian Cancer Patients: Contribution of CT Examinations Performed on Different MDCT (16 and 64 Slices) Scanners and Image Quality Evaluation

    Rizzo, S; D. Origgi; Brambilla, S.; Maria, F.; Foà, R; Raimondi, S; N. Colombo; Bellomi, M.

    2015-01-01

    Abstract The objective of this study is to compare radiation doses given to ovarian cancer patients by different computed tomographies (CTs) and to evaluate association between doses and subjective and objective image quality. CT examinations included were performed either on a 16-slice CT, equipped with automatic z-axis tube current modulation, or on a 64-slice CT, equipped with z-axis, xy-axis modulation, and adaptive statistical iterative algorithm (ASIR). Evaluation of dose included the f...

  2. Clinical application of 64-slice spiral CT for apical hypertrophic cardiomyopathy

    Objective: To evaluate the clinical application values of 64-row MSCT for apical hypertrophic cardiomyopathy (AHCM). Methods: Twenty-one patients with AHCM were included in this study, 14 patients were diagnosed by echocardiography (UCG), and 7 patients were diagnosed by MRI. All patients underwent MSCT exam, and 5 patients also had ventriculography and coronary angiography. The left ventricular wall thickness in end-systole and end-diastole phases were measured at MSCT workstation, the left ventricular apex thickening rate (LVAT) and the ratio of maximum wall thickness of the left ventricular apex (LVA) to the left ventrieular posterior wall thickness (LVA/LVPW) in end-diastole phase were calculated. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were quantitatively evaluated with cardiac functional analysis software. The results were compared with the measurement results from the normal control group (30 volunteers). The independent-samples t test was used for the statistics. At the same time, the coronary stenosis was measured. Results: Diffuse or partial thickening of the LV apical myocardium were found in the four-chamber view and two-chamber view of MSCT images, which leaded to the deformation of the left ventricle chamber. The LVEDV were (82.6± 11.4) and (108.5±10.6) ml in the AHCM group and the control group, respectively; the LVA were (20.6±3.4) and (9.9±1.5) mm; LVA/LVPW were 2.1±0.5 and 1.1±0.2; the LVAT were (25.6± 4.7)% and (81.5±8.5)%. There were significant differences in LYEDV, LVA, LVA/LVPW and LVAT between the two groups (t=8.32 and 15.29, P 0.05). Five patients had myocardium bridging and 4 patients had coronary stenosis. Conclusion: AHCM can be diagnosed accurately with MSCT, and the cardiac anatomy, function and coronary artery are also assessed simultaneously. (authors)

  3. Comparison of myocardial perfusion SPECT with 64-slice multi-slice computed tomography angiography in cardiac screening of asymptomatic diabetic patients

    Lim, Il Han; Lee, Won Woo; Chang, Hyuck Jae; Choi, Sang II; Kim, Sang Eun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2007-07-01

    Asymptomatic diabetic patients may suffer silent ischemia. However, the question that what is the optimal screening tool for detection of cardiac disease in asymptomatic diabetic patients has not been addressed. We prospectively recruited diabetic patients who had not complained chest pain, and obtained myocardial perfusion SPECT (MPS) and cardiac CT angiography (CTA). We compared perfusion status on MPS with findings on CTA. A total of 110 diabetic patients (Age range 41-84, mean age 61.6{+-}7.74; gender, M: F 66:44) without cardiac symptom underwent both MPS and CTA. The MPS protocol was one-day single isotope study, adenosine stress Tc-99m MIBI/rest Tc-99m MIBI. CTA was conducted using 64-slice multi-slice CT (Brillance64, Philips Medical Systems). Perfusion status on MPS was assessed by summed-stress score (SSS) using 20-segment model, and SSS of {>=}4 was considered abnormal. Coronary stenosis of more than 50% luminal narrowing in CTA was considered significant, and coronary artery calcium scoring (CACS) was graded as: < or =10, 11-100, 101-400, or >400. MPS found abnormal perfusion in 11.8% (13/110) and CTA significant coronary stenosis in 20.9% (23/110). Five patients showed both abnormal perfusion and significant coronary stenosis. CACS (n=103 patients) were measured as; < or =10 in 45.6%, 11-100 in 28.1%, 101-400 in 19.4%, and >400 in 6.8%. The patient proportion of abnormal MPS in each CACS group were; 10.6% with < or = 10, 17.2% with 11-100, 5% with 101-400, and 0% with >400. The patient proportion of significant coronary stenosis on CTA in each CACS group were; 2.13% with < or =10, 27.6% with 11-100, 35% with 101-400, and 57.1% with >400. In asymptomatic diabetic patients, coronary stenosis by CTA showed correlation with coronary artery calcium scoring, but myocardial perfusion status by MPS did not. Long-term evaluation is essential for determination of prognostic significance of MPS and cardiac CTA.

  4. Radiation exposure of ovarian cancer patients: contribution of CT examinations performed on different MDCT (16 and 64 slices) scanners and image quality evaluation: an observational study.

    Rizzo, Stefania; Origgi, Daniela; Brambilla, Sarah; De Maria, Federica; Foà, Riccardo; Raimondi, Sara; Colombo, Nicoletta; Bellomi, Massimo

    2015-05-01

    The objective of this study is to compare radiation doses given to ovarian cancer patients by different computed tomographies (CTs) and to evaluate association between doses and subjective and objective image quality.CT examinations included were performed either on a 16-slice CT, equipped with automatic z-axis tube current modulation, or on a 64-slice CT, equipped with z-axis, xy-axis modulation, and adaptive statistical iterative algorithm (ASIR). Evaluation of dose included the following dose descriptors: volumetric CT dose index (CTDIvol), dose length product (DLP), and effective dose (E). Objective image noise was evaluated in abdominal aorta and liver. Subjective image quality was evaluated by assessment of image noise, spatial resolution and diagnostic acceptability.Mean and median CTDIvol, DLP, and E; correlation between CTDIvol and DLP and patients' weight; comparison of objective noise for the 2 scanners; association between dose descriptors and subjective image quality.The 64-slice CT delivered to patients 24.5% lower dose (P descriptors (CTDIvol, DLP, E) and weight (P descriptors and image noise for the 64-slice CT, and between dose descriptors and spatial resolution for the 16-slice CT.Current dose reduction systems may reduce radiation dose without significantly affecting image quality and diagnostic acceptability of CT exams. PMID:25929914

  5. Preliminary study of X-ray dosage reduction using post-processing filter in 64-slice spiral CT cardiac examination

    Objective: To evaluate the adaptive post-processing filter (C2) on reducing X-ray dosage in 64-slice CT cardiac examinations. Methods: The study was divided into two steps: (1) On 30 consecutive patients (group A) prescribed for cardiac scans on 64-slice CT, the scan protocol was 120 kV, 640 mA, 0.35 s/r, 0.625 mm slice thickness, 0.22-0.24 pitch and large body bowtie. For each patients, cardiac images were reconstructed with and without C2 filter to create two image sets (C2 and NC2, respectively). The image quality was blindly evaluated between C2 and NC2. Image noises were also measured and their means and standard deviations calculated for the two sets. Statistical t-test analysis was performed on the quality scores and the noise between the two data sets. (2) On the 30 consecutive cardiac patients in another group (group B), the protocol was kept the same as in group A except for decreasing the tube current 450 mA based on the results from group A. Images were reconstructed using post-processing filter C2 to create 2C2 image set. Statistical t-test was performed between image sets of 2C2 and NC2 in step 1. (3) CTDIvol values from the 2C2 and NC2 (C2) groups were converted into effective dose (ED) and the ED values of the two groups were compared. Results: (1) The image quality scores for the C2 and NC2 sets were 3.71±0.31 and 3.72±0.29, respectively, with t-test of P>0.05, indicating no significant statistical difference (P>0.05). The noise of C2 and NC2 sets were 22±4, 27±5, respectively, indicating the difference was statistically significant (P2 filter had 18% noise reduction compared to those without C2 filter. (2) The image quality scores for the 2C2 and NC2 sets were 3.67± 0.34, 3.72±0.29, indicating no significant statistical difference (P>0.05). The noise of 2C2 and NC2 sets were 26±3, 27±5, indicating no significant statistical difference (P>0.05). (3) The average CTDIvol values were 60±5 mGy, 88±10 mGy for 2C2 and NC2 (C2) groups

  6. Quantitative evaluation of benign meningioma and hemangiopericytoma with peritumoral brain edema by 64-slice CT perfusion imaging

    REN Guang; CHEN Shuang; WANG Yin; ZHU Rui-jiang; GENG Dao-ying; FENG Xiao-yuan

    2010-01-01

    Background Hemangiopericytomas (HPCs) have a relentless tendency for local recurrence and metastases,differentiating between benign meningiomas and HPCs before surgery is important for both treatment planning and the prognosis appraisal.The purpose of this study was to evaluate the correlations between CT perfusion parameters and microvessel density (MVD) in extra-axial tumors and the possible role of CT perfusion imaging in preoperatively differentiating benign meningiomas and HPCs.Methods Seventeen patients with benign meningiomas and peritumoral edema, 12 patients with HPCs and peritumoral edema underwent 64-slice CT perfusion imaging pre-operation.Perfusion was calculated using the Patlak method.The quantitative parameters, include cerebral blood volume (CBV), permeability surface (PS) of parenchyma, peritumoral edema among benign meningiomas and HPCs were compared respectively.CBV and PS in parenchyma, peritumoral edema of benign meningiomas and HPCs were also compared to that of the contrallateral normal white matter respectively.The correlations between CBV, PS of tumoral parenchyma and MVD were examined.Results The value of CBV and PS in parenchyma of HPCs were significantly higher than that of benign meningiomas (P<0.05), while the values of CBV and PS in peritumoral edema of benign meningiomas and HPCs were not significantly different (P >0.05).MVD in parenchyma of HPCs were significantly higher than that of benign meningiomas (P<0.05).There were positive correlations between CBV and MVD (r=0.648, P<0.05), PS and MVD (r=0.541, P<0.05) respectively.Furthermore, the value of CBV and PS in parenchyma of benign meningiomas and HPCs were significantly higher than that of contrallateral normal white matter (P<0.05), the value of CBV in peritumoral edema of benign meningiomas and HPCs were significantly lower than that of contrallateral normal white matter (P<0.05), while the value of PS in peritumoral edema of benign meningiomas and HPCs were not

  7. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT

    Objectives: To assess the diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials and methods: The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analyzed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analyzed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results: Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-Benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-Benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥3.8 cm2, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54–1.0), 100%, 100% and 70% respectively. Conclusion: The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT

  8. Quantitative parameters to compare image quality of non-invasive coronary angiography with 16-slice, 64-slice and dual-source computed tomography.

    Burgstahler, Christof; Reimann, Anja; Brodoefel, Harald; Daferner, Ulrike; Herberts, Tina; Tsiflikas, Ilias; Thomas, Christoph; Drosch, Tanja; Schroeder, Stephen; Heuschmid, Martin

    2009-03-01

    Multi-slice computed tomography (MSCT) is a non-invasive modality to visualize coronary arteries with an overall good image quality. Improved spatial and temporal resolution of 64-slice and dual-source computed tomography (DSCT) scanners are supposed to have a positive impact on diagnostic accuracy and image quality. However, quantitative parameters to compare image quality of 16-slice, 64-slice MSCT and DSCT are missing. A total of 256 CT examinations were evaluated (Siemens, Sensation 16: n = 90; Siemens Sensation 64: n = 91; Siemens Definition: n = 75). Mean Hounsfield units (HU) were measured in the cavum of the left ventricle (LV), the ascending aorta (Ao), the left ventricular myocardium (My) and the proximal part of the left main (LM), the left anterior descending artery (LAD), the right coronary artery (RCA) and the circumflex artery (CX). Moreover, the ratio of intraluminal attenuation (HU) to myocardial attenuation was assessed for all coronary arteries. Clinical data [body mass index (BMI), gender, heart rate] were accessible for all patients. Mean attenuation (CA) of the coronary arteries was significantly higher for DSCT in comparison to 64- and 16-slice MSCT within the RCA [347 +/- 13 vs. 254 +/- 14 (64-MSCT) vs. 233 +/- 11 (16-MSCT) HU], LM (362 +/- 11/275 +/- 12/262 +/- 9), LAD (332 +/- 17/248 +/- 19/219 +/- 14) and LCX (310 +/- 12/210 +/- 13/221 +/- 10, all p < 0.05), whereas there was no significant difference between DSCT and 64-MSCT for the LV, the Ao and My. Heart rate had a significant impact on CA ratio in 16-slice and 64-slice CT only (p < 0.05). BMI had no impact on the CA ratio in DSCT only (p < 0.001). Improved spatial and temporal resolution of dual-source CT is associated with better opacification of the coronary arteries and a better contrast with the myocardium, which is independent of heart rate. In comparison to MSCT, opacification of the coronary arteries at DSCT is not affected by BMI. The main advantage of DSCT lies with the

  9. Quantitative parameters to compare image quality of non-invasive coronary angiography with 16-slice, 64-slice and dual-source computed tomography

    Burgstahler, Christof [University Hospital Tuebingen, Department of Cardiology, Tuebingen (Germany)]|[Eberhard-Karls-University Tuebingen, Department of Internal Medicine III-Cardiology, Tuebingen (Germany); Reimann, Anja; Brodoefel, Harald; Tsiflikas, Ilias; Thomas, Christoph; Heuschmid, Martin [University Hospital Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Daferner, Ulrike; Drosch, Tanja; Schroeder, Stephen [University Hospital Tuebingen, Department of Cardiology, Tuebingen (Germany); Herberts, Tina [University of Tuebingen, Department of Medical Biometry, Tuebingen (Germany)

    2009-03-15

    Multi-slice computed tomography (MSCT) is a non-invasive modality to visualize coronary arteries with an overall good image quality. Improved spatial and temporal resolution of 64-slice and dual-source computed tomography (DSCT) scanners are supposed to have a positive impact on diagnostic accuracy and image quality. However, quantitative parameters to compare image quality of 16-slice, 64-slice MSCT and DSCT are missing. A total of 256 CT examinations were evaluated (Siemens, Sensation 16: n=90; Siemens Sensation 64: n=91; Siemens Definition: n=75). Mean Hounsfield units (HU) were measured in the cavum of the left ventricle (LV), the ascending aorta (Ao), the left ventricular myocardium (My) and the proximal part of the left main (LM), the left anterior descending artery (LAD), the right coronary artery (RCA) and the circumflex artery (CX). Moreover, the ratio of intraluminal attenuation (HU) to myocardial attenuation was assessed for all coronary arteries. Clinical data [body mass index (BMI), gender, heart rate] were accessible for all patients. Mean attenuation (CA) of the coronary arteries was significantly higher for DSCT in comparison to 64- and 16-slice MSCT within the RCA [347{+-}13 vs. 254{+-}14 (64-MSCT) vs. 233{+-}11 (16-MSCT) HU], LM (362{+-}11/275 {+-} 12/262{+-}9), LAD (332{+-}17/248{+-}19/219{+-}14) and LCX (310{+-}12/210{+-}13/221{+-}10, all p<0.05), whereas there was no significant difference between DSCT and 64-MSCT for the LV, the Ao and My. Heart rate had a significant impact on CA ratio in 16-slice and 64-slice CT only (p<0.05). BMI had no impact on the CA ratio in DSCT only (p<0.001). Improved spatial and temporal resolution of dual-source CT is associated with better opacification of the coronary arteries and a better contrast with the myocardium, which is independent of heart rate. In comparison to MSCT, opacification of the coronary arteries at DSCT is not affected by BMI. The main advantage of DSCT lies with the heart rate independency

  10. Quantitative parameters to compare image quality of non-invasive coronary angiography with 16-slice, 64-slice and dual-source computed tomography

    Multi-slice computed tomography (MSCT) is a non-invasive modality to visualize coronary arteries with an overall good image quality. Improved spatial and temporal resolution of 64-slice and dual-source computed tomography (DSCT) scanners are supposed to have a positive impact on diagnostic accuracy and image quality. However, quantitative parameters to compare image quality of 16-slice, 64-slice MSCT and DSCT are missing. A total of 256 CT examinations were evaluated (Siemens, Sensation 16: n=90; Siemens Sensation 64: n=91; Siemens Definition: n=75). Mean Hounsfield units (HU) were measured in the cavum of the left ventricle (LV), the ascending aorta (Ao), the left ventricular myocardium (My) and the proximal part of the left main (LM), the left anterior descending artery (LAD), the right coronary artery (RCA) and the circumflex artery (CX). Moreover, the ratio of intraluminal attenuation (HU) to myocardial attenuation was assessed for all coronary arteries. Clinical data [body mass index (BMI), gender, heart rate] were accessible for all patients. Mean attenuation (CA) of the coronary arteries was significantly higher for DSCT in comparison to 64- and 16-slice MSCT within the RCA [347±13 vs. 254±14 (64-MSCT) vs. 233±11 (16-MSCT) HU], LM (362±11/275 ± 12/262±9), LAD (332±17/248±19/219±14) and LCX (310±12/210±13/221±10, all p<0.05), whereas there was no significant difference between DSCT and 64-MSCT for the LV, the Ao and My. Heart rate had a significant impact on CA ratio in 16-slice and 64-slice CT only (p<0.05). BMI had no impact on the CA ratio in DSCT only (p<0.001). Improved spatial and temporal resolution of dual-source CT is associated with better opacification of the coronary arteries and a better contrast with the myocardium, which is independent of heart rate. In comparison to MSCT, opacification of the coronary arteries at DSCT is not affected by BMI. The main advantage of DSCT lies with the heart rate independency, which might have a

  11. Left coronary to right ventricle fistula in a child: management strategy based on cardiac-gated 64-slice CT

    Congenital coronary fistulae are a diagnostic challenge. A prerequisite for best management is accurate anatomical evaluation, traditionally provided by invasive catheter angiography. Multislice CT (MSCT) is an emerging noninvasive technique for coronary artery evaluation. We present a 3-year-old boy and highlight the clinical usefulness of new-generation MSCT to study coronary artery fistulae in children. Multiplanar and 3-D reconstruction offer invaluable information to plan the best therapeutic strategy in this setting. We provide evidence for the expanding clinical role of MSCT for coronary artery imaging in children. (orig.)

  12. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT

    Murphy, David J., E-mail: david.murphy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); McEvoy, Sinead H., E-mail: s.mcevoy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); Iyengar, Sri, E-mail: sri.iyengar@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Feuchtner, Gudrun, E-mail: Gudrun.Feuchtner@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck (Austria); Cury, Ricardo C., E-mail: r.cury@baptisthealth.net [Department of Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176 (United States); Roobottom, Carl, E-mail: carl.roobottom@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Plymouth University Peninsula Schools of Medicine and Dentistry (United Kingdom); Baumueller, Stephan, E-mail: Hatem.Alkadhi@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Alkadhi, Hatem, E-mail: stephan.baumueller@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Dodd, Jonathan D., E-mail: jonniedodd@gmail.com [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland)

    2014-08-15

    Objectives: To assess the diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials and methods: The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analyzed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analyzed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results: Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-Benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-Benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥3.8 cm{sup 2}, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54–1.0), 100%, 100% and 70% respectively. Conclusion: The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT

  13. Influence of heart rate on image quality of 64-slice spiral computed coronary angiography and optimization on reconstruction of phase window

    Objective: To evaluate the influence of heart rate on the image quality of 64-slice spiral computed coronary angiography (MSCTCA) and optimize the image reconstruction window. Methods: According to the heart rate, 86 patients were classified into 5 groups: group A, the heart rate ≤60 beat per minute(BMP); group B,61-70BMP, group C,71-80BMP, and group D>80BMP. The image quality of MSCTCA was scored 5 grades from 1-5 according to heart motion artifact. The influences of heart rate and reconstruction phase on the image quality of MSCTCA were evaluated. Results: Average heart rate was 64.4 ±10.1BMP. Diagnostic image quality (score>3) was attained in 277 of 344 segments at the best reconstruction interval. There was a significant corxelation between average heart rate and image quality, but there was no difference between relative delay (%) reconstruction and absolute delay (ms) reconstruction on the image quality. Conclusion: Reducing average heart rate is beneficial for improving the image quality. (authors)

  14. Coronary imaging quality in routine ECG-gated multidetector CT examinations of the entire thorax: preliminary experience with a 64-slice CT system in 133 patients

    Delhaye, Damien; Remy-Jardin, Martine; Salem, Randa; Teisseire, Antoine; Khalil, Chadi; Remy, Jacques [Hospital Calmette, University Center of Lille, Department of Thoracic Imaging, Lille Cedex (France); Delannoy-Deken, Valerie; Duhamel, Alain [University of Lille, Department of Medical Statistics, Lille Cedex (France)

    2007-04-15

    To evaluate image quality in the assessment of the coronary arteries during routine ECG-gated multidetector CT (MDCT) of the chest. One hundred and thirty three patients in sinus rhythm underwent an ECG-gated CT angiographic examination of the entire chest without {beta}-blockers with a 64-slice CT system. In 127 patients (95%), it was possible to assess the coronary arteries partially or totally; coronary artery imaging failed in six patients (5%), leading to a detailed description of the coronary arteries in 127 patients. Considering ten coronary artery segments per patient, 75% of coronary segments were assessable (948/1270 segments). When the distal segments were excluded from the analysis (i.e., seven coronary segments evaluated per patient), the percentage of assessable segments was 86% (768/889 proximal and mid coronary segments) and reached 93% (474/508) when assessing proximal segments exclusively. The mean number of assessable segments was significantly higher in patients with a heart rate {<=}80 bpm (n=95) than in patients with a heart rate >80 bpm (n=38) (p<0.002). Proximal and mid-coronary segments can be adequately assessed during a whole-chest ECG-gated CT angiographic examination without administration of {beta}-blockers in patients with a heart rate below 80 bpm. (orig.)

  15. Volumetric evaluation of dual-energy perfusion CT by the presence of intrapulmonary clots using a 64-slice dual-source CT

    Okada, Munemasa; Nakashima, Yoshiteru; Kunihiro, Yoshie; Nakao, Sei; Matsunaga, Naofumi [Dept. of Radiology, Yamaguchi Univ. Graduate School of Medicine, Yamaguchi (Japan)], e-mail: radokada@yamaguchi-u.ac.jp; Morikage, Noriyasu [Medical Bioregulation Dept. of Organ Regulatory Surgery, Yamaguchi Univ. Graduate School of Medicine, Yamaguchi (Japan); Sano, Yuichi [Dept. of Radiology, Yamaguchi Univ. Hospital, Yamaguchi (Japan); Suga, Kazuyoshi [Dept. of Radiology, St Hills Hospital, Yamaguchi (Japan)

    2013-07-15

    Background: Dual-energy perfusion CT (DE{sub p}CT) directly represents the iodine distribution in lung parenchyma and low perfusion areas caused by intrapulmonary clots (IPCs) are visualized as low attenuation areas. Purpose: To evaluate if volumetric evaluation of DE{sub p}CT can be used as a predictor of right heart strain by the presence of IPCs. Material and Methods: One hundred and ninety-six patients suspected of having acute pulmonary embolism (PE) underwent DE{sub p}CT using a 64-slice dual-source CT. DE{sub p}CT images were three-dimensionally reconstructed with four threshold ranges: 1-120 HU (V{sub 120}), 1-15 HU (V{sub 15}), 1-10 HU (V{sub 10}), and 1-5 HU (V{sub 5}). Each relative ratio per V{sub 120} was expressed as the %V{sub 15}, %V{sub 10}, and %V{sub 5}. Volumetric data-sets were compared with D-dimer, pulmonary arterial (PA) pressure, right ventricular (RV) diameter, RV/left ventricular (RV/LV) diameter ratio, PA diameter, and PA/aorta (PA/Ao) diameter ratio. The areas under the ROC curves (AUCs) were examined for their relationship to the presence of IPCs. This study was approved by the local ethics committee. Results: PA pressure and D-dimer were significantly higher in the patients who had IPCs. In the patients with IPCs, V{sub 15}, V{sub 10}, V{sub 5}, %V{sub 15}, %V{sub 10}, and %V{sub 5} were also significantly higher than those without IPC (P = 0.001). %V{sub 5} had a better correlation with D-dimer (r = 0.30, P < 0.001) and RV/LV diameter ratio (r = 0.27, P < 0.001), and showed a higher AUC (0.73) than the other CT measurements. Conclusion: The volumetric evaluation by DE{sub p}CT had a correlation with D-dimer and RV/LV diameter ratio, and the relative ratio of volumetric CT measurements with a lower attenuation threshold might be recommended for the analysis of acute PE.

  16. CT coronary angiography vs. invasive coronary angiography in CHD

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  17. 64排螺旋CT泌尿系三维成像患者的护理%Nursing of patients undergoing 64-slice CT urography

    高丽; 张金玲; 赵云霞; 申秀芬

    2009-01-01

    目的 探讨护理工作在64排螺旋CT泌尿系三维成像(MSCTU)中的价值.方法 240例患者应用64排螺旋CT进行泌尿系三维成像检查,检查前询问病史及碘过敏史,关注患者的心理状态,做好碘预试验;检查中认真观察患者,对可能出现的任何不良反应进行预判,并制订相应的措施;检查后对症处理出现的各种情况,并做好护理指导.结果 239例患者顺利完成检查,1例在扫描过程中出现药物外渗,扫描失败,经过重新扫描,获得满意图像.结论 利用64排螺旋CT行泌尿系三维成像检查,作为一种无创伤、费用相对较低、安全性高的检查技术,护理操作应贯穿检查的每一步.有效的护理措施直接影响检查结果的准确性,熟练的护理操作及耐心细致的心理护理是MSCTU检查中的重要环节.%Objective To discuss the value of nursing work in 64-slice CT urography. Methods 240 patients participated in the 64-slice CT urography, inquiring medical history and iodine allergic history, paying attention to their psychological state and finishing iodine preliminary test before examination, ob-serving patients carefully, pre-judging any possible adverse effect and formulating corresponding measures during the examination, giving expectant treatment according to the various condition and nursing instruc-tion. Results 239 patients passed through the examination smoothly, agents exosmosis happened in one case and led to failure, but satisfactory image was obtained after rescanning. Conclusions Nursing oper-ation penetrates every step of 64-slice CT urography, which is a non-traumatic, low-expense and high-safety examination. Effect nursing directly influences the accuracy of the results, proficient nursing opera-tion and patient psychological nursing is the important part of it.

  18. Non-invasive detection of aortic and coronary atherosclerosis in homozygous familial hypercholesterolemia by 64 slice multi-detector row computed tomography angiography

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector row ...

  19. Non-invasive Detection of Aortic and Coronary Atherosclerosis in Homozygous Familial Hypercholesterolemia by 64 Slice Multi-detector Row Computed Tomography Angiography

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector-row ...

  20. Effect of Heart Rate and Body Mass Index on the Interscan and Interobserver Variability of Coronary Artery Calcium Scoring at Prospective ECG-Triggered 64-Slice CT

    To test the effects of heart rate, body mass index (BMI) and noise level on interscan and interobserver variability of coronary artery calcium (CAC) scoring on a prospective electrocardiogram (ECG)-triggered 64-slice CT. One hundred and ten patients (76 patients with CAC) were scanned twice on prospective ECG-triggered scans. The scan parameters included 120 kV, 82 mAs, a 2.5 mm thickness, and an acquisition center at 45% of the RR interval. The interscan and interobserver variability on the CAC scores (Agatston, volume, and mass) was calculated. The factors affecting the variability were determined by plotting it against heart rate, BMI, and noise level (defined as the standard deviation: SD). The estimated effective dose was 1.5 ± 0.2 mSv. The mean heart rate was 63 ± 12 bpm (range, 44-101 bpm). The patient BMIs were 24.5 ± 4.5 kg/m2 (range, 15.5-42.3 kg/m2). The mean and median interscan variabilities were 11% and 6%, respectively by volume, and 11% and 6%, respectively, by mass. Moreover, the mean and median of the algorithms were lower than the Agatston algorithm (16% and 9%, respectively). The mean and median interobserver variability was 10% and 4%, respectively (average of algorithms). The mean noise levels were 15 ± 4 Hounsfield unit (HU) (range, 8-25 HU). The interscan and interobserver variability was not correlated with heart rate, BMI, or noise level. The interscan and interobserver variability of CAC on a prospective ECG-triggered 64-slice CT with high image quality and 45% of RR acquisition is not significantly affected by heart rate, BMI, or noise level. The volume or mass algorithms show reduced interscan variability compared to the Agatston scoring (p < 0.05).

  1. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    Yi, Ji Sook; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Han, Jong Kyu [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Hyun Joo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2015-08-15

    To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.

  2. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI

  3. Non-invasive assessment of congenital pulmonary vein stenosis in children using cardiac-non-gated CT with 64-slice technology

    Background: Management of congenital pulmonary vein stenosis is a diagnostic challenge. Echocardiography may be insufficient and thus cardiac catheterization remains the reference standard in this setting. The aim of the study was to investigate the accuracy of cardiac-non-gated CT using 64-slice technology in detecting congenital pulmonary vein stenosis in children. Materials and methods: CT examinations were consecutively performed from May 2005 to December 2006 in 13 children aged 1.5-12 months (median 5 months) for suspected congenital pulmonary vein stenosis. Cardiac-non-gated CT acquisitions were performed after the peripheral injection of contrast agent. Pulmonary veins were evaluated for their pattern of connectivity from the lung to the left atrium and for the presence of stenosis. CT findings of pulmonary vein stenosis were compared with combined findings available from echocardiography, catheterization and surgery. Results: Pulmonary veins from the right lung (n = 29) and left lung (n = 26) were evaluated as separate structures (N = 55). Of the 55 structures, 32 had surgical and/or catheterization data and 45 had echocardiography for comparison. CT visualized 100% (55/55) of the investigated structures, while echocardiography visualized 82% (45/55). In the 13 subjects CT identified 10 stenotic pulmonary veins. CT confirmed the echocardiography suspicion of pulmonary vein stenosis in 100% (7/7) and established a new diagnosis in 3 other patients. CT agreed with surgery/catheterization in 100% (10/10) of the available comparisons. Conclusion: Cardiac-non-gated CT assessed the pulmonary veins more completely than echocardiography and should be considered as a viable alternative for invasive pulmonary venography for detecting pulmonary vein stenosis in children.

  4. Evaluation of organ doses and specific k effective dose of 64-slice CT thorax examination using an adult anthropomorphic phantom

    Hashim, S.; Karim, M. K. A.; Bakar, K. A.; Sabarudin, A.; Chin, A. W.; Saripan, M. I.; Bradley, D. A.

    2016-09-01

    The magnitude of radiation dose in computed tomography (CT) depends on the scan acquisition parameters, investigated herein using an anthropomorphic phantom (RANDO®) and thermoluminescence dosimeters (TLD). Specific interest was in the organ doses resulting from CT thorax examination, the specific k coefficient for effective dose estimation for particular protocols also being determined. For measurement of doses representing five main organs (thyroid, lung, liver, esophagus and skin), TLD-100 (LiF:Mg, Ti) were inserted into selected holes in a phantom slab. Five CT thorax protocols were investigated, one routine (R1) and four that were modified protocols (R2 to R5). Organ doses were ranked from greatest to least, found to lie in the order: thyroid>skin>lung>liver>breast. The greatest dose, for thyroid at 25 mGy, was that in use of R1 while the lowest, at 8.8 mGy, was in breast tissue using R3. Effective dose (E) was estimated using three standard methods: the International Commission on Radiological Protection (ICRP)-103 recommendation (E103), the computational phantom CT-EXPO (E(CTEXPO)) method, and the dose-length product (DLP) based approach. E103 k factors were constant for all protocols, ~8% less than that of the universal k factor. Due to inconsistency in tube potential and pitch factor the k factors from CTEXPO were found to vary between 0.015 and 0.010 for protocols R3 and R5. With considerable variation between scan acquisition parameters and organ doses, optimization of practice is necessary in order to reduce patient organ dose.

  5. Comparison of 64-slice multi-detector computed tomography coronary angiography between asymptomatic, type 2 diabetes mellitus and impaired glucose tolerance patients

    Cardiovascular disease is the most frequent cause of death and disability for diabetic patients, and patients with diabetes are more likely to have silent ischemia. Multi-detector computed tomography (MDCT) allows non-invasive assessment of coronary artery stenosis and plaque properties. In this study, we investigated whether 64-slice MDCT can non-invasively identify significant coronary artery stenosis in asymptomatic, type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) patients. The study population consisted of 154 consecutive asymptomatic patients [IGT (n=93), T2DM (n=61)]. All patients underwent contrast-enhanced 64-slice MDCT. The number of diseased coronary segments was classified as showing obstructive (≥50% luminal narrowing) disease or not. Significant coronary stenosis was detected in 43 (27.9%) of 154 enrolled patients. Patients with T2DM showed significantly more coronary stenosis than patients with IGT (41% vs. 19.4%; p<0.01). Twenty-three patients [14.9%; IGT (n=9), T2DM (n=14)] underwent percutaneous coronary intervention (PCI) for severe stenosis. Patients with T2DM showed significantly more calcified plaque than IGT (47.5% vs. 29%; p<0.05), but not significantly more soft plaque (19.7% vs. 15.1%; ns), or significantly different remodeling index (1.05±0.18 vs. 1.04±0.21; ns), respectively. 64-Slice MDCT can non-invasively identify significant coronary artery stenosis in asymptomatic, T2DM and IGT patients. (author)

  6. Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study

    Our two-centre prospective study evaluates the usefulness of 64-slice coronary computed tomography (CCT) to rule out significant coronary artery stenosis in patients admitted in emergency departments (ED) for acute coronary syndromes (ACS) with low-to-intermediate risk score. Patients (175) admitted for acute chest pain (ACP), unmodified electrocardiogram and first troponin measurement within normal ranges were included. A second troponin measurement and a 64-slice CCT within 24 h were performed. Major adverse cardiac events (MACE) were recorded during follow-up (6 months ± 2). 64-slice CCT was either normal or showed non-significant coronary stenosis in the majority of patients (78%). 64-slice CCT depicted significant stenosis (>50% diameter) in 22% of patient whereas initial clinical and biological evaluation was reassuring. For negative CCTs, elevated troponin at second measurement did not modify the strategy or treatment of patients. No MACEs were noted during follow up. In 12% of patients CCT identified unsuspected non-coronary abnormalities. Our study confirms 64-slice CCT utility to rule out significant coronary artery stenosis in 8/10 patients admitted in ED with ACP or ACS with low-to-intermediate risk score. Early discharge with a negative 64-slice CCT is associated with very low risk of cardiac events at 6 months. (orig.)

  7. The optimization of low-dose scanning protocols of 64-slice spiral CT in the adult chest: a multicenter study

    Objective: To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current. control (CCC) and explore a more reasonable scanning protocol. Methods: Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (Al) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (Cl) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols. The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically. Differences of radiation dose and noise among groups were determined with variance analysis and t test, image quality with Mann- Whitney test and the consistency of diagnosis with Kappa test. Results: There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31) vs (110.81±18.21) mGy · cm (F=56.88, P 0.05]. The noisy of AEC group was higher than that of CCC group both on lung window (41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference (Flung=0.835, P=0.476, Fwediastinum=1.910, P=0.128). The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49± 0.56 vs 4.38±0.64, superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32, the right superior lobar bronchus Level: 4.87±0.27 vs 4.84±0.22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level (4.92±0.25 vs 4.93±0.17) and superior margin of the left diaphragmatic dome level (4.91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P>0.05) were observed. A significant higher

  8. Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience

    AND Dwivedi

    2012-01-01

    Full Text Available Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India. Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87 were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%. Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%. Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

  9. Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography

    Behroozi, Hamid; Davoodi, Mohammad; Aghasi, Shahriar

    2015-01-01

    Background: The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. Objectives: The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. Patients and Methods: Eighty-one patients (41 males an...

  10. Evaluation of coronary calcifications with 64-slice CT - variability of the scores and the influence of the reconstruction interval; Bestimmung des koronaren Kalzium-Scores mittels 64-Zeilen-CT - Variabilitaet der Scores und Einfluss des Rekonstruktionszeitpunktes

    Weininger, M.; Ritter, C.O.; Beer, M.; Hahn, D.; Beissert, M. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Wuerzburg (Germany)

    2007-09-15

    Purpose: To evaluate the variability of coronary calcium scores depending on the image reconstruction interval using a 64-slice CT scanner. Materials and Methods: 30 patients (18 male, 12 female; mean age 57 {+-} 9 yrs; mean heart rate 66 {+-} 10 bpm) underwent coronary calcium scoring using a 64-slice CT scanner (Somatom Sensation 64, Siemens Medical Solutions, Erlangen) and a standardized scanning protocol. Oral {beta}-blockers were administered to 12 patients with a baseline heart rate > 70 bpm. Images were reconstructed in 10 % increments from 10 - 100 % of the RR interval. Two blinded experienced observers independently calculated Agatston (AS), calcium mass (MS) and volume scores (VS) for every reconstructed image series. The results were compared to similar studies for 16-slice CT scanners. Results: The mean values and mean coefficients of variation among all patients were as follows: AS, 397 {+-} 829, 109 % MS, 88 {+-} 225, 154 % VS, 335 {+-} 669, 100 %. Regarding the reconstruction intervals, the mean coefficients of variation were as follows: 107 % (AS), 97 % (VS), 116 % (MS). No specific image reconstruction interval with statistically significant lower variability for each score could be identified. High inter-observer agreement was achieved (K = 0.98). With statistical significance (p < 0.05) 10/30 patients (pts) were able to be allocated to more than one risk group (RG): 6 pts = 2 RG; 3 pts = 3 RG; 1 pts = 4 RG. The scores for 5/30 patients were zero for at least one reconstruction interval, but further reconstructions revealed calcifications. The number of patients assignable to different risk groups was significantly lower compared to published data using a 16-slice scanner (p < 0.05). Conclusion: Coronary calcium scores determined using a 64-slice scanner display a wide range of variability depending on the image reconstruction interval as already described for 16-slice CT scanners. However, compared to previous studies, our data indicate that this

  11. Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan

    The potential impact of dual-source ECG-triggered sequential CT scan on coronary artery visibility has not been evaluated in free-breathing young children. To compare coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT between dual-source ECG-triggered sequential (DSET) scan and single-source non-ECG-synchronized spiral (SSNE) scan. In 93 young children, 108 cardiac 64-slice CT examinations were performed during free-breathing. Visibility of coronary arteries and side branches was compared between SSNE and DSET scans. Heart rates and trigger delays for DSET scan were recorded. Effective dose of each scan technique was calculated. Visual grades were significantly higher (P < 0.001 or =0.011) on DSET scan than on SSNE scan except for the distal left anterior descending artery. Coronary arteries were traceable in 79.3% on DSET scan and 54.3% on SSNE scan in the overlapped scan range (P < 0.0001), and 97.1% and 71.9% for the origins and proximal segments (P < 0.0001). Visibility of side branches was improved on DSET scan by a factor of 2.0. Heart rates and trigger delays for DSET scan were 131 ± 24 beats per min and 199 ± 44 ms, respectively. Effective doses of DSET and SSNE scans were 0.36 ± 0.12 mSv and 0.99 ± 0.23 mSv, respectively. DSET scan improves visibility of coronary arteries on cardiac 64-slice CT in free-breathing young children with congenital heart disease, compared with SSNE scan. (orig.)

  12. Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan

    Goo, Hyun Woo; Yang, Dong Hyun [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of)

    2010-10-15

    The potential impact of dual-source ECG-triggered sequential CT scan on coronary artery visibility has not been evaluated in free-breathing young children. To compare coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT between dual-source ECG-triggered sequential (DSET) scan and single-source non-ECG-synchronized spiral (SSNE) scan. In 93 young children, 108 cardiac 64-slice CT examinations were performed during free-breathing. Visibility of coronary arteries and side branches was compared between SSNE and DSET scans. Heart rates and trigger delays for DSET scan were recorded. Effective dose of each scan technique was calculated. Visual grades were significantly higher (P < 0.001 or =0.011) on DSET scan than on SSNE scan except for the distal left anterior descending artery. Coronary arteries were traceable in 79.3% on DSET scan and 54.3% on SSNE scan in the overlapped scan range (P < 0.0001), and 97.1% and 71.9% for the origins and proximal segments (P < 0.0001). Visibility of side branches was improved on DSET scan by a factor of 2.0. Heart rates and trigger delays for DSET scan were 131 {+-} 24 beats per min and 199 {+-} 44 ms, respectively. Effective doses of DSET and SSNE scans were 0.36 {+-} 0.12 mSv and 0.99 {+-} 0.23 mSv, respectively. DSET scan improves visibility of coronary arteries on cardiac 64-slice CT in free-breathing young children with congenital heart disease, compared with SSNE scan. (orig.)

  13. Diagnostic Accuracy of 64-Slice Multislice Computed Tomography in Assessment of Coronary Artery Bypass Grafts

    A. Arjmand Shabestari

    2007-05-01

    Full Text Available Background and Objective: Nowadays 64-slice mul-tislice computed tomography (MSCT has gained a wide acceptance as a non-invasive diagnostic imaging modality in native coronary arteries. This study was performed to determine the diagnostic accuracy of 64-slice MSCT in assessment of coronary artery by-pass grafting (CABG patency. Materials and Methods: 73 patients underwent both coronary CT-angiography (CTA using 64-slice MSCT scanner and quantitative coronary angiography (QCA were studied. Arterial and venous CABG patency was graded as: a-normal, b-patent with non-significant (<50% diameter reduction stenosis, c-patent with significant (≥50% diameter reduction stenosis or d-totally occluded. The results of CTA and QCA were compared. Results: Totally, 236 CABG were assessed, including 49 arterial and 187 venous grafts. Sensitivity, specific-ity, positive predictive value (PPV and negative pre-dictive value (NPV in detecting normal patency of arterial grafts were 100%, 85%, 95% and 100%, re-spectively and those in finding normal patency of ve-nous grafts all were 100%. The above-mentioned fig-ures for non-significant stenosis were 67% (2 out of 3 patients, 100%, 100% and 98% in arterial and 95%, 100%, 100% and 99% in venous grafts, respectively. Regarding to the significant stenosis, the results were 67% (2 out of 3 patients, 100%, 100% and 98% in arterial and 100%, 99%, 94% and 100% in venous grafts, respectively. All of these numerals were meas-ured being 100% for total occlusion of both arterial and venous grafts. Conclusion: Diagnostic accuracy of 64-slice MSCT in detecting normal patency, non-significant stenosis, significant stenosis and total occlusion of arterial and particularly venous CABG is extremely high so that QCA may be eventually substituted by CTA in a near future.

  14. CT Angiography of the Coronary Arteries

    H.Ghanaati

    2005-08-01

    Full Text Available Introduction & Background: Cardiac imaging is currently one the most rapidly advancing fields in clinical cardiology. Continuing technical innovations are expanding the applicability and usefulness of non-invasive imaging modalities such as ultrasound, nuclear imaging, positron emis-sion tomography Magnetic Resonance Imaging and most recently computed tomography (CT. In 1998, the 4-slice spiral CT scanners were introduced with a rotation time of 500ms a collimated detector width varying from 0.5 to 1.25mm. In 2002, the 16-slice spiral CT scanners were first used for coronary imag-ing. The rotation time and some of these scanners is now less than 400ms, the slice thickness varies be-tween 0.5 and 0.75mm, and a complete cardiac scan can be performed in less than 20s. In 2004, 64-slice spiral CT released into the market. Imaging of the heart requires acquisition or image reconstruction that is synchronized to the motion of the heart. Nie-man et al, irrespectively of the image quality, evalu-ated all branches with a minimal luminal diameter of 2.0mm and sensitivity and specificity of 95% and 86% respectively in comparison to angiography.

  15. Diagnostic Significance of Lumbar Spine Bone Metastases by 64 Slice Spiral CT and Whole Body Bone Imaging%64层螺旋CT与全身骨显像对腰椎骨转移瘤的诊断意义

    宋世祥

    2014-01-01

    目的:探讨64层螺旋CT与99Tcm-MDP全身骨显像对腰椎骨转移瘤的诊断意义。方法回顾性分析临床确诊腰椎骨转移瘤且资料完整的住院诊治27例患者49处腰椎骨转移瘤,总结分析27例患者的64层螺旋CT与99Tcm-MDP全身骨显像检查结果。比较两种检查结果的灵敏度及特异性。结果经64层螺旋CT检查示,27例患者有41处腰椎锥体破坏;经99Tcm-MDP全身骨显像检查示,23例患者有31处腰椎椎体放射性异常浓集,27例患者发现椎体外多发放射性异常浓集。64层螺旋CT检查的灵敏度为83.6%,特异性为98.6%;99Tcm-MDP全身骨显像检查的灵敏度为63.2%,特异性为96.7%。经64层螺旋CT检查示,有17例明确诊断为腰椎转移瘤,10例可疑为腰椎转移瘤;经99Tcm-MDP全身骨显像检查示,有20例明确诊断为腰椎转移瘤,7例可疑为腰椎转移瘤。结论64层螺旋CT对腰椎骨转移瘤的诊断较99Tcm-MDP全身骨显像具有更高的灵敏度,但多数患者经99Tcm-MDP全身骨显像可获得较为明确的诊断。%Objective To investigate the diagnostic significance of lumbar spine bone metastases by 64 slice spiral CT and 99Tcm-MDP whole body bone imaging. Methods 27 cases of lumbar spine bone metastases with 49 places by clinical diagnosis and with complete hospitalization data were retrospectively analyzed, and the examination results of 27 cases with 64 slice spiral CT and 99Tcm-MDP whole body bone imaging were summarized and analyzed. The sensitivity and specificity of two kinds of examination results were compared. Results The examination result of 64 slice spiral CT showed that 41 vertebrae were damaged in 27 patients, the sensitivity was 83.6%, 17 cases of lumbar spine bone metastases were confirmed by 64 slice spiral CT, 10 patients were suspected. The examination result of 99Tcm-MDP whole body bone imaging showed that 31 vertebrae had radioactive anomaly concentration in 27 patients, the

  16. Conventional and CT angiography in children: dosimetry and dose comparisons

    Tremendous advances have been made in imaging in children with both congenital and acquired heart disease. These include technical advances in cardiac catheterization and conventional angiography, especially with advancements in interventional procedures, as well as noninvasive imaging with MR and CT angiography. With rapid advances in multidetector CT (MDCT) technology, most recently 64-detector array systems (64-slice MDCT), have come a number of advantages over MR. However, both conventional and CT angiography impart radiation dose to children. Although the presence of radiation exposure to children has long been recognized, it is apparent that our ability to assess this dose, particularly in light of the rapid advancements, has been limited. Traditional methods of dosimetry for both conventional and CT angiography are somewhat cumbersome or involve a potential for substantial uncertainty. Recent developments in dosimetry, including metal oxide semiconductor field effect transistors (MOSFET) and the availability of anthropomorphic, tissue-equivalent phantoms have provided new opportunities for dosimetric assessments. Recent work with this technology in state-of-the-art cardiac angiography suites as well as with MDCT have offered direct comparisons of doses in infants and children undergoing diagnostic cardiac evaluation. It is with these dose data that assessment of risks, and ultimately the assessment of risk-benefit, can be better achieved. (orig.)

  17. 64-slice Computed Tomography Assessment of Coronary Artery Stents: a Phantom Study

    Mahnken, A.H.; Muehlenbruch, G.; Seyfarth, T.; Flohr, T.; Stanzel, S.; Wildberger, J.E.; Guenther, R.W.; Kuettner, A. [Aachen Univ. of Technology (Germany). Dept. of Diagnostic Radiology

    2006-02-15

    Purpose: To compare the use of a new 64-slice computed tomography (CT) scanner with 16-slice CT in the visualization of coronary artery stent lumen. Material and Methods: Eight different coronary artery stents, each with a diameter of 3 mm, were placed in a static chest phantom. The phantom was positioned in the CT gantry at an angle of 0 deg and 45 deg towards the z-axis and examined with both a 64-slice and a 16-slice CT scanner. Effective slice thickness was 0.6 mm with 64-slice CT and 1 mm with 16-slice CT. A reconstruction increment of 0.3 mm was applied in both scanners. Image quality was assessed visually using a 5-point grading scale. Stent diameters were measured and compared using paired Wilcoxon tests. Results: Artificial lumen reduction was significantly less with 64-slice than with 16-slice CT. Average visible stent lumen was 53.4% using 64-slice CT and 47.5% with 16-slice MSCT. Most severe artifacts were seen in stents with radiopaque markers. Using 64-slice CT, image noise increased by approximately 30% due to thinner slice thickness. Conclusion: Improved spatial resolution of 64-slice CT resulted in superior assessment of coronary artery stent lumen compared to 16-slice CT. However, a relevant part of the stent lumen is still not assessable with multi-slice CT.

  18. 急性阑尾炎超声与64排螺旋 CT 检查对比分析%The comparative analysis between ultrasound and 64-slice spiral CT examination in acute appendicitis

    王振芳; 岳学旺; 毕言刚; 李飞; 张仕状

    2014-01-01

    目的:探讨超声与64排螺旋 CT 平扫检查在诊断急性阑尾炎中的应用价值。方法收集经手术、病理证实或经保守治疗好转确诊急性阑尾炎的患者65例,术前或治疗前均做了 B 超和 CT 检查,对急性阑尾炎病理改变的显示情况及诊断符合率进行对比分析。结果65例阑尾炎病变,在 CT 图像上正确诊断58例,诊断符合率为89.23%,超声图像正确诊断48例,诊断符合率为73.85%,2种检查方法诊断符合率具有统计学差异(χ2=5.11,P =0.024)。结论多排螺旋 CT 与超声相比在诊断急性阑尾炎方面有较高的诊断符合率。%Objective To investigate the application of ultrasound and 64-slice spiral CT in the diagnosis of acute appendicitis. Methods Sixty-five patients with pathologically or clinally confirmed acute appendicitis were underwent ultrasound and CT examina-tion before operation or conservative treatment.Compared with pathology,the accuracy of CT and B-ultrasound imaging were ana-lyzed.Results Fifty-eight cases were correctly diagnosed by CT and 48 cases were correctly diagnosed by ultrasound,the accuracy was 89.23% (58/65)and 73.85% (48/65),respectively.There was a statistically significant difference between two groups (χ2 =5.1 1,P =0.024).Conclusion The accuracy of multi-slice spiral CT is higher than ultrasound in the diagnosis of acute appendicitis.

  19. Comparison of findings of spontaneous splenorenal shunt in color Doppler sonography with multislice CT scan (64 slices) in liver transplant candidates

    Bagheri, Mohammadhadi, E-mail: Bagherimh@gmail.com [Department of Radiology, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz (Iran, Islamic Republic of); Hajati, Azadeh, E-mail: azadeh.hajati@gmail.com [Department of Radiology, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz (Iran, Islamic Republic of); Hosseini, Mohammadkazem, E-mail: hosseiniaslm@sums.ac.ir [Department of Radiology, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz (Iran, Islamic Republic of); Ostad, Seyed Pouria, E-mail: Pouria.Ostad@gmail.com [Department of Radiology, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz (Iran, Islamic Republic of)

    2012-09-15

    Background: Liver transplantation is the only definite treatment for end stage liver disease and it has high costs for the medical system so decreasing its complication and increasing its effectiveness is crucial. One of the factors that affect liver transplantation is the presence of spontaneous splenorenal shunt. Its diagnosis is mainly overlooked in pre-liver transplant patients. Main modality for its diagnosis is multislice CT scan however this is more expensive than sonography. Also, it exposes the patients to ionizing radiation. Considering the advantages of color Doppler ultrasound, studies to determine the sensitivity and specificity for detection of spontaneous splenorenal shunt is essential. Materials and methods: In our study 70 cirrhotic patients who were referred by liver transplant surgeons for evaluation of abdomen by CT and sonograhy were assessed for presence of spontaneous splenorenal shunt, left adrenal varix and left renal vein diameter and velocity and sensitivity and specificity of both modalities were checked. Patients in whom left renal vein could not evaluated by sonography and patients with splenectomy and nutcracker syndrome were excluded. Results: In the point of 10 mm diameter of left renal vein in CT scan there was 78.6% sensitivity and 67.9% specificity for the presence of spontaneous splenorenal shunt. Left adrenal varix in CT had sensitivity of 71.4%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 70% and varix below spleen in CT had sensitivity of 54.8%, specificity of 96.4%, and positive predictive value of 95.8% and negative predictive value of 58.7% for the presence of spontaneous splenorenal shunt. In the point of 8 mm diameter of left renal vein in sonography there was 66.7% sensitivity and 85.7% specificity for the presence of spontaneous splenorenal shunt. For the velocity of more than 35 cm/s of left renal vein in sonography there was 61.9% sensitivity and 82.1% specificity for

  20. Comparison of findings of spontaneous splenorenal shunt in color Doppler sonography with multislice CT scan (64 slices) in liver transplant candidates

    Background: Liver transplantation is the only definite treatment for end stage liver disease and it has high costs for the medical system so decreasing its complication and increasing its effectiveness is crucial. One of the factors that affect liver transplantation is the presence of spontaneous splenorenal shunt. Its diagnosis is mainly overlooked in pre-liver transplant patients. Main modality for its diagnosis is multislice CT scan however this is more expensive than sonography. Also, it exposes the patients to ionizing radiation. Considering the advantages of color Doppler ultrasound, studies to determine the sensitivity and specificity for detection of spontaneous splenorenal shunt is essential. Materials and methods: In our study 70 cirrhotic patients who were referred by liver transplant surgeons for evaluation of abdomen by CT and sonograhy were assessed for presence of spontaneous splenorenal shunt, left adrenal varix and left renal vein diameter and velocity and sensitivity and specificity of both modalities were checked. Patients in whom left renal vein could not evaluated by sonography and patients with splenectomy and nutcracker syndrome were excluded. Results: In the point of 10 mm diameter of left renal vein in CT scan there was 78.6% sensitivity and 67.9% specificity for the presence of spontaneous splenorenal shunt. Left adrenal varix in CT had sensitivity of 71.4%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 70% and varix below spleen in CT had sensitivity of 54.8%, specificity of 96.4%, and positive predictive value of 95.8% and negative predictive value of 58.7% for the presence of spontaneous splenorenal shunt. In the point of 8 mm diameter of left renal vein in sonography there was 66.7% sensitivity and 85.7% specificity for the presence of spontaneous splenorenal shunt. For the velocity of more than 35 cm/s of left renal vein in sonography there was 61.9% sensitivity and 82.1% specificity for

  1. Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners

    Ay, Mohammad Reza; Mehranian, Abolfazi; Maleki, Asghar; Ghadiri, Hossien; Ghafarian, Pardis; Zaidi, Habib

    2013-01-01

    Beam hardening filters have long been employed in X-ray Computed Tomography (CT) to preferentially absorb soft and low-energy X-rays having no or little contribution to image formation, thus allowing the reduction of patient dose and beam hardening artefacts. In this work, we studied the influence o

  2. 64层螺旋CT低剂量扫描在新生儿气胸诊断中的应用%Low dose scanning of 64 slice spiral CT in the diagnosis of pneumothorax in neonates

    武军; 李彦杰

    2015-01-01

    Objective Application of low dose of 64 row spiral CT scanning in the diagnosis of pneumothorax in neonatal pneumothorax, analysis CT charac-teristics, in order to improve the diagnostic level of understanding and CT on neonatal pneumothorax. Methods Twenty-three patients with clinically suspected of pneumothorax in neonates of low voltage, low current and increasing pitch were scanned by 64 slice spiral CT. And the image analysis. Results Patients with CT showed different types, such as lateral lung chest,medial mediastinum side pneumothorax, diaphrag-matic surface and near the front of pneumothorax. Conclusion Neonatal lung chest clinic and CT features, the timely detection of pneumothorax in neonates, for clinical diagnosis and timely treatment is meaningful.%目的:探讨64层螺旋CT低剂量扫描在新生儿气胸诊断中的应用,分析新生儿气胸的CT表现特点,以提高对新生儿气胸的认识及CT的诊断水平。方法用64层螺旋CT对23例临床可疑新生儿气胸进行低电压、低电流和增大螺距进行扫描,并对图像进行分析。结果患儿有不同类型的CT表现,如外侧肺气胸、内侧纵隔旁气胸、膈面附近及胸前部气胸等。结论新生儿肺气胸有一定的临床CT特征,对及时发现新生儿气胸,对临床诊断并及时处理有重要意义。

  3. The application value of 64-slice spiral CT in the diagnosis of occult rib fracture%64层螺旋CT在隐匿性肋骨骨折诊断中的应用价值

    迟宝权; 刘亚静; 康洁

    2011-01-01

    Objective To evaluate the diagnostic value of 64-slice spiral CT and post-reconstruction technique in the diagnosis of occult rib fracture. Methods 42 patients with suspected chest trauma and occult rib fracture were examined by 64-slice spiral CT scan. All the original images were transferred to workstation to be post-processed to obtain volume rendering ( VR ) , maximum intensity projection ( MIP), multiplanar reformation (MPR) ,curved planar reformation(CPR) images in order to reveal occult rib fractures clearly. The abilities in displaying occult rib fractures were compared among VR, MIP, MPR, and CPR. Results The comprehensive application of various reconstruction techniques could show clearly the different parts and different types of occult rib fractures. The CPR reconstruction was the best one of them in displaying occult rib fractures,as compared with MPR and VR. A total of 59 parts of occult rib fracture were diagnosed in 42 patients with chest trauma. Conclusion The 64-slice spiral CT and post-reconstruction technique to treat the images can show clearly occult rib fracture, and can meet the positioning and qualitative analysis for occult fracture ribs,so which is the preferred method for detecting occult rib fracture.%目的 探讨64层螺旋CT及其后重建技术在隐匿性肋骨骨折诊断中的临床应用价值.方法 对42例胸部外伤考虑隐匿性肋骨骨折患者,进行64层螺旋CT平扫,将所得原始数据经工作站进行图像后处理,获得容积再现(VR),最大密度投影(MIP),多平面重组(MPR)、曲面重建(CPR)图像.并比较各种重建图像对隐匿性骨折的显示能力.结果 综合运用各种后重建技术,可清晰显示不同部位、不同类型肋骨隐匿性骨折.重建以CPR技术显示效果最佳,MPR、VR次之.42例胸部外伤患者共确诊59处肋骨隐匿性骨折.结论 64层螺旋CT及其后重建技术图像显示清晰,满足对肋骨隐匿性骨折进行定位、定性分析,是肋骨隐匿性骨折检查首选方法.

  4. 64排螺旋CT在泌尿系三维成像检查中的影响%Effects of 64 slice spiral CT 3D imaging in urinary system

    王强

    2013-01-01

    Objective To investigate the clinical value of 3D imaging exams after 64-slice spiral CT scan.Methods Conventional thin plain scan and arterial phase,venous phase,delayed phase scans to 50 patients with urinary tract diseases were performed respectively by applicating 64-slice spiral CT,then,the data were transferred to the imaging workstation for MPR,VR and MIP and other 3D reconstruction,ifnally,a comprehensive analysis was made to all image data.Results kidney or ureteral stones in 33 cases,occupying of kidney,ureter or bladder in 8 cases,inflammation in 6 cases,congenital malformations in 2 cases,ureteral clot in 1 case.Conclusion 3D imaging exams after 64-slice spiral CT scan has a reliable value to the diagnosis of urinary tract disease,it can not only get a clear kidneys,ureter and bladder dimensional reconstructed images,but also accurately display the urological global and local ifne structure,shape,extending direction and its relationship with the surrounding tissue.In addition,the image can be made rotation,cutting,ampliifcation and other post-processing.%目的:探讨64排螺旋CT在泌尿系三维成像检查中的临床应用价值。方法抽取来我院就诊的泌尿系疾病患者50例,应用64排螺旋CT分别行常规薄层平扫及动脉期、静脉期、延迟期扫描,并将所得数据传输至影像工作站进行MPR、VR及MIP等三维重建,对其影像资料进行综合分析。结果肾或输尿管结石33例,肾、输尿管或膀胱占位8例,炎症6例,先天性畸形2例,输尿管内血块1例。结论64排螺旋CT三维成像检查不仅能够获得清晰的双肾、输尿管及膀胱的三维重建图像,而且能够准确地显示出泌尿系统整体和局部的细微结构、形状、走形及其与周围组织关系,还可对图像进行旋转、切割、放大等后处理操作,对于临床诊断泌尿系统疾病具有可靠价值。

  5. Evaluation of the Correlation Between Myocardial Bridging and Atherosclerotic Changes in Coronary Artery Segment Proximal to the Bridge by 64-Slice Multidetector CT Scan

    Safa Hoodeshenas; Abbas Arjmand Shabestari

    2011-01-01

    Background/Objective: The aim of this study was"nto evaluate the prevalance and characteristics of myocardial bridging (MB) and to assess the correlation"nbetween atherosclerosis and MB."nMaterials and Methods: Retrospective evaluation"nof 2790 coronary angiograms were obtained by 64-"nslice multidetector CT. The prevalance, length, depth,"nprecise of MB location and concomitant atherosclerosis"nproximal to tunneled segment were evaluated. The"ngroup of...

  6. Application of low-dose 64-slice spiral CT scanning technology in adenoidal hypertrophy in children%64层CT对儿童腺样体肥大低剂量扫描的应用

    黄冰; 杨玲; 桂绍高

    2014-01-01

    Objective To investigate clinical application value of low-dose 64-slice spiral CT scanning technology in the ade-noidal hypertrophy of children. Methods 100 cases of children with adenoidal hypertrophy underwent low-dose(group A)and con-ventional-dose (group B)64-slice spiral CT scanning. The A/N ratio,Dand radiation dose in two groups were compared. Results The A/N ratio (P=0.981) and D (P=0.199) showed no significant difference between low-dose CT scanning and conventional-dose CT scanning (P=0.981). The CTDIvol of low-dose CT scanning was 6.93mGy and the CTDIvol of conventional-doses was 27. 92mGy. The CTDIvol of low-dose CT scanning decreased about 75%as compared with those of conventional dose scanning. Con-clusion The diagnostic result of image of low dose CT scanning is the same as that of conventional dose scanning,and the low-dose spiral CT scanning in children with adenoidal hypertrophy can substitute the conventional-dose spiral CT scanning.%目的:探讨低剂量64层螺旋CT扫描技术在儿童腺样体肥大中的应用。方法对100例临床疑似腺样体肥大儿童行64层螺旋CT低剂量和常规剂量扫描,将其随机分为两组,对比两种剂量扫描的鼻咽气腔前后径A/N比值和鼻咽气腔有效气道的前后径(D值)及患者的辐射剂量。结果64层螺旋CT低剂量扫描与常规剂量扫描之间鼻咽气腔前后径A/N比值无统计学差异(P=0.981);低剂量组与常规剂量组鼻咽气腔有效气道的前后径(D值)无统计学差异(P=0.199)。低剂量CT扫描显示儿童鼻咽部容积CT剂量指数CTDIvol为6.93mGy,常规剂量CTDIvol为27.92mGy。低剂量与常规剂量相比,其CTDIvol降低了约75%的辐射剂量。结论64层螺旋CT低剂量扫描对腺样体肥大的诊断结果与常规剂量均相同,故64层螺旋CT低剂量扫描临床疑似腺样体肥大的患者,完全能替代常规剂量的64层螺旋CT扫描。

  7. Evaluation of the Correlation Between Myocardial Bridging and Atherosclerotic Changes in Coronary Artery Segment Proximal to the Bridge by 64-Slice Multidetector CT Scan

    Safa Hoodeshenas

    2011-05-01

    Full Text Available Background/Objective: The aim of this study was"nto evaluate the prevalance and characteristics of myocardial bridging (MB and to assess the correlation"nbetween atherosclerosis and MB."nMaterials and Methods: Retrospective evaluation"nof 2790 coronary angiograms were obtained by 64-"nslice multidetector CT. The prevalance, length, depth,"nprecise of MB location and concomitant atherosclerosis"nproximal to tunneled segment were evaluated. The"ngroup of subjects with MB was compared with the"ncontrol group (subjects without MB."nResults: Of the 2790 subjects, 548 (19.64% were"nfound to have MB. MB was present equally in men"nand women. The tunneled segment was intact in"nall subjects. A negative significant correlation was"nfound between the presence of MB and severity of"natherosclerosis in the proximal segment of the coronary"nartery (p<0.001; df=2×2=42.75. The mid LAD was the"nmost common coronary artery involved. The severity"nof atherosclerosis in the part proximal to the tunneled"nsegment correlated with the thickness of bridge"n(p=0.035, but no significant correlation was found"nwith the length of the bridged segment (p=0.431."nConclusion: The myocardial bridge not only does not"npredispose to the development of atherosclerosis in"nthe coronary artery segment proximal to the bridge,"nbut may also be a protective factor.

  8. Correlation of 64-slices CT Features with Vascular Endothelial Growth Factor Expression in Brain Astrocytoma%VEGF在脑星形细胞瘤中的表达与64排CT征象的关系

    蔡胜艳; 孙妍; 胡嘉航

    2012-01-01

    目的:探讨脑星形细胞瘤64排CT征象与VEGF表达之间的关系.方法:搜集经手术证实的脑星形细胞瘤30例,分析其CT表现,术后对肿瘤组织标本进行免疫组化染色,分析其VEGF表达的程度与CT征象之间的关系.结果:星形细胞瘤的VEGF表达程度与肿瘤的分级、瘤周水肿的范围及肿瘤的强化程度有相关性.结论:星形细胞瘤的CT表现可以反映VEGF的表达程度,能对临床治疗方案的选择和患者预后的评估起到重要作用.%Objective To study the correlation of 64-slices CT features with vascular endolhelial growth factor(VEGF) expression in brain astrocytoma. Methods CT findings in 30 cases with surgically and pathologically proved astrocytoma were retrospectively analyzed. VEGF was stained with immuno- histochemical technique, and VEGF expression levels were compared with CTfeatures. Results VEGF expression levels were with correlated with pathological grade, the extent of per tumor edema and the degree of contrast enhancement. Conclusion CT features of astrocytoma can reflect VEGF expression levels. It is important for the choice of clinical treatment and prognostic evaluation of patients. [Chinese Medical Equipment Journal,2012,33(6):67-68

  9. 混合性生殖细胞瘤的64层螺旋CT诊断及病理表现%Diagnosis of mixed germ cell tumor by 64-slice spiral CT and pathological manifestations

    朱刚明; 谭琦碹; 钟胜; 李兆勇; 付东

    2011-01-01

    目的:探讨64层螺旋CT对混合性生殖细胞瘤的诊断价值.方法:回顾性分析7例经病理证实的混合性生殖细胞瘤的CT平扫及两期增强表现、病理标本及切片特征.结果:7例病灶3例位于卵巢,3例位于前纵隔.1例位于睾丸;其中3例边界清楚;各病灶密度不均匀,内见囊变、坏死区,1例可见脂肪及钙化:增强扫描静脉期较动脉期强化明显,均呈不均匀强化.病理结果2例卵黄囊瘤与成熟畸胎瘸混合型.2例卵黄囊瘤与未成熟畸胎瘤混合型.1例卵黄囊瘤、胚胎性癌、畸胎瘤混合型,1例绒癌与无性细胞癌混合型,1例精原细胞瘤、胚胎性癌、滋养细胞成分混合型.结论:64层螺旋CT对混合性生殖细胞瘤的诊断虽无特异性,但在一定程度上为肿瘤良恶性判断、临床分期提供十分重要的依据.%Objective:To investigate the diagnostic value of mixed germ cell tumor by 64 -slice spiral CT. Methods: The plain CT and two-phase enhanced CT scanning and pathological specimens of 7 cases of the tumor confirmed by pathology were retrospectively studied. Results: 3 cases were found in ovarian and 3 cases in anterior mediastinum and 1 case in testis. 3 lesions were clear boundary, with fat and calcification in 1 lesion. All the lesions were uneven density and the cystic or necrotic area could be found. Venous phase enhancement was significantly higher than other phase, showed inhomogc-neous enhance. Pathological findings: induded 2 cases of yolk sac tumor and mature teratoma mixed. 2 cases of yolk sac tumor and immature teratoma mixed, 1 case of yolk sac tumor embryonal carcinoma and teratoma mixed. 1 case of chorio-carcinoma and asexual cell carcinoma mixed, and 1 case of seminoma embryonal carcinoma and trophoblastic ingredients mixed. Conclusion: Although there is no specific by 64-slice spiral CT. To a certain degree.it can determine the benign or malignant tumor and give the important prop for clinical staging.

  10. The initial clinical application of multi-detector CT on spinal angiography

    Objective: To explore the value of Multi-detector CT in spinal cord angiography. Methods: Ten patients with initial MR and clinical findings suggestive of spinal cord vessel disease were performed CT spinal cord angiography. Among these, 7 patients were performed DSA later within 1 week, and 4 patients were therapy by operation. CT protocol: Toshiba Aquilion 64 slice CT scanner, 0.5 mm thickness, 0.5/r, 120 kV, 350 mA, choose aortic arch level as inspection position, and use 'surestart' technique with CT threshold 180 HU. Contrast medium was Iohexol (370 mg I/ml), with injection velocity of 6 ml/s. The total volume was 80 ml. The CT spinal cord angiography images were analyzed according to disease model, disease range, feeding artery, fistula, draining veins, and were compared with DSA and operation results. Results: All CT spinal cord angiography images displayed spinal vessel malformation. Among these, 3 patients were inner-medullary arteriovenous malformation; 2 patients were peri-medullary arteriovenous fistula; 5 patients were spinal dural arteriovenous fistula. All cases showed disease range, and draining veins clearly, one patient had two vessels that were false positive, and all the other cases showed feeding arteries clearly, which were confirmed by DSA. Conclusion: There are great values for CT spinal angiography in diagnosing spinal vessel disease, it can be a screening exam before DSA. (authors)

  11. 低仟伏64层MSCT扫描对泌尿系结石检出的研究%Low kilovotage 64-slice spiral CT in the detection of urinary calculus:an experimental study

    王秋霞; 陈亮; 黄文华; 胡道予

    2011-01-01

    目的:探讨低仟伏值(kV)低辐射量MSCT扫描对泌尿系结石的检出率及对图像质量的影响.方法:将4种单一成分的泌尿系结石108粒放入猪里脊肉内制成结石模型,应用64层螺旋CT对模型进行扫描,扫描的管电压分别为120 kV、100 kV和80 kV,并与不同的管电流进行组合,层厚为5 mm,层间距为5 mm,螺距为0.984.扫描后的原始数据(5mm层厚)重建成1.25mm层厚,使用GE ADW4.3工作站对数据进行处理.测量图像质量的噪声水平,记录X线辐射剂量指标CTDIvol.结果:与对照组120kV-250mAs相比,实验组80kV-150mAs及100kV-50mAs组的噪声SD值仅分别升高7.60%和8.62%,主观评分均为合格,结石检出率为100%,而辐射剂量降低率分别达到81.40%和87.60%.结论:合适的低kV-mAs组合对泌尿系结石的检出率可以达到100%,且明显降低辐射剂量.%Objective : To investigate the detectability of urinary calculi undergoing 64-slice CT scanning with reducing kV and to evaluate the image quality,so as to obtain the optimal scanning program. Methods : The calculi model was made by inserting 108 granules of urinary calculus containing four kinds of simple constituent into pork loin,and then scanned by 64-slice CT. The scanning parameters were as follows : three different dose-groups were chosen according to the fixed kV set 120kV, 100kV , 80kV : slice thickness and interval 5mm ; the pitch is 0.984; the raw data were reconstructed into 1.25mm ; all the reconstructed images were transferred to GE ADW4.3 workstation. To evaluate image quality according to different dose-groups and counted the number of detected calculus respectively. The standard deviation (SD) and signal to noise ratio (SNR) of the images were measured. CT dose index volume (CTDIvol) was obtained automatically. Results: 120kV~250mAs was set to be the control group. Compared with the control group,80kV-150mAs,100kV~50mAs and 120kV~30mAs noise SD values were only increased by 7.60 %,8

  12. Contrast-enhanced 64-slice computed tomography in detection and evaluation of anomalous coronary arteries

    Anomalous coronary artery (ACA) has either an unusual origin or different anatomical course and is associated with sudden cardiac death. The absence or nonspecific symptoms of ACA make its diagnosis difficult. Mostly, ACA is diagnosed coincidentally during invasive coronary angiogram (ICA). A conventional computed tomography (CT) cannot provide detailed images of coronary arteries of the moving heart, but 64-slice CT, with its short acquisition time, can provide detailed anatomy of coronary arteries non-invasively. In this study, we assessed the validity of contrast-enhanced 64-slice CT in the evaluation of ACA. ICA was performed in 7,574 patients for the diagnosis or evaluation of occlusive coronary artery disease and detected coronary anomalies in 56 patients (0.7%). We then performed 64-slice CT in 53 patients out of the 56 patients with demonstrated or suspected coronary anomaly, showing the origin and the course of the ACA along with stenosis, except for one patient who could not be evaluated due to image distortion artifacts. Contrast-enhanced 64-slice CT was also performed in 374 patients with vague signs and symptoms, detecting coronary anomalies in 7 patients (1.2%). Thus, in the total of 59 patients undergone 64-slice CT, we were able to visualize the entire abnormal coronary tree with a high diagnostic image quality. This is the first study to demonstrate the utility of 64-slice CT in a large series of ACA. Contrast-enhanced 64-slice CT is superior to ICA to identify the presence and course of ACA and should be the first line diagnostic tool in the evaluation of ACA. (author)

  13. Multislice CT angiography

    The introduction of multislice CT into clinical radiology constitutes a quantum leap that significantly widens the scope of vascular CT imaging. The advances over conventional spiral CT have been quantitative, mainly in terms of increased image acquisition speed which provides unprecedented volume coverage and spatial resolution. Moreover, significant technical innovations, such as cardiac scanning capabilities, have brought about a qualitative shift towards applications that were thought to be beyond the scope of CT imaging. This way multislice CT offers a wealth of new opportunities for quickly and accurately diagnosing suspected vascular disease in all organ systems; however, as we move towards faster and faster image acquisition techniques, we are also facing new challenges that require development of novel strategies in order to take full advantage of the increased capabilities of multislice CT in its current form and future generations of CT scanners. (orig.)

  14. Preliminary study of the optimization of abdominal CT scanning parameters on 64-slice spiral CT%64层螺旋CT腹部扫描参数优化的初步研究

    胡敏霞; 赵心明; 宋俊峰; 周纯武; 赵红枫

    2011-01-01

    Objective To investigate the appropriate low tube current of abdominal CT on a 64-slice spiral CT. Methods (1) Phantom study:The phantom Catphan500R was scanned with a fixed 120 kVp,and 450,400,380,360,340,320,300,280 mA, respectively. 15, 9, 8, 7, 6 mm diameter low-contrast objects with 1% contrast were scanned for evaluating image quality. CT images were graded in terms of lowcontrast conspicuity by using a five-point scale. Statistical analyses were performed to determine the appropriate tube current and the interval leading to the qualitative change. (2) Clinical study: 3 groups of 45 patients who had 2 examinations of non-enhanced abdominal CT within 3 months were enrolled. All patients were scanned with 450 mA at first scanning. For the second scanning, group-1 was scanned with optimal tube current, group-2 was scanned with optimal tube current plus interval, group-3 was scanned with optimal tube current sinus interval. CT images were graded in terms of the diagnostic acceptability at three anatomic levels including porta hepatis, pancreas and the upper pole kidney, and the image noises of eight organs including abdominal aorta, portal vein, liver, spleen, gallbladder, pancreas, renal cortex, renal medulla were graded by using a five-point scale. The image quality was compared with non-parametric rank sum test,and the individual factors of the patients were compared with the A VONA. Results (1) The optimal tube current and interval leading to the qualitative change were 340 mA and 40 mA respectively. (2) There were no significant differences in image quality between 340 mA and 450 mA in group-1, between 380 mA and 450 mA in group-2 (P > 0. 05). There was significant difference in image quality between 300 mA and 450 mA in group-3 (the mean scores for 300 mA were 2. 92 ± 0. 62,2.92 ± 0. 62,2.64 ± 0. 84,2. 72 ±0.82,2.63 ±0.71,2.51 ±0.84,3.04 ±0.72,3.04 ±0.72,2.63 ±0.71,2.52 ±0.73,2.93 ±0.81respectively; for 450 mA were 3.93 ± 0. 72,3.94 ± 0. 72

  15. 64-slice coronary computed tomography angiography using low tube voltage of 80 kV in subjects with normal body mass indices: comparative study using 120 kV

    Background. The radiation dose of coronary computed tomography (CT) angiography (CCTA) is generally higher than that of CT scans of other parts of the body, and there is concern that the high radiation dose may result in increased cancer risk. Although various techniques have recently been introduced to lower the radiation dose of CCTA, there has been no direct comparison between protocols with 80 and 120 kV. Purpose. To assess the image quality and radiation dose of 80-kV electrocardiography (ECG)-gated CCTA in subjects with a normal body mass index (BMI), compared to 120-kV ECG-gated CCTA. Material and Methods. This retrospective study was approved by our local ethics board, and the requirement of written informed consent was waived. We analyzed the CCTA images of 100 subjects with BMIs <25 kg/m2. Fifty subjects underwent 120-kV CCTA, and the other 50 subjects underwent 80-kV CCTA. Two blinded observers independently evaluated the subjective image quality of the coronary arteries. The objective image quality (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) and radiation dose were also measured in each group. Results. Although the objective image quality of the 80-kV protocol images was significantly poorer than that of 120-kV protocol images (mean SNR, 14.9 ± 4.7 vs. 19.8 ± 4.4, P < 0.0001; mean CNR, 15.2 ± 4.8 vs. 21.6 ± 4.7, P < 0.0001), there was no significant difference in the subjective image quality between the two groups (mean image score, 4.7 ± 1.1 vs. 4.5 ± 0.7 for radiologist 1, P 0.273; 5.0 ± 1.0 vs. 4.8 ± 1.0 for radiologist 2, P = 0.197). The radiation dose was reduced by 70% with the 80-kV protocol and by 88% with the 80-kV and ECG-based tube current modulation than with the 120-kV protocol (3.42 ± 1.16 and 2.9 ± 0.8 vs. 11.49 ± 3.62 mSv, P < 0.0001). Conclusion. The low tube voltage CCTA protocol using 80 kV allows significant reduction of the radiation dose without impairing the subjective image quality in subjects with

  16. Diagnostic value of CT angiography in myocardial bridge and mural coronary artery

    Objective: To discuss the clinical value of CT angiography (CTA) in diagnosis of myocardial bridge and mural coronary artery. Methods: Three hundred twenty-seven patients were performed 64 slices CT angiography to observe myocardial bridge, and evaluate the stenosis of mural coronary artery.All cases with myocardial bridge received coronary arteriongraphy and comparison. Results: Fifty-seven cases with 66 myocardial bridge segments were found, with mean length (4.72 ± 0.93) mm, mean thickness (2.04 ± 0.62) mm, the mean stenosis of mural coronary artery was (33 ± 20)%. Twenty-nine cases with 35 myocardial bridge segments were found by coronary arteriongraphy, the difference between them has statistical significance (P<0.05). Conclusion: CTA can clearly show myocardial bridge and mural coronary artery, and it has important significance in clinical diagnosis compared with traditional coronary arteriongraphy. (authors)

  17. Assessment of carotid arteri calcification using 3D-CT angiography

    The aim of this study was to evaluate carotid arteri calcifications using 3D-CT angiography. We performed a retrospective review of 181 patients referred for 64-slice multi-detector row computed tomography. Using curved multiplanar reformation (curved MPR) images of ZIOSOFT M900 QUADRA, we evaluated the distribution of calcifications around the carotid bifurcation. Among the 181 patients, 66 patients (36%) had arterial calcifications. The present study found that almost arterial calcifications localized at the carotid bifurcation. Furthermore, in the group with carotid arterial stenosis, we found arterial calcifications localized not only at the carotid bifurcation, but also at the distal side of internal carotid artery. Curved MPR imaging using 3D-CT angiography is a helpful tool for evaluating calcification of carotid arteries. (author)

  18. [Spiral CT angiography in practice].

    Pavcec, Zlatko; Zokalj, Ivan; Rumboldt, Zoran; Pal, Andrej; Saghir, Hussein; Ozretić, David; Latin, Branko; Perhoć, Zeljka; Marotti, Miljenko

    2005-01-01

    Incidence of vascular diseases and development of new radiologic techniques in the last three decades has given strong impuls for introduction of non-invasive vascular diagnostic methods. Thanks to the introduction of Doppler ultrasound, new types of computed tomography (CT) and magnetic resonance (MR) scanners, non-invasive vascular diagnostic methods are replacing conventional invasive (catheter) angiographic methods. Computed tomographic angiography (CTA) is a noninvasive vascular diagnostic method based on continuous scanning with CT scanner during intravenous application of contrast material. Performing of CTA is possible after introduction of spiral CT technique whose characteristics are short imaging time and volumetric data acquisition. The main goal of this article, based on our experiences, is to review the role of CTA, performed on single-slice CT scanner, in managment of patients with vascular pathology. PMID:16145870

  19. Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy

    Objective: The aim of this study was to assess the impact of heart rate, heart rate variability and calcification on image quality and diagnostic accuracy in an unselected patient collective. Subjects and methods: One hundred and two consecutive patients with known or suspected coronary artery disease underwent both 64-MSCT and invasive coronary angiography. Image quality (IQ) was assessed by independent observers using a 4-point scale from excellent (1) to non-diagnostic (4). Accuracy of MSCT regarding detection or exclusion of significant stenosis (>50%) was evaluated on a per segment basis in a modified AHA 13-segment model. Effects of heart rate, heart rate variability, calcification and body mass index (BMI) on IQ and accuracy were evaluated by multivariate regression. IQ and accuracy were further analysed in subgroups of significant predictor variables and simple regression performed to calculate thresholds for adequate IQ. Results: Mean heart rate was 68.2 ± 13.3 bpm, mean heart rate variability 11.5 ± 16.0 beats per CT-examination (bpct) and median Agatston score 226.5. Average IQ score was 2 ± 0.6 whilst diagnostic quality was obtained in 89% of segments. Overall sensitivity, specificity, PPV or NPV was 91.2%, 99.2%, 95.3% or 98.3%. According to multivariate regression, overall IQ was significantly related to heart rate and calcification (P = 0.0038; P < 0.0001). The effect of heart rate variability was limited to IQ of RCA segments (P = 0.018); BMI was not related to IQ (P = 0.52). Calcification was the only predictor variable with significant effect on the number of non-diagnostic segments (P < 0.0001). In a multivariate regression, calcification was also the single factor with impact on diagnostic accuracy (P = 0.0049). Conclusion: Whilst heart rate, heart rate variability and calcification all show an inverse correlation to IQ, severe calcium burden remains the single factor with translation of such effect into decrease of diagnostic accuracy

  20. Introduction to coronary imaging with 64-slice Computed Tomography

    The aim of this article is to illustrate the main technical improvements in the last generation of 64-row CT scanners and the possible applications in coronary angiography. In particular, we describe the new physical components (X-ray tube-detectors system) and the general scan and reconstruction parameters. We then define the scan protocols for coronary angiography with the new generation of 64-row CT scanners to enable radiologists to perform a CT study on the basis of the diagnostic possibilities

  1. Persistent hypoglossal artery and its variants diagnosed by CT and MR angiography

    Persistent hypoglossal artery (PHA) is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. We evaluated the prevalence of PHA on computed tomography (CT) angiography. We also evaluated characteristic features of PHA and its variants on magnetic resonance (MR) angiography. We retrospectively reviewed our database of 2,074 CT angiographic images obtained using either of two 64-slice multidetector CT scanners. We also reviewed our database of 7,646 MR angiographic images obtained using either of two 1.5-T or one 3.0-T imager. We could not determine the exact number of patients whose MR angiography included the hypoglossal canal. Most patients had or were suspected of having cerebrovascular diseases. We found six usual PHAs arising from the cervical internal carotid artery on CT angiography among 2,074 patients. On MR angiography, we also found six additional usual PHAs (total 12, right/left = 6/6, male/female = 3/9), three right PHAs originating from the external carotid artery (ECA), and two posterior inferior cerebellar arteries (PICAs) arising from the ECA without connection to the vertebral artery. The prevalence of usual PHA diagnosed by CT angiography was 0.29 %, slightly higher than that reported for angiography and may be due to selection bias in the examined patients. We propose naming usual PHA ''type 1 PHA''; PHA originating from the ECA, of which we found three, ''type 2 PHA''; and PICA arising from the ECA, of which we found two, ''type 2 PHA variant''. (orig.)

  2. CT angiography in carotid stenosis; CT-Angiographie bei Karotisstenosen

    Mildenberger, P.; Kauczor, H.U.; Ehrhard, K.; Thelen, M. [Johannes Gutenberg-Universitaet Mainz (Germany). Klinik und Poliklinik fuer Radiologie; Schmiedt, W. [Johannes Gutenberg-Universitaet Mainz (Germany). Klinik fuer Herz-, Thorax- und Gefaesschirurgie

    1997-11-01

    Purpose: Prospective evaluation of the accuracy CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5%, by MIP in 85%, and 3D in 100%. Correct classification was found in 65.5% for MPR, 66% for MIP and 88.5% for 3D. The sensitivity for severe stenoses was 74% for MPR, 82% for MIP, and 93% for 3D. The specificity of these methods was 98%, 96%, and 97%, respectively. All carotid occlusions were correctly identified, no carotid artery was wrongly classified as occluded. (orig./AJ) [Deutsch] In einer prospektiven Untersuchung sollte die Genauigkeit verschiedener Nachverarbeitungsmethoden der CT-Angiographie (CTA) der extrakraniellen Karotis im Vergleich zur DSA untersucht werden. 100 Patienten wurden mit einer standardisierten CTA untersucht. Zur Nachverarbeitung wurden MPR, MIP und 3D-Rekonstruktion nach Segmentation mit doppeltem Schwellenwert eingesetzt. Fuer die Durchmesserbestimmung wurden die intravasalen Dichteprofile beruecksichtigt. Alle CTA-Untersuchungen wurden mit intraarteriellen DSA-Untersuchungen korreliert. Die Bestimmung des Stenosegrades und die Klassifizierung erfolgte nach den NASCET-Kriterien. Die Auswertung der CTA war mit MPR in 82,5% mit MIP in 85% und mit der 3D in 100% moeglich. Die Uebereinstimmung zwischen DSA und CTA in der Klassifikation der Stenosegrade betrug fuer MPR 65,5%, fuer die MIP 66% und fuer die 3D-Rekonstruktion 88,5%. Die Sensitivitaet im Nachweis relevanter Karotisstenosen ist fuer die MPR 74%, fuer die MIP 82

  3. CT angiography in carotid stenosis

    Purpose: Prospective evaluation of the accuracy CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5%, by MIP in 85%, and 3D in 100%. Correct classification was found in 65.5% for MPR, 66% for MIP and 88.5% for 3D. The sensitivity for severe stenoses was 74% for MPR, 82% for MIP, and 93% for 3D. The specificity of these methods was 98%, 96%, and 97%, respectively. All carotid occlusions were correctly identified, no carotid artery was wrongly classified as occluded. (orig./AJ)

  4. Coronary CT angiography and MR angiography of Kawasaki disease

    Although the incidence of coronary artery aneurysms has diminished in patients with Kawasaki disease, coronary artery involvement is still regarded as a major complication of the disease, significantly affecting morbidity and mortality. Recent technical advances in coronary CT angiography (CTA) and MR angiography (MRA) have led to the possibility of using these two imaging methods as minimally invasive alternatives to the more invasive diagnostic catheter angiography in evaluating coronary artery abnormalities, such as aneurysm, stenosis, and occlusion. In this article, we describe imaging techniques and findings of coronary CTA and MRA in Kawasaki disease. (orig.)

  5. 64层螺旋CT评价膝关节创伤后的隐匿病变及软组织损伤%Evaluation of the occult lesions and soft tissue injury after knee injury by 64-slice spiral CT

    钟俊; 杨法宝; 赵学航; 张丽; 李勤祥

    2012-01-01

    背景:膝关节创伤患者在行X射线检查后进一步选择64层螺旋CT检查时,根据伤情及重建需要选择何种后处理技术在临床上存在一定分歧.目的:探讨64层螺旋CT及后处理技术在膝关节创伤中的应用价值.方法:回顾性分析79例膝关节创伤患者的普通X射线片及64排螺旋CT影像学资料,采用多平面重组、容积显示和表面遮盖显示等后处理技术,结合原始骨窗及软组织窗图像,由2名以上有经验的放射科和骨科医生对图像进行双盲分析并与临床及图像重建结果对照.结果与结论:在79例膝关节创伤患者中,共计92处骨折.普通X射线片诊断68例82处骨折,1例假阳性,5例假阴性,检出率约为89%;经64层螺旋CT及三维重建后确诊79例共92处骨折,检出率100%.证实,和X射线检查相比,64层螺旋CT及多种图像重建是膝关节创伤的重要辅助检查手段,能进一步明确有无膝关节周围隐匿性骨折、微骨折及脱位及软组织损伤等.%BACKGROUND: The patients with knee trauma received the 64-slice spiral CT examination after the X-ray examination, and there still some differences on the choice of the post-processing technology in clinic according to the injury and reconstruction needs. OBJECTIVE: To investigate application value of 64-slice spiral CT and the post-processing technology in the knee injury. METHODS: The imaging data of the X-ray and 64-slice spiral CTofthe 79 patients with knee injury were retrospectively analyzed, the post-processing technology, such as the multiple planar reformation, volume rendering and shaded surface display were adopted and combined with the image of the original bone and soft tissue window, and the images were dealt by two or more experienced X-ray and orthopaedic surgeons with double-blind analysis and compared with the clinical and operation results . RESULTS AND CONCLUSION: In all the 79 patients with knee injury, there were a total of 92 fractures

  6. 64排螺旋CT血管成像诊断永存三叉动脉%Diagnosis of persistent trigeminal artery with 64-slice spiral CT angiography

    袁飞; 刘银社; 赵军; 谷鹏; 顾欣; 冯凯琳

    2010-01-01

    目的 观察64排螺旋CT血管成像(CTA)在诊断永存三叉动脉(PTA)中的价值,提高对该血管变异的认识.方法 回顾性分析2734例行头颈64排螺旋CTA检查中的5例PTA患者的影像学资料,分析PTA的发生率、起源、走行、后循环供血及合并其他血管畸形的情况.结果 ①PTA的发生率为0.18%(5/2734),其中3例位于右侧,2例位于左侧.②三叉动脉均起自颈内动脉海绵窦段,血管走行外侧型4例,内侧型1例;按Saltzman分型显示PTA后循环供血情况:Ⅰ型1例,Ⅱ型1例,Ⅲ型3例.③吻合点近端的基底动脉及双侧椎动脉发育不良3例,吻合点近端基底动脉完全萎缩1例;合并PTA的动脉瘤1例,合并对侧大脑中动脉成窗1例.结论 64排CTA能清晰、快速、无创、准确地显示PTA及其走行.在鞍区或鞍上区手术及介入治疗前,了解这种异常血管的有助于制定合理的手术和介入治疗方案,避免因操作不当所致的危险.

  7. 64排螺旋CT血管造影诊断颅内动脉瘤%DIAGNOSIS OF INTRACRANIAL ANEURYSM WITH 64-SLICE SPIRAL CT ANGIOGRAPHY

    钱惠农; 王有刚; 朱蕴杰; 姜峰

    2009-01-01

    [目的]评估64排螺旋CT血管造影(CTA)在颅内动脉瘤诊断中的作用.[方法]对48例自发性蛛网膜下腔出血(SAH)患者进行CTA检查,同期行数字减影血管造影(DSA),分析比较两种检查的结果.[结果]11例SAH患者其CTA和DSA均未见异常.37例CTA和DSA结果存在异常患者中,CTA发现37个动脉瘤,DSA发现38个(2例多发性动脉瘤),CTA遗漏2个动脉瘤,误诊1个动脉瘤.CTA诊断动脉瘤的灵敏度为94.7%,特异度为91.7%.[结论]64排螺旋CTA是诊断颅内动脉瘤的一种简单、快速、准确的方法,具有极高的临床价值.

  8. Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

    Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ''CORE-64'' trial (''Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors''). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows. (orig.)

  9. Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

    Miller, Julie M.; Vavere, Andrea L.; Arbab-Zadeh, Armin; Bush, David E.; Lardo, Albert C.; Texter, John; Brinker, Jeffery; Lima, Joao A.C. [Johns Hopkins Hospital, Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Dewey, Marc [Charite - Universitaetsmedizin Berlin, Medical School, Humboldt-Universitaet und Freie Universitaet zu Berlin, Department of Radiology, Berlin, PO Box 10098 (Germany); Rochitte, Carlos E.; Lemos, Pedro A. [University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo (Brazil); Niinuma, Hiroyuki [Iwate Medical University, Department of Cardiology, Morioka (Japan); Paul, Narinder [Toronto General Hospital, Department of Medical Imaging, Toronto (Canada); Hoe, John [Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, Singapore (Singapore); Roos, Albert de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Yoshioka, Kunihiro [Iwate Medical University, Department of Radiology, Morioka (Japan); Cox, Christopher [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Clouse, Melvin E. [Harvard University, Department of Radiology, Beth Israel Deaconess, Boston, MA (United States)

    2009-04-15

    Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ''CORE-64'' trial (''Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors''). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows. (orig.)

  10. Detection of pulmonary embolism using 64-slice multidetector-row computed tomography: accuracy and reproducibility on different image reconstruction parameters

    Jung, Jung Im; Ahn, Myeong Im; Park, Seog Hee (Dept. of Radiology, Seoul St Mary' s Hospital, College of Medicine, The Catholic Univ. of Korea (Korea, Republic of)), email: jijung@catholic.ac.kr; Kim, Ki Jun (Deparment of Radiology, Incheon St Mary' s Hospital, College of Medicine, The Catholic Univ. of Korea (Korea, Republic of)); Kim, Hyo Rim (Deparment of Radiology, Yeouido St Mary' s Hospital, College of Medicine, The Catholic Univ. of Korea (Korea, Republic of)); Park, Hyun Jin (Dept. of Radiology, St Vincent Hospital, College of Medicine, The Catholic Univ. of Korea (Korea, Republic of)); Jung, SeungHee; Lim, Hyeon Woo (Deparment of Preventive Medicine, College of Medicine, The Catholic Univ. of Korea (Korea, Republic of))

    2011-05-15

    Background Direct comparison of different image reconstruction parameters to detect pulmonary embolism (PE) using 64-slice multidetector-row computed tomography (MDCT) is absent and the most accurate image reconstruction parameters have not yet been proven. Purpose To compare different image reconstruction parameters for detecting PE using 64-slice MDCT in patients suspected of having an acute PE. Material and Methods Forty patients who underwent pulmonary CT angiography with 64-slice MDCT for a suspected PE were included. Different image reconstruction parameters were used for each patient: axial and coronal images with slice thicknesses of 0.625 mm, 1.3 mm, and 2.5 mm and axial maximum intensity projection (MIP) images with slab thicknesses of 1.3 mm, 2.5 mm, and 5 mm. Four experienced radiologists reviewed the images. The diagnosis of a PE was based on consensus review of axial 0.625 mm slice thickness images by two chest radiologists with allowing multiplanar reconstruction. Accuracy and reproducibility (kappa value) were evaluated. Results In 15 of 40 patients, a PE was diagnosed. For detecting lobar PEs, axial images with a slice thickness of 1.25 mm and all coronal re-formatted images showed comparable results to axial images with a slice thickness of 0.625 mm. For detecting segmental PEs, axial images with a slice thickness of 1.25 mm and coronal images with a slice thickness of 0.625 mm re-formatted images showed comparable results to axial images of a slice thickness of 0.625 mm. For detecting subsegmental PEs, axial images with a slice thickness of 0.625 mm showed the highest sensitivity. Better reproducibility was obtained when the thinner slice thickness reconstructions were in axial and coronal images. However, reproducibility of MIP images with slab thicknesses of 2.5 mm and 5 mm was similar for detecting segmental and subsegmental PEs. Conclusion Thin-slice reconstruction of less than 1 mm is mandatory for visualization of PE at the subsegmental

  11. Diagnostic accuracy of sixty four multi-slice CT angiography in assessment of arterial cut-off and run-off in comparison with surgical findings

    The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography in run-off and cut-off sites of arterial disease. Patients and Methods: Throughout the study, multislice CT angiography followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93) years. Multislice CT angiography was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. Results: Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to multislice CT angiography findings, the most frequent site of stenosis was the superficial femoral artery. Spear man's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of multislice CT angiography compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. Multislice CT angiography findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases (81.6%). Cut-off sites were correctly identified by multislice CT angiography in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%). Conclusion: multislice CT angiography angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis.

  12. Post-mortem CT-coronary angiography

    Pøhlsgaard, Camilla; Leth, Peter Mygind

    2007-01-01

    post-mortem coronary angiography and computerized tomography.  We describe how to prepare and inject the contrast medium, and how to establish a CT-protocol that optimizes spatial resolution, low contrast resolution and noise level. Testing of the method on 6 hearts, showed that the lumen of the...

  13. Experimental measurement of the scatter fraction in skull and body CT for teams 64- slice computed tomography; Medida experimental de la fraccion de dispersion TC en craneo y cuerpo para equipo de tomografia computarizada de 64 cortes

    Sanchez, G.; Haro, G.; Herrador, M.

    2011-07-01

    Different formalisms for the calculation of shielding in Cf equipment, the proposed document 147 of NCRP are widely accepted. Of the three methods mentioned in the protocol, two involve the use of two independent factor a of equipment, called scatter fraction CT in skull and body. Interestingly, the experimental measurement of the same, especially in those models following the publication of the document, which are also coincides with the highest number of detector channels and overall a greater radiation beam in the z axis.

  14. Evaluation of the Optimal Image Reconstruction Interval for Coronary Artery Imaging Using 64-Slice Computed Tomography

    Background: Cardiac computed tomography (CT) has become an established complement in cardiac imaging. Thus, optimized image quality is diagnostically crucial. Purpose: To prospectively evaluate whether, by using 64-slice CT, a specific reconstruction interval can be identified providing best image quality for all coronary artery segments and each individual coronary artery. Material and Methods: 311 coronary segments of 14 men and seven women were analyzed using 64-slice CT. Data reconstruction was performed in 5% increments from 5-100% of the R-R interval. Four experienced observers independently evaluated image quality of the coronary arteries according to the AHA classification. A three-point ranking scale was applied: 1, very poor, no evaluation possible; 2, diagnostically sufficient quality; 3, highest image quality, no artifacts. Results: The best reconstruction point for all segments was found to be 65% of the R-R interval (mean value 2.4±0.5; P<0.05). On a per-artery basis, best image quality was again achieved at 65% of the R-R interval: RCA 2.2±0.4, LCA 2.4±0.5, LM 2.5±0.2, LAD 2.3±0.4, LCX 2.3±0.5. Conclusion: By using 64-slice CT, the need for adjusting the reconstruction point to each coronary segment might be overcome. Best image quality was achieved with image reconstruction at 65% of the R-R interval for all coronary segments as well as each coronary artery

  15. Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography

    The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. Eighty-one patients (41 males and 40 females) who were diagnosed with suspected coronary artery disease and were referred to Golestan Hospital, Imaging Department were recruited. Inclusion criteria were based on the protocol of multi-slice CT coronary angiography. The radiation dose to the thyroid and pelvis regions was measured using thermo luminescent dosimeters (TLDs). The mean radiation dose to the thyroid in male and female subjects was 0.32 mSv and 0.41 mSv, respectively (P = 0.032) (total mean, 0.36 mSv). The mean radiation dose to the pelvis in male and female subjects was 81 μSv and 112 μSv, respectively (P = 0.026) (total mean, 96.5 μSv), The total mean radiation dose to the thyroid and gonads was 0.36 mSv, and 96.5 μSv, respectively for the subjects. These values were high for one organ in a single study. Gender can affect the radiation dose to the thyroid and gonads. This can be attributed to the anatomical characteristic differences of the male and female subjects

  16. 64排CT与全景牙片在埋伏牙诊断中的应用%Diagnositic Value of 64-Slice CT and Intraoral Digital Dental Radiography Technique in Embedded Teeth

    陈殿森; 陈望; 滑炎卿

    2011-01-01

    目的:评价64排螺旋CT与口腔全景X线牙片对上颌前部埋伏牙诊断及定位的应用价值.方法:对42例全景X线牙片疑上颌埋伏牙患者行64排螺旋CT扫描,并应用64排螺旋CT图像后处理功能,做三维重建和多层面重建,获取相应牙体的任意平面、任意方位图像.结果:42例患者,38例为上颌前部埋伏牙,25例埋伏牙位于腭侧,9例埋伏牙位于唇侧,4例埋伏牙牙根位于腭侧,而牙冠位于唇侧,经手术证实,符合率100%.结论:多排螺旋CT对儿童上颌埋伏牙能做出精确定位,对上颌埋伏牙诊断及定位的价值优于全景数字X线牙片,可作为上颌埋伏牙临床外科治疗及正畸治疗前的重要检查方法.%Objective: To compare the clinic application of multirow spiral CT (MSCT) and intraoral digital dental radiography technique in location with embedded teeth of children. Methods: Forty-two children suspected for embedded teeth were examined by MSCT and intraoral digital dental radiography technique with multiplanar reformation (MPR) and three dimensional (3D) reconstruction of MSCT. Results: A total of 38 cases of embedded teeth were diagnosed, including 25 embedded teeth located in palate sides, 9 in lip sides, and 4 cases of which the teeth root located in palate sides, and the teeth crown located in lip sides. According to the resluts of surgery, the accurate rate was 100%. Conclusion; Multirow spiral CT can accurately locate embedded teeth of children, and have an obvious advantage over the intraoral digital dental radiography technique in diagnosis and locating of embedded teeth. It is an important method to be applied in examing embedded teeth in upper jaw.

  17. CT Angiography and MR Angiography of Carotid Arteries

    M Motevalli

    2009-01-01

    Full Text Available  CT angiography (CTA has revolutionized vascular imaging. Vessels smaller than 1mm in diameter can be visualized with single slice CTA and vessels 2 mm or more in diameter can be diagnostically evaluated. The acquisition of 3D data volumes makes it possible to generate "angiographic" views that facilitate anatomic orientation."nWith the advent of multi slice CTA, near isotropic resolution becomes available for most applications and allows evaluation of even smaller vessels."nMulti slice scanning makes CTA less technically challenging and more robust. It reduces scan time and the vulnerability to motion artifacts, and may be used to substantially decrease the required contrast material volume to as little as 50 ml in selected cases."nThe advantages of CTA over arterial angiography (DSA include substantially lower invasiveness, less cost, less radiation exposure, and better patient tolerance. Diagnostic advantages include simultaneous visualization of the vessel wall and lumen, and the ability to study vascular anatomy from arbitrary viewing angles using only one data acquisition."nCTA even allows projections (such as Caudocranial that cannot be obtained with conventional angiographic techniques."nAlthough CTA can replace diagnostic ultrasound with its various Doppler techniques, it may be preferred over CTA in regions that are easily accessible by sonography or when flow information is required. It also holds advantages whenever bedside imaging is to be preferred."nMagnetic resonance angiography (MRA has become the common place in the last few years. The improvements in pulse sequence design, hardware design, and post processing methods make it possible to acquire data in a short period with excellent vascular visualization in a variety of clinical applications."nContrast -enhanced magnetic resonance angiography (MRA offers competitive results to CTA, although spatial resolution is often lower than with multi slice CT scanning. The lack of

  18. Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease and cor pulmonale using cardiac 64-slice spiral CT comparing with 1.7 T MRI

    cardiac CT were correlated well with that on cardiac MRI. The MM of the RV showed moderate correlation (r=0.82), RV volumes and RVEF significant correlation (r=0.98 and 0.97 for RV EDV and RV ESV, r=0.95 for RVEF, respectively). A strong correlation between MSCT and MRI for the assessment of RV function was also found using Bland-Altman plot. The correlation was excellent between the MSCT results and forced expiratory volume in 1 sec (r=0.781 for RVEF, r=-0.824 for RV MM) in COPD patients. Conclusions: Cardiac MSCT can accurately assess the RV size and function in comparison to MRL Patients with severe COPD have RV dysfunction. (authors)

  19. Usefulness of 64-slice MDCT for follow-up of young children with coronary artery aneurysm due to Kawasaki disease: Initial experience

    To evaluate the initial application and value of 64-slice multidetector computed tomography as an alternative diagnostic modality in the follow-up of young children with coronary artery aneurysm due to Kawasaki disease. Twelve boys (mean age 5.1 years, range 1.8-7.8 years) for follow-up (time range from 1.1 to 5.1 years) of known Kawasaki disease and coronary artery aneurysm underwent 64-slice MDCT ECG-gated coronary angiography. All data were acquired without breath holding. Two pediatric radiologists independently assessed image quality and the diameter of all coronary segments were measured for each patient. The number, position, shape and size of each coronary artery aneurysm were observed and compared with those of ECHO performed previously. A total of 118/156 segments permitted visualization with diagnostic image quality, the CT measurements showed good inter-observer and intra-observer reliability, coefficients were 0.93 and 0.88, respectively. A total of 30 coronary artery aneurysms were identified with measured mean of 7.5 ± 3.8 mm in diameter, and of 12.4 ± 9.1 mm in longitudinal lengths.10 tumors were small, 8 tumors were medium and 12 tumors were giant aneurysm. The affected segments included LM7/12(58.3%), 9/12(75%) of LAD1, 4/12(33.3%) of LAD2, 2/12(16.7%) of LCX1; 6/12(50%) of RCA1, 9/12(75%) of RCA2 and 4/12(33.3%) of RCA3, including affected two segments in 9 tumors and three segments in 1 tumor. Calcifications were found in 5 aneurysms and 3/5 with thrombosis; six stenotic segments were found. ECHO failed to detect 8 tumors with 2/8 in LAD, 1/8 in LCX and 5/8 in RCA, and those included 4 small aneurysms. The use of 64-slice MDCT angiography proved valuable for monitoring young children with Kawasaki disease. However, further study is necessary to specify the sensitivity and specificity of MDCT in the follow-up.

  20. Multidetector-row CT angiography of hepatic artery: comparison with conventional angiography

    To determine the usefulness of three-dimensional CT angiography using multidetector-row CT (MD-CT) for delineating the arterial anatomy of the liver. Hepatic arterial three-dimensional CT angiography was performed using MDCT (lightspeed Qx/I; GE medical systems, milwaukee, Wis., U.S.A.) in 45 patients with HCC undergoing conventional angiography for transcatheter hepatic arterial chemoembolization. The scanning parameters during the early arterial phase were 2.5 mm slice thickness, 7.5 mm rotation of table speed, and a pitch of 3. Images were obtained by one radiologist using maximum intensity projection from axial CT images obtained during the early arterial phase. Two radiologists blinded to the findings of conventional angiography independently evaluated the hepatic arterial anatomy and the quality of the images obtained. Compared with conventional angiography, reader A correctly evaluated the hepatic arterial anatomy depicted at three-dimensional CT angiography. Reader B's evaluation was correct in 40 of 45 patients. Interobserver agreement was good (kappa value, 0.73), and both readers assessed the quality of three-dimensional CT angiography as excellent. Three-dimensional CT angiography using MDCT was accurate for delineating the arterial anatomy of the liver, and interobserver agreement was good. The modality may provide, prior to conventional angiography, valuable information regrading a patient's hepatic arterial anatomy

  1. Müller状态下64排螺旋CT对阻塞性睡眠呼吸暂停低通气综合征诊断价值的研究%The study of the diagnostic value of 64-slice CT in obstructive sleep apnea hypopnea syndrome in Müller mameuver

    周旭; 王建中; 刘骏桢

    2013-01-01

    目的:通过对平静呼吸和Müller状态下的中重度OSAHS患者行CT扫描,了解Müller状态下上气道阻塞塌陷的具体部位、程度及累及范围,为手术治疗提供依据.方法:对30例经PSG确诊的中重度OSAHS患者分别行平静呼吸和Müller状态下64排VCT扫描,并经上气道三维重建和仿真内镜技术处理,比较2种状态下上气道各平面横截面积和各径线长度以及咽壁厚度、软腭悬雍垂长厚度、软硬腭角度、舌骨硬腭距离等指标.结果:平静呼吸时吸气末和Müller's动作吸气末各平面截面积和径线比较,舌根后区及会厌后区的前后径差异无统计学意义(P>0.05),其余所有气道径线的差异均有统计学意义(P<0.05).各平面软组织厚度比较,软腭后区、悬雍垂后区、舌根后区左右侧壁软组织厚度及软腭后区的后壁厚度、悬雍垂软腭长厚度比较差异均有统计学意义(P<0.05),软硬腭角度比较差异有统计学意义(P<0.05),舌骨的位置在Müller' s动作时有显著的下移.结论:通过64排CT上气道三维重建和仿真内镜技术,可推测中重度OSAHS患者打鼾时上气道塌陷阻塞的具体部位、程度、累及范围,以及上气道各平面软组织的变化情况,其临床应用价值大.%Objective:To examine the location,extent and cause of collapsed airway in Muller maneuver in OS-AHS patients with CT scan,and provide the evidence for surgery. Method:Thirty patients with moderate or severe OSAHS were measured with 64 slice CT in quiet breathing and in Muller maneuver. After three-dimensional reconstruction and virtual endoscope handing of the upper airway, we compare the cross-section area and the dimensions of five levels as well as the thickness of retropharyngeal and lateral pharyngeal tissue in two conditions. The evaluation values include the length and thickness of soft palate and uvula, soft-hard palate angle and hyoid hard palate distance. Result:The lateral distance

  2. Assessment of anemia during CT pulmonary angiography

    Objectives: Anemia is associated with increased mortality in patients with acute symptomatic pulmonary embolism (PE). The purpose of this study was to evaluate the feasibility of Hounsfield unit (HU) measurements on the single unenhanced trigger slice of pulmonary CT angiography scans for diagnosis of anemia. Material and Methods: 150 consecutive patients (median age 64 ± 16 years) with suspected PE underwent pulmonary CT angiography. Two radiologists, blinded to laboratory results, performed HU measurements in the single unenhanced trigger scan independently by region-based analysis (ROI). HU values from ascending and descending aorta and the calculated mean of both were correlated with serum hemoglobin levels. Inter- and intraobserver variability was determined for HU measurements, and ROC analysis was performed for diagnosis of anemia. Calculated linear models were used to assess formulas for estimation of hemoglobin levels from HU measurements. Results: HU measurements revealed high intra- and interrater reliability (ICC > 0.981 and ICC > 0.965, respectively). Calculated mean HU values showed a strong correlation with serum hemoglobin levels (r = 0.734), which allowed generation of different formulas for calculation of hemoglobin levels from HU measurements. ROC analyses confirmed a high sensitivity (80.4 for men; 91.3 for women) and specificity (84.0 for men; 84.9 for women) for diagnosing anemia. Conclusion: Diagnosis of anemia and quantification of hemoglobin levels upon a single unenhanced trigger scan of pulmonary CT angiography is feasible. We suggest disclosing the anemic state in the radiological report, independent of the presence of PE, since anemia carries increased risks of morbidity and mortality.

  3. Assessment of anemia during CT pulmonary angiography

    Jung, Caroline, E-mail: cjung@uke.de [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Groth, Michael; Bley, Thorsten A.; Henes, Frank O. [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Treszl, András [Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Adam, Gerhard; Bannas, Peter [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany)

    2012-12-15

    Objectives: Anemia is associated with increased mortality in patients with acute symptomatic pulmonary embolism (PE). The purpose of this study was to evaluate the feasibility of Hounsfield unit (HU) measurements on the single unenhanced trigger slice of pulmonary CT angiography scans for diagnosis of anemia. Material and Methods: 150 consecutive patients (median age 64 ± 16 years) with suspected PE underwent pulmonary CT angiography. Two radiologists, blinded to laboratory results, performed HU measurements in the single unenhanced trigger scan independently by region-based analysis (ROI). HU values from ascending and descending aorta and the calculated mean of both were correlated with serum hemoglobin levels. Inter- and intraobserver variability was determined for HU measurements, and ROC analysis was performed for diagnosis of anemia. Calculated linear models were used to assess formulas for estimation of hemoglobin levels from HU measurements. Results: HU measurements revealed high intra- and interrater reliability (ICC > 0.981 and ICC > 0.965, respectively). Calculated mean HU values showed a strong correlation with serum hemoglobin levels (r = 0.734), which allowed generation of different formulas for calculation of hemoglobin levels from HU measurements. ROC analyses confirmed a high sensitivity (80.4 for men; 91.3 for women) and specificity (84.0 for men; 84.9 for women) for diagnosing anemia. Conclusion: Diagnosis of anemia and quantification of hemoglobin levels upon a single unenhanced trigger scan of pulmonary CT angiography is feasible. We suggest disclosing the anemic state in the radiological report, independent of the presence of PE, since anemia carries increased risks of morbidity and mortality.

  4. Usefulness of CT angiography for demonstrating cerebral aneurysm

    We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60 % urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89 %, higher than those of previous reports. Thirteen aneurysms were located at internal carotidposterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2 - 3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms. (author)

  5. Study on the three dimensional hepatic virtual operation based on the data of 64-slice helical CT scanning%基于64排螺旋CT扫描数据三维肝脏手术仿真的研究

    朱新勇; 方驰华; 鲍苏苏; 全显跃; 焦培峰; 钟世镇

    2008-01-01

    目的 研究基于64排螺旋CT扫描数据的三维肝脏虚拟手术的设计和仿真效果,以及基于自由设计模型系统(FreeForm Modeling System)的虚拟手术的可行性.方法 采集正常人肝脏64排薄层扫描数据集,利用医学三维重建软件(MIMICS软件)进行肝脏及其肝内血管三维重建,并将重建的肝脏及其管道模型、人工绘制肝脏肿瘤模拟物导入FreeForm Modeling System,利用力反馈设备(PHANToM),对肝脏模型进行手术切割.结果 通过旋转和放大目标物体,肿瘤与肝内血管的立体关系能清晰展示.根据手术原则,使用PHANToM操纵"手术刀",仿真左外叶切除,术中肝内管道结构容易识别,其过程基本符合临床肝脏肿瘤切除的手术过程并可调节目标物体的强度,感受切割时力反馈的大小.结论 利用FreeForm Modeling System虚拟手术系统仿真肝脏手术切割,可以制定合理的个体化手术方案,减少并发症发生,提高手术成功率.%Objective To study the surgery plan and simulation effect of the three dimensional(3D)hepatic virtual operation based on the data of 64-slice helical CT scanning and to probe the feasibility of the virtual operation based on the FreeFotin Modeling System.Methods The volunteer liver Was scanned to collect two dimensional(2D)DICOM data of 64-slice helical CT scanning and the 3D hepatic and intrahepatic vessels model were reconstructed by MIMICS software.The reconstructed liver,the intrahepatic vessels model and the artificial tumor models were outputted into the FreeForm Modeling System in the STL format.The device PHANToM with the characterization of dynamo-feedback was applied to make the operation on tlle 3D hepatic.Resuits The spatial relationship between the tumour and the intrahepatic vessels were clearly observed by rotation and enlargement of the target.According to the operation principle,the left lobe of liver resection was simulated by manipulating the device PHANToM.Through the

  6. Peripheral CT angiography for interventional treatment planning

    Lower extremity CT angiography (CTA) has evolved into a very effective, widely available and robust imaging modality for patients with peripheral arterial occlusive disease (PAOD). In this article we briefly review the acquisition and contrast administration techniques for 4- through 64-channel peripheral CTA. Visualization of atherosclerotic disease with CTA in general requires 'angiography-like' 3D images (such as volume rendered or maximum intensity projection images), but-notably in the presence of vessel wall calcifications and stents-cross-sectional views (such as curved planar reformations, CPR) are also required to accurately assess the flow lumen of the aorta down to the pedal arteries. Adequate visualization and mapping of atherosclerotic lesions in patients with PAOD is not only a prerequisite for generating a dictated report, but more importantly, standardized postprocessed images are the key to communicating the findings to the treating physician, and they also serve as a treatment planning tool. Treatment decisions (surgical versus transluminal revascularization, or conservative treatment), and percutaneous treatment planning (access site, antegrade versus retrograde puncture) can be made in the majority of patients with PAOD based on lower extremity CT angiograms. (orig.)

  7. Data acquisition for pediatric CT angiography: problems and solutions

    With appropriate attention to the technical aspects, excellent CT angiography can be obtained even in young infants. In this article, we will present the problems inherent with pediatric CT angiography and offer solutions that minimize or eliminate these difficulties. In addition, a literature review of specific pediatric applications is provided. (orig.)

  8. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis.

    Barbero, Umberto; Iannaccone, Mario; d'Ascenzo, Fabrizio; Barbero, Cristina; Mohamed, Abdirashid; Annone, Umberto; Benedetto, Sara; Celentani, Dario; Gagliardi, Marco; Moretti, Claudio; Gaita, Fiorenzo

    2016-08-01

    A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation. PMID:27140337

  9. Comparative study of 64-slice CT angiography and digital subtraction angiography in spontaneous subarachnoid hemorrhage cases%自发性蛛网膜下腔出血的CTA与DSA对比研究

    薛波; 高国波; 李勇; 张立军; 李昌晓

    2013-01-01

    目的:探讨64层CTA与DSA对自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,s-SAH)的应用价值及其限度.方法:收集153例s-SAH患者的CTA及DSA检查资料,回顾性分析2种检查方法的图像质量(采取1~3分评分制),并比较2种方法在脑动脉瘤检出方面的灵敏度、特异度及准确度.结果:图像质量评分CTA为(2.63±0.262)分,DSA为(2.73±0.254)分,二者差异无统计学意义(P>0.05).CTA对脑动脉瘤的检出的灵敏度为96.2%,特异度为94.9%,准确度为95.9%;DSA灵敏度为97.7%,特异度为97.4%,准确度为97.6%,二者差异无统计学意义(P>0.05).结论:在s-SAH患者中,CTA与DSA均能准确检出动脉瘤所致破裂出血.相较于DSA,CTA能多方位显示病变,对血管壁及血管周围情况的显示更具价值.

  10. Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: A comparative study

    Objective: To evaluate a 100-kilovoltage (kV) tube voltage protocol regarding radiation dose and image quality, in comparison with the standard 120 kV setting in cardiac computed tomography angiography (CCTA). Methods: 103 patients undergoing retrospective ECG-gated helical 64-slice CCTA were enrolled (100 kV group: 51 patients; 120 kV group: 52 patients). Inclusion criteria were: (1) BMI 2; (2) weight 25 kg/m2). Conclusions: The 100 kV protocol significantly reduces the radiation dose in CCTA in patients with a low BMI 2 and a low calcium load while maintaining high image quality and the advantages of helical scan algorithm.

  11. Hybrid cardiac SPECT/64-slice CTA-derived LV function parameters: Correlation and reproducibility assessment

    The purpose of this study is to define the relationship between SPECT and CTA measured parameters of left ventricular (LV) function and volumes obtained in a single session using SPECT/64-slice CT hybrid imaging device, and in addition, to assess the reproducibility of LV parameters measured using 64-slice CTA. Materials and methods: Seventy-six patients with suspected or known coronary artery disease underwent cardiac CTA and GSPECT in one session using a hybrid SPECT/CT device. LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were measured on each component of the hybrid device. For the CTA component, these parameters were re-measured by the same investigator and by a second investigator with an interval of 3-54 weeks. Corresponding GSPECT and CTA measured parameters were compared. For CTA, intra-observer and inter-observer variability of LV function and volume measurements were calculated. Results: A very good correlation was found between the GSPECT and CTA measured LVEF (r = 0.81), ESV (r = 0.90) and EDV (r = 0.82). There was a small positive difference by CTA measured LVEF (3.9 ± 14.2%), and more prominent positive differences by CTA measured ESV and EDV (9.8 ± 14.8 and 44.9 ± 23.1 cm3, respectively). There was excellent reproducibility in the measurements of all parameters with very low intra- and inter-observer variability (r = 0.93 for EF and 0.98 for EDV and ESV). Conclusions: Although a good correlation was found between the EF measurements obtained from CTA and SPECT, interchangeable use of EF measurements between the two modalities should be done cautiously and interchangeable use of LV EDV and ESV should be avoided.

  12. Multidetector CT angiography in Takayasu arteritis

    Khandelwal, Niranjan; Kalra, Naveen [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Garg, Mandeep Kumar, E-mail: gargmandeep@hotmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Kang, Mandeep; Lal, Anupam [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Jain, Sanjay [Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Suri, Sudha [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India)

    2011-02-15

    Objective: To analyse the spectrum of Takayasu's arteritis (TA) on multidetector CT angiography (MDCTA). Materials and methods: A retrospective analysis of the MDCTA findings was performed on 15 patients clinically diagnosed as Takayasu's arteritis. The spectrum and incidence of imaging findings on CTA were compared to studies in literature on catheter angiography in Takayasu's arteritis. Laboratory parameters were available in nine patients. The disease was considered active if erythrocyte sedimentation rate (ESR) levels were elevated and 'C' reactive protein (CRP) was positive. An attempt was made to correlate disease activity with the imaging findings. Results: Ascending aorta, arch of aorta and descending thoracic aorta were involved in 14 out of 15 (93%) patients. The wall thickness varied between 1 and 10 mm with maximal involvement in arch and descending thoracic aorta. Major neck vessels were involved in 11 (73%) patients with most pronounced changes seen in the brachiocephalic trunk, left common carotid artery (CCA) and left subclavian artery (SCA). Abdominal aorta and its branches were involved in all the 11 (100%) patients in whom abdominal CTA was performed. Celiac axis and SMA were involved in 10 (91%) and seven (64%) patients, respectively while renal artery stenosis was present in five (45%) patients. In six patients, ESR was elevated and CRP was positive indicating active disease. All patients in whom the laboratory parameters were available showed mural thickening in the aorta and at least one of the neck vessels except for one patient with inactive disease who had aortic mural thickening only. Conclusion: MDCTA provides information about both the vessel wall and lumen in patients with Takayasu's disease.

  13. Multidetector CT angiography in Takayasu arteritis

    Objective: To analyse the spectrum of Takayasu's arteritis (TA) on multidetector CT angiography (MDCTA). Materials and methods: A retrospective analysis of the MDCTA findings was performed on 15 patients clinically diagnosed as Takayasu's arteritis. The spectrum and incidence of imaging findings on CTA were compared to studies in literature on catheter angiography in Takayasu's arteritis. Laboratory parameters were available in nine patients. The disease was considered active if erythrocyte sedimentation rate (ESR) levels were elevated and 'C' reactive protein (CRP) was positive. An attempt was made to correlate disease activity with the imaging findings. Results: Ascending aorta, arch of aorta and descending thoracic aorta were involved in 14 out of 15 (93%) patients. The wall thickness varied between 1 and 10 mm with maximal involvement in arch and descending thoracic aorta. Major neck vessels were involved in 11 (73%) patients with most pronounced changes seen in the brachiocephalic trunk, left common carotid artery (CCA) and left subclavian artery (SCA). Abdominal aorta and its branches were involved in all the 11 (100%) patients in whom abdominal CTA was performed. Celiac axis and SMA were involved in 10 (91%) and seven (64%) patients, respectively while renal artery stenosis was present in five (45%) patients. In six patients, ESR was elevated and CRP was positive indicating active disease. All patients in whom the laboratory parameters were available showed mural thickening in the aorta and at least one of the neck vessels except for one patient with inactive disease who had aortic mural thickening only. Conclusion: MDCTA provides information about both the vessel wall and lumen in patients with Takayasu's disease.

  14. Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography

    CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combination of the two might improve diagnostic accuracy. We conducted a head-to-head comparison of CTA, measurement of MBF by 15O-water PET, and hybrid PET/CTA for the detection of significant coronary artery stenoses. The study group comprised 44 outpatients scheduled for invasive coronary angiography (ICA) with an intermediate pretest likelihood of coronary artery disease. The patients underwent 64-slice CTA and baseline and hyperaemic PET before ICA with quantitative coronary angiography analysis. On a per-patient basis, the negative predictive values (NPV; 95 % confidence intervals in parentheses) were 88 % (64 - 97 %) for CTA, 90 % (71 - 97%) for PET and 92 % (74 - 98%) for PET/CTA, and the positive predictive values (PPV) were 71 % (53 - 85%) for CTA, 87 % (68 - 95%) for PET and 100 % (84 - 100%) for PET/CTA. Similarly, on a per-vessel basis the NPVs (which were generally high) were 97 % (94 - 100%) for CTA, 95 % (90 - 99%) for PET and 97 % (95 - 100%) for PET/CTA, and the PPVs (which were lower, but higher with PET/CTA) were 53 % (39 - 66%) for CTA, 53 % (40 - 66%) for PET and 85 % (73 - 97%) for PET/CTA. In six patients, CTA analysis was hampered by the presence of severe calcifications. However, with the addition of the PET data, all six patients were correctly categorized. Cardiac quantitative hybrid PET/CTA imaging has better diagnostic accuracy than CTA alone and PET alone. CTA has a suboptimal PPV, suggesting that hybrid PET/CTA imaging should be used to assess the significance of coronary stenoses diagnosed by CTA. (orig.)

  15. Hybrid CT angiography and quantitative {sup 15}O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography

    Thomassen, Anders; Petersen, Henrik; Johansen, Allan; Braad, Poul-Erik; Hoeilund-Carlsen, Mette M.; Hoeilund-Carlsen, Poul F. [OUH, Odense University Hospital, Department of Nuclear Medicine, Odense C (Denmark); Diederichsen, Axel C.P.; Mickley, Hans; Jensen, Lisette O.; Thayssen, Per [OUH, Odense University Hospital, Department of Cardiology, Odense (Denmark); Gerke, Oke [OUH, Odense University Hospital, Department of Nuclear Medicine, Odense C (Denmark); University of Southern Denmark, Centre of Health Economics Research, Odense (Denmark); Vach, Werner [University Medical Center Freiburg, Clinical Epidemiology, Institute of Medical Biometry and Medical Informatics, Freiburg (Germany); Knuuti, Juhani [Turku University Hospital and University of Turku, Turku (Finland)

    2013-12-15

    CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combination of the two might improve diagnostic accuracy. We conducted a head-to-head comparison of CTA, measurement of MBF by {sup 15}O-water PET, and hybrid PET/CTA for the detection of significant coronary artery stenoses. The study group comprised 44 outpatients scheduled for invasive coronary angiography (ICA) with an intermediate pretest likelihood of coronary artery disease. The patients underwent 64-slice CTA and baseline and hyperaemic PET before ICA with quantitative coronary angiography analysis. On a per-patient basis, the negative predictive values (NPV; 95 % confidence intervals in parentheses) were 88 % (64 - 97 %) for CTA, 90 % (71 - 97%) for PET and 92 % (74 - 98%) for PET/CTA, and the positive predictive values (PPV) were 71 % (53 - 85%) for CTA, 87 % (68 - 95%) for PET and 100 % (84 - 100%) for PET/CTA. Similarly, on a per-vessel basis the NPVs (which were generally high) were 97 % (94 - 100%) for CTA, 95 % (90 - 99%) for PET and 97 % (95 - 100%) for PET/CTA, and the PPVs (which were lower, but higher with PET/CTA) were 53 % (39 - 66%) for CTA, 53 % (40 - 66%) for PET and 85 % (73 - 97%) for PET/CTA. In six patients, CTA analysis was hampered by the presence of severe calcifications. However, with the addition of the PET data, all six patients were correctly categorized. Cardiac quantitative hybrid PET/CTA imaging has better diagnostic accuracy than CTA alone and PET alone. CTA has a suboptimal PPV, suggesting that hybrid PET/CTA imaging should be used to assess the significance of coronary stenoses diagnosed by CTA. (orig.)

  16. CT Angiography in the Diagnosis of Brain Death

    Summary Brain death is defined as the irreversible cessation of functioning of the entire brain, including the brainstem. Brain death is principally established using clinical criteria including coma, absence of brainstem reflexes and loss of central drive to breathe assessed with apnea test. In situations in which clinical testing cannot be performed or when uncertainty exists about the reliability of its parts due to confounding conditions ancillary tests (i.a. imaging studies) may be useful. The objective of ancillary tests in the diagnosis of brain death is to demonstrate the absence of cerebral electrical activity (EEG and evoked potentials) or cerebral circulatory arrest. In clinical practice catheter cerebral angiography, perfusion scintigraphy, transcranial Doppler sonography, CT angiography and MR angiography are used. Other methods, like perfusion CT, xenon CT, MR spectroscopy, diffusion weighted MRI and functional MRI are being studied as potentially useful in the diagnosis of brain death. CT angiography has recently attracted attention as a promising alternative to catheter angiography – a reference test in the diagnosis of brain death. Since 1998 several major studies were published and national guidelines were introduced in several countries (e.g. in France, Austria, Switzerland, the Netherlands and Canada). This paper reviews technique, characteristic findings and criteria for the diagnosis of cerebral circulatory arrest in CT angiography

  17. Serial changes of coronary atherosclerotic plaque: Assessment with 64-slice multi-detector computed tomography

    Kim, Eun Young; Kang, Doo Kyoung; Sun, Joo Sung; Choi, So Yeon [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2013-12-15

    Evaluate the progression of coronary atherosclerotic plaque during follow-up, and its association with cardiovascular risk factors. Fifty-six atherosclerotic patients with plaque were enrolled in this retrospective study. Patient's plaque was detected on repeat 64-slice multidetector CT scans with a mean interval of 25 ± 10 months changes in calcified and non-calcified plaque volumes and cardiovascular risk factors were assessed over time. Absolute and relative changes in plaque volume were compared, and the association between rapid progression and cardiovascular risk factors was determined. Diameter of the stenosis, length, calcified and non-calcified lesion plaque volumes increased significantly on follow-up CT. Absolute and relative annual changes in plaque volumes were significantly greater in non-calcified plaque (median, 22.7 mm{sup 3}, 90.4%) than in calcified plaque (median, 0.7 mm{sup 3}, 0%). Obesity, smoking, hypertension, hypercholesterolemia, and low high-density lipoprotein were significant predictors of progression of non-calcified plaque. Progression of calcified plaque was not associated with any cardiovascular risk factors. Coronary plaque volume increased significantly on follow-up CT. The rate of progression is related to non-calcified plaque than to calcified plaque. Cardiovascular risk factors are independently associated with the rapid progression of non-calcified plaque volume, but not associated with the progression of calcified plaque.

  18. Serial changes of coronary atherosclerotic plaque: Assessment with 64-slice multi-detector computed tomography

    Evaluate the progression of coronary atherosclerotic plaque during follow-up, and its association with cardiovascular risk factors. Fifty-six atherosclerotic patients with plaque were enrolled in this retrospective study. Patient's plaque was detected on repeat 64-slice multidetector CT scans with a mean interval of 25 ± 10 months changes in calcified and non-calcified plaque volumes and cardiovascular risk factors were assessed over time. Absolute and relative changes in plaque volume were compared, and the association between rapid progression and cardiovascular risk factors was determined. Diameter of the stenosis, length, calcified and non-calcified lesion plaque volumes increased significantly on follow-up CT. Absolute and relative annual changes in plaque volumes were significantly greater in non-calcified plaque (median, 22.7 mm3, 90.4%) than in calcified plaque (median, 0.7 mm3, 0%). Obesity, smoking, hypertension, hypercholesterolemia, and low high-density lipoprotein were significant predictors of progression of non-calcified plaque. Progression of calcified plaque was not associated with any cardiovascular risk factors. Coronary plaque volume increased significantly on follow-up CT. The rate of progression is related to non-calcified plaque than to calcified plaque. Cardiovascular risk factors are independently associated with the rapid progression of non-calcified plaque volume, but not associated with the progression of calcified plaque.

  19. Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients

    Non-contrast-enhanced cranial computed tomography (NECT) and CT angiography (CTA) are the most frequently used modalities in the triage of patients with acute ischemic and hemorrhagic stroke. CTA bone removal can improve the delineation of vasculature closely adjacent to bony structures, which is sometimes limited in standard CTA. The aim of this study was the evaluation of the clinical benefit of bone subtraction (BS) regarding delineation of cerebral vasculature, reading time and depiction of vascular pathologies compared to standard CTA without BS. A total of 100 patients who underwent NECT and supraaortic CTA on a 64-slice CT system were retrospectively included in the study. Bone removal was performed by subtraction of the NECT data from the CTA data using a dedicated workstation. Standard and BS CTA of each patient was reviewed for delineation of cerebral vasculature (grading scale from 1 ''excellent delineation'' to 10 = ''hardly any delineation''), reading time and depiction of vascular pathologies (standardized catalog) by two blinded readers. For BS data sets, the quality of BS was rated by a combination of the criteria complete bone removal, depiction of vascular structures and sufficient quality for diagnostic evaluation. The use of BS significantly reduced reading time from 4.60 min to 3.49 min (p < 0.001). Performing BS, the quality of vascular delineation of the cerebral arteries, cerebral veins and cavernous segment of the ICA increased significantly as compared to standard CTA (1.70 vs. 2.70; 2.60 vs. 4.12; 2.35 vs. 4.40, all p < 0.001). Consensus reading showed 41 pathologies in 35 patients. Diagnosis was missed or wrong overall in 15 cases, with 3 missed aneurysms (CTA: 2 vs. BS: 1), 8 wrong stenotic findings (CTA: 3 vs. BS: 5) and 4 missed partial thromboses (CTA: 2 vs. BS: 2). Performing BS in supraaortic CTA for the evaluation of cerebral vasculature reduces reading time and improves delineation of vessels. Diagnostic accuracy in general is

  20. Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients

    Morhard, Dominik; Fink, Christian; Becker, Christoph; Reiser, Maximilian F.; Nikolaou, Konstantin [Ludwig-Maximilians-University of Munich, Institute of Clinical Radiology, Munich (Germany)

    2008-05-15

    Non-contrast-enhanced cranial computed tomography (NECT) and CT angiography (CTA) are the most frequently used modalities in the triage of patients with acute ischemic and hemorrhagic stroke. CTA bone removal can improve the delineation of vasculature closely adjacent to bony structures, which is sometimes limited in standard CTA. The aim of this study was the evaluation of the clinical benefit of bone subtraction (BS) regarding delineation of cerebral vasculature, reading time and depiction of vascular pathologies compared to standard CTA without BS. A total of 100 patients who underwent NECT and supraaortic CTA on a 64-slice CT system were retrospectively included in the study. Bone removal was performed by subtraction of the NECT data from the CTA data using a dedicated workstation. Standard and BS CTA of each patient was reviewed for delineation of cerebral vasculature (grading scale from 1 = 'excellent delineation' to 10 = 'hardly any delineation'), reading time and depiction of vascular pathologies (standardized catalog) by two blinded readers. For BS data sets, the quality of BS was rated by a combination of the criteria complete bone removal, depiction of vascular structures and sufficient quality for diagnostic evaluation. The use of BS significantly reduced reading time from 4.60 min to 3.49 min (p < 0.001). Performing BS, the quality of vascular delineation of the cerebral arteries, cerebral veins and cavernous segment of the ICA increased significantly as compared to standard CTA (1.70 vs. 2.70; 2.60 vs. 4.12; 2.35 vs. 4.40, all p < 0.001). Consensus reading showed 41 pathologies in 35 patients. Diagnosis was missed or wrong overall in 15 cases, with 3 missed aneurysms (CTA: 2 vs. BS: 1), 8 wrong stenotic findings (CTA: 3 vs. BS: 5) and 4 missed partial thromboses (CTA: 2 vs. BS: 2). Performing BS in supraaortic CTA for the evaluation of cerebral vasculature reduces reading time and improves delineation of vessels. Diagnostic

  1. Evaluation of effective dose received by patients undergoing Cardiac Angiography Computed Tomography (CT) and Conventional Angiography

    Cardiac Angiography is a field of studies that utilizes the energy of radiation to study the coronary arteries of the heart. Patients undergoing this procedure has a probability of receiving an over dose of radiation that may further cause stochastic effect. The main objective of this research is to compare and clarify an approach for minimal effective dose receive by patients between procedures of Cardiac Angiography Computerized Tomography (CT) and Conventional Angiography. Based on this study, the patients recorded are based in Hospital University Sains Malaysia, Kubang Kerian, Kelantan. The Dose-Length-Product (DLP) was extracted from the Computed Tomography Dose Index (CTDI); meanwhile the Dose-Area-Product (DAP) was extracted from the modalities console screen. These relevant data are the means to clarify the effective dose receive by patients. The result shows that patients who undergo Conventional Angiography had a mean effective dose of 8.50 ± 6.41 mSv. Meanwhile, as for Cardiac Angiography Computerized Tomography, the patients had a mean effective dose of 7.08 ± 2.42 mSv. A significant difference in effective dose was seen between the two procedures. Cardiac Angiography CT provides high accurate diagnostic information with less radiation dose to patients compared to Conventional Angiography. (author)

  2. Clinical utility of landiolol for use in coronary CT angiography

    Tomizawa N

    2015-11-01

    Full Text Available Nobuo Tomizawa,1 Yayoi Hayakawa,1 Shinichi Inoh,1 Takeshi Nojo,1 Sunao Nakamura2 1Department of Radiology, 2Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan Abstract: Although remarkable advancement in computed tomography (CT has been achieved, heart rate control is important to maintain an optimal image quality in coronary CT angiography. Oral or intravenous β-blockers are used as premedication for this purpose. Landiolol was developed as a β-blocker with very high cardioselectivity (β1/β2 =255 and short half-life (4 minutes. In this review, we report the pharmacological features and usage of landiolol and also its effects on heart rate and image quality in coronary CT angiography. In addition, we discuss the safety of landiolol. Keywords: coronary computed tomography angiography, heart rate, image quality

  3. Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

    Ergun, Elif; Haberal, Murat; Koşar, Pınar; Yılmaz, Ali; Koşar, Uğur

    2011-01-01

    Objective: To prospectively evaluate the diagnostic value of 64-slice CTA in detecting intracranial aneurysms and to compare it with 2D-DSA and/or intra-operative findings. Material and Methods: 37 cases with SAH according to unenhanced cranial CT were included in the study. A 64-slice CTA was performed to all cases immediately after the nonenhanced cranial CT. DSA was performed in 24-48 hours following CTA. CT images were reviewed by two radiologists experienced in CT vascular imag...

  4. Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

    Elif Ergun; Murat Haberal; Pınar Koşar; Ali Yılmaz; Uğur Koşar

    2011-01-01

    Objective: To prospectively evaluate the diagnostic value of 64-slice CTA in detecting intracranial aneurysms and to compare it with 2D-DSA and/or intra-operative findings.Material and Methods: 37 cases with SAH according to unenhanced cranial CT were included in the study. A 64-slice CTA was performed to all cases immediately after the nonenhanced cranial CT. DSA was performed in 24-48 hours following CTA. CT images were reviewed by two radiologists experienced in CT vascular imaging. The ...

  5. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x2 = 3.5, P=0.6) and (x2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

  6. New abdominal CT angiography protocol on a 16 detector-row CT scanner - first results

    Purpose. Purpose of this study was the implementation of a new abdominal CT angiography protocol on a 16 detector-row CT scanner and the comparison to selective catheter angiography.Methods. 76 patients with various vascular disorders underwent abdominal CT angiography on a recently developed 16 detector-row CT scanner using submillimeter slice collimation (16 x 0.75 mm). Results were compared with mesenteric and/or hepatic angiography in 17 patients performed during tumor embolization. Opacification was provided using individually tailored contrast application with a test bolus setting. To evaluate the contrast injection protocol density measurements within the vessel lumen were performed.Results. Diagnostic image quality was achieved in all patients with angiographic comparison (n = 17). Within the hepatic and mesenteric vasculature up to 4th generation vessels could be identified. Compared to selctive angiography CT angiography provided equivalent morphologic information up to the detectable vessel generation. With the applied contrast application regimen there were no significant differences in vessel enhancement along the abdominal aorta and iliac arteries.Conclusion. 16 detector-row CT enables whole abdominal angiographic studies with submillimeter resolution in a single breath-hold. The improved spatial resolution enables for high quality 3D visualization. Compared to invasive angiography, 16 detector-row CT reveals equivalent morphologic information. (orig.)

  7. Effect of CT scan protocols on x-ray-induced DNA double-strand breaks in blood lymphocytes of patients undergoing coronary CT angiography

    To compare in vivo DNA lesions induced during helical and sequential coronary computed tomography angiography (CTA) and to evaluate the effect of CT parameters on double-strand break (DSB) levels. Thirty-six patients were examined with various CT protocols and modes (helical scan, n = 27; sequential scan, n = 9) either using a 64-slice dual-source or a 128-slice CT system. Blood samples were obtained before and 30 min after CT. Lymphocytes were isolated, stained against the phosphorylated histone variant γ-H2AX, and DSBs were visualised by using fluorescence microscopy. DSB yields 30 min after CTA ranged from 0.04 to 0.71 per cell and showed a significant correlation to DLP (ρ = 0.81, p < 0.00001). Median DSB yield and median DLP were significantly lower after sequential compared to helical CT examinations (0.11 vs. 0.37 DSBs/cell and 249 vs. 958 mGy cm, p < 0.00001). Additional calcium scoring led to an increase in DLP (p = 0.15) and DSB levels (p = 0.04). DSB levels normalised to the DLP showed a significant correlation to the attenuation of the blood (ρ = 0.53, p = 0.01) and a negative correlation to the body mass index of the patients (ρ = -0.37, p = 0.06). γ-H2AX immunofluorescence microscopy allows one to determine dose-related effects on x-ray-induced DSB levels and to consider individual factors which cannot be monitored by physical dose measurements. (orig.)

  8. Effect of CT scan protocols on x-ray-induced DNA double-strand breaks in blood lymphocytes of patients undergoing coronary CT angiography

    Kuefner, M.A.; Hamann, J.; Lell, Michael; Anders, K.; Schwab, S.A.; Uder, M. [University of Erlangen-Nuernberg, Department of Radiology, Erlangen (Germany); Grudzenski, S.; Loebrich, M. [Darmstadt University of Technology, Radiation Biology and DNA Repair, Darmstadt (Germany); Achenbach, S. [University of Erlangen-Nuernberg, Department of Cardiology, Erlangen (Germany); Haeberle, L. [University of Erlangen-Nuernberg, Department of Medical Informatics, Biometry and Epidemiology, Erlangen (Germany)

    2010-12-15

    To compare in vivo DNA lesions induced during helical and sequential coronary computed tomography angiography (CTA) and to evaluate the effect of CT parameters on double-strand break (DSB) levels. Thirty-six patients were examined with various CT protocols and modes (helical scan, n = 27; sequential scan, n = 9) either using a 64-slice dual-source or a 128-slice CT system. Blood samples were obtained before and 30 min after CT. Lymphocytes were isolated, stained against the phosphorylated histone variant {gamma}-H2AX, and DSBs were visualised by using fluorescence microscopy. DSB yields 30 min after CTA ranged from 0.04 to 0.71 per cell and showed a significant correlation to DLP ({rho} = 0.81, p < 0.00001). Median DSB yield and median DLP were significantly lower after sequential compared to helical CT examinations (0.11 vs. 0.37 DSBs/cell and 249 vs. 958 mGy cm, p < 0.00001). Additional calcium scoring led to an increase in DLP (p = 0.15) and DSB levels (p = 0.04). DSB levels normalised to the DLP showed a significant correlation to the attenuation of the blood ({rho} = 0.53, p = 0.01) and a negative correlation to the body mass index of the patients ({rho} = -0.37, p = 0.06). {gamma}-H2AX immunofluorescence microscopy allows one to determine dose-related effects on x-ray-induced DSB levels and to consider individual factors which cannot be monitored by physical dose measurements. (orig.)

  9. Vertebral angiography of cerebellar astrocytoma. Tumor stain, tumor circulation, CT and angiography in diagnosis

    Kitaoka, K.; Ito, T.; Tashiro, K.; Abe, H.; Tsuru, M.; Miyasaka, K. (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1982-05-01

    Thirteen cases of cerebellar astrocytoma were examined primarily for tumor stain and pathological tumor circulation by angiography and CT. Tumor stain was observed in only one case by cerebral angiogram. A tumor was demonstrated as an avascular mass in the remaining 12 cases. It is suggested that mural nodules of cystic lesions should have certain weight and sizes so that they could be demonstrated as tumor stain. In the supratentorial region, five of the 12 low-grade astrocytoma exhibited abnormal tumor stain and tumor circulation by cerebral angiogram. It is considered that supratentorial and posterior fossa astrocytoma must usually exhibit different pathological tumor circulation by cerebral angiogram, since each group has distinctive clinical and biological characteristics. CT was performed in 7 of 13 cases. It appeared to be more useful than cerebral angiography in the morphological diagnosis. Especially in cystic tumors, CT produced minute information concerning peritumoral edema, enhancement of margin of cystic astrocytoma after intravenous contrast medium, and marginal enhancement with layering in the dependent part of the cyst. Neuroradiological differential diagnosis of cerebellar astrocytoma and cerebellar hemagioblastoma by CT was difficult in the cases of tumors. However, both tumors were differentiated from each other with ease by tumor stain and tumor circulation in cerebral angiography. Thus, it is concluded that cerebral angiography is superior to CT in differential diagnosis between cerebellar astrocytoma and cerebellar hemangioblastoma.

  10. 64层螺旋CT血管造影在蛛网膜下腔出血诊断的临床运用%Clinical application of 64-slices spiral CT angiography in diagnosing subarachnoid haemorrhage

    苏海; 孙晓川; 朱继; 唐文渊

    2007-01-01

    目的:探讨64层螺旋CT血管造影(CTA)在蛛网膜下腔出血(SAH)病因诊断中的作用.方法:对2005年9月到2006年9月收治入院的89例SAH患者行64层螺旋CT血管造影检查,其中49例同时接受数字减影血管造影(DSA)检查.分析CTA检查结果并与DSA检查结果比较.结果:89例患者中CTA检出动脉瘤70例,动静脉畸形9例,静脉窦血栓2例,阴性8例;在同时接受DSA检查的49例患者中,发现动脉瘤41例,动静脉畸形4例,阴性4例,其中除1例CTA发现并经临床证实的动脉瘤DSA检查为阴性外,其余全部证实CTA诊断.CTA对SAH病因诊断中的敏感性和特异性都为100%,DSA分别为98%和100%.结论:64层螺旋CTA对SAH的病因诊断是一种无创、快速、便捷的影像学检查方法,可显示血管的空间立体结构及周边关系,有助于治疗方法的选择和难度的评估.

  11. The value in detection of acute nontraumatic subarachnoid hemorrhage with 64 slice multidetector CT angiography%64层CTA对急性非外伤性蛛网膜下腔出血的应用价值

    杜忆兵; 闫宇涛; 王晓辉; 陆利霞

    2009-01-01

    目的:用64层螺旋CTA评价急性非外伤性蛛网膜下腔出血(SAH)病因并选择治疗方法.方法:对68例急性非外伤性SAH患者发病7天内行CTA检查,明确病因,根据CTA结果选择治疗方法并评价疗效.图像处理采用MPVR、MIP及3DVR重建.结果:68例SAH患者均经DSA及外科手术证实.其中45例为动脉瘤破裂所致,1例血管炎,2例动脉硬化,1例夹层动脉瘤,19例动脉无明显异常.68例SAH中64例由CTA做出病因诊断(准确率94.1%、敏感性91.8%、特异性100%、阳性预测值100%、阴性预测值82.6%).CTA直接显示43例动脉瘤,1例血管炎及1例夹层动脉瘤.43例动脉瘤有42例根据CTA结果选择治疗(97.7%).其中栓塞29例,有26例(89.7%)栓塞满意.13例行外科手术钳闭.结论:64层CTA能准确评价SAH病因及动脉瘤的特征.对选择治疗方法十分有价值.

  12. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

  13. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

    2011-05-15

    Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

  14. Clinical utility of landiolol for use in coronary CT angiography

    Tomizawa N; Hayakawa Y; Inoh S; Nojo T; Nakamura S

    2015-01-01

    Nobuo Tomizawa,1 Yayoi Hayakawa,1 Shinichi Inoh,1 Takeshi Nojo,1 Sunao Nakamura2 1Department of Radiology, 2Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan Abstract: Although remarkable advancement in computed tomography (CT) has been achieved, heart rate control is important to maintain an optimal image quality in coronary CT angiography. Oral or intravenous β-blockers are used as premedication for this purpose. Landiolol was developed as a β-blocker with very ...

  15. Clinical utility of landiolol for use in coronary CT angiography

    Tomizawa, Nobuo

    2015-01-01

    Nobuo Tomizawa,1 Yayoi Hayakawa,1 Shinichi Inoh,1 Takeshi Nojo,1 Sunao Nakamura2 1Department of Radiology, 2Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan Abstract: Although remarkable advancement in computed tomography (CT) has been achieved, heart rate control is important to maintain an optimal image quality in coronary CT angiography. Oral or intravenous β-blockers are used as premedication for this purpose. Landiolol was developed as a β-blocker wi...

  16. Varices from portal hypertension: correlation of CT and angiography

    McCain, A.H.; Bernardino, M.E.; Sones, P.J. Jr.; Berkman, W.A.; Casarella, W.J.

    1985-01-01

    Two hundred abdominal CT and angiographic examinations were performed on 137 patients with portal hypertension. These patients were being evaluated before or after a distal splenorenal shunt. CT increased the detection of umbilical and retroperitoneal varices. Angiography better detected peripancreatic varices and cavernous transformation. Both modalities together added more information than either alone in identification of coronary and/or gastroesophageal, retrogastric, and perisplenic-mesenteric varices. This additional anatomic information helped in the patient's management pre- and postoperatively.

  17. Comparison of digital subtraction angiography, CT angiography, and ultrasonic doppler examination in the evaluation of penile arterial lesions

    CT angiography reconstructed by a multidetector-row helical CT scanner is a newly developed form of imaging. We compared CT angiography and ultrasonic Doppler examination with digital subtraction angiography (DSA) in the diagnosis of arterial lesion. Eighteen patients with arteriogenic erectile dysfunction (ED) underwent color Doppler study DSA, and CT angiography after providing informed consent. The CT angiography images were obtained by a multidetector-row helical CT scanner, Asteion TSX021A (TOSHIBA). We injected prostaglandin E1 into the penile cavernous body, and then rapidly infused nonionic contrast medium into the antecubital vein. DSA and CT angiography images of the bilateral internal pudendal arteries and cavernous arteries were examined for stenotic lesions or occlusion. We also compared the peak systolic blood flow velocity in the cavernous artery measured by color Doppler ultrasound with CT angiography and DSA. The CT anigography and color Doppler studies were performed on an outpatient basis, but DSA required hospitalization. In the 36 internal pudendal arteries, DSA represented 22 normal arteries and 14 stenosis or occlusions. CT angiography showed 15 normal arteries and 21 occlusions. For the diagnosis of stenosis or occlusion in the internal pudendal artery, the CT angiography image had a good agreement, with a sensitivity of 1.00, specificity of 0.68, and accuracy of 0.81. For diagnosis in the cavernous artery, CT angiography image also showed a good agreement with DSA; however, the quality of the images of fine arteries was better in the DSA images. The inferior view and internal view of the pelvis in CT angiography were helpful for visulaizing the internal pudendal artery, especially at the pubic bone. There was insufficient correlation between peak systolic blood flow velocity and DSA findings. There were no serious complications involved in either examination. CT angiography has not yet reached the same level as DSA in the evaluation of fine

  18. Comparison of digital subtraction angiography, CT angiography, and ultrasonic doppler examination in the evaluation of penile arterial lesions

    Kawanisi, Yasuo; Kimura, Kazunori; Lee, Kyong Soo; Koizumi, Takahiro; Nakatsuji, Hiroyoshi; Kojima, Keiji; Yamamoto, Akira; Numata, Akira [Takamatsu Red Cross Hospital (Japan)

    2001-11-01

    CT angiography reconstructed by a multidetector-row helical CT scanner is a newly developed form of imaging. We compared CT angiography and ultrasonic Doppler examination with digital subtraction angiography (DSA) in the diagnosis of arterial lesion. Eighteen patients with arteriogenic erectile dysfunction (ED) underwent color Doppler study DSA, and CT angiography after providing informed consent. The CT angiography images were obtained by a multidetector-row helical CT scanner, Asteion TSX021A (TOSHIBA). We injected prostaglandin E{sub 1} into the penile cavernous body, and then rapidly infused nonionic contrast medium into the antecubital vein. DSA and CT angiography images of the bilateral internal pudendal arteries and cavernous arteries were examined for stenotic lesions or occlusion. We also compared the peak systolic blood flow velocity in the cavernous artery measured by color Doppler ultrasound with CT angiography and DSA. The CT anigography and color Doppler studies were performed on an outpatient basis, but DSA required hospitalization. In the 36 internal pudendal arteries, DSA represented 22 normal arteries and 14 stenosis or occlusions. CT angiography showed 15 normal arteries and 21 occlusions. For the diagnosis of stenosis or occlusion in the internal pudendal artery, the CT angiography image had a good agreement, with a sensitivity of 1.00, specificity of 0.68, and accuracy of 0.81. For diagnosis in the cavernous artery, CT angiography image also showed a good agreement with DSA; however, the quality of the images of fine arteries was better in the DSA images. The inferior view and internal view of the pelvis in CT angiography were helpful for visulaizing the internal pudendal artery, especially at the pubic bone. There was insufficient correlation between peak systolic blood flow velocity and DSA findings. There were no serious complications involved in either examination. CT angiography has not yet reached the same level as DSA in the evaluation

  19. Radiation dose in cardiac CT angiography: Protocols and image quality

    This paper aims to evaluate the radiation dose exposure of patients submitted to cardiac computed tomography angiography. The effective dose was obtained from the product of dose-length product values and the conversion factor established in the European Working Group for Guidelines on Quality Criteria in CT. The image noise and contrast-and signal-to-noise ratios were obtained for all images. Sixty-four- and 256-slice CT angiographies were used in 211 (68.5 %) and 97 (31.5 %) patients, respectively. The calculated mean effective dose with prospective CT angiography was 6.0±1.0 mSv and the retrospective mode was 8.4±1.2 mSv. The mean image noise values were 38.5±9.5 and 21.4±5.3 for prospective and retrospective modes, respectively. It was observed that the image noise increased by 44.4 % using a prospective mode. Prospective CT angiography reduces radiation dose by ∼29 % compared with the retrospective mode, while maintaining diagnostic image quality and the ability to assess obstructions in patients. (authors)

  20. Coronary CT Angiography versus Conventional Cardiac Angiography for Therapeutic Decision Making in Patients with High Likelihood of Coronary Artery Disease

    Moscariello, Antonio; Vliegenthart, Rozemarijn; Schoepf, U. Joseph; Nance, John W.; Zwerner, Peter L.; Meyer, Mathias; Townsend, Jacob C.; Fernandes, Valerian; Steinberg, Daniel H.; Fink, Christian; Oudkerk, Matthijs; Bonomo, Lorenzo; O'Brien, Terrence X.; Henzler, Thomas

    2012-01-01

    Purpose: To assess the efficacy of coronary computed tomographic (CT) angiography for therapeutic decision making in patients with high likelihood of coronary artery disease (CAD)-specifically the ability of coronary CT angiography to help differentiate patients without and patients with a need for

  1. High-resolution ex vivo imaging of coronary artery stents using 64-slice computed tomography - initial experience

    Rist, Carsten; Nikolaou, Konstantin; Wintersperger, Bernd J.; Reiser, Maximilian F.; Becker, Christoph R. [Ludwig-Maximilians University, Department of Clinical Radiology, Munich (Germany); Flohr, Thomas [Siemens Medical Solutions, CT Division, Forchheim (Germany)

    2006-07-15

    The aim of the study was to evaluate the potential of new-generation multi-slice computed tomography (CT) scanner technology for the delineation of coronary artery stents in an ex vivo setting. Nine stents of various diameters (seven stents 3 mm, two stents 2.5 mm) were implanted into the coronary arteries of ex vivo porcine hearts and filled with a mixture of an iodine-containing contrast agent. Specimens were scanned with a 16-slice CT (16SCT) machine; (Somatom Sensation 16, Siemens Medical Solutions), slice thickness 0.75 mm, and a 64-slice CT (64SCT, Somatom Sensation 64), slice-thickness 0.6 mm. Stent diameters as well as contrast densities were measured, on both the 16SCT and 64SCT images. No significant differences of CT densities were observed between the 16SCT and 64SCT images outside the stent lumen: 265{+-}25HU and 254{+-}16HU (P=0.33), respectively. CT densities derived from the 64SCT images and 16SCT images within the stent lumen were 367{+-}36HU versus 402{+-}28HU, P<0.05, respectively. Inner and outer stent diameters as measured from 16SCT and 64SCT images were 2.68{+-}0.08 mm versus 2.81{+-}0.07 mm and 3.29{+-}0.06 mm versus 3.18{+-}0.07 mm (P<0.05), respectively. The new 64SCT scanner proved to be superior in the ex vivo assessment of coronary artery stents to the conventional 16SCT machine. Increased spatial resolution allows for improved assessment of the coronary artery stent lumen. (orig.)

  2. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding:A meta-analysis

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in ...

  3. Effects of Propranolol on the Left Ventricular Volume of Normal Subjects During CT Coronary Angiography

    The purpose of this study is to determine the effects of propranolol on the left ventricular (LV) volume during CT coronary angiography. The LV volume of 252 normal Chinese subjects (126 subjects with propranolol medication and 126 age- and gender-matched Chinese subjects without medication) was estimated using 64 slices multi-detector CT (MDCT). The heart rate difference was analyzed by the logistic linear regression model with variables that included gender, age, body height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the dosage of propranolol. The following global LV functional parameters were calculated: the real-end diastolic volume (EDV), the real-end systolic volume (ESV) and the real-ejection fraction (EF). The female subjects had a greater decrease of heart rate after taking propranolol. The difference of heart rate was negatively correlated with the dosage of propranolol. The real-EDV, the real-ESV and the real-EF ranged from 48.1 to 109 mL/m2, 6.1 to 57.1 mL/m2 and 41% to 88%, respectively. There was no significant difference in the SBP and DBP between the groups without and with propranolol medication (123 ± 17 and 80 ± 10 mmHg; 120 ± 14 and 80 ± 11 mmHg, respectively). The real-EDV showed no significant difference between these two groups, but the real-ESV and real-EF showed significant differences between these two groups (69.4 ± 9.3 and 70.6 ± 8.9 mL/m2; 23.5 ± 5.7 and 25.6 ± 3.7 mL/m2, 66.5 ± 5.1% and 63.5 ± 4.6%, respectively). The difference of heart rate is significantly influenced by gender and the dosage of propranolol. Propranolol will also increase the ESV, which contributes to a decreased EF, while the SBP, DBP and EDV are not statistically changed.

  4. Low dose coronary CT angiography with 256-slice helical CT

    Objective: To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral ( RGS) technique on a 256-slice CT scanner. Methods: A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: (1) 50 patients with an average heart rate (HR) ≤ 70 bpm were scanned with a data acquisition time window centered at the 75% of the R-R cycle (group A) and (2) 50 patients with HR > 70 bpm were scanned with the data acquisition time window centered at the 45% of the R-R cycle, including a phase tolerance of ± 5% (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤ 70 bpm were scanned with cardiac dose right set to phase of 75% ( group C) and (4) 50 patients with HR > 70 bpm were scanned with cardiac ose Rdight set to phases of 45% and 75% (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 (1: excellent; 4: non-assessable). Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test. The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A Spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode. Results: Of 2338 coronary artery segments, excellent or good image quality (score of 1 or 2) was achieved in 96.5% (585 of 606) in group A, 77.7% (445

  5. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

    Purpose: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. Materials and methods: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. Results: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. Conclusion: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients

  6. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

    Hyare, Harpreet [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)]. E-mail: hhyare@doctors.org.uk; Desigan, Sharmini [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Nicholl, Helen [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Guiney, Michael J. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Brookes, Jocelyn A. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Lees, William R. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)

    2006-08-15

    Purpose: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. Materials and methods: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. Results: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. Conclusion: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients.

  7. Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

    Lee, Yong Hee; You, Jin Jong; Choi, Ho Cheol; Kim, Ji Eun [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Choi, Dae Seob [Gyeongsang Institue of Health Science, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of); Ryoo, Jae Wook [Dept. of Radiology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A four-step scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on S-CTA (n = 4). MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis.

  8. Congenital anomalies of aortic arch: CT angiography

    Moon, Yung; Kim, Yang Min; Kim, Tae Hoon; Kim, Mi Young [Sejong General hospial, Seoul (Korea, Republic of); Lee, Jae Young [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Hyung Seok [Cheju Medical Center, Cheju (Korea, Republic of)

    2001-01-01

    Aortic arch anomalies result from the failure of an embryonic vascular structure to persists and regress in the usual manner during formation of the aortic arch. The anomalous aortic arch may encircle and compress the trachea and esophagus as a form of a vascular ring. The diagnosis of aortic arch anomaly and the recognition of airway compression are important because they are conditions which complicate the natural and surgical course of related diseases. CT can demonstrate the nature of anatomic structures such as thr treachea and esophagus not revealed by angiogrphy, simultaneosuly disclosing the relationship of stenotic airways and offending mediastinal vessels. Volumetric data acquisition by means of spiral CT enables three dimensional reconstruction, which can provide easy global understanding for the complex anatomy and spatial relationship of airway and cardiovascular structures. Three dimensional imaging is very useful for the physician and surgeon who are not accustomed to mentally reconstructing axial images, and can facilitate surgical planning.

  9. Hepatic arterial supply in 1297 CT-angiographies

    Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2%), followed by type V in 114 patients (8.8%) and type III in 83 patients (6.4%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n=10). Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification.

  10. CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study

    The purpose of our experimental study was to assess the accuracy and precision of CT angiography (CTA), MR angiography (MRA) and rotational digital subtraction angiography (DSA) for measuring the volume of an in vitro aneurysm model. A rigid model of the anterior cerebral circulation harbouring an anterior communicating aneurysm was connected to a pulsatile circuit. It was studied using unenhanced 3D time-of-flight MRA, contrast-enhanced CTA and rotational DSA angiography. The source images were then postprocessed on dedicated workstations to calculate the volume of the aneurysm. CTA was more accurate than MRA (P=0.0019). Rotational DSA was more accurate than CTA, although the difference did not reach statistical significance (P=0.1605), and significantly more accurate than MRA (P<0.00001). CTA was more precise than MRA (P=0.12), although this did not reach statistical significance. Rotational DSA can be part of the diagnosis, treatment planning and support endovascular treatment of intracranial aneurysms. The emerging endovascular treatment techniques which consist of using liquid polymers as implants to exclude aneurysms from arterial circulation would certainly benefit from this precise measurement of the volume of aneurysms. (orig.)

  11. Cardiac CT angiography in children with congenital heart disease

    Siripornpitak, Suvipaporn, E-mail: ssiripornpitak@yahoo.com [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Pornkul, Ratanaporn [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Khowsathit, Pongsak [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Layangool, Thanarat; Promphan, Worakan [Pediatric Cardiology Unit, Queen Sirikit National Institute of Child Health, Bangkok (Thailand); Pongpanich, Boonchob [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand)

    2013-07-15

    Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.

  12. Cardiac CT angiography in children with congenital heart disease

    Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted

  13. Preoperative cerebral aneurysm assessment by three-dimensional CT angiography. Feasibility of surgery without cerebral angiography

    The purpose of this study is to assess the capability of three-dimensional CT angiography (3D-CTA) to replace conventional catheter angiography as a preoperative examination for unruptured intracranial aneurysms. A prospective study was designed to evaluate 18 patients with 20 unruptured intracranial aneurysms (13 middle cerebral artery aneurysms, 6 anterior communicating artery aneurysms, and 1 internal carotid posterior communicating artery aneurysm) who underwent surgery. There were 12 women and 6 men with the average age of 63 years old. All patients were initially diagnosed as having intracranial aneurysms by MR angiography, followed by 3D-CTA and conventional catheter angiography for confirmation. Three experienced neurosurgeons were in charge of the operations. One of the neurosurgeons (surgeon 1) was provided with only 3D-CTA as the preoperative radiological evaluation, while the others (surgeon 2 and 3) were given through assessments with MRA, 3D-CTA, and conventional angiography. Surgeon 1 carried out the operations under careful observation by the surgeons 2 and 3. Problems encountered by the surgeon 1 during surgery were recorded. Neck clipping in 19 aneurysms and dome wrapping in 1 were successfully accomplished. All patients were discharged without complication. Surgeries went smoothly in 16 aneurysms with 3D-CTA alone. Discrepancies between the 3D-CTA findings and microsurgical anatomy were noted in 4 aneurysms: the size of the neck was overestimated in 3 aneurysms, the relationships to parent arteries were obscure in 2 aneurysms, and a perforating artery problematic to neck clipping was missed in 1 aneurysms by 3D-CTA. The results of this study support the notion that 3D-CTA can replace conventional catheter angiography as preoperative examination in the majority of regular-sized anterior circulation aneurysms. Nevertheless, surgeons should recognize and be prepared for the fact that 3D-CTA can give false impression about the aneurysm neck and

  14. Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler

    Objective: assessment of the degree of stenosis is the central point in the treatment of carotid stenosis. The purpose of our study was to assess whether invasive CT angiography (CTA) is a feasible alternative to the current invasive gold standard carotid digital subtraction angiography (DSA) and the current non-invasive gold standard color flow doppler. Subjects and methods: about 178 patients with cerebrovascular disease underwent digital subtraction angiography (DSA), CFD and CTA. CTA was performed on a Somatom plus 4 (Siemens, Erlangen Germany). CT was performed with 2/3/2 (collimation/table feed/reconstruction interval) or 2/3/1 mm, start delay 15-20 s, flow 2.5-3.0 ml/s, using 120 ml non-ionic contrast medium (300 mg J/ml). Quantification of degree of stenosis was based on the perfused area in the axial slices. Plaque morphology (soft and hard) and ulceration were evaluated. Results: CTA detected nine cases of significant stenosis, which had been underestimated by DSA. CTA failed in two cases of a membraneous stenosis, which were underestimated, and in two cases with teeth artifacts. Calcifications were more readily appreciated by CTA than in CFD. In this respect, both methods were superior to DSA. CFD, DSA and CTA had a sensitivity of 100% for occlusions, respectively. Conclusion: CT angiography is useful in case of inconclusive CFD in the pre- and postoperative phase, and as a third modality in case of disagreement between DSA and CFD

  15. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

    2015-07-15

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  16. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  17. Multislice Cardiac CT-Angiography; A Review on Accepted Indications and Potentials for Other Applications Regarding the Newest Development

    M. Motevalli

    2007-05-01

    Full Text Available There were not any clear-cut criteria available for clinical use of cardiac CT-angiography (CCTA up to October 2006 in which the American College of Car-diology (ACC, American College of Radiology (ACR and six other medical institutions released a joint consensus on clinical indications of cardiac CT and MRI. A statement was released by the American Heart Association together with two other radiology and cardiology institutions in the same month on the same matter. An illustrated review will be presented on the newly accepted indications of cardiac CT, especially CCTA. Some prominent indications are as follow: 1. Evaluation of chest pain syndrome in patient with intermediate pretest probability of coronary artery disease (CAD when exercise test is not feasible. 2. Evaluation of acute chest pain in patient with in-termediate pretest probability of CAD and negative ECG and enzymes. 3. Uninterpretable or equivocal stress test (exercise, perfusion scan, or stress echo. 4. Evaluation of coronary arteries in patients with new onset heart failure. 5. Assessment of congenital coronary and cardiac anomalies. 6. Noninvasive coronary vein mapping prior to placement of biventricular pacemaker. 7. Noninvasive coronary arterial mapping, including internal mammary artery prior to repeat cardiac sur-gical revascularization. Some recent research indicated that CCTA is useful in some other specific situations too, like evaluating in-stent re-stenosis for stainless steel or cobalt stents more than 3mm in diameter and has also some roles in the evaluation of coronary bypass grafts, etc. Fi-nally, the newer progressions in the field of multislice CT are promising of even better performance which may widen the scope of its indications. Dual-source CT scanners have shown better performance com-pared with 64-slice CT scanners in the preliminary studies, namely slice-thickness of 0.25mm vs. 0.4mm, temporal resolution of 83ms vs.165ms, assessable segments of 98.6% vs. 97

  18. Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography

    The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms. (orig.)

  19. Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage

    Purpose: To evaluate the usefulness of CT angiography (CTA) in the detection of intracranial aneurysms in patients with acute subarachnoid hemorrhage (SAH). Material and Methods: In 53 patients with nontraumatic SAH a helical contrast-enhanced CTA was performed. CTA data were reconstructed with maximum intensity projection (MIP). Each patient underwent selective arteriography of the cerebral vessels (as the gold standard). CTA (axial images and MIP reconstructions) and arteriography were evaluated separately and their diagnostic information was compared. Results: In 14 of the 53 patients neither CTA nor angiography showed a vascular malformation. In the remaining 39 patients, angiography demonstrated a total of 51 aneurysms ranging in size from 3 mm to 16 mm. CTA missed one of these aneurysms, which was located at the internal carotid artery. 3-D CT reconstruction was slightly superior to arteriography in the demonstration of the neck, shape and direction of the aneurysms. Partial thrombosis of 3 aneurysms was demonstrated only by CTA. Conclusion: Although CTA cannot replace cerebral arteriography in the diagnostic work-up of acute SAH, it proved to be helpful in demonstrating the topographic anatomy of cerebral aneurysms and surrounding structures. (orig.)

  20. Acute stent thrombosis after bifurcation stenting with the crush technique visualized with 64-slice computed tomography

    Kristensen, T.S.; Engstrom, T.; Kofoed, Klaus Fuglsang

    2008-01-01

    Acute stent thrombosis remains a potential complication after stent implantation. With the introduction of electrocardiographic gated multidetector row computed tomography (MDCT), a new nonnvasive imaging modality has become available that may contribute to the detection of complications after co...... complex interventional procedures. We present a case where CT angiography was performed just prior to the clinical presentation of acute stent thrombosis in a 55-year-old male who was treated with the crush technique in a bifurcation lesion Udgivelsesdato: 2008/7...

  1. 320-detector row CT coronary angiography in patients with arrhythmia

    Objective: To evaluate the feasibility of CT coronary angiography (CTCA) in patients with arrhythmia using 320-detector row CT. Methods: Thirty-one patients with persistent atrial fibrillation and 8 patients with premature ventricular contraction were enrolled in this study. All patients underwent 320- detector row CTCA. CT image quality was evaluated with 4-point grading scale by two radiologists. Inter- observer agreement was evaluated by Kappa statistics. The radiation dose was calculated. Results: In total 510 coronary segments, 496 (97.2%) segments met diagnostic standard. The mean effective dose was (12.7±4.8) mSv in this study. There was a good agreement in image quality scoring between the two reviewers (Kappa = 0.72). Conclusion: 320-detector row CTCA is feasible in patients with atrial fibrillation and premature ventricular contraction. Arrhythmia may not be considered as a contraindication to CTCA. (authors)

  2. Combined CT Angiography and CT Venography in Thromboembolic disease: clinical impact

    Combined CT Venography and Pulmonary Angiography was described in 1998 as a tool for diagnostic Thromboembolic Disease. The purpose is to relate our own experience with this technique in a population with suspected pulmonary embolism. 46 consecutive patients with suspected pulmonary embolism underwent combined CT Venography after Pulmonary CT Angiography to depict Deep Venous Thrombosis (DVT). CT Venography where obtained with a 3 minutes delay from injection, without additional intravenous contrast, from upper abdomen to fibular head. A prospective study from emergency reports where used. The reports where aimed by nine different radiologist at diary emergency room (images where not retrospective review). We report if a pulmonary embolus or deep venous thrombus or another alternative diagnostic where done. An endo luminal thrombus in any pulmonary arteries was assessed as a positive study for PE. A Thrombus in the leg veins or in an abdominal vein without diminished size of vein was assessed as an acute DVT. In those patients with a CT negative to Thromboembolic Disease was the clinician who decide if more proves where needed. Those patients without evidence in CT of Thromboembolic Disease where asked for symptoms related to the episode in a 3 months period after initial CT. Patients free of symptoms for 3 months without anticoagulation therapy where considered true negative for CT. CT shows Thromboembolic Disease in 23 of 46 patients. 21PE, 14 DVT 2 of 14 patients with DVT don't show PE, CT excluded thromboembolic disease in 23 patients and in 15 of those patients an alternative diagnostic was shown. In 22 of those 23 patients CT excluded correctly Thromboembolic Disease. One patient result in a false negative CT, Pulmonary Angiography of that patient shows us a subsegmentary embolus. (Author) 9 refs

  3. Beam hardening artifacts by dental implants: Comparison of cone-beam and 64-slice computed tomography scanners

    Farzad Esmaeili

    2013-01-01

    Full Text Available Background: Cone beam computed tomography (CBCT is an alternative to a computed tomography (CT scan, which is appropriate for a wide range of craniomaxillofacial indications. The long-term use of metallic materials in dentistry means that artifacts caused by metallic restorations in the oral cavity should be taken into account when utilizing CBCT and CT scanners. The aim of this study was to quantitatively compare the beam hardening artifacts produced by dental implants between CBCT and a 64-Slice CT scanner. Materials and Methods: In this descriptive study , an implant drilling model similar to the human mandible was used in the present study. The implants (Dentis were placed in the canine, premolar and molar areas. Three series of scans were provided from the implant areas using Somatom Sensation 64-slice and NewTom VGi (CBCT CT scanners. Identical images were evaluated by three radiologists. The artifacts in each image were determined based on pre-determined criteria. Kruskal-Wallis test was used to compare mean values; Mann-Whitney U test was used for two-by-two comparisons when there was a statistical significance ( P < 0.05. Results: The images of the two scanners had similar resolutions in axial sections ( P = 0.299. In coronal sections, there were significant differences in the resolutions of the images produced by the two scanners ( P < 0.001, with a higher resolution in the images produced by NewTom VGi scanner. On the whole, there were significant differences between the resolutions of the images produced by the two CT scanners ( P < 0.001, with higher resolution in the images produced by NewTom VGi scanner in comparison to those of Somatom Sensation. Conclusion: Given the high quality of the images produced by NewTom VGi and the lower costs in comparison to CT, the use of the images of this scanner in dental procedures is recommended, especially in patients with extensive restorations, multiple prostheses and previous implants.

  4. Sinus valsalva aneurysm on cardiac CT angiography: assessment and detection

    After the advent of ECG gated cardiac CT angiography (CCTA) there has been significant improvement in image quality of the ascending aorta. As a result the sinuses of valsalva are readily assessable. Sinuses of valsalva aneurysm can cause significant dysfunction of the aortic root and annulus and can be congenital or acquired. The aneurysm most commonly originates from the right coronary sinus. Complications related to sinuses of valsalva aneurysm can cause chest pain and can be life threatening. The cardiac imager should actively assess the sinuses of valsalva in every CCTA study.

  5. 3D Multislice CT Angiography in Post-Aortic Stent Grafting: A Pictorial Essay

    Helical CT angiography has been widely used in both pre- and post-aortic stent grafting and it has been confirmed to be the preferred modality when compared to conventional angiography. The recent development of multislice CT (MSCT) has further enhanced the applications of CT angiography for aortic stent grafting. One of the advantages of MSCT angiography over conventional angiography is that the 3D reconstructions, based on the volumetric CT data, provide additional information during follow-up of aortic stent grafting. While endovascular repair has been increasingly used in clinical practice, the use of 3D MSCT imaging in endovascular repair continues to play an important role. In this pictorial essay, we aimed to discuss the diagnostic performance of 3D MSCT angiography in post aortic stent grafting, including the most commonly used surface shaded display, curvilinear reformation, the maximum intensity projection, volume rendering and virtual endoscopy. The advantages and disadvantages of each 3D reconstruction are also explored

  6. Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

    The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EMG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

  7. Efficacy of 'fine' focal spot imaging in CT abdominal angiography

    To assess the efficacy of fine focal spot imaging in calcification beam-hardening artefact reduction and vessel clarity on CT abdominal angiography (CTAA). Adult patients of any age and gender who presented for CTAA were included. Thirty-nine patients were examined with a standard focal spot size (SFSS) of 1 x 1 mm in the first 3 months while 31 consecutive patients were examined with a fine focal spot size (FFSS) of 1 x 0.5 mm in the following 3 months. Vessel clarity and calcification beam-hardening artefacts of the abdominal aorta, celiac axis, superior mesenteric artery, inferior mesenteric artery, renal arteries, and iliac arteries were assessed using a 5-point grading scale by two blinded radiologists randomly. Cohen's Kappa test indicated that on average, there was substantial agreement among reviewers for vessel wall clarity and calcification artefact grading. Mann-Whitney test showed that there was a significant difference between the two groups, with FFSS performing significantly better for vessel clarity (U, 6481.50; p < 0.001; r, 0.73) and calcification artefact reduction (U, 1916; p < 0.001; r, 0.77). Fine focus CT angiography produces images with better vessel wall clarity and less vessel calcification beam-hardening artefact. (orig.)

  8. Quantitativa analysis by 64-slice computed tomography in diagnosis of intermediate coronary artery stenosis%64排CT冠状动脉造影定量分析在冠状动脉临界病变中的价值

    施鸿毓; 陈晖; 仇兴标; 曲新凯; 方唯一

    2012-01-01

    目的 评价64排CT冠状动脉造影对临界病变定量分析的可行性.方法 入选2009年5月-2010年8月于上海交通大学附属胸科医院行64排CT冠状动脉造影检查提示为临界病变的91例患者,共205处病变.在2周内进行经皮冠状动脉造影及定量冠状动脉造影(QCA)分析.采用Bland-Altman分析和Pearson相关分析对比64排CT冠状动脉造影定量分析与QCA的结果.结果 64排CT冠状动脉造影检查示,病变参考直径为(3.1±0.4) mm,病变长度为(14.2±11.3)mm;狭窄程度为(57.8±0.7)%,与QCA测定的(58.2±13.9)%的差异无统计学意义(P=0.64).205个经64排CT冠状动脉造影定量分析示冠状动脉狭窄程度为40%~70%的病变中,QCA检查示27个病变(13.2%)的狭窄程度低于40%,43个病变(21.0%)高于70%,135个病变(65.9%)属于冠状动脉狭窄程度为40%~70%的临界病变.64排CT冠状动脉造影定量分析与QCA结果呈中度相关(r=0.599,P<0.001),但一致性较差(平均偏差为0.4%,95%一致性可信区间为-22.1%~22.9%).结论 64排CT冠状动脉造影对临界病变的诊断价值有限,其定量分析与QCA的一致性欠佳,目前临床实用价值有限.%Objective To evaluate the feasibility of quantitative analysis by 64-slice computed tomography (CT) in intermediate coronary artery lesions. Methods Totally 91 patients with 205 lesions were diagnosed as intermediate coronary artery stenosis by 64-slice CT from May 2009 to August 2010. Conventional percutaneous coronary angiography was performed within 2 weeks after CT scan. The results of 64-slice CT quantitative analysis and quantitive coronary angiography (OCA) were compared by Bland-Altman analysis and Pearson correlations. Results The average reference values of lesions were (3.1 ±0.4) mm in diameter and (14.2±11.3) mm in length by CT scan. Diameter stenosis was (57.8 + 0.7)% by CT quantification and (58.2 + 13.91)% by OCAi there was no significant difference

  9. Radiation dose in cerebral angiography and flat detector CT applications in neuroradiology; Strahlendosis bei zerebraler Angiographie und Flachdetektor-CT-Applikationen in der Neuroradiologie

    Struffert, T.; Lang, S.; Doerfler, A. [Universitaetsklinikum Erlangen, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Abteilung fuer Neuroradiologie, Erlangen (Germany); Scholz, R. [Siemens Healthcare GmbH, Forchheim (Germany); Hauer, M. [Klinikum Nuernberg Sued, Institut fuer Radiologie und Neuroradiologie, Nuernberg (Germany)

    2015-08-15

    Flat detectors (FD) have completely replaced image intensifiers in angiography. Due to this development not only the image quality of 2D digital subtraction angiography series (2-D-DSA) could be improved but also the acquisition of computed tomography (CT)-like cross-sectional images (FD-CT) within the angio suite became feasible. These techniques are now being used in daily clinical routine. Only little information about effective doses of these applications to patients has been published in the literature. We describe the effective patient dose of current applications in the field of angiography and demonstrate strategies to minimize the dose to the patient. In addition, we compare FD-CT applications to standard multislice CT applications. (orig.) [German] Flachdetektoren haben Bildverstaerker in der Angiographie vollstaendig abgeloest. Mit dieser Entwicklung verbesserte sich nicht nur die Bildqualitaet subtrahierter 2-D-Angiographieserien (2-D-DSA), sondern auch die Akquisition CT-aehnlicher Schnittbilder (FD-CT) mit unterschiedlichen Indikationen wurde moeglich. Diese Techniken werden nun in der taeglichen klinischen Routine eingesetzt. Angaben zur effektiven Patientendosis dieser Applikationen sind bis jetzt in der Literatur nur wenige publiziert worden. Wir beschreiben die effektive Patientendosis aktueller Anwendungen im Bereich der Angiographie und zeigen Strategien zur Minimierung der Dosis fuer den Patienten auf. Zudem vergleichen wir FD-CT-Applikationen mit Standard-Multislice-CT-Anwendungen. (orig.)

  10. Diagnostic Accuracy of Sixty Four Multi-Slice CT Angiography in Assessment of Arterial Cut-Off and Run-Off in Comparison with Surgical Findings

    M. Noaparast

    2011-06-01

    Full Text Available Background/Objective: The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed todetermine the diagnostic value of 64-multislice CT angiography (MSCTA in run-off and cut-off sites of arterial disease.Patients and Methods: Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterialdisease (AD all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93 years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively.Results: Atherosclerosis and arterial disease, the most common causes of vascular occlusion,were more common in the lower extremities. According to MSCTA findings, the most frequentsite of stenosis was the superficial femoral artery. Spearman’s correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictivevalue (PPV, negative predictive value (NPV and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgeryas a standard of reference, which showed concordance in the majority of cases (81.6%. Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%.Conclusion: MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis.

  11. Investigation of temporal resolution required for CT coronary angiography

    Ohashi, Kazuya; Ichikawa, Katsuhiro; Kawai, Tatsuya; Shibamoto, Yuta

    2012-03-01

    Sub-second multi-detector computed tomography systems (MDCTs) offer great potentials for improving cardiac imaging. However, since the temporal resolution of such CT systems is not sufficient, blurring and artifacts produced by fast cardiac motion are still problematic. The purposes of this study were to investigate the accurate method for measurement of temporal resolution (TR) of the cardiac CT and required TR for obtaining better CT coronary angiography (CTCA). We employed a dual source CT system (Somatom Definition, Siemens), which has various temporal resolution modes (83, 125, and 165 msec) for electro-cardiogram (ECG)-gated scanning. The temporal sensitivity profiles (TSPs) were measured by a new method using temporal impulse generated by metal ball (impulse method). The CTCA images of 200 patients with heart rates (HRs) ranging from 36 to 117 beat per minute (bpm) were visually evaluated using a 4-point scale. The 165-msec TR mode, which is mostly available on recent MDCTs, showed a sufficient image quality only at low HR (80 bpm).

  12. Diagnosis of carotid artery disease by CT scan. Intravenous CT carotid-angiography

    Kuriyama, Y.; Sawada, T.; Naito, H.; Karasawa, J. (National Cardiovascular Center, Osaka (Japan))

    1981-09-01

    Non-invasive methods, such as radioisotope angiography, oculoplethsmography, and ultrasonic Doppler flowmetry, are used for the detection of caroid artery lesion. However, these methods are qualitative, and diagnostic accuracies are inferior to arteriography. On the other hand arterography needs catheterization. So we tried to use CT scan and intravenous contrast enhancement for the diagnosis of carotid artery disease. A CT/T scanner (X-2) was used, which enabled to produce computer reconstruction image of the carotid artery by use of the arrange program. 12 sequential axial images of the neck (between heights of C2 and C5) were obtained before and during infusion of contrast material. Analysis of sequential axial images and reformatted images were obtained in patients with cerebrovascular disease. Carotid arteriography were made in 53 arteries, lesions with stenosis and/or occlusion were demonstrated in 26/53 arteries. Intravenous CT carotid-angiography revealed lesions with stenosis and/or occlusion in 25/53 arteries. Results of statistical analysis were as follows; overall diagnostic accuracy 52/53 (98%), diagnostic sensitivity 25/26 (96%) and diagnostic specificity 27/27 (100%), respectively. Moreover, intravenous CT carotid-angiography provided following benefits beyond arteriography. 1) Minimal calcification of the carotid wall and precise localisation of atheromatous plaque could be detected. 2) Patent arterial lumen above the occluded lesion could be found out. 3) CT carotid-angiography would be suitable for the follow-up study after carotid endoarterectomy because of the unneccessity of catheterization. 4) Thrombus formation in the internal jugular vein could be grasped.

  13. Evaluation of middle cerebral artery stents using multidetector row CT angiography in vivo study: comparison of the three different kernels

    Background: There are very few reports assessing middle cerebral artery (MCA) stents using multidetector computed tomography (MDCT). Purpose: To assess MCA stents using multidetector CT angiography (CTA) in vivo evaluation: the differences in the CTA results according to the three different kernels. Material and Methods: We retrospectively evaluated 27 MCA stents from 26 patients who underwent CTA with 16- and 64-slice MDCT after percutaneous transluminal angioplasty and stenting (PTAS). By CTA, using medium-smooth kernel (B30), medium-sharp kernel (B50), and sharp kernel (B60), the lumen diameter, artificial luminal narrowing (ALN), and subjective visibility score of the stented vessels were evaluated. The subjective visibility score ranged from 1 (poor quality) to 5 (excellent) using a five-point scale. Results: There were excellent inter-observer agreements for the lumen diameter measurements (P < 0.001). The mean diameter of the stented vessels was 2.10 ± 0.31 mm on digital subtraction angiography (DSA), 0.93 ± 0.20 mm on CTA using B30, 1.18 ± 0.27 mm on CTA using B50, and 1.29 ± 0.29 mm on CTA using B60. The mean ALN was 55.7 ± 6.0% on CTA using B30, 43.8 ± 7.5% on CTA using B50, and 38.7 ± 8.3% on CTA using B60. CTA with higher kernels had a smaller ALN than images with smaller kernels. The median subjective visibility score on the CTA using B50 was 3, which was higher than for the other kernels. The differences in the lumen diameter, ALN, and the subjective visibility score of the stented vessels on CTA using the three different kernels was statistically significant (P < 0.001). Conclusion: The sharp kernel was better to assess the lumen diameter and ALN, but was inferior to the medium-sharp kernel for in-stent evaluation due to high image-to-noise. CTA with medium-sharp kernel showed good lumen visibility and acceptable ALN for MCA stents. This could therefore be a non-invasive, readily applicable clinical method for assessing MCA stent patency after

  14. Evaluation of middle cerebral artery stents using multidetector row CT angiography in vivo study: comparison of the three different kernels

    Jang, Jin Hee; Lim, Yeon Soo; Lee, Youn Joo; Yoo, Won Jong; Sung, Mi Sook (Dept. of Radiology, Bucheon St Mary' s Hospital, Coll. of Medicine, The Catholic Univ. of Korea, Bucheon (Korea, Republic of)), email: wjyu@catholic.ac.kr; Kim, Bum Soo (Dept. of Radiology, Seoul St Mary' s Hospital, Coll. of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of))

    2012-05-15

    Background: There are very few reports assessing middle cerebral artery (MCA) stents using multidetector computed tomography (MDCT). Purpose: To assess MCA stents using multidetector CT angiography (CTA) in vivo evaluation: the differences in the CTA results according to the three different kernels. Material and Methods: We retrospectively evaluated 27 MCA stents from 26 patients who underwent CTA with 16- and 64-slice MDCT after percutaneous transluminal angioplasty and stenting (PTAS). By CTA, using medium-smooth kernel (B30), medium-sharp kernel (B50), and sharp kernel (B60), the lumen diameter, artificial luminal narrowing (ALN), and subjective visibility score of the stented vessels were evaluated. The subjective visibility score ranged from 1 (poor quality) to 5 (excellent) using a five-point scale. Results: There were excellent inter-observer agreements for the lumen diameter measurements (P < 0.001). The mean diameter of the stented vessels was 2.10 +- 0.31 mm on digital subtraction angiography (DSA), 0.93 +- 0.20 mm on CTA using B30, 1.18 +- 0.27 mm on CTA using B50, and 1.29 +- 0.29 mm on CTA using B60. The mean ALN was 55.7 +- 6.0% on CTA using B30, 43.8 +- 7.5% on CTA using B50, and 38.7 +- 8.3% on CTA using B60. CTA with higher kernels had a smaller ALN than images with smaller kernels. The median subjective visibility score on the CTA using B50 was 3, which was higher than for the other kernels. The differences in the lumen diameter, ALN, and the subjective visibility score of the stented vessels on CTA using the three different kernels was statistically significant (P < 0.001). Conclusion: The sharp kernel was better to assess the lumen diameter and ALN, but was inferior to the medium-sharp kernel for in-stent evaluation due to high image-to-noise. CTA with medium-sharp kernel showed good lumen visibility and acceptable ALN for MCA stents. This could therefore be a non-invasive, readily applicable clinical method for assessing MCA stent patency after

  15. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    Bechan, R.S.; Peluso, J.P.; Sluzewski, M.; Rooij, W.J. van [Sint Elisabeth Ziekenhuis Tilburg, Department of Radiology, Tilburg (Netherlands); Rooij, S.B. van [Medisch Centrum Alkmaar, Department of Radiology, Alkmaar (Netherlands); Sprengers, M.E.; Majoie, C.B. [Academisch Medisch Centrum, Department of Radiology, Amsterdam (Netherlands)

    2015-12-15

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  16. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  17. Hilar cholangiocarcinoma. An evaluation of subtypes with CT and angiography.

    Yamashita, Y; Takahashi, M; Kanazawa, S; Charnsangavej, C; Wallace, S

    1992-07-01

    Sixty-seven patients had hilar cholangiocarcinomas which were divided into 3 types based on tumor morphology as observed on cholangiography and CT. The pathology, vascularity, and pattern of tumor spread of these types were compared. Most of the infiltrative tumors (n = 44) were scirrhous adenocarcinomas, which on CT showed poor or no contrast enhancement with frequent lymph node metastases and liver atrophy. At angiography, there was vascular encasement in 52%, in rare cases neovascularity, and tumor stain. The exophytic type (n = 19) was divided into 2 subgroups depending on the main location of the tumor. The nodular subtype (n = 16) was mainly inside the liver and somewhat hypervascular similar to peripheral cholangiocarcinoma, often with intrahepatic metastases. The periductal subtype (n = 3) was hypovascular, similar to the infiltrative cholangiocarcinoma, and had a tendency to spread along the portal vein. The intraductal type (n = 4) was observed as a filling defect on cholangiography. CT revealed an intraluminal low density mass. Histologically, they were papillary adenocarcinomas. The radiologic types of hilar cholangiocarcinoma showed different characteristics with regard to pathologic findings, vascularity, and pattern of spread. PMID:1321653

  18. Hilar cholangiocarcinoma; An evaluation of subtypes with CT and angiography

    Yamashita, Y.; Takahashi, M.; Kanazawa, S.; Charnsangavej, C.; Wallace, S. (Dept. of Radiology, Kumamoto University School of Medicine (Japan) Dept. of Radiology, Univ. of Texas, M.D. Anderson Hospital and Tumor Inst., Houston, TX (United States))

    1992-07-01

    Sixty-seven patients had hilar cholangiocarcinomas which were divided into 3 types based on tumor morphology as observed on cholangiography and CT. The pathology, vascularity, and pattern of tumor spread of these types were compared. Most of the infiltrative tumors were scirrhous adenocarcinomas, which on CT showed poor or no contrast enhancement with frequent lymph node metastases and liver atrophy. At angiography, there was vascular encasement in 52%, in rare cases neovascularity, and tumor stain. The exophytic type was divided into 2 subgroups depending on the main location of the tumor. The nodular subtype was mainly inside the liver and somewhat hypervascular similar to peripheral cholangiocarcinoma, often with intrahepatic metastases. The periductal subtype was hypovascular, similar to the infiltrative cholangiocarcinoma, and had a tendency to spread along the portal vein. The intraductal type was observed as a filling defect on cholangiography. CT revealed an intraluminal low density mass. Histologically, they were papillary adenocarcinomas. The radiologic types of hilar cholangiocarcinoma showed different characteristics with regard to pathologic findings, vascularity, and pattern of spread. (orig.).

  19. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis.

    Choi, Jin-Ho; Min, James K; Labounty, Troy M; Lin, Fay Y; Mendoza, Dorinna D; Shin, Dae Hee; Ariaratnam, Nikki S; Koduru, Sunaina; Granada, Juan F; Gerber, Thomas C; Oh, Jae K; Gwon, Hyeon-Cheol; Choe, Yeon Hyeon

    2011-11-01

    Coronary computed tomography angiography (CTA) assessment of calcified or complex coronary lesions is frequently challenging. Transluminal attenuation gradient (TAG), defined as the linear regression coefficient between luminal attenuation and axial distance, has a potential to evaluate the degree of coronary stenosis. We examined the value of TAG in determining the stenosis severity on 64-slice coronary CTA. The value of TAG of 370 major coronary arteries was measured from 7,263 intervals of 5-mm length. Compared with coronary CTA and invasive coronary angiography, TAG decreased consistently and significantly with maximum stenosis severity on a per-vessel basis, from -1.91 ± 4.25 Hounsfield units/10 mm for diameter stenosis of 0% to 49% to -13.37 ± 9.81 Hounsfield units/10 mm for diameter stenosis of 100% (p TAG to the interpretation of coronary CTA improved diagnostic accuracy (p = 0.001), especially in vessels with calcified lesions (N = 127; net reclassification improvement 0.095; p = 0.046). TAG appears to be able to contribute to improved classification of coronary artery stenosis severity in coronary CTA, especially in severely calcified lesions. PMID:22093264

  20. Usefulness of Y-shaped sheaths in CT angiography for examination of liver tumors

    Toru; Ishikawa; Kazuo; Higuchi; Tomoyuki; Kubota; Kei-ichi; Seki; Terasu; Honma; Toshiaki; Yoshida; Takeo; Nemoto; Keiko; Takeda; Tomoteru; Kamimura

    2010-01-01

    AIM: To conduct a single-stage, combined computed tomography (CT) arterial portography (CTAP) and CT arteriography (CTA) imaging operation, we used Y-shaped sheaths with 2 valves, which allowed the insertion of 2 catheters simultaneously. METHODS: Of 1254 patients who underwent abdominal angiography for transarterial embolization and/or intraarterial chemotherapy in our department from May 2002 to November 2009, 664 patients in whom Y-shaped sheaths with 2 valves were used underwent CT angiography using a c...

  1. The structures mimicking aneurysm on 3-dimensional volume rendering CT angiography using a 16-row detector CT

    This study was conducted to identify the structures that can mimic aneurysm on CT angiography with using the 3-D volume rendering technique and a 16-row detector CT. This study examined 206 patients who underwent CT angiography with a 16-row detector CT from May 2003 to July 2004. For the CT angiography, the contrast media was injected at a rate of 4 cc per second. The scanning was then done when 5 seconds delay time had elapsed after the CT number of the common carotid artery had reached 150. The baseline images were obtained by reconstructing the row data with a kernel value of H31f, a slice thickness of 1 mm and an increment of 0.5 mm. Finally, the 3-D images were constructed by using a volume rendering technique. The structures that were confused with aneurysm on CT angiography were further evaluated by MPR or MIP to ascertain whether they were aneurysms. For comparison, digital subtraction angiography was done in 86 patients and surgery was done in 5 patients. On CT angiography, 51 patients did not show any abnormalities, and 80 patients showed definitive aneurysms, as was ascertained by their sizes, shapes and locations, or by the aneurysm clips only. The remaining 75 patients showed 90 aneurysm mimicking structures that were 35 infundibular dilatations or preaneurysmal blebs, 24 focal dilatations of the branches of the deep middle cerebral veins, 6 focal dilatations of the sphenoparietal sinuses adjacent to the middle cerebral artery, 18 focal dilatations of the inferior sagittal sinuses adjacent to the pericallosal artery and 7 low density calcifications of the vessel walls that were adjacent to the aneurysm-prevalent arteries. CT angiography based on volume rendering technique was able to identify the structures that were confused with aneurysm. Accordingly, careful observation is required for interpreting the reconstructing 3-D images since a wide variety of structures can be confused with aneurysm on CT angiography

  2. CT coronary angiography versus conventional invasive coronary angiography. The view of the referring physician

    Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. 53 questionnaires (30%) were assessable, corresponding to more than 72% of the patients referred. Of the referring physicians who responded, 94% saw a concrete advantage of CCTA in the treatment of patients, whereby 87% were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1-5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42% of the referring physicians. 90% of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87% of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

  3. CT coronary angiography versus conventional invasive coronary angiography. The view of the referring physician

    Maurer, Martin H. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Universitaetsspital Bern (Switzerland). Dept. fuer Diagnostische, Interventionelle und Paediatrische Radiologie; Zimmermann, E.; Hamm, B. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Dewey, M.

    2014-12-15

    Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. 53 questionnaires (30%) were assessable, corresponding to more than 72% of the patients referred. Of the referring physicians who responded, 94% saw a concrete advantage of CCTA in the treatment of patients, whereby 87% were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1-5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42% of the referring physicians. 90% of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87% of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

  4. Hepatic arterial supply in 1297 CT-angiographies; Die arterielle Leberversorgung in 1297 CT-Angiografien

    Loeschner, C.; Kausche, S.; Teichgraeber, U. [Jena University Hospital, Jena (Germany). Dept. of Radiology; Nagel, S.N. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology

    2015-04-15

    Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2%), followed by type V in 114 patients (8.8%) and type III in 83 patients (6.4%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n=10). Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification.

  5. Can CT angiography rule out aneurysmal subarachnoid haemorrhage in CT scan-negative subarachnoid haemorrhage patients?

    Lim, Lee Kai; Dowling, Richard J; Yan, Bernard; Mitchell, Peter J

    2014-01-01

    Current management guidelines for CT scan-negative subarachnoid haemorrhage (SAH) patients recommend cerebral digital subtraction angiography (DSA). We aimed to investigate the utility of CT angiography (CTA) as a substitute for DSA in these patients. We included patients who presented with SAH confirmed by spectrophotometric xanthochromia analysis of cerebrospinal fluid (CSF) whereby the CT scan was negative. Electronic records were reviewed to collect data on non-contrast CT scan, CTA and DSA results. Patients without DSA or with other explanations for CSF xanthochromia were excluded. Sixty-three patients with CT scan-negative SAH were included. The diagnosis of SAH was confirmed by CSF analysis. All 63 patients underwent both DSA and CTA. Using DSA as the benchmark, CTA demonstrated a negative predictive value, positive predictive value, sensitivity and specificity of 98%, 82%, 90% and 96%, respectively, for the detection of intracranial aneurysms. CTA correctly identified patients in whom there were no underlying aneurysms responsible for SAH, with one patient with suspected dissection referred for further evaluation using MRI and DSA. PMID:23954458

  6. Minimizing the acquisition phase in coronary CT angiography using the second generation 320-row CT

    We aimed to compare the radiation dose and image quality of a minimal phase window centered at 77% compared with a wide phase window in coronary CT angiography using the second-generation 320-row CT. Eighty patients with heart rate ≤75 bpm were retrospectively included. The first 40 patients underwent scanning with a wide phase window (65-85%), while the last 40 patients underwent scanning with a minimal phase window centered at 77%. Subjective image quality was graded using a 4-point scale (4=excellent). Image noise and contrast-to-noise ratio at the proximal segments were also analyzed. The mean effective dose was derived from the dose length product multiplied by a chest conversion coefficient (κ=0.014 mSv mGy-1 cm-1). Minimal phase window scanning centered at 77% reduced the radiation dose by 30% compared with wide phase window scanning (1.7 vs 2.4 mSv, p=0.0009). The subjective image quality showed no significant difference (3.75 vs 3.76, p=0.77). No significant difference was observed in the image noise, CT number, and contrast-to-noise ratio. Radiation dose could be reduced while maintaining image quality by use of a minimal phase window centered at 77% compared with a wide phase window in coronary CT angiography using the second generation 320-row CT. (author)

  7. Detection of hypervascular hepatocellular carcinoma: Comparison of multi-detector CT with digital subtraction angiography and Lipiodol CT

    Zheng, Xiao-Hua; Guan, Yong-Song; Zhou, Xiang-Ping; Huang, Juan; Sun, Long; Li, Xiao; Liu, Yuan

    2005-01-01

    AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA) and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).

  8. First results of spiral CT angiography in the evaluation of carotid artery stenosis; Erste Ergebnisse der Spiral-CT-Angiographie beim Nachweis von Stenosen der A. carotis

    Link, J. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany); Mueller-Huelsbeck, S. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany); Brossmann, J. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany); Grabener, M. [Klinik fuer Herz- und Gefaesschirgurgie, Kiel Univ. (Germany); Voss, C. [Klinik fuer Herz- und Gefaesschirgurgie, Kiel Univ. (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany)

    1995-03-01

    To determine the value of spiral CT angiography in Maximum Intensity Projection (MIP)-technique for evaluation of carotid artery stenosis. A comparison of the MIP technique with intraarterial DSA was done in 24 patients with 40 stenoses. Quantification of stenosis was determined according to the NASCET study: mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%). Totally the correlation of spiral CT angiography with DSA was 80% (r=0.93; p=0.0001). In the moderate stenosis group (r=1; p=0.1573), severe stenosis group (r=0.89; p=0.002) and the occlusion group (r=1; p=0.0009) there was a good correlation with DSA. In the mild stenosis group (r=0.55; p=0.0704) correlation of spiral CT angiography with DSA was poor. Spiral CT angiography allows an excellent delineation of calcifications. Tandem lesions and collateral flow cannot be shown with spiral CT angiography. (orig./MG) [Deutsch] Ziel der Studie war es, die Wertigkeit der Spiral-CT-Angiographie in der Maximum-Intensitaets-Projektion (MIP)-Technik bei der Beurteilung von Stenosen der A. carotis interna zu ueberpruefen. Ein Vergleich der MIP-Technik mit der selektiven DSA wurde bei 24 Patienten mit 40 Stenosen der A. carotis interna durchgefuehrt. Die Stenosequantifizierung erfolgte nach den Kriterien der NASCET-Studie: Geringgradig (0-29%); mittelgradig (30-69%); hochgradig (70-99%); Verschluss (100%). Die Spinal-CT-Angiographie korrelierte mit der DSA in 80% (R=0,93; p=0,0001). Bei den mittelgradigen (R=1; p=0,1573) und hochgradigen Stenosen (R=0,89; p=0,002) sowie bei den Verschluessen (R=1; p=0,0009) bestand eine gute Korrelation zur DSA. Bei den geringgradigen Stenosen (R=0,55; p=0,0704) war die Korrelation mit der DSA weniger gut. Kalkplaques lassen sich mit der Spiral-CT-Angiographie hervorragend darstellen. Tandemstenosen und der intrazerebrale Kollateralkreislauf sind mit der Spiral-CT-Angiographie bisher nicht evaluierbar. (orig./MG)

  9. CT angiography and Color Doppler ultrasonography features and sensitivity in detection of carotid arteries diseases

    Samir Kamenjaković

    2013-04-01

    Full Text Available Introduction: The aim of this research was to compare specifi city and sensitivity of Color Doppler ultrasonographywith CT angiography.Methods: A total of one hundred patients suffering from carotid artery disease (n=200 were tested in this research in the period from June till October, 2011. Average age of the patients was 61.5 years, and most of the patients were in the age group ranging from 55 to 65 years. The level of carotid artery stenosis is measured according to Standards of the North America Symptomatic Carotid Endarterectomy Trail study,by method of Color Doppler ultrasonography and CT angiography.Results: Stenosis <50% registered by Doppler ultrasonography was found in 62% and by CT angiography in 64% patients. Stenosis from 70 to 79% registered by Doppler ultrasonography was found in 88% and by CT angiography in 82% patients. In patients with level of stenosis 70-79% there was a tendencyof registering the stenosis to be higher by Color Doppler ultrasonography, than by CT angiography. In the case of the occlusion, there was also the similar observation, with variation of 8% carotid arteries.Conclusion: Extracranial Doppler and color duplex ultrasound enable reliable detection of both stenosis and occlusion of carotid arteries and accordingly they occupy an important place in radiological algorithm. When it comes to CT angiography it can be concluded that it can provide accurate and exact information regarding the condition of blood vessels as good as Digital Subtractive Angiography can.

  10. Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion

    Hanson, Eric H. [Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); University of Nevada Las Vegas, Department of Health Physics and Diagnostic Sciences, 4505 Maryland Parkway, Box 453037, Las Vegas, NV (United States); Amigenics, Inc, Las Vegas, NV (United States); Roach, Cayce J. [Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); University of Nevada Las Vegas, School of Life Sciences, Las Vegas, NV (United States); Ringdahl, Erik N. [University of Nevada Las Vegas, Department of Psychology, Las Vegas, NV (United States); Wynn, Brad L. [Family Medicine Spokane, Spokane, WA (United States); DeChancie, Sean M.; Mann, Nathan D. [Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); Diamond, Alan S. [CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); Orrison, William W. [Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); University of Nevada Las Vegas, Department of Health Physics and Diagnostic Sciences, 4505 Maryland Parkway, Box 453037, Las Vegas, NV (United States); CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); University of Nevada School of Medicine, Department of Medical Education, Reno, NV (United States)

    2011-05-15

    Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, -10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures. (orig.)

  11. Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion

    Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, -10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures. (orig.)

  12. Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography

    M. van der Jagt (Mathieu); H.Z. Flach (Zwenneke); H.L.J. Tanghe (Hervé); S.L.M. Bakker (Stef); M.G.M. Hunink (Myriam); P.J. Koudstaal (Peter Jan); A. van der Lugt (Aad)

    2008-01-01

    textabstractBackground: It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage. Methods: We studied 80 consecutive patients with

  13. Pancreatic pseudoaneurysm in a child with hereditary pancreatitis: diagnosis with multidetector CT angiography

    Ahmed, Hossam K.; Hagspiel, Klaus D.; Angle, John F.; Leung, Daniel A.; Spinosa, David J.; Matsumoto, Alan H. [Department of Radiology, University of Virginia Health System, Box 800170, VA 22908, Charlottesville (United States); McGahren, Eugene D.; Rodgers, Bradley M. [Department of Surgery, Division of Pediatric Surgery, University of Virginia Health System, Box 800170, VA 22908, Charlottesville (United States)

    2004-08-01

    Pseudoaneurysm formation is a serious vascular complication of pancreatitis. It most commonly affects splenic and gastroduodenal arteries. We report a rare case of superior mesenteric artery pseudoaneurysm in a child with hereditary pancreatitis. Multidetector CT angiography allowed the comprehensive assessment of the aneurysm and allowed accurate surgical planning obviating the need for catheter angiography. (orig.)

  14. Pancreatic pseudoaneurysm in a child with hereditary pancreatitis: diagnosis with multidetector CT angiography

    Pseudoaneurysm formation is a serious vascular complication of pancreatitis. It most commonly affects splenic and gastroduodenal arteries. We report a rare case of superior mesenteric artery pseudoaneurysm in a child with hereditary pancreatitis. Multidetector CT angiography allowed the comprehensive assessment of the aneurysm and allowed accurate surgical planning obviating the need for catheter angiography. (orig.)

  15. Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

    Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

    2014-10-15

    CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

  16. Generalised brain edema and brain infarct in ergotamine abuse: Visualization by CT, MR and angiography

    Abuse of ergotamine can release a generalised brain edema and brain infarctions. This can be visualized by CT, MR and angiography. The reason, however, can only be found in the patients history. (orig.)

  17. A study of whole brain perfusion CT and CT angiography in hyperacute and acute cerebral infarction

    Objective: To evaluate the diagnostic value of whole-brain perfusion blood volume-weighted CT imaging (PWCT) and simultaneous CT angiography (CTA) on early stage of cerebral ischemic infarction. Methods: Non-contrast CT (NCCT), CT perfusion-weighted imaging (PWCT) and delayed CT (DCT) were conducted on 20 cases of early ischemic infarction of whose onset time ranged from 2 to 24 hours. All cases were reexamined with CT or MRI one week to one month later. CT values and perfusion blood volume (PBV) of central and peripheral low perfusion areas as well as those of collateral side were measured. CTA was reconstructed with PWCT as source images to evaluate occlusion or stenosis of blood vessel, and DCT was used to detect the collateral circulation. Results: Of the 20 cases, NCCT, PWCT and CTA were negative in 10 cases in which 6 were confirmed as Transient Ischemic Attack (TIA) on reexamined CT and clinical features, and the other 4 were confirmed as lacunar infarction. For the remaining 10 cases, a comparison was made with ANOVA between low perfusion area (central, peripheral inside and outside) and collateral side. The difference was significant (P<0.01). However, no significant difference was revealed in the central, peripheral inside and outside areas. PBV values were significant in low perfusion area and collateral side (P<0.05). The area of the final infarction was larger than that of the low perfusion area, and the percentage of enlargement exhibited medium negative correlation to the time of ischemia. CTA indicated that 2 cases suffered from left middle cerebral artery occlusion, meanwhile anterior and middle branches of MCA in the other 3 cases were not identified. The sensitivity of NCCT, PWCT and CTA were 28.5%, 71.4% and 35.7% respectively. DCT indicated that 5 cases had asymmetrical blood vessels. Conclusion: The whole-brain perfusion-weighted CT imaging and simultaneous CT angiography (CTA) is p roved to be a simple, timesaving and effective method for the

  18. Combined hepatocellular and cholangiocarcinoma of the liver: sonography, CT, angiography, and iodized-oil CT with pathologic correlation.

    Choi, B I; Han, J K; Kim, Y I; Kim, H C; Park, J H; Kim, C W; Han, M C

    1994-01-01

    To evaluate the characteristics of combined hepatocellular and cholangiocarcinoma of the liver by imaging techniques, six patients (five male and one female), aged 46-60 years, with proved combined tumors were selected for this study from the review of 500 resected specimens of liver tumors. Images obtained from sonography, computed tomography (CT), angiography, and CT after intraarterial injection of iodized oil (iodized-oil CT) were retrospectively reviewed and correlated with the appearance of pathologic specimens. Sonographic findings were round or ovoid hypoechoic masses with central hyperechoic area (target appearance) in all patients. On CT scans, tumors were relatively well-defined low-and/or iso-attenuation masses in all patients. Angiography showed hypovascular masses in five patients. In one patient, the tumor appeared as a hypovascular mass with a central hypervascular area. On iodized-oil CT scans, all patients showed partial retention of iodized oil in tumors. Echogenicity in tumors at sonography or attenuation in tumors at CT could not be correlated with histologic difference in tumors at pathologic specimens. However, the hypervascular area at angiography and the compact retention areas of iodized oil at iodized-oil CT corresponded to portions of hepatocellular carcinoma within the combined tumor. On the basis of our results, imaging features, including target appearance at sonography, hypovascular mass with central hypervascular portions at angiography, and partial retention of iodized oil in tumors at iodized-oil CT, might be helpful in making accurate diagnosis of these rare tumors. PMID:8161902

  19. Radiological findings of dissecting aneurysm -a correlative study of CT with angiography-

    Bae, Tae Yeong; Park, Jae Hyung; Kim, Seung Hyup; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1987-06-15

    This study comprised 16 patients with aortic dissecting aneurysm who were admitted to Seoul National University Hospital from May 1984 to January 1987. CT findings in 16 cases of aortic dissecting aneurysm were correlated with angiographic findings retrospectively. The results were analysed. 1. Number of male was 11 and that of female was 5. Male patients in fifties were most common and 4 in number. 13 patients had hypertension or history of hypertension among 14 patients. There were one case of Marfan's syndrome, preeclampsia and Takayasu's arteritis respectively. 2. There were 5 cases of DeBakey type I, 1 case of type II and 9 cases of types III dissecting aneurysm. Type III was most common. 3. CT confirmed as superior vena cava which was not identified whether it was superior vena cava or unopacified false lumen by angiography in one case. Regarding distal extent, authors defined A whose extent was proximal to diaphragm and B beyond it for convenience sake. There was one false negative case in CT among 16 cases which was diagnosed as dissecting aneurysm type IIIB by angiography and confirmed as type III surgically. One case was diagnosed as type IB by CT and as type IIIB by angiography and confirmed as type I surgically. Extent was more accurate in CT than angiography. One case was diagnosed as type II by CT but misdiagnosed as right atrial tumor by angiography. 4. Diagnostic sensitivities of CT and angiography in this study were 94% (15/16) respectively. CT was more advantageous in hemothorax, hemopericardium, hemomediastinum, unopacified false lumen, aortic wall calcification and getting information about mediastinum. In angiography aortic regurgitation and tear site and involvement of abdominal vessels could be observed.

  20. Radiological findings of dissecting aneurysm -a correlative study of CT with angiography-

    This study comprised 16 patients with aortic dissecting aneurysm who were admitted to Seoul National University Hospital from May 1984 to January 1987. CT findings in 16 cases of aortic dissecting aneurysm were correlated with angiographic findings retrospectively. The results were analysed. 1. Number of male was 11 and that of female was 5. Male patients in fifties were most common and 4 in number. 13 patients had hypertension or history of hypertension among 14 patients. There were one case of Marfan's syndrome, preeclampsia and Takayasu's arteritis respectively. 2. There were 5 cases of DeBakey type I, 1 case of type II and 9 cases of types III dissecting aneurysm. Type III was most common. 3. CT confirmed as superior vena cava which was not identified whether it was superior vena cava or unopacified false lumen by angiography in one case. Regarding distal extent, authors defined A whose extent was proximal to diaphragm and B beyond it for convenience sake. There was one false negative case in CT among 16 cases which was diagnosed as dissecting aneurysm type IIIB by angiography and confirmed as type III surgically. One case was diagnosed as type IB by CT and as type IIIB by angiography and confirmed as type I surgically. Extent was more accurate in CT than angiography. One case was diagnosed as type II by CT but misdiagnosed as right atrial tumor by angiography. 4. Diagnostic sensitivities of CT and angiography in this study were 94% (15/16) respectively. CT was more advantageous in hemothorax, hemopericardium, hemomediastinum, unopacified false lumen, aortic wall calcification and getting information about mediastinum. In angiography aortic regurgitation and tear site and involvement of abdominal vessels could be observed

  1. CT ANGIOGRAPHY EVALUATION OF PERIPHERAL VASCULAR DISEASE AND COMPARISON WITH COLOR DOPPLER ULTRASOUND

    Sathyabhuwan Singh

    2015-10-01

    Full Text Available I NTRODUCTION: Peripheral vascular disease is narrowing or occlusion of arteries and comprises of atherosclerosis, burger,s disease, Renoud,s disease and aneurysm. DSA, CT angiography and color Doppler ultrasound are the radiological modalities used for these diseases. Here we compared role of the CT angiography and Color Doppler ultrasonography in detection of peripheral vascular disease. AIMS AND OBJECTIVE: To assess the role of CT angiography in peripheral vascular disease and comparison with color Doppler ultrasound. MATERIAL AND METHOD: we examined 50 patients by CT angiography and color Doppler ultrasound who were suspected for arterial disease. We divided the disease on the ground of severity as follows: No stenosis - grade - 0, 0 - 25% stenosis - grade - 1 , 25 - 50% stenosis - grade - 2, 50 - 75 % stenosis - grade - 3 and 75 - 100% stenosis - grade - 4. We compared the two modalities in terms of diagnosis and grading of peripheral vascular disease . RESULT: We found Color Doppler ultrasound detected more number of normal vessel segment, gra de - 1 and grade - 2 stenosis. In stenosis grade - 3 and grade - 4 CT angiography and Color Doppler ultrasound are equally sensitive. CONCLUSION: Doppler sonography is better than CT angiography in the diagnosis of early onset ( Grade I & II cases, with a better a ssessment of soft plaques, segmental flow and re - canalisation in peripheral arterial disease. CDUS is the initial modality of choice in any case of peripheral arterial disease. CT angiography is more accurate in assessing grade - 3 and grade - 4 stenosis. CT a ngiography exceeds the color Doppler in detecting vascular lesions in cases of gas gangrene and thick patients.

  2. Cardiac carcinoid: tricuspid delayed hyperenhancement on cardiac 64-slice multidetector CT and magnetic resonance imaging.

    Martos, R

    2012-02-01

    INTRODUCTION: Carcinoid heart disease is a rare condition in adults. Its diagnosis can be easily missed in a patient presenting to a primary care setting. We revised the advantages of using coronary multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) in diagnosing this condition. MATERIALS AND METHODS: We studied a 65-year-old patient with carcinoid heart disease and right heart failure using transthoracic Doppler-echocardiogram, cardiac MDCT and MRI. Cardiac echocardiogram revealed marked thickening and retraction of the tricuspid leaflets with dilated right atrium and ventricle. Cardiac MDCT and MRI demonstrated fixation and retraction of the tricuspid leaflets with delayed contrast hyperenhancement of the tricuspid annulus. CONCLUSION: This case demonstrates fascinating imaging findings of cardiac carcinoid disease and highlights the increasing utility of contrast-enhanced MRI and cardiac MDCT in the diagnosis of this interesting condition.

  3. Radiation Dose and Image Quality at High-Pitch CT Angiography of the Aorta : Intraindividual and Interindividual Comparisons With Conventional CT Angiography

    Apfaltrer, Paul; Hanna, E. Lexworth; Schoepf, U. Joseph; Spears, J. Reid; Schoenberg, Stefan O.; Fink, Christian; Vliegenthart, Rozemarijn

    2012-01-01

    OBJECTIVE. The objective of our study was to evaluate radiation dose and quantitative image quality parameters at high-pitch CT angiography (CTA) of the aorta compared with conventional CTA. MATERIALS AND METHODS. We studied the examinations of 110 patients (65 men and 45 women; mean age +/- SD, 64

  4. X-ray induced DNA double-strand breaks in coronary CT angiography: Comparison of sequential, low-pitch helical and high-pitch helical data acquisition

    Background: Aim of this study was to compare DNA double-strand breaks (DSBs) in blood lymphocytes of patients undergoing high-pitch helical, low-pitch helical and sequential coronary CT angiography. Methods and results: 66 patients were examined with various scan protocols and modes (low-pitch helical scan: 100–120 kV, 320–438 mAs/rot, pitch 0.18–0.39, with or without ECG-pulsing, n = 35; prospectively ECG-triggered high-pitch helical scan: 100–120 kV, 320–456 mAs/rotation, pitch 3.2–3.4, n = 19; prospectively ECG-triggered sequential scan: 100–120 kV, 150–300 mAs or 320–370 mAs/rotation, n = 12) either using a 64-slice or 128-slice dual-source CT or a 128-slice single source CT scanner. Blood samples were obtained before and 30 min after CT and DSBs were analyzed in isolated lymphocytes using γ-H2AX immunofluorescence microscopy. A significant increase of DSBs was measurable 30 min after CTA (range 0.01–0.71/cell). CT induced DSBs showed a significant correlation with the estimated effective dose (ρ = 0.90, p < 0.00001). Both prospectively ECG-triggered sequential (0.10 DSBs/cell, 176 mGy cm, p < 0.00001) and high-pitch helical scan protocols (0.03 DSBs/cell, 109 mGy cm, p < 0.00001) led to a significant reduction of median DLP and DSB levels compared to low-pitch helical scans (0.34 DSBs/cell, 828 mGy cm). A reduction of the tube voltage resulted in significantly lower whereas additional calcium scoring resulted in elevated DLP and DNA damages (p < 0.05 each). Conclusion: In coronary CTA, data acquisition protocols have a significant influence on the X-ray induced DSB levels. Using γ-H2AX immunofluorescence microscopy different scan modes in different CT generations can be compared concerning their biological impact.

  5. The use of 3D-CT-Angiography in the diagnostic procedure of intracranial aneurysms evaluated

    Aalders, Th.; Labisch, C.; Seifert, V.; Zanella, F.E.; Stolke, D. [Univ. Clinic Essen (Germany)

    1998-11-01

    With improving quality of images obtained by 3D-CT-Angiography, this procedure may promise to become a powerful tool in intracranial aneurysm diagnostic. We have evaluated this method comparatively between angiographic and intra-operative findings. Forty-one patients were examined by cerebral angiography and 3D-Angio-CT. Radiological findings were evaluated by neuroradiologists and neurosurgeons. Intra-operative findings were documented by video or photography. All angiographically proven aneurysms were also visualized by 3D-Angio-CT. In over sixty percent of cases 3D-Angio-CT showed the aneurysmal anatomy equally well to angiography or presented valuable additional information not obtainable by angiography. In complex aneurysms as well as in aneurysms of the posterior circulation, the additional information offered by 3D-Angio-CT was most valuable. Intra-operative anatomical findings showed a high correlation with 3D-images. In our experience 3D-Angio-CT proved to be a powerful tool in the diagnostic procedure of intracranial aneurysms, either in the acute or non-acute phase. In many cases 3D-images present valuable additional information not otherwise obtainable, especially in complex aneurysms and aneurysms of the posterior circulation. In selected cases neurosurgical therapy can be planned on 3D-images alone. Nontheless conventional cerebral angiography remains the gold standard in diagnostic management of intracranial aneurysms. (author)

  6. CT coronary angiography in patients with atrial fibrillation

    Purpose: Reliable visualization of the coronary arteries with multislice spiral CT angiography (MSCTA) in patients with atrial fibrillation (AF) remains a challenge despite retrospective ECG gating. A recently developed new algorithm automatically compensates dynamic changes in the heart rate during the scan, thus reducing misregistration and motion artifacts. The HeartBeat-RT algorithm combines a fixed percent delay determined from the first R wave and the fixed offset delay based on the second R wave in the ECG cycle. The purpose of this study was to find out the optimal reconstruction window in MSCTA in patients with AF for each of the three major coronary arteries during the cardiac cycle. Materials and methods: 20 patients with permanent AF were imaged on a 16-slice scanner (slice collimation: 16 x 0.75 mm; rotation time 0.42 s; 140 kV; 380 mAs; 120 ml Ultravist 370 registered i.v.). The patients had not received any previous drugs for heart frequency regulation. Acquisition was started after bolus tracking of a biphasic bolus of 120 ml Ultravist 370 injected intravenously. Each coronary segment was reconstructed at 0%-90% of the cardiac cycle in increments of 10%. For image analysis we used coronary segments as defined by the American Heart Association. Two blinded independent readers assessed the image quality in terms of visibility and artifacts (five-point rating scale 1=very poor, 2=poor, 3=fair, 4=good and 5=excellent) and the degree of stenosis (five-point rating scale 1=0%, 2=1%-49%, 3=50%-74%, 4=75%-99%, 5=100%) on axial slices, multiplanar reconstructions and three-dimensional volume-rendered images. (orig.)

  7. CT compared to angiography for staging of tumors of the pancreatic head

    Aspestrand, F.; Kolmannskog, F. (Dept. of Diagnostic Radiology, National Hospital, Oslo Univ. (Norway))

    1992-11-01

    A retrospective study of 32 patients with malignant tumor of the pancreatic head and ampullary region is presented. The aim of the study was to compare the ability of CT and angiography to evaluate the peripancreatic vessels, and to correlate the results of tumor staging based upon CT criteria to angiographic and surgical findings. In 5 patients (16%) CT disclosed contiguous tumor growth around vessels not discernible at angiography and, in contradiction to previous reports, angiography added no valuable information regarding main vessel involvement. In terms of sensitivity, specificity, and positive predictive value CT was more accurate in predicting unresectable than resectable tumors, the former with a sensitivity of 92% and a specificity and positive predictive value of 100%. (orig.).

  8. CT compared to angiography for staging of tumors of the pancreatic head

    A retrospective study of 32 patients with malignant tumor of the pancreatic head and ampullary region is presented. The aim of the study was to compare the ability of CT and angiography to evaluate the peripancreatic vessels, and to correlate the results of tumor staging based upon CT criteria to angiographic and surgical findings. In 5 patients (16%) CT disclosed contiguous tumor growth around vessels not discernible at angiography and, in contradiction to previous reports, angiography added no valuable information regarding main vessel involvement. In terms of sensitivity, specificity, and positive predictive value CT was more accurate in predicting unresectable than resectable tumors, the former with a sensitivity of 92% and a specificity and positive predictive value of 100%. (orig.)

  9. First results of spiral CT angiography in the evaluation of carotid artery stenosis

    To determine the value of spiral CT angiography in Maximum Intensity Projection (MIP)-technique for evaluation of carotid artery stenosis. A comparison of the MIP technique with intraarterial DSA was done in 24 patients with 40 stenoses. Quantification of stenosis was determined according to the NASCET study: mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%). Totally the correlation of spiral CT angiography with DSA was 80% (r=0.93; p=0.0001). In the moderate stenosis group (r=1; p=0.1573), severe stenosis group (r=0.89; p=0.002) and the occlusion group (r=1; p=0.0009) there was a good correlation with DSA. In the mild stenosis group (r=0.55; p=0.0704) correlation of spiral CT angiography with DSA was poor. Spiral CT angiography allows an excellent delineation of calcifications. Tandem lesions and collateral flow cannot be shown with spiral CT angiography. (orig./MG)

  10. The Efficacy of Iopamidol (Pamiray 370) in Aortic and Extremity CT Angiography

    To evaluate the clinical safety and radiological feasibility of a domestic iopamidol-based contrast media (Pamiray 370) during an aortic and extremity CT angiography. Between August and December of 2008, 100 patients (M:F=51:49; mean age, 59 years) underwent an aortic and extremity CT angiography using Pamiray 370 based with informed consent. All changes in vital signs, clinical symptoms, and adverse reactions to the contrast media were monitored. Two radiologists assessed the image quality of the CT angiography. A statistical comparison was conducted using an independent t-test and a Mann-Whitney test based on the 100-patient group studied using Optiray 350. The contrast enhancement of the descending aorta in the arterial phase showed a statistically greater efficacy (p<0.001) of Pamiray 370 compared to Optiray 350, which was the routine contrast media for CT angiography for our institute. Adverse reaction signs were evident in 3%(3/100) of the subjects. All of them showed mild and transient reactions such as vomiting (n=2) and coughing (n=1), with no medical treatment required. Contrast media related symptoms including dizziness (n=7), nausea (n=3), headaches (n=2), and injection site pain (n=1), were noted in 12%(12/100). The clinical efficacy of Pamiray 370 was acceptable for the aortic and extremity CT angiography, in terms of clinical safety, tolerance, and image quality

  11. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

    Seeters, Tom van; Schaaf, Irene C. van der; Dankbaar, Jan Willem; Horsch, Alexander D.; Niesten, Joris M.; Luitse, Merel J.A.; Mali, Willem P.T.M.; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Vos, Jan Albert [St. Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Schonewille, Wouter J. [St. Antonius Hospital, Department of Neurology, Nieuwegein (Netherlands); Walderveen, Marianne A.A. van [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Wermer, Marieke J.H. [Leiden University Medical Center, Department of Neurology, Leiden (Netherlands); Duijm, Lucien E.M. [Catharina Hospital, Department of Radiology, Eindhoven (Netherlands); Keizer, Koos [Catharina Hospital, Department of Neurology, Eindhoven (Netherlands); Bot, Joseph C.J. [VU University Medical Center, Department of Radiology, Amsterdam (Netherlands); Visser, Marieke C. [VU University Medical Center, Department of Neurology, Amsterdam (Netherlands); Lugt, Aad van der [Erasmus MC University Medical Center, Department of Radiology, Rotterdam (Netherlands); Dippel, Diederik W.J. [Erasmus MC University Medical Center, Department of Neurology, Rotterdam (Netherlands); Kesselring, F.O.H.W. [Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Hofmeijer, Jeannette [Rijnstate Hospital, Department of Neurology, Arnhem (Netherlands); Lycklama a Nijeholt, Geert J. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Boiten, Jelis [Medical Center Haaglanden, Department of Neurology, The Hague (Netherlands); Rooij, Willem Jan van [St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Kort, Paul L.M. de [St. Elisabeth Hospital, Department of Neurology, Tilburg (Netherlands); Roos, Yvo B.W.E.M. [Academic Medical Center, Department of Neurology, Amsterdam (Netherlands); Meijer, Frederick J.A. [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands); Pleiter, C.C. [St. Franciscus Hospital, Department of Radiology, Rotterdam (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: Dutch acute stroke study (DUST) investigators

    2016-04-15

    We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R{sup 2} was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R{sup 2} = 0.58) was superior to patient characteristics and non-contrast CT alone (R{sup 2} = 0.44) and to addition of CTA alone (R{sup 2} = 0.55) or CTP alone (R{sup 2} = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

  12. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

    We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

  13. Volume Subtraction Three-dimensional CT Angiography for Cerebrovascular Disease : Report of Two Cases

    Sakamoto, Shigeyuki; Kiura, Yoshihiro; Ohba, Shinji; Shibukawa, Masaaki; Arita, Kazunori; Ishifuro, Minoru; Kurisu, Kaoru

    2005-01-01

    We report two cases in which volume subtraction three-dimensional CT angiography (VS- 3DCTA) was used for cerebral aneurysm and vascular stenosis with intramural calcification. Case 1: VS-3DCTA with volume rendering clearly showed carotid cave aneurysm of the internal carotid artery. The location and size of the aneurysm was confirmed by digital subtraction angiography (DSA). In evaluation of the aneurysm, VS-3DCTA was equal to DSA and endovascular findings. Case 2: VS-3DCTA with volume rende...

  14. Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis

    We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis. We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed. Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography. While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose. (author)

  15. Coronary calcium mass scores measured by identical 64-slice MDCT scanners are comparable : a cardiac phantom study

    Dijkstra, Hildebrand; Greuter, Marcel J. W.; Groen, Jaap M.; Vliegenthart-Proenca, Rozemarijn; Renema, KlaasJan W. K.; de Lange, Frank; Oudkerk, Matthijs

    2010-01-01

    To assess whether absolute mass scores are comparable or differ between identical 64-slice MDCT scanners of the same manufacturer and to compare absolute mass scores to the physical mass and between scan modes using a calcified phantom. A non-moving anthropomorphic phantom with nine calcifications o

  16. Evaluation of CT-angiography of lower limb arteries: a preliminary study

    The purpose of this study was to assess the feasibility of CT Angiography (CTA) with a single row of detectors and to compare it to digital subtraction angiography (DSA) in the evaluation of lower limb peripheral arterial disease. A total of 22 patients underwent 24 lower limb Helical CTA using a Somatom Plus 4A (Siemens) and 24 DSA using an Angiostar unit (Siemens). CT angiography was performed in one acquisition (collimation 3 mm/couch motion 9 mm/ interval 2 mm) with tube rotation time of 0.75 sec from the aortic bifurcation to the calf. DSA was performed after catheterization of a common femoral artery using the Seldinger technique. Arteries were classified in four categories (normal or stenosis 50%, occlusion, aneurysm). VRT images and axial source images were assessed by two independent radiologists whereas digital angiographies were read by a vascular radiologist. Global interobserver agreement was good (Kappa=0.71). The degree of agreement between CTA and DSA ranged from low to excellent (0.25 to 0.97) depending on the artery. Lower limb CT angiography is a promising non invasive technique. VRT allows quick evaluation. However, is not accurate enough to replace digital angiography. (authors)

  17. Diagnostic Performance of Transluminal Attenuation Gradient and Noninvasive Fractional Flow Reserve Derived from 320-Detector Row CT Angiography to Diagnose Hemodynamically Significant Coronary Stenosis

    Ko, Brian S; Wong, Dennis T L; Nørgaard, Bjarne L; Leong, Darryl P; Cameron, James D; Gaur, Sara; Marwan, Mohamed; Achenbach, Stephan; Kuribayashi, Sachio; Kimura, Takeshi; Meredith, Ian T; Seneviratne, Sujith K

    2015-01-01

    Purpose To compare the diagnostic performance of 320-detector row computed tomography (CT) coronary angiography-derived computed fractional flow reserve (FFR; FFRCT), transluminal attenuation gradient (TAG; TAG320), and CT coronary angiography alone to diagnose hemodynamically significant stenosis...

  18. Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

    To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery

  19. Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

    Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam Univ. Hospital, Kwangju (Korea, Republic of)

    1999-11-01

    To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery.

  20. Pancreatic carcinoma: MR, MR angiography and dynamic helical CT in the evaluation of vascular invasion

    Objective: To assess the value of MR angiography in combination with contrast-enhanced MR imaging, and to compare MR imaging including MR angiography with dynamic contrast-enhanced dual phase helical CT in the preoperative assessment of vascular invasion in patients with suspected pancreatic carcinoma. Methods and material: MR imaging only, MR imaging including MR angiography and dynamic contrast-enhanced dual phase helical CT images of 48 patients who were operated due to suspicion of pancreas cancer were correlated with the surgery results in terms of vascular invasion. Pathologic diagnosis were pancreatic adenocarcinoma in 31 patients of which nine had surgically confirmed vascular invasion. Sensitivity, specificity, predictive values (including 95% confidence intervals) and accuracy of MR imaging only, MR imaging including MR angiography and helical CT were calculated. Results: Sensitivity, specificity, positive and negative predictive values and accuracy were 56, 100, 100, 85, 87%; 67, 100, 100, 88, 90% and 67, 100, 100, 88, 90%, respectively, for MR imaging only, MR imaging including MR angiography and helical CT in the adenocarcinoma group. The corresponding figures in the overall study group were 56, 97, 83, 90, 90%; 67, 97, 86, 93, 92% and 67, 97, 86, 93, 92%. Confidence intervals (95%) showed that the differences in the diagnostic efficacy of the techniques were not statistically significant in the overall study group, but the confidence intervals were undefined in the adenocarcinoma group due to the small sample size. Conclusion: Diagnostic efficacy of MR imaging when combined with MR angiography is equal to that of dynamic contrast-enhanced dual phase helical CT in the assessment of vascular invasion of pancreatic tumors

  1. Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography

    Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p 1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 ± 13.9 HU vs. 43.5 ± 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.

  2. Cerebral artery evaluation of dual energy CT angiography with dual source CT

    MA Rui; LIU Cheng; DENG Kai; SONG Shao-juan; WANG Dao-ping; HUANG Ling

    2010-01-01

    Background Conventional computed tomography angiography (CTA) is time consuming, user-dependent and has poor image quality in skull base region. This study assessed the feasibility of a new method, dual energy CTA for depicting the cerebral artery.Methods Phantom scan was done with head CTA sequences on dual source CT and 64 spiral CT for radiation dose calculation. Dual energy CTA was done with dual source CT on 36 patients who were suspected of having cerebral vascular disease. Three series axial images in 0.75 mm thick, 0.4 mm increment were acquired, which were named with 80 kV, 140 kV and merged images; 80 kV and 140 kV images were transferred into dual energy software, and maximum intensity projection (MIP) image was generated quickly by dual energy bone remove (DEBR group); merged images were transferred into In Space software to acquire MIP image through manual conventional bone remove (CoBR group). Post processing time and reading time were compared. Image qualities of the two groups were compared, mainly focusing on skull base segments of internal carotid artery and bone subtraction. ANOVA and SNK tests were applied for radiation dose comparison. Student's t test and Wilcoxon rank sum test were applied for assessing differences between data for significance. Cohen's kappa was used for interobserver agreement. Results Radiation dose of phantom scan showed dual energy CTA was between digital bone subtraction and conventional CTA. The post processing time and reading time were much shorter in DEBR than CoBR, and image quality in skull base was much higher in DEBR than CoBR (P0.5). Interobserver agreement for all vessel segments was excellent (kappa=0.97). Conclusions Dual energy CTA is a reliable, new modality for depicting cerebral artery, overcoming the limitation of conventional CTA in the skull base region. It can save much time in post processing and reading than conventional CTA.

  3. Angiography

    The history of angiography is short, with its centennial approaching. A very brief review of milestones begins with the discovery of x-rays in 1895. Only a few months later contrast agents too toxic for human use were being injected into cadavers, severed limbs, and animals. The next major developments came in the late 1970s when percutaneous translumbar aortography and cerebral angiography were described. Contrast agents were now less toxic, and clinically useful angiography was a reality. In 1953 a technique for percutaneous vascular catheterization which formed the basis of many catheterization techniques to follow was described. In the 1970s the development of less invasive diagnostic methods such as computed tomography and diagnostic ultrasound decreased the indications for angiography, but newer interventional techniques such as embolization therapy and angioplasty have taken up the slack. Angiography remains the most important way to demonstrate vascular diseases graphically. Specific techniques such as angioplasty and digital subtraction angiography will be dealt with in other chapters. The authors hope to provide an overview of major areas of angiographic utilization. The basic techniques of arterial puncture and catheterization have been well described elsewhere

  4. Combined screening method for unruptured cerebral aneurysm, using magnetic resonance angiography and three-dimensional CT angiography

    Sensitivity and specificity for cerebral aneurysms were investigated in MR angiography (MRA) and three-dimensional CT angiography (3D-CTA), and the usefulness of combining the two methods was evaluated. Thirty-one patients with 39 unruptured intracranial aneurysms verified by conventional angiography and 11 control patients underwent 3D time-of-flight MRA (maximum intensity projection image) and helical scanning 3D-CTA (volume rendering image). Five neuroradiologists independently read the images, and sensitivity and specificity were calculated. The sensitivity of 3D-CTA (86.7%) was significantly higher (p value<0.001) than that of MRA (70.1%). False negatives on MRA were attributed to the small size of aneurysms; those on 3D-CTA were due to the bony structures hiding the aneurysms. Sensitivity with combined 3D-CTA and MRA (94.4%) was much higher than that of MRA alone (p value <0.001). The specificity of MRA (97.4%) was similar to that of 3D-CTA (96.3%). While fairly good sensitivity and specificity were obtained with either 3D-CTA or MRA, false-negative and false-positive findings were still present. The combined method using both 3D-CTA and MRA improved the efficacy of screening for cerebral aneurysm because considering both types of results together enables the neuroradiologist to compensate for problems encountered in each method. (author)

  5. CT angiography for the pre- and postoperative evaluation of the thoracic aorta

    CT angiography is the imaging modality of choice for the pre- and postsurgical evaluation of patients with pathologies of the thoracic aorta. The purpose of this review is to familiarize the reader with the technical principle, recent technical developments and requirements for specific examination protocols and image interpretation, and to highlight common pathologies and findings. (orig.)

  6. Hybrid CT angiography and quantitative (15)O-water PET for assessment of coronary artery disease

    Thomassen, Anders; Petersen, Henrik; Diederichsen, Axel C P; Mickley, Hans; Jensen, Lisette O; Johansen, Allan; Gerke, Oke; Braad, Poul-Erik; Thayssen, Per; Høilund-Carlsen, Mette M; Vach, Werner; Knuuti, Juhani; Høilund-Carlsen, Poul F

    2013-01-01

    CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combinati...

  7. Radiation burden and risks associated with non-invasive coronary CT angiography

    The radiation load of patients undergoing coronary CT angiography by applying the retrospective ECG gating approach was estimated. The radiation burden is rather high and was found to be higher in men than in women, whereas the risk of secondary induced tumours appears to be higher in women than in men. (orig.)

  8. Detection, characterization and endovascular therapy planning of intracranial aneurysms with 16-channel multidetector row CT angiography

    Amr Badry

    2014-03-01

    Conclusion: Sixteen channel Multidetector CT angiography offers high diagnostic accuracy nearly equivalent to that of DSA in the detection of intracranial aneurysms. However, 16 channel- MDCTA still has limited sensitivity in detecting aneurysms of 3 mm or less, despite its technical advances. MDCT can be used as a reliable alternative imaging technique to DSA in selected cases.

  9. Diagnostic Accuracy and Radiation Dose of CT Coronary Angiography in Atrial Fibrillation

    Vorre, Mette Medom; Abdulla, Jawdat

    2013-01-01

    Purpose:To determine by means of a systematic review and meta-analysis the diagnostic accuracy, associated radiation dose, and technical challenges of computed tomographic (CT) coronary angiography in patients with atrial fibrillation.Materials and Methods:A systematic literature search was perfo...

  10. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography

    Dammert, S.; Krings, T.; Moller-Hartmann, W.; Ueffing, E.; Mull, M.; Thron, A. [Department of Neuroradiology, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Hans, F.J. [Department of Neurosurgery, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Willmes, K. [Department of Neurology, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany)

    2004-06-01

    We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small (<4 mm), 90.6% for medium-size (5-12 mm) and 100% for large (>13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH. (orig.)

  11. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography.

    Dammert, S; Krings, T; Moller-Hartmann, W; Ueffing, E; Hans, F J; Willmes, K; Mull, M; Thron, A

    2004-06-01

    We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small ( 13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH. PMID:15105978

  12. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

    Weintraub Nealw F

    2009-04-01

    Full Text Available Abstract We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  13. Whole-brain dynamic CT angiography and perfusion imaging

    Orrison, W.W. [CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); College of Osteopathic Medicine, Touro University Nevada, Henderson, NV (United States); Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Department of Medical Education, University of Nevada School of Medicine, Reno, NV (United States); Snyder, K.V.; Hopkins, L.N. [Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Buffalo, NY (United States); Roach, C.J. [School of Life Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); Ringdahl, E.N. [Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV (United States); Nazir, R. [Shifa International Hospital, Islamabad (Pakistan); Hanson, E.H., E-mail: eric.hanson@amigenics.co [College of Osteopathic Medicine, Touro University Nevada, Henderson, NV (United States); Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States)

    2011-06-15

    The availability of whole brain computed tomography (CT) perfusion has expanded the opportunities for analysing the haemodynamic parameters associated with varied neurological conditions. Examples demonstrating the clinical utility of whole-brain CT perfusion imaging in selected acute and chronic ischaemic arterial neurovascular conditions are presented. Whole-brain CT perfusion enables the detection and focused haemodynamic analyses of acute and chronic arterial conditions in the central nervous system without the limitation of partial anatomical coverage of the brain.

  14. Whole-brain dynamic CT angiography and perfusion imaging

    The availability of whole brain computed tomography (CT) perfusion has expanded the opportunities for analysing the haemodynamic parameters associated with varied neurological conditions. Examples demonstrating the clinical utility of whole-brain CT perfusion imaging in selected acute and chronic ischaemic arterial neurovascular conditions are presented. Whole-brain CT perfusion enables the detection and focused haemodynamic analyses of acute and chronic arterial conditions in the central nervous system without the limitation of partial anatomical coverage of the brain.

  15. Coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection: the role of 64-slice MDCT.

    Das, K M; Abdou, Sayed M; El-Menyar, Ayman; Ayman, El Menyar; Khulaifi, A A; Nabti, A L

    2008-01-01

    A rare case of bilateral coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection is described. 64-slice multidetector computed tomography (MDCT) was able to demonstrate both this findings along with involvement of other neck vessels. TEE demonstrated the severity and mechanisms of aortic valve damage and assisted the surgeon in valve repair. MDCT has played an invaluable role in the diagnosis of the abnormal details of such life-threatening vascular complications. PMID:18384568

  16. Liver hydatid cyst ruptured into the thorax: CT angiography findings of a case

    Full text: Introduction: Intrathoracic rupture of hepatic hydatid cyst is a rare but severe condition causing a spectrum of lesions to the pleura, lung parenchyma, and bronchi. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. Objectives and tasks: In this report we aimed to present computed tomography (CT) angiography findings of a case with liver hydatid cyst ruptured into the thorax. The patient underwent CT angiography examination with suspicion of pulmonary embolism. Materials and methods: A 71-year-old female patient admitted to our emergency department with complaints of severe and persistent cough. Basal region of the right hemithorax could not get breath sounds on physical examination. Chest radiography revealed the presence of consolidation-effusion. The patient was treated with antibiotherapy for pneumonia and parapneumonic effusion. Because of the clinical symptoms and chest radiograph findings persisted the patient underwent CT angiography examination with suspicion of pulmonary embolism. Results: On CT angiography images pulmonary artery and its branches were normal. There were subtotal collapse in the right middle and lower lung lobes and complicated cystic lesion that has air densities in the basal interlobar space. Another thick walled complicated cystic lesion with multiple septations and air densities was detected in the right posterior liver lobe. The right hemidiaphragm was interrupted and the right liver lobe partially herniated into the thorax cavity. Serologic tests were positive for Echinococcus granulosus and there were prior therapy history for liver cyst hydatid. The diagnostic aspiration findings were consistent with hydatid cyst lesion. Conclusion: In patients with hepatic hydatid cyst associated with persistent and severe cough, thoracic rupture of the cyst should be considered in differential diagnosis. CT angiography is fast, non-invasive and effective method in the detection of

  17. Automatic segmentation and co-registration of gated CT angiography datasets: measuring abdominal aortic pulsatility

    Wentz, Robert; Manduca, Armando; Fletcher, J. G.; Siddiki, Hassan; Shields, Raymond C.; Vrtiska, Terri; Spencer, Garrett; Primak, Andrew N.; Zhang, Jie; Nielson, Theresa; McCollough, Cynthia; Yu, Lifeng

    2007-03-01

    Purpose: To develop robust, novel segmentation and co-registration software to analyze temporally overlapping CT angiography datasets, with an aim to permit automated measurement of regional aortic pulsatility in patients with abdominal aortic aneurysms. Methods: We perform retrospective gated CT angiography in patients with abdominal aortic aneurysms. Multiple, temporally overlapping, time-resolved CT angiography datasets are reconstructed over the cardiac cycle, with aortic segmentation performed using a priori anatomic assumptions for the aorta and heart. Visual quality assessment is performed following automatic segmentation with manual editing. Following subsequent centerline generation, centerlines are cross-registered across phases, with internal validation of co-registration performed by examining registration at the regions of greatest diameter change (i.e. when the second derivative is maximal). Results: We have performed gated CT angiography in 60 patients. Automatic seed placement is successful in 79% of datasets, requiring either no editing (70%) or minimal editing (less than 1 minute; 12%). Causes of error include segmentation into adjacent, high-attenuating, nonvascular tissues; small segmentation errors associated with calcified plaque; and segmentation of non-renal, small paralumbar arteries. Internal validation of cross-registration demonstrates appropriate registration in our patient population. In general, we observed that aortic pulsatility can vary along the course of the abdominal aorta. Pulsation can also vary within an aneurysm as well as between aneurysms, but the clinical significance of these findings remain unknown. Conclusions: Visualization of large vessel pulsatility is possible using ECG-gated CT angiography, partial scan reconstruction, automatic segmentation, centerline generation, and coregistration of temporally resolved datasets.

  18. Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

    Elif Ergun

    2011-03-01

    Full Text Available Objective: To prospectively evaluate the diagnostic value of 64-slice CTA in detecting intracranial aneurysms and to compare it with 2D-DSA and/or intra-operative findings.Material and Methods: 37 cases with SAH according to unenhanced cranial CT were included in the study. A 64-slice CTA was performed to all cases immediately after the nonenhanced cranial CT. DSA was performed in 24-48 hours following CTA. CT images were reviewed by two radiologists experienced in CT vascular imaging. The DSA reader was the angiographer who performed the DSA. The results of the CTA were compared with the DSA results and/or intraoperative findings in order to determine the diagnostic efficacy of CTA in detecting intracranial aneurysms. Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA in detecting aneurysms were 92.8%, 83.3%, 96.2%, 71.4% and 91.2% respectively. The diagnostic value of CTA in detecting intracranial aneurysms was found to be equal to DSA by Mcnemar test. Conclusion: CTA is invaluable in detecting intracranial aneurysms. It may be used as a first line modality in SAH, and DSA may be reserved for patients with negative or equivocal CTA results.

  19. Appearance and impact of post-operative intracranial clips and coils on whole-brain CT angiography and perfusion

    Background: To evaluate the effect of vascular clips and endovascular coils placed for intracranial aneurysms and arteriovenous malformations on whole-brain computed tomography (CT) angiography and perfusion. Methods: A 320-detector row dynamic volume CT system imaged 11 patients following surgical placement of vascular clips or endovascular coils. The extent of clip and coil subtraction by automated software was evaluated using CT digital subtraction angiography and CT perfusion. Impact on CT perfusion values by retained intracranial devices was compared to age- and gender-matched controls. Results: Clip and coil subtraction on CT angiography was graded as good in 8 and moderate in 3 cases. A residual neck and additional aneurysm were noted in 1 of 11 patients. Post-procedural axial slice level CT perfusion values decreased in reliability with increasing proximity to the metallic devices secondary to beam hardening. However, the intracranial devices did not affect axial slice level CTP values of cerebral blood volume, cerebral blood flow and mean transit time outside of the level of the device. Time to peak values was globally decreased outside of the immediate vascular intervention region. Conclusions: Advances in CT technology have provided clinically useful subtraction of intracranial clips and coils. While CT perfusion values were altered in device subtraction areas and within beam hardening artifact areas; they can provide valuable postoperative information on whole-brain hemodynamics. In selected cases, the combination of CT angiography and whole-brain CT perfusion can offer an alternative to conventional angiography that is a more invasive option.

  20. Effects of dual-energy CT with non-linear blending on abdominal CT angiography

    Li, Sulan; Wang, Chaoqin; Jiang, Xiao Chen; Xu, Ge [Dept. of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou (China)

    2014-08-15

    To determine whether non-linear blending technique for arterial-phase dual-energy abdominal CT angiography (CTA) could improve image quality compared to the linear blending technique and conventional 120 kVp imaging. This study included 118 patients who had accepted dual-energy abdominal CTA in the arterial phase. They were assigned to Sn140/80 kVp protocol (protocol A, n = 40) if body mass index (BMI) < 25 or Sn140/100 kVp protocol (protocol B, n = 41) if BMI ≥ 25. Non-linear blending images and linear blending images with a weighting factor of 0.5 in each protocol were generated and compared with the conventional 120 kVp images (protocol C, n = 37). The abdominal vascular enhancements, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and radiation dose were assessed. Statistical analysis was performed using one-way analysis of variance test, independent t test, Mann-Whitney U test, and Kruskal-Wallis test. Mean vascular attenuation, CNR, SNR and subjective image quality score for the non-linear blending images in each protocol were all higher compared to the corresponding linear blending images and 120 kVp images (p values ranging from < 0.001 to 0.007) except for when compared to non-linear blending images for protocol B and 120 kVp images in CNR and SNR. No significant differences were found in image noise among the three kinds of images and the same kind of images in different protocols, but the lowest radiation dose was shown in protocol A. Non-linear blending technique of dual-energy CT can improve the image quality of arterial-phase abdominal CTA, especially with the Sn140/80 kVp scanning.

  1. Effects of dual-energy CT with non-linear blending on abdominal CT angiography

    To determine whether non-linear blending technique for arterial-phase dual-energy abdominal CT angiography (CTA) could improve image quality compared to the linear blending technique and conventional 120 kVp imaging. This study included 118 patients who had accepted dual-energy abdominal CTA in the arterial phase. They were assigned to Sn140/80 kVp protocol (protocol A, n = 40) if body mass index (BMI) < 25 or Sn140/100 kVp protocol (protocol B, n = 41) if BMI ≥ 25. Non-linear blending images and linear blending images with a weighting factor of 0.5 in each protocol were generated and compared with the conventional 120 kVp images (protocol C, n = 37). The abdominal vascular enhancements, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and radiation dose were assessed. Statistical analysis was performed using one-way analysis of variance test, independent t test, Mann-Whitney U test, and Kruskal-Wallis test. Mean vascular attenuation, CNR, SNR and subjective image quality score for the non-linear blending images in each protocol were all higher compared to the corresponding linear blending images and 120 kVp images (p values ranging from < 0.001 to 0.007) except for when compared to non-linear blending images for protocol B and 120 kVp images in CNR and SNR. No significant differences were found in image noise among the three kinds of images and the same kind of images in different protocols, but the lowest radiation dose was shown in protocol A. Non-linear blending technique of dual-energy CT can improve the image quality of arterial-phase abdominal CTA, especially with the Sn140/80 kVp scanning.

  2. A comparative study of the accuracy in locating adrenal lesions between CT, adrenal imaging and angiography

    This study was undertaken to compare the accuracy in locating adrenal lesions between CT, adrenocortical imaging and angiography in a total of 30 cases of adrenal diseases; 15 of primary aldosteronism, 8 of pheochromocytoma (9 tumors), 4 of Cushing's syndrome and 3 of adrenogenital syndrome. The correct localization was obtained in 90%(27/30) in CT, 94%(29/31) in adrenocortical imaging, 100%(15/15) by arteriography and 90%(18/20) in venography. However the locating accuracy decreased to 83%(15/18) in arteriography and 67%(18/27) in venography when the technically failed cases were included. These results suggest that CT and adrenocortical imaging are sufficient to detect adrenal lesions in most cases. Ambiguous cases in these noninvasive methods may be the subjects for angiography. (author)

  3. CT, MR, and Angiography Findings of a Solitary Fibrous Tumor of the Larynx: a Case Report

    Chang, Suk Ki; Yoon, Dae Young; Choi, Chul Soon; Yun, Eun Joo; Seo, Young Lan; Nam, Eun suk

    2008-01-01

    This report details the CT, MR, and angiography findings of a solitary fibrous tumor involving the larynx of a 34-year-old man. A precontrast CT scan revealed a well-defined isodense mass in the submucosal region of the supraglottic larynx. The tumor appeared as a mixed intensity lesion on the T1- and T2-weighted MR images. A T2-weighted MR image showed a central, round, and low signal intensity area within the mass. For both the CT and MR images, the mass demonstrated heterogeneous enhanceme...

  4. Detection of hypervascular hepatocellular carcinoma: Comparison of multi-detector CT with digital subtraction angiography and Lipiodol CT

    Xiao-Hua Zheng; Yong-Song Guan; Xiang-Ping Zhou; Juan Huang; Long Sun; Xiao Li; Yuan Liu

    2005-01-01

    AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules >20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules <10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005<0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005<0.01 vs Lipiodol CT and X2= 29.03,P = 0.005<0.01 vs HAP-MDCT). However, six nodules <10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.

  5. Detection of malignant right coronary artery anomaly by multi-slice CT coronary angiography

    Coronary artery anomalies occur in 0.3-0.8% of the population and infer a high risk for sudden cardiac death in young adults. Diagnosis is usually established during coronary angiography, which is hampered by poor spatial visualization. Magnetic resonance imaging is an alternative, but it is not feasible in the presence of metal objects or claustrophobia. In this report, a 15-year-old boy experienced ventricular fibrillation and was successfully resuscitated. Cardiac catheterization was inconclusive, and pacemaker implantation prohibited the use of MR imaging. Multi-slice CT coronary angiography revealed a malignant anomalous right coronary artery. (orig.)

  6. Spiral-CT angiography after intraarterial iliac stent placement

    In a prospective study 32 patients underwent CT-A after stent placement in the iliac arteries. The vascular morphology was analyzed regarding neointimal hyperplasia and calcification pattern. The results were compared with those of clinical findings (walking distance), Doppler ultrasound (ankle-brachial index) and DSA. All 47 stents were visible and patent (100%). One misplacement was identified. A good correlation was found between an improved ankle-brachial index and CT-A (88.5%) and extension of the walking distance and CT-A (92.3%). Concerning location, number and grade of stenoses the results between CT-A and DSA matched in 42.1%. An exact mapping of calcified plaques was possible in all cases. (orig./MG)

  7. Analysis about Inlfuencing Factors of Image Quality of Coronary Angiography with Multi-Slice CT%MSCT冠状动脉成像质量的影响因素分析

    赵坤; 邵广瑞; 王勇; 侯代伦

    2014-01-01

    目的:分析64层螺旋CT冠状动脉扫描中影响成像质量的各种因素。方法对89例怀疑冠心病或冠心病复查患者进行64层螺旋CT冠状动脉检查,回顾性分析成像质量,探讨心率及心率波动对冠脉成像质量的影响,pitch值与心率的关系,替代(override)功能的应用价值,从而优化扫描参数。结果心率及心率波动与冠脉成像质量成负相关;心率与扫描/重建方式及pitch值存在相互对应关系;心率替代功能的合理使用可以提高CT冠状动脉的成像质量。结论通过控制心率及心率波动,选择心率替代功能,采取适当的扇区扫描/重建模式可以提高图像质量和冠状动脉诊断的可靠性。%Objective To analyze the inlfuencing factors of image quality of coronary angiography with 64-slice CT.Methods Eighty-nine patients with known or suspected CAD underwent CT coronary angiography using 64 multi-slice CT. The image quality in those cases was analyzed retrospectively to evaluate the influence of heart rate, fluctuation of heart rate during the scanning. The relationship between heart rate and the value of pitch was analyzed, and the application value of the override function was discussed.Results① The patient’s heart rate and lfuctuation were negatively related to the coronary image quality.② There was corresponding relationship between the value of pitch and segment scan/reconstruction mode according to the heart rate.③ Correct use of override function could improve the image quality of coronary.Conclusion The appropriate control of heart rate and lfuctuation, the correct use of override function, and the corresponding selection of segment scan/reconstruction mode according to the heart rate could improve the image quality and reliability of coronary angiography.

  8. Evaluation of spinal cord vessels using multi-slice CT angiography

    陈爽; 钱建国; 冯晓源

    2004-01-01

    @@ Compared with the large number of head and neck vascular studies, computer tomography (CT) angiography of spinal vascular lesions has received relatively little attention. Several series and a few isolated cases of spinal vascular malformations demonstrated with magnetic resonance (MR) angiography have been reported.1-3 Selective digital subtraction angiography (DSA) is gold standard for diagnosis of spinal vascular lesions.4 However, it is invasive, time consuming, expensive, and dependent on the skills of the operator. Based on the DSA appearance and the surgical findings, spinal vascular malformations are generally, although not universally, classified as intradural (intramedullary and/or extramedullary) arteriovenous malformation (AVM) or arteriovenous fistula (AVF), and dural AVF. Recommended treatments of dural AVF consist of surgical obliteration and/or embolization.5-8

  9. Carotid artery stenosis: reproducibility of automated 3D CT angiography analysis method

    The aim of this study was to assess the reproducibility and anatomical accuracy of automated 3D CT angiography analysis software in the evaluation of carotid artery stenosis with reference to rotational DSA (rDSA). Seventy-two vessels in 36 patients with symptomatic carotid stenosis were evaluated by 3D CT angiography and conventional DSA (cDSA). Thirty-one patients also underwent rotational 3D DSA (rDSA). Multislice CT was performed with bolus tracking and slice thickness of 1.5 mm (1-mm collimation, table feed 5 mm/s) and reconstruction interval of 1.0 mm. Two observers independently performed the stenosis measurements on 3D CTA and on MPR rDSA according to the NASCET criteria. The first measurements on CTA utilized an analysis program with automatic stenosis recognition and quantitation. In the subsequent measurements, manual corrections were applied when necessary. Interfering factors for stenosis quantitation, such as calcifications, ulcerations, and adjacent vessels, were registered. Intraobserver and interobserver correlation for CTA were 0.89 and 0.90, respectively. (p<0.001). The interobserver correlation between two observers for MPR rDSA was 0.90 (p<0.001). The intertechnique correlation between CTA and rDSA was 0.69 (p<0.001) using automated measurements but increased to 0.81 (p<0.001) with the manually corrected measurements. Automated stenosis recognition achieved a markedly poorer correlation with MPR rDSA in carotids with interfering factors than those in cases where there were no such factors. Automated 3D CT angiography analysis methods are highly reproducible. Manually corrected measurements facilitated avoidance of the interfering factors, such as ulcerations, calcifications, and adjacent vessels, and thus increased anatomical accuracy of arterial delineation by automated CT angiography with reference to MPR rDSA. (orig.)

  10. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

    Westerlaan, H. E.; Gravendeel, J.; Fiore, D.; Metzemaekers, J. D. M.; Groen, R. J. M.; Mooij, J. J. A.; Oudkerk, M.

    2007-01-01

    Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in

  11. Usefulness of CT angiography in patients with intracranial occlusive vascular disease of the circle of willis ; comparison with conventional angiography

    To assess the usefulness of CT angiography(CTA) compared with conventional angiography(CA) in the evaluation of intracranial occlusive vascular disease. We evaluated 26 patients with clinically suspected intracranial occlusive vascular disease studied with both CTA and CA. In cases where there was no vascular lesion on CA, we used CTA to retrospectively review the detection rate and size of individual vessels, and compared the findings with those obtained by CA. In cases of occlusive vascular lesion, we evaluated the degree of stenosis on CTA and compared this with the CA findings. We also measured the time taken to use both modalities. Sixteen patients had no vascular lesion and ten patients had occlusive vascular lesions. Compared with CA, CTA detected 97%(124/128) of normal intracranial arteries ; their diameter measured on CTA was slightly smaller than that on CA. On CTA, the degree of stenosis was correctly estimated in eight lesions, underestimated in one and overestimated in one. Examination time ranged between 15 and 20 minutes with CTA and between 40 and 60 minutes with CA. Compared with CA, CTA shows good correlation in the delineation of intracranial normal and occlusive vessels around the Circle of Willis. CTA may be an additional tool for the evaluation of the Circle of Willis in patients with suspected intracranial occlusive vascular disease. CTA may, additionally, be used as a follow-up method in patients with acute cerebral infarctions after thrombolytic therapy

  12. Spiral-CT angiography after intraarterial iliac stent placement; Spiral-CT-Angiographie nach arterieller iliakaler Stentapplikation

    Freund, M. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Palmie, S. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Wesner, F. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Heller, M. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik

    1995-10-01

    In a prospective study 32 patients underwent CT-A after stent placement in the iliac arteries. The vascular morphology was analyzed regarding neointimal hyperplasia and calcification pattern. The results were compared with those of clinical findings (walking distance), Doppler ultrasound (ankle-brachial index) and DSA. All 47 stents were visible and patent (100%). One misplacement was identified. A good correlation was found between an improved ankle-brachial index and CT-A (88.5%) and extension of the walking distance and CT-A (92.3%). Concerning location, number and grade of stenoses the results between CT-A and DSA matched in 42.1%. An exact mapping of calcified plaques was possible in all cases. (orig./MG) [Deutsch] Nach perkutaner transluminaler Angioplastie (PTA) und Stenteinlage wurden 32 Patienten prospektiv mittels CT-A untersucht. Es erfolgte eine Analyse der Gefaessmorphologie hinsichtlich neointimaler Hyperplasien und Verkalkungsmuster. Weiterhin wurden die Ergebnisse mit denen der intraarteriellen digitalen Subtraktionsangiographie (i.a. DSA), dem klinischen Befund (Gehstrecke) und der Doppler-Ultraschalluntersuchung (Arm-Knoechel-Index/AKI) verglichen. Alle 47 Stents konnten in der CT-A exakt lokalisiert und als offen identifiziert werden (100%). Eine Stentfehllage wurde diagnostiziert. Der Nachweis neointimaler Hyperplasie gelang aufgrund von Metallartefakten im Stentniveau nicht. Verkalkungen waren in allen Faellen nachweisbar. Eine Uebereinstimmung zwischen DSA und CT-A hinsichtlich des Schweregrades, der Anzahl und Lokalisation von Stenosen fand sich nur in 42,1%. In 88,5% der Faelle bestand eine Uebereinstimmung zwischen CT-morphologischem Befund und verbessertem AKI, in 92,3% mit verlaengerter Gehstrecke. (orig./MG)

  13. CT coronary angiography in patients with atrial fibrillation; CT-Koronarangiographie bei Patienten mit Vorhofflimmern

    Kovacs, A.; Sommer, T.; Leiss, A.; Naehle, P.; Schild, H.; Flacke, S. [Universitaetsklinikum Bonn, Radiologische Klinik (Germany); Probst, C.; Welz, A. [Universitaetsklinikum Bonn, Klinik fuer Herzchirurgie (Germany)

    2005-12-15

    Purpose: Reliable visualization of the coronary arteries with multislice spiral CT angiography (MSCTA) in patients with atrial fibrillation (AF) remains a challenge despite retrospective ECG gating. A recently developed new algorithm automatically compensates dynamic changes in the heart rate during the scan, thus reducing misregistration and motion artifacts. The HeartBeat-RT algorithm combines a fixed percent delay determined from the first R wave and the fixed offset delay based on the second R wave in the ECG cycle. The purpose of this study was to find out the optimal reconstruction window in MSCTA in patients with AF for each of the three major coronary arteries during the cardiac cycle. Materials and methods: 20 patients with permanent AF were imaged on a 16-slice scanner (slice collimation: 16 x 0.75 mm; rotation time 0.42 s; 140 kV; 380 mAs; 120 ml Ultravist 370 {sup registered} i.v.). The patients had not received any previous drugs for heart frequency regulation. Acquisition was started after bolus tracking of a biphasic bolus of 120 ml Ultravist 370 injected intravenously. Each coronary segment was reconstructed at 0%-90% of the cardiac cycle in increments of 10%. For image analysis we used coronary segments as defined by the American Heart Association. Two blinded independent readers assessed the image quality in terms of visibility and artifacts (five-point rating scale 1=very poor, 2=poor, 3=fair, 4=good and 5=excellent) and the degree of stenosis (five-point rating scale 1=0%, 2=1%-49%, 3=50%-74%, 4=75%-99%, 5=100%) on axial slices, multiplanar reconstructions and three-dimensional volume-rendered images. (orig.)

  14. Failing Hemodialysis Arteriovenous Fistula and Percutaneous Treatment: Imaging with CT, MRI and Digital Subtraction Angiography

    Purpose: To evaluate failing hemodialysis arteriovenous fistulas with helical CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), and to compare the efficacy of the three techniques in detecting the number, location, grade, and extent of stenoses and in assessing the technical results of percutaneous transluminal angioplasty (PTA) and stenting.Methods: Thirteen patients with Brescia-Cimino arteriovenous fistula malfunction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total of 11 PTAs were performed; in three cases an MR-compatible stent was placed. DSA served as the gold standard for comparison in all patients. The presence, site, and number of stenoses or occlusions and the technical results of percutaneous procedures were assessed with DSA, CTA, and MRA.Results: MRA underestimated a single stenosis in one patient; CTA and MRA did not overestimate any stenosis. Significant artifacts related to stent geometry and/or underlying metal were seen in MRA sequences in two cases.Conclusions: CT and MRI can provide information regarding the degree of vascular impairment, helping to stratify patients into those who can have PTA (single or multiple stenoses) versus those who require an operative procedure (occlusion). Conventional angiography can be reserved for candidates for percutaneous intervention

  15. Usefulness of three-dimensional CT angiography employing MDCT for peripheral artery occlusive disease

    The purpose of this study was to evaluate the diagnostic accuracy of three-dimensional CT angiography (3D-CTA) using MDCT for arteriosclerosis obliterans (ASO) in comparison with conventional intravenous digital subtraction angiography (IVDSA). MDCT and IVDSA were performed in 18 patients (mean age 69) with ASO. The number of occlusive lesions was 31 (10 occlusions and 21 stenoses). Three-dimensional CT images were displayed with volume rendering (VR) and maximum intensity projection (MIP). 3D-CTA and IVDSA were compared regarding visualization of the iliac and lower extremity arteries and of occlusive lesions. The visualization and detection of iliac and lower extremity arteries and occlusive lesions by 3D-CTA were possible in all the patients. In 2 patients, the detection of the tibial arteries was more difficult by 3D-CTA, as compared with IVDSA, because of venous return. In the other patients, 3D-CTA showed equal or clearer images than IVDSA. (author)

  16. The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: a Pictorial Essay

    The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment

  17. Semi-automatic quantitative measurements of intracranial internal carotid artery stenosis and calcification using CT angiography

    Bleeker, Leslie; Marquering, Henk A; van den Berg, René; Nederkoorn, Paul J; Majoie, Charles B

    2011-01-01

    Introduction Intracranial carotid artery atherosclerotic disease is an independent predictor for recurrent stroke. However, its quantitative assessment is not routinely performed in clinical practice. In this diagnostic study, we present and evaluate a novel semi-automatic application to quantitatively measure intracranial internal carotid artery (ICA) degree of stenosis and calcium volume in CT angiography (CTA) images. Methods In this retrospective study involving CTA images of 88 consecuti...

  18. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    Kun Tang; Rui Li; Jie Lin; Xiangwu Zheng; Ling Wang; Weiwei Yin

    2015-01-01

    Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA) with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA) group and low voltage CTA (L-CTA) group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. W...

  19. Usefulness of subtraction CT angiography (CTDSA) in the diagnosis of the peripheral arterial diseases

    Though CT angiography (CTA) has recognized as a useful and low invasive technique for evaluating the PAD, massive vascular wall calcifications make it difficult to evaluate vascular lumen. We report our clinical experience of subtraction CTA (CTDSA) in the diagnosis of PAD patients. CTDSA allows selective elimination of the wall calcification which improves the detection and evaluation of PAD patients even in the hemodialysis patients with severe wall calcification. (author)

  20. 64-MSCT coronary angiography with prospective ECG gating at intermediate heart rate

    Objective: To evaluate robustness of coronary artery computed tomographic (CT) angiography with prospectively gated axial (PGA) CT technique at intermediate heart rate (65-75 beats per minute) using retrospectively gated helical (RGH) CT technique in 64-slice spiral CT. Methods: 63 consecutive patients with heart rates (HR) of 65 to 75 bpm, heart rate variability of below 5 bpm underwent CT angiography with RGH technique (tube voltage was 120 kV and tube current tailored to BMI). The 5% acquired data during each intermediate temporal window in the R-R interval were used to reconstruct images. The intermediate temporal window was 400 ms in the R-R interval at current mean HR, and the centre of the temporal window was 60%. All coronary artery segments were evaluated for image quality with 5-point scale. The mean image quality score and the percentage of assessable coronary artery segments were used to evaluate diagnostic value on the selected temporal window. Results: 822 coronary artery segments were depicted and were evaluated. The mean image quality score was 4.15±0.72. The percentage of assessable coronary artery segments was 97.76%. Conclusion: PCA coronary CT angiography with proper revise image acquisition phase and padding time could offer assessable image quality at intermediate HR. (authors)

  1. Changes in Medical Management after Coronary CT Angiography

    Vânia Mairi Naue

    2015-01-01

    Full Text Available Abstract Introduction: Coronary computed tomography angiography (CCTA allows for non-invasive coronary artery disease (CAD phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. Objective: To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC levels. Methods: We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. Results: A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18% patients had no CAD, 38 (39% had non-obstructive (< 50% lesions and 41 (42% had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32. We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001. We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Conclusion: Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

  2. Effects of electrocardiogram gating on CT pulmonary angiography image quality

    Pulmonary embolism (PE) is the third most common cause of death from cardiovascular disease. Computed-tomographic pulmonary angiography (CTPA) is an accurate and safe test for diagnosing PE. The aim of this retrospective analysis was to evaluate the effects on image quality (IQ) of electrocardiogram (ECG) gating during CTPA. Fifty consecutive patients presenting for CTPA were included in the study. A single acquisition was performed, resulting in two reconstructions: one at 75% of the R–R interval and the other without ECG influence. IQ evaluation was undertaken by two radiologists, focusing on respiratory and cardiac motion, image noise, low-contrast resolution, vessel and lung clarity, contrast media opacification and artefacts. Various regions of the lungs and vasculature were evaluated, and IQ scores were statistically compared. For the ECG-tagged reconstructions, IQ was noted to be better overall with regard to vessel clarity (P<0.05) and cardiac motion (P<0.05), while lung clarity was better only in the left lower zone (P<0.05). IQ was better with regard to image noise (P<0.05) and low-contrast resolution (P<0.05) in the non-ECG-tagged reconstructions. No statistical IQ difference between the two types of reconstruction was noted with regard to respiratory motion, contrast media opacification or presence of artefacts. The two types of reconstruction provide complementary information for evaluating CTPA results.

  3. Efficiency of ultrasonography and CT angiography in follow-up studies of carotid stent and percutaneous transluminal angioplasty

    Ryu, Chang Woo; Lee, Byung Hee; Chung, Bong Sub; Ahn, Jung Yong; Heo, Kyung; Kho, Young Sik [Pundang CHA General Hospital, Pochon CHA Univ. College of Medicine, Pochon (Korea, Republic of)

    1999-12-01

    The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. Eleven carotid arteries of seven patients(men:5, women:2, mean age:56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven (mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverberation artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hardbeam artifact of the stent(11/11) and motion artifact(3/11). US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-invasive follow-up studies of carotid stenting.

  4. Efficiency of ultrasonography and CT angiography in follow-up studies of carotid stent and percutaneous transluminal angioplasty

    The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. Eleven carotid arteries of seven patients(men:5, women:2, mean age:56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven (mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverberation artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hardbeam artifact of the stent(11/11) and motion artifact(3/11). US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-invasive follow-up studies of carotid stenting

  5. Analysis of shielding calculation methods for 16- and 64-slice computed tomography facilities

    Moreno, C; Cenizo, E; Bodineau, C; Mateo, B; Ortega, E M, E-mail: c_morenosaiz@yahoo.e [Servicio de RadiofIsica Hospitalaria, Hospital Regional Universitario Carlos Haya, Malaga (Spain)

    2010-09-15

    The new multislice computed tomography (CT) machines require some new methods of shielding calculation, which need to be analysed. NCRP Report No. 147 proposes three shielding calculation methods based on the following dosimetric parameters: weighted CT dose index for the peripheral axis (CTDI{sub w,per}), dose-length product (DLP) and isodose maps. A survey of these three methods has been carried out. For this analysis, we have used measured values of the dosimetric quantities involved and also those provided by the manufacturer, making a comparison between the results obtained. The barrier thicknesses when setting up two different multislice CT instruments, a Philips Brilliance 16 or a Philips Brilliance 64, in the same room, are also compared. Shielding calculation from isodose maps provides more reliable results than the other two methods, since it is the only method that takes the actual scattered radiation distribution into account. It is concluded therefore that the most suitable method for calculating the barrier thicknesses of the CT facility is the one based on isodose maps. This study also shows that for different multislice CT machines the barrier thicknesses do not necessarily become bigger as the number of slices increases, because of the great dependence on technique used in CT protocols for different anatomical regions.

  6. Efficacy of dynamic CT perfusion imaging in conjunction with three dimensional CT angiography for the evaluation of acute ischemic stroke

    Nakaguchi, Hiroshi; Teraoka, Akira; Adachi, Shinobu; Yanagibashi, Kazutaka [Teraoka Memorial Hospital, Shinichi, Hiroshima (Japan)

    2003-01-01

    Through the use of a high-speed spiral CT scanner (GEMedical HiSpeedZX/i), CT/P/A technique, where conventional CT, CT perfusion imaging (CTP) and CT angiography (CTA) are consecutively performed, can now be performed with an imaging time of 90 seconds and a total contrast medium volume of 100 ml. A prospective clinical study was performed to ascertain the effectiveness of CT/P/A in diagnosing acute ischemic strokes. Twenty-nine consecutive patients of Teraoka Memorial Hospital suspected of suffering from the occlusion or constriction of cerebral arteries and who underwent CT/P/A within 3 hours from the onset served as subjects. The sensitivity, specificity, or Odds ratio of CTP and CTA in detecting lesions that caused cerebral infarction was calculated. CTP detected a hypoperfusion area with a sensitivity, specificity, and Odds ratio of 80%, 64%, and 7.2. The sensitivity in lobar infarcts, white matter infarcts, basal ganglia infarcts, and brainstem infarcts was 100%, 100%, 100%, 0% (p=0.0022). The sensitivity and Odds ratio of CT/P/A in cerebral infarcts differed according to the diameter of the infarcts. That with infarcts of 10 mm or more was 91%, 20. That with infarcts smaller than 10 mm was 50%, 2. CTA detected arterial lesions that caused cerebral ischemic attack with a sensitivity of 94% and specificity of 90%. The examination time for CT/P/A was 18 minutes, total radiation time being 90 seconds. Although CT/P/A was ineffective for the diagnosis of brainstem infarcts and lesions smaller than 10 mm, CT/P/A was useful in detecting moderate-sized hypoperfusion areas and arterial lesions three-dimensionally before an infarct is completed. (author)

  7. Low-dose CT coronary angiography using iterative reconstruction with a 256-slice CT scanner

    Carrascosa, Patricia; Rodriguez-Granillo, Gastón A; Capuñay, Carlos; Deviggiano, Alejandro

    2013-01-01

    AIM: To explore whether computer tomography coronary angiography (CTCA) using iterative reconstruction (IR) leads to significant radiation dose reduction without a significant loss in image interpretability compared to conventional filtered back projection (FBP).

  8. Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography

    Huang, W.-C. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: w.c.huang@yahoo.com.tw; Liu, C.-P. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: cpliu@isca.vghks.gov.tw; Wu, M.-T. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: wu.mingting@gmail.com; Mar, G.-Y. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: gymar@isca.vghks.gov.tw; Lin, S.-K. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: skyii89@yahoo.com.tw; Hsiao, S.-H. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: a841120@ms3.hinet.net; Lin, S.-L. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: sllin@isca.vghks.gov.tw; Chiou, K.-R. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: krchiou@isca.vghks.gov.tw

    2010-01-15

    Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p < 0.001). The STE-ACS culprit lesions (n = 54) had significantly higher luminal area stenosis (78.6 {+-} 21.2% vs. 66.7 {+-} 23.9%, p = 0.006), larger plaque burden (0.91 {+-} 0.10 vs. 0.84 {+-} 0.12, p = 0.007) and remodeling index (1.28 {+-} 0.34 vs. 1.16 {+-} 0.22, p = 0.021) than those with NSTE-ACS (n = 66). The percentage of expanding remodeling index (remodeling index >1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 {+-} 13.9 HU vs. 43.5 {+-} 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.

  9. Multi-detector CT angiography for lower gastrointestinal bleeding: can it select patients for endovascular intervention?

    Full text: This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.

  10. Clinical application of 64-slices spiral CT angiography in diagnosing subarachnoid hemorrhage and Nursing care%64层螺旋CT血管造影在蛛网膜下腔出血诊断的临床运用及护理

    黎兴华

    2007-01-01

    目的:探讨64层螺旋CT血管造影(CTA)在蛛网膜下腔出血(SAH)病因诊断中的运用及护理.方法:对2005年9月~2006年9月收治入院的89例SAH患者行64层螺旋CT血管造影检查,其中49例同时接受数字减影血管造影(DSA)检查.分析CTA检查结果并与DSA检查结果比较.结果:89例患者中CTA检出动脉瘤70例,动静脉畸形9例,静脉窦血栓2例,阴性8例;在同时接受DSA检查的49例患者中,发现动脉瘤41例,动静脉畸形4例,阴性4例,其中除1例CTA发现并经临床证实的动脉瘤DSA检查为阴性外,其余全部CTA确诊.CTA对SAH病因诊断中的敏感性和特异性均为100%,DSA分别为98%和100%.结论:64层螺旋CTA对SAH的病因诊断是一种无创、快速、便捷的影像学检查方法,做好检查时的护理配合,可使血管的空间立体结构及周边关系显示良好,有助于治疗方法的选择和难度的评估.

  11. Diagnostic accuracy of computed tomography coronary angiography in patients with a zero calcium score

    Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria - Parma, Department of Radiology, Parma (Italy); Maffei, Erica; Seitun, Sara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Palumbo, Alessandro; Martini, Chiara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Tedeschi, Carlo; Rosa, Roberto de [Ospedale San Gennaro, Department of Radiology and Cardiology, Napoli (Italy); Arcadi, Teresa; Salamone, Ignazio; Blandino, Alfredo [University Hospital, Department of Radiology, Messina (Italy); Weustink, Annick C.; Mollet, Nico R.; Feyter, Pim J. de; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands)

    2010-01-15

    To evaluate the diagnostic accuracy of 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in patients with zero on the Agatston Calcium Score (CACS). We enrolled 279 consecutive patients (96 male, mean age 48{+-}12 years) with suspected coronary artery disease. Patients were symptomatic (n = 208) or asymptomatic (n=71), and underwent conventional coronary angiography (CAG). For CT-CA we administered an IV bolus of 100 ml of iodinated contrast material. CT-CA was compared to CAG using a threshold for significant stenosis of {>=}50%. The prevalence of disease demonstrated at CAG was 15% (1.4% in asymptomatic). The population at CAG showed no or non-significant disease in 85% (238/279), single vessel disease in 9% (25/279), and multi-vessel disease in 6% (16/279). Sensitivity, specificity, and positive and negative predictive values of CT-CA vs. CAG on the patient level were 100%, 95%, 76%, and 100% in the overall population and 100%, 100%, 100%, and 100% in asymptomatic patients, respectively. CT-CA proves high diagnostic performance in patients with or without symptoms and with zero CACS. The prevalence of significant disease detected by CT-CA was not negligible in asymptomatic patients. The role of CT-CA in asymptomatic patients remains uncertain. (orig.)

  12. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography

    Gutte, Henrik; Mortensen, Jann; Jensen, Claus Verner;

    2009-01-01

    The diagnosis of pulmonary embolism (PE) is usually established by a combination of clinical assessment, D-dimer testing, and imaging with either pulmonary ventilation-perfusion (V/Q) scintigraphy or pulmonary multidetector CT (MDCT) angiography. Both V/Q SPECT and MDCT angiography seem to have...... prospective design, the diagnostic ability of V/Q SPECT, V/Q SPECT combined with low-dose CT, and pulmonary MDCT angiography obtained simultaneously using a combined SPECT/MDCT scanner in patients suspected of having PE. METHODS: Consecutive patients from June 2006 to February 2008 suspected of having acute...... greater than 2 were included and underwent V/Q SPECT, low-dose CT, and pulmonary MDCT angiography in a single session. Patient follow-up was 6 mo. RESULTS: A total of 81 simultaneous studies were available for analysis, of which 38% were from patients with PE. V/Q SPECT had a sensitivity of 97% and a...

  13. Non-invasive coronary angiography with multislice spiral CT

    The short imaging time of 1/4 second, renders the new generation of multiple-slice spiral CT devices with ECG gating enables the investigation of the heart without disturbing motion artefacts. With this method, calcifications of the coronary arteries can be detected or excluded. Certain amounts of coronary 'chalk' in asymptomatic patients with risk factors point to coronary artery disease and thus a need to modulate the risk factors. With the aid of intravenous injection of contrast medium during the examination, non-calcified plaques in the coronary arteries can also be visualized. A limiting factor is that the patient's heart rate should not exceed 60 beats per minute. Indications for this examination are visualization of coronary vessels with the aim of excluding coronary artery disease, pre-operative planning and monitoring of bypass vessels, and non-invasive follow-up after PTCA and stenting. (orig.)

  14. Automated coronary CT angiography plaque-lumen segmentation

    Cline, Harvey E.; Krishnan, Karthik; Napel, Sandy; Rubin, Geoffrey D.; Turner, Wesley D.; Avila, Ricardo S.

    2009-02-01

    We are investigating the feasibility of a computer-aided detection (CAD) system to assist radiologists in diagnosing coronary artery disease in ECG gated cardiac multi-detector CT scans having calcified plaque. Coronary artery stenosis analysis is challenging if calcified plaque or the iodinated blood pool hides viable lumen. The research described herein provides an improved presentation to the radiologist by removing obscuring calcified plaque and blood pool. The algorithm derives a Gaussian estimate of the point spread function (PSF) of the scanner responsible for plaque blooming by fitting measured CTA image profiles. An initial estimate of the extent of calcified plaque is obtained from the image evidence using a simple threshold. The Gaussian PSF estimate is then convolved with the initial plaque estimate to obtain an estimate of the extent of the blooming artifact and this plaque blooming image is subtracted from the CT image to obtain an image largely free of obscuring plaque. In a separate step, the obscuring blood pool is suppressed using morphological operations and adaptive region growing. After processing by our algorithm, we are able to project the segmented plaque-free lumen to form synthetic angiograms free from obstruction. We can also analyze the coronary arteries with vessel tracking and centerline extraction to produce cross sectional images for measuring lumen stenosis. As an additional aid to radiologists, we also produce plots of calcified plaque and lumen cross-sectional area along selected blood vessels. The method was validated using digital phantoms and actual patient data, including in one case, a validation against the results of a catheter angiogram.

  15. Multiple detector-row CT angiography of the renal and mesenteric vessels

    Computed tomography angiography (CTA) of the abdomen with multiple detector-row computed tomography (MD-CT) is an effective technique for minimally invasive imaging of the renal arteries and the visceral vasculature. This article reviews the clinical and technical aspects of MD-CT angiography in terms of image acquisition and reconstruction parameters, contrast medium application, and three-dimensional visualization with special attention to renal and mesenteric vascular imaging. Because of its high sensitivity to detect renal artery stenosis on the one hand, and because a normal renal CTA virtually excludes the presence of a significant renal artery stenosis on the other hand, renal CTA plays a useful role in the management of patients with suspected renovascular hypertension. Mesenteric CTA is a useful tool for visualizing normal vascular anatomy and its variants--particularly in the setting of organ transplantation. Vascular pathology, e.g. atherosclerotic disease (abdominal angina), or aneurysms of the visceral arteries are reliably assessed with CTA. Mesenteric CTA is an invaluable adjunct to abdominal CT in the setting of abdominal emergencies, because of its ability to detect the causes of acute intestinal ischemia (superior mesenteric artery embolism or thrombosis, superior mesenteric vein thrombosis). Accurate timing of the CTA acquisition and the subsequent parenchymal phase acquisition relative to the contrast medium transit time is critical to obtain excellent image quality in double-pass abdominal CT acquisitions

  16. Dose levels at coronary CT angiography - a comparison of Dual Energy-, Dual Source- and 16-slice CT

    Kerl, J.M.; Bauer, Ralf W.; Maurer, Tobias B.; Aschenbach, Rene; Korkusuz, Huedayi; Lehnert, Thomas; Deseive, Simon; Vogl, Thomas J. [Johann Wolfgang Goethe-University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); HELIOS Clinics Erfurt, Department of Diagnostic and Interventional Radiology and Neuroradiology, Erfurt (Germany); Ackermann, Hanns [Johann Wolfgang Goethe-University, Department of Biomathematics, Frankfurt (Germany); HELIOS Clinics Erfurt, Department of Diagnostic and Interventional Radiology and Neuroradiology, Erfurt (Germany)

    2011-03-15

    To compare the dose estimates and image quality of Dual Energy CT (DECT), Dual Source CT (DSCT) and 16-slice CT for coronary CT angiography (cCTA). Sixty-eight patients were examined with 16 - slice MDCT (group 1), 68 patients with DSCT (group 2) and 68 patients using DSCT in dual energy mode (DECT group 3). CT dose index volume, dose length product, effective dose, signal-to-noise, and contrast-to-noise ratio were compared. Subjective image quality was rated by two observers, blinded to technique. The mean estimated radiation dose of all patients investigated on a 16 - slice MDCT was 12 {+-} 3.59 mSv, for DSCT in single energy 9.8 {+-} 4.77 mSv and for DECT 4.54 {+-} 1.87 mSv. Dose for CTA was significantly lower in group 3 compared to group 1 and 2. The image noise was significantly lower in Group 2 in comparison to group 1 and group 3. There was no significant difference in diagnostic image quality comparing DECT and DSCT. cCTA shows better dose levels at both DECT and DSCT compared to 16-slice CT. Further, DECT delivers significantly less dose than regular DSCT or single source single energy cCTA while maintaining diagnostic image quality. (orig.)

  17. Pulmonary embolism: Comparison of ventilation-perfusion lung scintigraphy and helical CT angiography

    Full text: Objective: Retrospective study of the patients undergoing ventilation-perfusion pulmonary scintigraphy and helical CT angiography from March/ 2000 to July/ 2002, due to suspected pulmonary embolism (PE). Methods: Fifty-four patients were evaluated, with those unable to undergo a ventilation study or whose scintigraphy or CT studies were performed after anticoagulant therapy being excluded. The study group included 40 patients (24 male, 16 female) with an average age of 55,8 ± 18,8 years. Ninety per cent of the patients had a measurement of D-dimers levels and only 5% were submitted to angiography. Results: Both studies were concordant in 32 patients (80%), with concordant positive findings in 25 cases and concordant negative results in 7. In concordant positive cases, main risk factors included venous pathology of the lower extremities (40%) and malignant neoplasms (24%); no risk factors were found in 16% of these patients. Clinical findings included thoracic pain (16 patients), dyspnea (15 cases) and cough (7 patients). In these 25 patients PE was bilateral in 52%, right-sided in 28% and left-sided in the remaining 20%. D-dimers were elevated in 19 patients, normal in 3 and not measured in 3 cases. In concordant negative cases, D-dimers were elevated in 6 patients and not measured in one. Studies were discordant in 8 patients: in 5 of them, lung scintigraphy yielded a high-probability study but CT was negative for PE (revealing parenchymatous consolidation in 3 cases and pleural effusion in 2 patients); two patients had an intermediate-probability lung scintigram but CT was also negative (detecting a pericardial cyst around right hilum in one patient); in the remaining discordant case (a patient with chronic pulmonary hypertension), scintigraphy yielded a low-probability result but CT detected a non-occlusive clot in the right pulmonary artery. The angiographic studies performed in only 2 patients, both with concordant positive studies, confirmed the

  18. Coronary CT Angiography: Current Applications in Clinical Practice Promise for the Future

    S. Wann

    2007-05-01

    Full Text Available The use of computed tomography for cardiac diagno-sis has a long history. CT was first used experimentally to measure myocardial perfusion and to detect infarcation nearly 25 years ago, but poor temporal resolution and high radiation dosage pre-cluded its use in clinical medicine. Later electron beam computed tomography provided sufficiently high temporal resolution to precisely measure cal-cium depositions in the coronary arteries as a marker of coronary atherosclerosis. Large epidemiologic stud-ies have now shown that the coronary artery calcium score gives incremental predictive power to conven-tional risk factor analysis such as the Framinghan score. While its temporal resolution is unchallenged, electron beam CT lacks the spatial resolution to per-form clinically useful coronary angiography. The re-cent development of multi-detector computed tomo-graphy (MDCT has enabled non-invasive coronary angiography, capturing the excitement and enthusi-asm of clinicians around the world. This lecture will briefly review the technology underlying MDCT, dis-cussing limitations related to radiation dosimetry, calcium and gating, as well as other fundamental dif-ferences from conventional angiography. Current clinical indications and appropriate application of MDCT will be discussed, with an emphasis on evi-dence based practice. MDCT is a rapidly evolving field. Areas of research and technical development will be described.

  19. Learning-based automatic detection of severe coronary stenoses in CT angiographies

    Melki, Imen; Cardon, Cyril; Gogin, Nicolas; Talbot, Hugues; Najman, Laurent

    2014-03-01

    3D cardiac computed tomography angiography (CCTA) is becoming a standard routine for non-invasive heart diseases diagnosis. Thanks to its high negative predictive value, CCTA is increasingly used to decide whether or not the patient should be considered for invasive angiography. However, an accurate assessment of cardiac lesions using this modality is still a time consuming task and needs a high degree of clinical expertise. Thus, providing automatic tool to assist clinicians during the diagnosis task is highly desirable. In this work, we propose a fully automatic approach for accurate severe cardiac stenoses detection. Our algorithm uses the Random Forest classi cation to detect stenotic areas. First, the classi er is trained on 18 CT cardiac exams with CTA reference standard. Then, then classi cation result is used to detect severe stenoses (with a narrowing degree higher than 50%) in a 30 cardiac CT exam database. Features that best captures the di erent stenoses con guration are extracted along the vessel centerlines at di erent scales. To ensure the accuracy against the vessel direction and scale changes, we extract features inside cylindrical patterns with variable directions and radii. Thus, we make sure that the ROIs contains only the vessel walls. The algorithm is evaluated using the Rotterdam Coronary Artery Stenoses Detection and Quantication Evaluation Framework. The evaluation is performed using reference standard quanti cations obtained from quantitative coronary angiography (QCA) and consensus reading of CTA. The obtained results show that we can reliably detect severe stenosis with a sensitivity of 64%.

  20. Determining the organ of origin of large pelvic masses in females using multidetector CT angiography and three-dimensional volume rendering CT angiography

    Li, YangKang; Chen, JunWei; Chen, XueYin; Lin, JianBang; Cai, AiQun; Zhou, XiuGuo [Cancer Hospital, Shantou University Medical College, Department of Radiology, Shantou, Guangdong Province (China); Zheng, Yu [Cancer Hospital, Shantou University Medical College, Department of Clinical Pharmacology, Shantou (China)

    2015-04-01

    To study the value of tumour feeding arteries and the ovarian vein in determining the organ of origin of large pelvic tumours in females using multidetector CT. One hundred and thirty patients with 131 pathologically proven tumours (>6.5 cm) were retrospectively reviewed. Conventional CT images and CT angiography were evaluated, with focus on assessing the value of tumour feeding arteries and the ovarian vein in differentiating ovarian from non-ovarian tumours. For 97 ovarian tumours, the feeding arteries included the ovarian artery (n = 51) and the ovarian branch of uterine artery (n = 64). For 34 non-ovarian tumours, the feeding arteries included the ovarian artery (n = 2), the uterine artery (n = 21), the mesenteric artery (n = 5), and the internal iliac artery (n = 1). The ovarian vein was identified in 86 ovarian tumours and 12 non-ovarian tumours. When the feeding arteries and the ovarian vein were combined to confirm ovarian origin, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.8 %, 84.2 %, 93.8 %, 94.1 %, and 93.9 %, respectively. The accuracy was significantly higher than that of independently using the ovarian vein or the ovarian feeding arteries. Combined application of tumour feeding arteries and the ovarian vein is valuable to differentiate large ovarian from non-ovarian tumours. (orig.)

  1. Construction of a coronary artery atlas from CT angiography.

    Medrano-Gracia, Pau; Ormiston, John; Webster, Mark; Beier, Susann; Ellis, Chris; Wang, Chunliang; Young, Alistair A; Cowan, Brett R

    2014-01-01

    Describing the detailed statistical anatomy of the coronary artery tree is important for determining the aetiology of heart disease. A number of studies have investigated geometrical features and have found that these correlate with clinical outcomes, e.g. bifurcation angle with major adverse cardiac events. These methodologies were mainly two-dimensional, manual and prone to inter-observer variability, and the data commonly relates to cases already with pathology. We propose a hybrid atlasing methodology to build a population of computational models of the coronary arteries to comprehensively and accurately assess anatomy including 3D size, geometry and shape descriptors. A random sample of 122 cardiac CT scans with a calcium score of zero was segmented and analysed using a standardised protocol. The resulting atlas includes, but is not limited to, the distributions of the coronary tree in terms of angles, diameters, centrelines, principal component shape analysis and cross-sectional contours. This novel resource will facilitate the improvement of stent design and provide a reference for hemodynamic simulations, and provides a basis for large normal and pathological databases. PMID:25485418

  2. The role of CT angiography in the evaluation of pediatric renovascular hypertension

    Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility. Additionally, in our experience high-quality renal CTA can be performed using low-dose radiation exposures and can be acquired without sedation in most instances. This article illustrates by examples the usefulness of renal CTA for diagnosis of childhood renovascular hypertension and provides an overview of renal CTA findings in the most common childhood renovascular diseases. (orig.)

  3. Dynamic cone beam CT angiography of carotid and cerebral arteries using canine model

    Cai Weixing; Zhao Binghui; Conover, David; Liu Jiangkun; Ning Ruola [Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Department of Radiology, Shanghai 6th People' s Hospital, 600 Yishan Road, Xuhui, Shanghai (China); Koning Corporation, Lennox Tech Enterprise Center, 150 Lucius Gordon Drive Suite 112, West Henrietta, New York 14586 (United States); Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States) and Koning Corporation, Lennox Tech Enterprise Center, 150 Lucius Gordon Drive Suite 112, West Henrietta, New York 14586 (United States)

    2012-01-15

    Purpose: This research is designed to develop and evaluate a flat-panel detector-based dynamic cone beam CT system for dynamic angiography imaging, which is able to provide both dynamic functional information and dynamic anatomic information from one multirevolution cone beam CT scan. Methods: A dynamic cone beam CT scan acquired projections over four revolutions within a time window of 40 s after contrast agent injection through a femoral vein to cover the entire wash-in and wash-out phases. A dynamic cone beam CT reconstruction algorithm was utilized and a novel recovery method was developed to correct the time-enhancement curve of contrast flow. From the same data set, both projection-based subtraction and reconstruction-based subtraction approaches were utilized and compared to remove the background tissues and visualize the 3D vascular structure to provide the dynamic anatomic information. Results: Through computer simulations, the new recovery algorithm for dynamic time-enhancement curves was optimized and showed excellent accuracy to recover the actual contrast flow. Canine model experiments also indicated that the recovered time-enhancement curves from dynamic cone beam CT imaging agreed well with that of an IV-digital subtraction angiography (DSA) study. The dynamic vascular structures reconstructed using both projection-based subtraction and reconstruction-based subtraction were almost identical as the differences between them were comparable to the background noise level. At the enhancement peak, all the major carotid and cerebral arteries and the Circle of Willis could be clearly observed. Conclusions: The proposed dynamic cone beam CT approach can accurately recover the actual contrast flow, and dynamic anatomic imaging can be obtained with high isotropic 3D resolution. This approach is promising for diagnosis and treatment planning of vascular diseases and strokes.

  4. Dynamic cone beam CT angiography of carotid and cerebral arteries using canine model

    Purpose: This research is designed to develop and evaluate a flat-panel detector-based dynamic cone beam CT system for dynamic angiography imaging, which is able to provide both dynamic functional information and dynamic anatomic information from one multirevolution cone beam CT scan. Methods: A dynamic cone beam CT scan acquired projections over four revolutions within a time window of 40 s after contrast agent injection through a femoral vein to cover the entire wash-in and wash-out phases. A dynamic cone beam CT reconstruction algorithm was utilized and a novel recovery method was developed to correct the time-enhancement curve of contrast flow. From the same data set, both projection-based subtraction and reconstruction-based subtraction approaches were utilized and compared to remove the background tissues and visualize the 3D vascular structure to provide the dynamic anatomic information. Results: Through computer simulations, the new recovery algorithm for dynamic time-enhancement curves was optimized and showed excellent accuracy to recover the actual contrast flow. Canine model experiments also indicated that the recovered time-enhancement curves from dynamic cone beam CT imaging agreed well with that of an IV-digital subtraction angiography (DSA) study. The dynamic vascular structures reconstructed using both projection-based subtraction and reconstruction-based subtraction were almost identical as the differences between them were comparable to the background noise level. At the enhancement peak, all the major carotid and cerebral arteries and the Circle of Willis could be clearly observed. Conclusions: The proposed dynamic cone beam CT approach can accurately recover the actual contrast flow, and dynamic anatomic imaging can be obtained with high isotropic 3D resolution. This approach is promising for diagnosis and treatment planning of vascular diseases and strokes.

  5. Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus; Diagnostische Genauigkeit der Dual-energy-CT-Angiographie bei Patienten mit Diabetes mellitus

    Schabel, C.; Bongers, M.N.; Syha, R. [Klinikum der Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Klinikum der Eberhard-Karls-Universitaet, Sektion fuer Experimentelle Radiologie der Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Ketelsen, D.; Homann, G.; Notohamiprodjo, M.; Nikolaou, K.; Bamberg, F. [Klinikum der Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Thomas, C. [Universitaetsklinikum Duesseldorf, Abteilung fuer Diagnostische und Interventionelle Radiologie, Duesseldorf (Germany)

    2015-04-01

    Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. Among the 30 subjects included in the analysis (83 % male, mean age 70.0 ± 10.5 years, 83 % diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30 %). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100 % and 93.1 %, respectively) and MIP images (99 % and 91.8 %, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1 % vs. 99.2 vs. 90.9 %; respectively, p < 0.001). The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs. (orig.) [German] Die periphere arterielle Verschlusskrankheit (PAVK) ist eine wesentliche Komplikation des Diabetes mellitus und stellt aufgrund ausgepraegter Gefaessverkalkungen eine diagnostische

  6. Role of plain radiography and CT angiography in the evaluation of obstructed total anomalous pulmonary venous connection

    Shen, Quanli; Pa, Mier; Hu, Xihong; Wang, Junbo [Children' s Hospital, Fudan University, Department of Radiology, Shanghai (China)

    2013-07-15

    Obstructed total anomalous pulmonary venous connection (TAPVC) is frequently misdiagnosed as pulmonary disease and without operative correction early death is common. It is important to make a correct diagnosis before surgery. The purpose of this study was to describe the chest radiographic features of obstructed TAPVC and compare CT angiography with transthoracic echocardiography in the evaluation of obstructed TAPVC. Eighteen children with obstructed TAPVC were assessed. Their clinical and imaging data were retrospectively reviewed. The characteristic radiographic findings were analyzed and compared with surgical results, and the diagnostic accuracy of CT angiography and transthoracic echocardiography was evaluated in terms of pulmonary venous drainage and obstruction detection. The common radiographic features included pulmonary venous congestion or edema or both (16 of 18 cases, 89%), and absence of cardiomegaly (12 of 18 cases, 67%). CT angiography correctly diagnosed TAPVC and clearly revealed the draining sites in all children (five with supracardiac TAPVC, three with cardiac TAPVC, eight with infracardiac TAPVC and two with mixed TAPVC). The diagnostic agreement between CT angiography and surgery was 100%. Transthoracic echocardiography only correctly revealed the draining sites in 11 children (5 with supracardiac TAPVC, 2 with cardiac TAPVC and 4 with infracardiac TAPVC). The diagnostic agreement between transthoracic echocardiography and surgery was 61%. The diagnostic accuracy of CT angiography was higher than that of transthoracic echocardiography (P = 0.0156). Thirty-four sites of obstruction were correctly detected by CT angiography (11 in the mediastinum, 1 at the diaphragmatic level, 9 below the diaphragm and 13 stenotic individual pulmonary veins in the lung). The diagnostic agreement between CT angiography and surgery was 92%. Transthoracic echocardiography only correctly detected 15 sites of obstruction (11 in the mediastinum, 1 at the

  7. 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis

    Abdulla, Jawdat; Abildstrøm, Steen Zabell; Gøtzsche, Ole;

    2007-01-01

    AIMS: To evaluate the diagnostic accuracy of 64-slice multi-detector computed tomography coronary angiography (64-SCTA) compared with the standard reference conventional coronary angiography (CCA). METHODS AND RESULTS: Based on a systematic search, 27 studies including 1740 patients were eligible...

  8. Identification of the segmental artery feeding the anterior spinal artery. Correlation between helical CT and angiography

    We investigated whether identification of the segmental artery feeding the anterior spinal artery (ASA) is possible by single-slice helical CT. Enhanced CT and angiography were performed in 14 patients with retroperitoneal, liver, or bone tumor. A single-slice helical CT scanner with 7 mm collimation and a 1.0 helical pitch was used. Scanning was started 25 to 30 sec after an intravenous injection of 100 ml of contrast medium at a rate of 3.0 ml/sec. We predicted the segmental artery feeding the ASA in all 14 patients using enhanced CT images. In 12 of the 14 patients, the segmental artery feeding the ASA was angiographically identified. In 7 of these 12 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was the same level as that predicted by enhanced CT. In the remaining 5 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was one level higher or lower than the predicted spinal level. We could identify the segmental artery feeding the ASA by detailed examination and interpretation of single-slice helical CT images. (author)

  9. Bolus timing in high-pitch CT angiography of the aorta

    Beeres, Martin, E-mail: beeres@gmx.net [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Loch, Matthias, E-mail: MatthiasLoch@gmx.net [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schulz, Boris, E-mail: boris.schell@googlemail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Kerl, Matthias, E-mail: matthias.kerl@gmail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Al-Butmeh, Firas, E-mail: Firas.Albutmeh@gmail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Bodelle, Boris, E-mail: bbodelle@googlemail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Herrmann, Eva, E-mail: Herrmann@Med.Uni-Frankfurt.de [Clinic of the Goethe University, Department of Biostatistics, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Lee, Clara, E-mail: Clara.Lee@kgu.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Jacobi, Volkmar, E-mail: Volkmar.Jacobi@kgu.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J., E-mail: T.Vogl@em.uni-frankfurt.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); and others

    2013-06-15

    Objective: To investigate the bolus geometry in high-pitch CT angiography (CTA) of the aorta without ECG synchronisation in comparison to single-source CT. Methods: Overall 160 consecutive patients underwent CTA either in conventional single-source mode with a pitch of 1.2 (group 1), or in dual-source mode with a pitch of 3.0 (groups 2, 3 and 4) using different contrast media timings with bolus triggering at 140 HU (5 s, group 1; 10 s, group 2; 12 s, group 3; 14 s, group 4). Contrast material, saline flush, flow rate and kV/mAs settings were kept equal for optimum comparability. Aortic attenuation was measured along the z-axis of the patient at different anatomic landmarks and subjective image quality was compared. Results: The most homogeneous enhancement of the aorta was reached with a delay of 10 s after reaching the trigger threshold. The imaging length was not significantly different, but the examination time was significantly (p < 0.001) shorter in the high-pitch group (7.7 s vs. 1.7 s for group 1 vs. 2, 3 and 4). Conclusion: In high-pitch CT angiography using a start delay of 10 s after a trigger threshold of 140 HU in the descending aorta is reached, a homogenous contrast along the z-axis is accomplished.

  10. Clinical application of 3D-CT angiography. The usefulness in cases of unruptured cerebral aneurysms

    We studied three-dimensional (3D) images of unruptured aneurysms using JETT (Joining exposure translation) CT scanning with a bolus injection of contrast medium. 3D-CT angiography (3D-CTA) was performed in sixty cases with a total of 73 unruptured cerebral aneurysms. Sixty-eight of these 73 aneurysms were identified (detectability: 93.2%) by using the shaded surface display. The minimal size of the detected aneurysms was 2 mm in their longest diameter. The common site of the five aneurysms that could not be demonstrated was the internal carotid artery (cavernous portion or ophthalmic segment) and this technique thus requires further investigation. 3D-CT angiography (3D-CTA) was helpful in demonstrating the complex anatomy of cerebral aneurysms and their surrounding structures. On the 3D-CTA, it was possible to observe the necks of aneurysms from every direction by rotating it freely. This technique will be of value in surgical planning and follow up. Calcifications present in vessels or aneurysmal walls are clearly visualized by using the maximum intensity projection (MIP). Combining a wide variety of 3D display techniques (Shaded surface display, Multiplanar reconstruction, MIP) may become a valuable tool in evaluating cerebral aneurysms. (author)

  11. Role of coronary CT angiography in asymptomatic patients with type 2 diabetes mellitus

    Diabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis >70%. High-risk plaque was defined as plaque having both a CT density <30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P=0.022). We found significant stenosis even in patients whose CAC score =0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P=0.033) and current smoking (P=0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (author)

  12. Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

    To evaluate the feasibility, diagnostic accuracy, and radiation dose of CT coronary angiography (CTCA) in patients with atrial fibrillation (AF) using 320-detector CT. Thirty-seven patients with persistent AF and suspected coronary artery disease (CAD) were enrolled. All patients underwent both 320-detector CTCA and conventional coronary angiography (CCA). CT image quality and the presence of significant (≥50%) stenosis were evaluated by two radiologists blinded to the results of CCA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using CCA as the reference standard. Differences in detection of coronary artery stenosis between 320-detector CTCA and CCA were evaluated with McNemar's test. Patient radiation dose was calculated by multiplying dose length product by conversion coefficient of 0.017. In total 474 evaluated coronary segments, 459 (96.8%) segments were diagnostically evaluable. On per-segment analysis, sensitivity, specificity, PPV and NPV were 90.0% (18 of 20), 99.3% (436 of 439), 85.7% (18 of 21) and 99.5% (436 of 438). No significant difference was found between 320-detector CTCA and CCA on the detection of significant stenosis (P = 1.000). Effective doses of 320-detector CTCA was 13.0 ± 4.7 mSv. 320-detector CTCA is feasible and accurate in excluding CAD in patients with AF. (orig.)

  13. Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

    Xu, Lei; Yang, Lin; Fan, Zhanming; Yu, Wei; Lv, Biao; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China)

    2011-05-15

    To evaluate the feasibility, diagnostic accuracy, and radiation dose of CT coronary angiography (CTCA) in patients with atrial fibrillation (AF) using 320-detector CT. Thirty-seven patients with persistent AF and suspected coronary artery disease (CAD) were enrolled. All patients underwent both 320-detector CTCA and conventional coronary angiography (CCA). CT image quality and the presence of significant ({>=}50%) stenosis were evaluated by two radiologists blinded to the results of CCA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using CCA as the reference standard. Differences in detection of coronary artery stenosis between 320-detector CTCA and CCA were evaluated with McNemar's test. Patient radiation dose was calculated by multiplying dose length product by conversion coefficient of 0.017. In total 474 evaluated coronary segments, 459 (96.8%) segments were diagnostically evaluable. On per-segment analysis, sensitivity, specificity, PPV and NPV were 90.0% (18 of 20), 99.3% (436 of 439), 85.7% (18 of 21) and 99.5% (436 of 438). No significant difference was found between 320-detector CTCA and CCA on the detection of significant stenosis (P = 1.000). Effective doses of 320-detector CTCA was 13.0 {+-} 4.7 mSv. 320-detector CTCA is feasible and accurate in excluding CAD in patients with AF. (orig.)

  14. Dual-energy CT angiography plus CT perfusion-diagnostic value in coronary artery disease: initial experience

    Objective: To evaluate the combination of dual-energy CT angiography (DE-CTA) and dual-energy CT perfusion (DE-CTP) in the diagnosis of coronary artery disease. Methods: Thirty-one patients with angina pectoris were examined using dual-source dual energy CT and conventional coronary angiography. For DE-CTA, we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of' two tube detector arrays at 140 and 100 kVp. Two kinds of acquired images were fused for the CT angiogram and further calculated to construct a perfusion map (Siemens DE Heart PBV). The compared the following results: DE-CTA vs. CA, DE-CTP vs. CA to assess the sensitivity and specificity, and further compared DE-CTA plus DE-CTP with CA. Results: DECT obtained diagnostic image quality in 28 patients. DE-CTA detected 41/112 arterial stenosis. Using CA as a reference, the sensitivity of DE-CTA was 81% (38/47), specificity was 95% (62/65), positive predictive value was 92% (38/41), negative predictive value was 87% (62/71), and accuracy was 89% (100/112). DE-CTP detected 46 perfusion defects in artery territories. Using CA as a reference, the sensitivity of DE-CTP was 76% (36/47), specificity was 85% (55/65), positive predictive value was 78% (36/46), negative predictive value was 83% (55/66), and accuracy was 81% (91/112). DE-CTA plus DE-CTP diagnosed 52 arteries stenosis. Using CA as a reference, combination of DE-CTA and DE-CTP gave sensitivity of 95% (45/47), specificity of 89% (58/65), NPV of 97% (58/60), and accuracy of 92% (103/112). Conclusions: DECT can provide perfusion blood volume information as well as vessel pathology in one scan. DECT can provide comprehensive diagnosis and improve diagnosis of CAD. (authors)

  15. CT Angiography of the Aorta: Prospective Evaluation of Individualized Low-Volume Contrast Media Protocols.

    Higashigaito, Kai; Schmid, Tabea; Puippe, Gilbert; Morsbach, Fabian; Lachat, Mario; Seifert, Burkhardt; Pfammatter, Thomas; Alkadhi, Hatem; Husarik, Daniela B

    2016-09-01

    Purpose To prospectively develop individualized low-volume contrast media (CM) protocols adapted to tube voltage in patients undergoing computed tomographic (CT) angiography of the aorta. Materials and Methods The study was approved by the institutional review board and local ethics committee. All patients provided written informed consent. CT angiography was performed by using automated attenuation-based tube voltage selection (ATVS) (range, 70-150 kVp; 10-kVp increments). Iodine attenuation curves from an ex vivo experiment in a phantom were used to design CM protocols for CT angiography of the thoracoabdominal aorta in 129 consecutive patients (hereafter, cohort A). Further modified CM protocols based on results in cohort A were designed with the aim of homogeneous vascular attenuation of 300-350 HU across tube voltages and were applied to another 61 consecutive patients (cohort B). Three independent blinded radiologists assessed subjective image quality, and one reader determined objective image quality. The Kruskal-Wallis test was performed to test for differences in subjective image quality, and linear regression was performed to test for differences in objective image quality between the automatically selected tube voltages. Results Experiments revealed tube voltage-dependent iodine attenuation curves, which were used to determine the CM protocols in cohort A; these ranged from 68 mL at 110 kVp to 45 mL at 80 kVp. In both cohorts, ATVS selected 80 kVp in 62 patients, 90 kVp in 84, 100 kVp in 33, and 110 kVp in 11. In cohort A, image quality that was satisfactory or better was attained in 126 (98%) of 129 patients who had no significant differences in subjective image quality between tube voltages (P = .106) but who did have significant differences in attenuation and contrast-to-noise ratio (CNR) (P < .001 for both). In cohort B, the further-modified CM protocol (from 33 mL at 80 kVp to 68 mL at 110 kVp) yielded image quality that was satisfactory or better

  16. Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scanner

    Kajander, S; Ukkonen, H; Sipilä, H.; Teräs, M.; Knuuti, J

    2009-01-01

    Objectives: To test the image quality and feasibility of a sequential low radiation dose protocol for hybrid cardiac PET/CT angiography (CTA). Background: Multidetector computed tomography (MDCT) is a non-invasive method for coronary angiography. The negative predictive value of MDCT is high but perfusion imaging has a role in detecting functional significance of coronary lesions. This has encouraged combining these techniques. However, radiation dose is of concern. We report our first experi...

  17. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

    Westerlaan, H. E.; Gravendeel, J.; Fiore, D; Metzemaekers, J. D. M.; Groen, R. J. M.; Mooij, J.J.A.; Oudkerk, M.

    2007-01-01

    Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negativ...

  18. Electron-beam CT coronary angiography in the patients with high heart rate arrhythmia or pacemaker

    Objective: To report the clinical applicability of coronary angiography for patients with high heart rate, arrhythmia or cardiac pacing using the new-generation of electron-beam CT (e-Speed). Methods: EBCT (GE e-Speed) coronary angiography was performed in 36 eases (male 27, female 9, mean age 58), including the heart rate more than 90 bpm in 20 patients, frequent ectopic beats in 11 cases, implantation of cardiac pacemaker in 4 patients and the unacceptable MSCT image quality due to variability of interscan heart rate (from 82 bpm to 104 bpm) in 1 case. After volume data set was acquired using spiral mode with prospective ECG-gating, the reconstructions of MIP, CPR, VR and Cine were performed. The VR quality was evaluated using a five-point scale. Results: The quality of coronary imaging in all of 36 cases were acceptable. The total visualization rate of coronary artery branches was 80.0%. Left main, left anterior artery and right coronary artery were visualized in all patients and in 94.3% of all cases circumflex artery were visible. Conclusion: EBCT (e-Speed) is applicable in noninvasive coronary angiography for patients with high heart rate, arrhythmia or implanted cardiac pacemaker', and this examination can obtain satisfied diagnosis. (authors)

  19. Non-ECG-gated CT pulmonary angiography and the prediction of right ventricular dysfunction in patients suspected of pulmonary embolism

    Gutte, Henrik; Mortensen, Jann; Mørk, Mette Louise;

    2016-01-01

    PURPOSE: Right ventricular dysfunction (RVD) is an important prognostic factor of 30-day mortality in patients with acute pulmonary embolism (PE). The aim of our study was to evaluate whether non-electrocardiogram (ECG)-gated cardiovascular parameters attained during computed tomography pulmonary...... angiography (CTPA) could predict RVD in patients suspected of PE using ECG-gated cardiac CT angiography as reference. METHODS: Consecutive patients suspected of PE were referred to a ventilation/perfusion single-photon emission tomography (V/Q-SPECT) as first-line imaging procedure. Patients had a V....../Q-SPECT/CT, a CTPA and an ECG-gated cardiac CT angiography performed the same day. RESULTS: A total of 71 patients were available for analysis. Seventeen patients (24%) had RVD. The non-ECG-gated dimensions of left and right ventricle and the major vessels were correlated with ECG-gated cardiac dimensions. The...

  20. Anomalous origin of coronary artery: the role of multislice CT Angiography: a case report and literature review

    Rabelo, Daniel Rocha; Barros, Marcio Vinicius Lins; Nunes, Maria do Carmo Pereira; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil)

    2012-07-15

    Anomalous origin of coronary arteries is a relatively rare entity and can present different clinical forms. Recently, CT angiography of the coronary arteries have demonstrated an important role in the diagnosis and management of these anomalies. We present the case of a young female without significant comorbidities who presented with cardiopulmonary arrest, being revived by a team of customer service mobile emergency. After completion of multislice CT angiography of the coronary arteries was observed anomalous origin of left main coronary artery in the right coronary artery, no signs of extrinsic compression. Patient received a defibrillator and had an uneventful follow-up performed. Multislice CT angiography is minimally invasive diagnostic methods to detect the origin and trajectory of the coronary arteries, allowing an alternative to cardiac catheterization for evaluation of patients with anomalous origin of coronary arteries. (author)

  1. Anomalous origin of coronary artery: the role of multislice CT Angiography: a case report and literature review

    Anomalous origin of coronary arteries is a relatively rare entity and can present different clinical forms. Recently, CT angiography of the coronary arteries have demonstrated an important role in the diagnosis and management of these anomalies. We present the case of a young female without significant comorbidities who presented with cardiopulmonary arrest, being revived by a team of customer service mobile emergency. After completion of multislice CT angiography of the coronary arteries was observed anomalous origin of left main coronary artery in the right coronary artery, no signs of extrinsic compression. Patient received a defibrillator and had an uneventful follow-up performed. Multislice CT angiography is minimally invasive diagnostic methods to detect the origin and trajectory of the coronary arteries, allowing an alternative to cardiac catheterization for evaluation of patients with anomalous origin of coronary arteries. (author)

  2. Chronic thromboembolic pulmonary hypertension: Evaluation with 64-detector row CT versus digital substraction angiography

    The aim of the study was to evaluate the role of 64-row CT in the diagnostic workup of patients with chronic thromboembolic pulmonary hypertension (CTEPH) using digital substraction angiography (DSA) as the method of diagnostic reference. CT and DSA studies of 27 patients (54 main, 162 lobar and 540 segmental arteries) with a clinical suspicion of CTEPH were included in this retrospective and blinded analysis. Axial images and multiplanar thin maximum intensity projections (MIPs) (3 mm) were consequently used for exact image interpretation whereas additional reconstructed thick MIPs gave an overview of the entire vascular tree comparable to DSA. Sensitivity and specificity of CT regarding CTEPH-related pathological changes in general were 98.3% and 94.8% at main/lobar level and 94.1% and 92.9% at segmental level, respectively. Sensitivity and specificity of CT regarding the different pathological criteria of CTEPH (complete obstruction, intimal irregularities, bands and webs, indirect signs) were 88.9-100% and 96.1-100% at main/lobar level and 84.3-90.5% and 92-98.7% at segmental level, respectively. Our results show that CT is an accurate and reliable non-invasive alternative to conventional DSA in the diagnostic workup in patients with CTEPH.

  3. Assessment of right ventricular function for patients with rheumatic mitral stenosis by 64-slice multi-detector row computed tomography: comparison with magnetic resonance imaging

    ZHANG Xiao-chun; YANG Zhi-gang; GUO Yin-kun; ZHANG Rui-ming; WANG Jian; ZHOU Dai-quan; CHENG Lin; CHEN Lin

    2012-01-01

    Background Right ventricular (RV) dysfunction ensues due to rheumatic mitral stenosis (RMS).The evaluation of RV function is clinically important for the diagnosis,treatment,and follow-up for patients with different degrees of RMS.Thepurpose of this study was to determine whether the 64-slice multi-detector row computed tomography (64-slice MDCT)can assess the RV function in RMS with high accuracy and reproducibility when compared to MR imaging (MRI).Methods Right ventricular end-diastolic and end-systolic volumes (RV-EDV and RV-ESV),stroke volume (RV-SV),ejection fraction (RV-EF),cardiac output (RV-CO),and wall mass (RV-Mass) were measured with dedicated cardiac analysis software on 64-slice MDCT and compared with values measured with MRI in 43 consecutive patients with RMS.Agreement between MRI and 64-MDCT results were compared with Bland and Altman analysis and linear regression analysis.Repeated measurements were performed to determine intraobserver and interobserver variability.Results No significant differences were revealed in calculated RV function parameters between the two methods.RV-EDV,RV-ESV,RV-SV,RV-EF,RV-CO,and RV-Mass by 64-slice MDCT were similar to those by MRI (P>0.05).There were good correlations (r=0.98,0.97,0.96,0.96,0.95 and 0.77,respectively) and close agreement (bias=-0.2 ml,-1.0ml,0.8 ml,0.5%,26.1 ml,and 0.5 g,respectively,P>0.05).The variability in 64-slice MDCT measurements was similar to that in MRI values.Conclusion ECG-gated 64-slice MDCT could assess the RV function in RMS with high accuracy and reproducibility when compared to MRI.

  4. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

    Dournes, Gael; Verdier, Damien; Montaudon, Michel; Laurent, Francois; Lederlin, Mathieu [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France); University Bordeaux Segalen, Bordeaux Cedex (France); Bullier, Eric; Riviere, Annalisa [Hopital Haut-Leveque, CHU Bordeaux, Department of Nuclear Medicine, Pessac (France); Dromer, Claire [Hopital Haut-Leveque, CHU Bordeaux, Department of Respiratory Diseases, Pessac (France); Picard, Francois [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiology, Pessac (France); Billes, Marc-Alain [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiac Surgery, Pessac (France); Corneloup, Olivier [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France)

    2014-01-15

    To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

  5. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

    To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

  6. Impact of image noise levels, scout scan dose and lens shield on image quality and radiation exposure in z-axis dose-modulated neck MSCT on 16- and 64-slice Toshiba Aquilion scanners

    Objective: Assessing the impact of image noise (IN) levels, scout scan dose and lens shield use on image quality and radiation exposure in neck multislice CT (MSCT) when using z-axis dose modulation (DM). Methods: Neck MSCT phantom studies with/without z-axis DM were performed by using different IN levels (S.D. 7.5-30 HU) and scout scan tube currents (7.5-50 mA) on Toshiba Aquilion scanners (16-/64-slice). Image quality indices were evaluated by two radiologists and radiation exposure parameters calculated. Cadaveric phantom measurements elucidated lens shield interactions with DM efficacy. The lowest dose scan protocol with diagnostic image quality was introduced into the clinical imaging routine and retrospectively evaluated in 20 age-matched patients undergoing neck MSCT with/without DM. Results: The highest image noise level in DM neck studies with comparable image quality to standard neck CT amounted to 20 HU, resulting in a mean tube current of 50 mAs (CTDIw 6.3 mGy). DM reduced effective dose by 35% and organ dose figures (lens, thyroid) by 33%. Scout scan dose lowering to 20 mA resulted in an effective dose (ED) decrease of 0.06 mSv (5%). Avoiding lens shield placement during scout scan effected an organ dose decrease of 20%. Overall contour sharpness and image contrast did not differ significantly (DM/without DM) whereas image noise was rated higher in DM neck CT studies (p < 0.05). Conclusions: z-Axis dose modulation, as assessed on 16- and 64-slice Toshiba Aquilion scanners, is effective and mandatory in neck MSCT. DM efficacy can be enhanced by optimising scout scan doses and lens shield use.

  7. Diagnostic value of multi-slice spiral CT angiography in visceral aneurysm

    Objective: To evaluate the diagnostic value of multi-slice spiral CT angiography (MSCTA) in visceral aneurysm. Methods: Unenhanced and contrast-enhanced CT scans in 42 cases of visceral aneurysm were retrospectively analyzed. volume rendering and multiplanar reconstruction were performed to reconstruct the vascular images. Results: The relationship between parent arteries and 58 aneurysms found in 42 patients were displayed clearly. The aneurysms arose from the splenic artery (27, 46.6%), hepatic artery (6, 17.2%), mesenteric artery (7, 12.1%), celiac artery (8, 13.8%). Three of the aneurysms were ruptured (5.2%) and 8 were associated with parent artery stenosis (13.8%). Conclusion: MSCTA clearly depict visceral aneurysm and complications. (authors)

  8. Effect of saline flush on enhancement of proximal and distal segments using 320-row coronary CT angiography

    Tomizawa, Nobuo, E-mail: tomizawa-tky@umin.ac.jp [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Suzuki, Fumio; Akahane, Masaaki [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Torigoe, Rumiko [Toshiba Medical Systems Corporation, Tokyo Metropolitan Regional Office, 1-6, Tsukuda 2-Chome, Chuo-ku, Tokyo 104-0051 (Japan); Kiryu, Shigeru [Department of Radiology, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639 (Japan); Ohtomo, Kuni [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan)

    2013-08-15

    Objective: To investigate the effect of saline flush on coronary CT angiography of proximal, middle, and distal coronary artery segments, using 320-row CT, and to compare two injection duration protocols as to amount of contrast in the right heart chambers. Methods: This retrospective study was approved by the local ethics committee, and the requirement for informed consent to participate in this study was waived. The final study group included 108 patients who underwent coronary CT angiography. The first 36 patients received contrast medium without saline flush (group 1); the next 36 patients received contrast medium for 14 s and saline flush (group 2); the last 36 patients received contrast medium for 12 s and saline flush (group 3). The CT number, noise, contrast-to-noise ratio (CNR), and number of segments with a CT number greater than 325 Hounsfield units (HU) were recorded for proximal, middle, and distal segments. Results: The CT numbers and the CNR in groups 2 and 3 were significantly higher than that in group 1 (p < 0.005); the difference between groups 2 and 3 was not significant. The proportion of segments greater than 325 HU improved with saline flush (p < 0.05), with a larger improvement in the distal segments. Conclusions: Saline flush improves enhancement and CNR of coronary arteries, particularly of distal segments, in coronary CT angiography using 320-row CT. An average contrast medium injection of 44 mL was feasible using a saline flush.

  9. Effect of saline flush on enhancement of proximal and distal segments using 320-row coronary CT angiography

    Objective: To investigate the effect of saline flush on coronary CT angiography of proximal, middle, and distal coronary artery segments, using 320-row CT, and to compare two injection duration protocols as to amount of contrast in the right heart chambers. Methods: This retrospective study was approved by the local ethics committee, and the requirement for informed consent to participate in this study was waived. The final study group included 108 patients who underwent coronary CT angiography. The first 36 patients received contrast medium without saline flush (group 1); the next 36 patients received contrast medium for 14 s and saline flush (group 2); the last 36 patients received contrast medium for 12 s and saline flush (group 3). The CT number, noise, contrast-to-noise ratio (CNR), and number of segments with a CT number greater than 325 Hounsfield units (HU) were recorded for proximal, middle, and distal segments. Results: The CT numbers and the CNR in groups 2 and 3 were significantly higher than that in group 1 (p < 0.005); the difference between groups 2 and 3 was not significant. The proportion of segments greater than 325 HU improved with saline flush (p < 0.05), with a larger improvement in the distal segments. Conclusions: Saline flush improves enhancement and CNR of coronary arteries, particularly of distal segments, in coronary CT angiography using 320-row CT. An average contrast medium injection of 44 mL was feasible using a saline flush

  10. CT angiography in case of occlusion of the basilar artery; Angiographische Diagnostik mittels Mehrzeilen-Spiral-CT beim Akutverschluss der Arteria basilaris

    Schmitt, R.; Christopoulos, G.; Brunner, H.; Wedell, E. [Inst. fuer Diagnostische und Interventionelle Radiologie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Salveter, E.; Ziegler, V.; Griewing, B. [Neurologische Klinik GmbH, Bad Neustadt an der Saale (Germany)

    2004-07-01

    Objective: to evaluate the diagnostic efficiency of CT angiography in case of clinical signs of acute brainstem infarction for the therapeutic management of catheter-based local thrombolysis. Material and methods: 3 patients (2 males, 1 female) suffering from an acute onset of brainstem symptoms and being suspicious of an occluded basilar artery were included into this report. 1 patient underwent selective vertebral arteriography. 2 patients were initially examined with CT angiography using a 4-row scanner and 100ml intravenous contrast agent. Results: in one patient, an occlusion of the basilar artery was excluded with catheter-based angiography. Sub-sequently, the patient was treated with systemic thrombolysis using r-tPA because of a thalamus infarction seen in MRI. 2 patients who have been initially examined with CT angiography presented with complete occlusions of the basilar arteries. These patients underwent r-tPA thrombolysis by means of superselective micro-catheter approaches of the vertebrobasilar vessels. CT angiography was very useful for determinating the occlusion length of the basilar artery pre-therapeutically, and in 1 case for ruling out an occluded vertrebral artery for catheterization. All patients recovered well under thrombolytic therapy applied systemically or selectively. (orig.)

  11. Efficacy of 'fine' focal spot imaging in CT abdominal angiography

    Oh, Lawrence Chia Wei; Devapalasundaram, Ashwini; Ardley, Nicholas [Monash Health, Department of Diagnostic Imaging, Clayton, Victoria (Australia); Lau, Kenneth K. [Monash Health, Department of Diagnostic Imaging, Clayton, Victoria (Australia); Monash University, Department of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Victoria (Australia); Buchan, Kevin [Phillips Healthcare, Clinical Science, PO Box 312, Mont Albert, Victoria (Australia); Huynh, Minh [RMIT University, School of Mathematical and Geospatial Sciences, Victoria (Australia)

    2014-12-15

    To assess the efficacy of fine focal spot imaging in calcification beam-hardening artefact reduction and vessel clarity on CT abdominal angiography (CTAA). Adult patients of any age and gender who presented for CTAA were included. Thirty-nine patients were examined with a standard focal spot size (SFSS) of 1 x 1 mm in the first 3 months while 31 consecutive patients were examined with a fine focal spot size (FFSS) of 1 x 0.5 mm in the following 3 months. Vessel clarity and calcification beam-hardening artefacts of the abdominal aorta, celiac axis, superior mesenteric artery, inferior mesenteric artery, renal arteries, and iliac arteries were assessed using a 5-point grading scale by two blinded radiologists randomly. Cohen's Kappa test indicated that on average, there was substantial agreement among reviewers for vessel wall clarity and calcification artefact grading. Mann-Whitney test showed that there was a significant difference between the two groups, with FFSS performing significantly better for vessel clarity (U, 6481.50; p < 0.001; r, 0.73) and calcification artefact reduction (U, 1916; p < 0.001; r, 0.77). Fine focus CT angiography produces images with better vessel wall clarity and less vessel calcification beam-hardening artefact. (orig.)

  12. Three-dimensional CT angiography of the vascular disorders in the upper extremity

    This study was conducted to determine the usefulness of three-dimensional CT angiography (3DCTA) as a diagnostic tool in the evaluation of vascular disorders in the upper extremity. 11 cases, including 3 cases with vascular malformation and 8 cases to be confirmed the existence of vascular occlusion, were examined by a multidetector-row CT scanner after the administration of contrast media in the vein. 3D image was composed of the maximum intensity projection technique and the volume rendering technique. The location and extent of the lesion was clearly confirmed in all cases of vascular malformation by the 3DCTA image. The existence of vascular occlusion was confirmed in 4 of 8 cases by the image. Even in the finger level, the running of the artery could be confirmed in all cases by the 3DCTA. We found 3DCTA to be a useful procedure in the investigation and diagnosis of vascular disorders in the upper extremity. 3DCTA is a method with the possibility of replacing the conventional angiography. (author)

  13. The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

    2005-01-01

    Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique,Tll level abdominal aorta was set as the target vessel and the threshold was 180-200 Hu, slice width was 3 mm and with a pitch of 4-6.Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rupture site of abdominal aorta intima and mural thrombus. Conclusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

  14. The ascending aortic image quality and the whole aortic radiation dose of high-pitch dual-source CT angiography

    Liu, Ying; Xu, Jian; Jian LI; Ren, Jing; LIU, HONGTAO; Xu, Junqing; Wei, Mengqi; Hao, Yuewen; Zheng, Minwen

    2013-01-01

    Background Aortic dissection is a lift-threatening medical emergency associated with high rates of morbidity and mortality. The incidence rate of aortic dissection is estimated at 5 to 30 per 1 million people per year. The prompt and correct diagnosis of aortic dissection is critical. This study was to compare the ascending aortic image quality and the whole aortic radiation dose of high-pitch dual-source CT angiography and conventional dual-source CT angiography. Methods A total of 110 conse...

  15. Dual energy CT pulmonary angiography for evaluation of pulmonary embolism in pediatric patients with nephrotic syndrome

    Objective: The purpose of this study was to evaluate the value of dual energy CT pulmonary angiography (DE-CTPA) in detection of pulmonary embolism in the children with nephritic syndrome. Materials and Methods: Fifty-two patients aged ≤18 years were included into this study from April 2010 to June 2011. Two radiologists reviewed and recorded the presence of perfusion defects or filling defects at dual energy CT perfusion images and CTPA images. CT enhancement values of embolic and nonembolic regions were measured with automatic and manual methods. Results: Of 52 patients, 11 (21.2%, 11/52) patients had pulmonary embolism. Of 11 patients with pulmonary embolism, 9 patients had lobar (n=3), segmental (n=5), and subsegmental (n=1) filling defects, while two patients were negative at the initial CTPA from average weighted images but positive at dual energy CT perfusion images. Eight patients had lobar (n=3), segmental (n=5) perfusion defects while 3 patients had no typical perfusion defects at dual energy CT perfusion images. Automatic and manual measurements showed the CT enhancement value of embolic regions measured with automatic method [(37.8±15.6) HU vs. (49.5±14.1) HU, t=-2.663, P=0.014] and CT enhancement value measured with annual method [(19.1±11.2) HU vs. (49.6±12.7) HU, t=-8.841, P<0.001] were lower than those of nonembolic regions. Conclusions: The incidence of pulmonary embolism was 21.2% in pediatric patients with nephritic syndrome in this study. Dual energy CTPA can show the perfusion defects resulting from pulmonary embolism, having a potential to improve the detection of pulmonary embolism in pediatric population. (authors)

  16. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    Masih Saboori; Ali Reza Hekmatnia; Navid Omidifar; Amirhossein Ghazavi; Farzaneh Hekmatnia

    2011-01-01

    Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography) in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indica...

  17. 3-D CT for cardiovascular treatment planning

    Wildermuth, S.; Leschka, S.; Duru, F.; Alkadhi, H. [Inst. for Diagnostic Radiology, Univ. Hospital Zurich (Switzerland)

    2005-11-15

    The recently developed 64-slice CT scanner together with the use of 2-D and 3-D reconstructions can aid the cardiovascular surgeon and interventional radiologist in visualizing exact geometric relationships to plan and execute complex procedures via minimally invasive or standard approaches.Cardiac 64-slice CT considerably benefits from the high temporal and spatial resolution allowing the reliable depiction of small coronary segments. Similarly, abdominal vascular 64-slice CT became possible within short examination times and allowing an optimal arterial contrast bolus exploitation. We demonstrate four representative cardiac and abdominal examples using the new 64-slice CT technology which reveal the impact of the new scanner generation for cardiovascular treatment planning. (orig.)

  18. Development and validation of a CT-3D rotational angiography registration method for AVM radiosurgery

    In this paper a novel technique is proposed and validated for radiosurgery treatment planning of arteriovenous malformations (AVMs). The technique was developed for frameless radiosurgery by means of the CyberKnife, a nonisocentric, linac-based system which allows highly conformed isodose surfaces to be obtained, while also being valid for other treatment strategies. The technique is based on registration between computed tomography (CT) and three-dimensional rotational angiography (3DRA). Tests were initially performed on the effectiveness of the correction method for distortion offered by the angiographic system. These results determined the registration technique that was ultimately chosen. For CT-3DRA registration, a twelve-parameter affine transformation was selected, based on a mutual information maximization algorithm. The robustness of the algorithm was tested by attempting to register data sets increasingly distant from each other, both in translation and rotation. Registration accuracy was estimated by means of the 'full circle consistency test'. A registration quality index (expressed in millimeters) based on these results was also defined. A hybrid subtraction between CT and 3DRA is proposed in order to improve 3D reconstruction. Preprocessing improved the ability of the algorithm to find an acceptable solution to the registration process. The robustness tests showed that data sets must be manually prealigned within approximately 15 mm and 20 deg. with respect to all three directions simultaneously. Results of the consistency test showed agreement between the quality index and registration accuracy stated by visual inspection in 20 good and 10 artificially worsened registration processes. The quality index showed values smaller than the maximum voxel size (mean 0.8 mm compared to 2 mm) for all successful registrations, while it resulted in much greater values (mean 20 mm) for unsuccessful registrations. Once registered, the two data sets can be used for

  19. Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

    To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

  20. Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

    Bilhim, Tiago [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Pisco, Joao M. [Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Universidade Nova de Lisboa, Departamento Universitario de Radiologia, Faculdade de Ciencias Medicas, Lisbon (Portugal); Furtado, Andrea; Casal, Diogo; Pais, Diogo; O' Neill, Joao E.G. [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Campos Pinheiro, Luis [Universidade Nova de Lisboa, Departamento Universitario de Urologia, Faculdade de Ciencias Medicas, Lisbon (Portugal)

    2011-05-15

    To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

  1. A retrospective comparison of smart prep and test bolus multi-detector CT pulmonary angiography protocols

    Optimal arterial opacification is crucial in imaging the pulmonary arteries using computed tomography (CT). This poses the challenge of precisely timing data acquisition to coincide with the transit of the contrast bolus through the pulmonary vasculature. The aim of this quality assurance exercise was to investigate if a change in CT pulmonary angiography (CTPA) scanning protocol resulted in improved opacification of the pulmonary arteries. Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. A total of 160 CTPA examinations (80 using each protocol) performed between January 2010 and February 2011 were assessed retrospectively. CT attenuation coefficients were measured in Hounsfield Units (HU) using regions of interest at the level of the pulmonary trunk. The average pixel value, standard deviation (SD), maximum, and minimum were recorded. For each of these variables a mean value was then calculated and compared for these two CTPA protocols. Minimum opacification of 200 HU was achieved in 98% of the TBP sample but only 90% of the SPP sample. The average CT attenuation over the pulmonary trunk for the SPP was 329 (SD = ±21) HU, whereas for the TBP it was 396 (SD = ±22) HU (P = 0.0017). The TBP also recorded higher maximum (P = 0.0024) and minimum (P = 0.0039) levels of opacification. This study has found that a TBP resulted in significantly better opacification of the pulmonary trunk than the SPP

  2. A retrospective comparison of smart prep and test bolus multi-detector CT pulmonary angiography protocols

    Suckling, Tara [Medical Imaging Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales (Australia); Smith, Tony [University Department of Rural Health, The University of Newcastle, Tamworth, New South Wales (Australia); Reed, Warren [Discipline of Medical Radiation Sciences, The University of Sydney, Lidcombe (Australia); Medical Imaging Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales (Australia)

    2013-06-15

    Optimal arterial opacification is crucial in imaging the pulmonary arteries using computed tomography (CT). This poses the challenge of precisely timing data acquisition to coincide with the transit of the contrast bolus through the pulmonary vasculature. The aim of this quality assurance exercise was to investigate if a change in CT pulmonary angiography (CTPA) scanning protocol resulted in improved opacification of the pulmonary arteries. Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. A total of 160 CTPA examinations (80 using each protocol) performed between January 2010 and February 2011 were assessed retrospectively. CT attenuation coefficients were measured in Hounsfield Units (HU) using regions of interest at the level of the pulmonary trunk. The average pixel value, standard deviation (SD), maximum, and minimum were recorded. For each of these variables a mean value was then calculated and compared for these two CTPA protocols. Minimum opacification of 200 HU was achieved in 98% of the TBP sample but only 90% of the SPP sample. The average CT attenuation over the pulmonary trunk for the SPP was 329 (SD = ±21) HU, whereas for the TBP it was 396 (SD = ±22) HU (P = 0.0017). The TBP also recorded higher maximum (P = 0.0024) and minimum (P = 0.0039) levels of opacification. This study has found that a TBP resulted in significantly better opacification of the pulmonary trunk than the SPP.

  3. Evaluation of patients radiation dose from computed tomography during lower peripheral angiography procedure

    The purpose of this study was to evaluate patient radiation doses in lower peripheral angiography CT examinations in Sudan. Survey was conducted in four major hospitals which almost carry out lower peripheral angiography procedures in Sudan at the time of study. All hospitals were equipped with 64 slices multi detectors CT from Toshiba (Japan). The total number of patients was 74. Information on patient's genders and ages, exposure technique factors and radiation dose were collected. The procedures performed in multi phases, up to five phases covering part of the abdomen region, which can make patients exposure reasonably high. CTDI values in the different phases ranged between (13-30) mGy. The total DLP in the four hospitals were 6888.75, 5065.05, 6608.88 and 5754.9 mGy.cm. This study provided first survey for patient dose during lower peripheral angiography procedures in Sudan. Taking into account that the CT machines were similar: the variation between patient's DLP and CTDI values in the different hospitals indicated the need of optimization of radiation protection. Staff training and awareness on factors affecting patient dose are essential.(Author)

  4. Prospectively ECG Gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: Impact on cardiac related motion artifacts and patient radiation dose

    Shuman, William P., E-mail: wshuman@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Leipsic, Jonathon A., E-mail: JLeipsic@providencehealth.bc.ca [University of British Columbia and St. Paul' s Hospital, Department of Radiology, 1081 Burrard Street, Vancouver, BC, V6Z1Y6 (Canada); Busey, Janet M., E-mail: jbonny@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Green, Douglas E., E-mail: dougreen@uw.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Pipavath, Sudhakar N., E-mail: snjp@u.wwashington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Hague, Cameron J., E-mail: cjhague@interchange.ubc.ca [University of British Columbia and St. Paul' s Hospital, Department of Radiology, 1081 Burrard Street, Vancouver, BC, V6Z1Y6 (Canada); Koprowicz, Kent M., E-mail: kentk@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States)

    2012-09-15

    Objective: To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose. Subjects and methods: Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters. Results: Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9 mSv versus 6.8 mSv, p = 0.02). Similar results were found in the prospectively ECG gated exams from the second institution. Conclusion: Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose.

  5. Prospectively ECG Gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: Impact on cardiac related motion artifacts and patient radiation dose

    Objective: To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose. Subjects and methods: Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters. Results: Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9 mSv versus 6.8 mSv, p = 0.02). Similar results were found in the prospectively ECG gated exams from the second institution. Conclusion: Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose

  6. The influence of heart rate, slice thickness, and calcification density on calcium scores using 64-slice multidetector computed tomography - A systematic phantom study

    Groen, Jaap M.; Greuter, Marcel J.; Schmidt, Bernhard; Suess, Christoph; Vliegenthart, Rozemarijn; Oudkerk, Matthis

    2007-01-01

    Objective: The purpose of this study was to investigate the influence of heart rate, slice thickness, and calcification density on absolute value and variability of calcium score using 64-slice multidetector computed tomography (MDCT). Methods and Materials: Three artificial arteries containing each

  7. Celiaco-Mesenterial Arterial Aberrations in Patients Undergoing Extended Pancreatic Resections: Correlation of CT Angiography with Findings at Surgery

    Viacheslav I Egorov

    2010-07-01

    Full Text Available Context It is important to recognize arterial variants in the preoperative planning of extended pancreatic resections. The absence of surgical confirmation of radiological data is a limitation of the majority of angiographic or CT-angiographic studies of celiac and mesenteric arterial anatomy. Objective The purpose of this study was to test the accuracy of CT angiography in delineating the arterial architecture by comparing the resultant 3D images with findings at surgery and determining the frequency of different celiac and mesenteric arterial anatomy variants. Methods Abdominal CT angiographies of 350 patients were performed on a 64- and 256- MDCT scanner prior to major pancreatic or hepatobiliary surgery. Variants of celiac and mesenteric arterial anatomy were documented as 3D reconstructions. Radiological data were compared to operative photographs during extended pancreaticoduodenectomies and extended distal pancreatectomies in 59 cases. Results Only 197 patients (56.3% had the classic arterial anatomy identified at CT angiography. The most common variants were a replaced or accessory right hepatic artery originating from the superior mesenteric artery (62 cases, 17.7% and a replaced or accessory left hepatic artery (43 cases, 12.3% originating from the left gastric artery. According to a comparison with operative photographs, CT angiography demonstrated 100% accuracy in identifying celiac and mesenteric arterial anatomy variants, stenoses, obstructions and aneurysms of the celiac and mesenteric branches, including those which were hemodynamically significant and which influence the choice and sequence of operative procedures. Conclusion The celiac and mesenteric arterial anatomy variants are fairly common and are of great significance in planning extended pancreatic resections. Radiological findings were fully corroborated by operative data, which means that CT angiography is a reliable tool for identifying celiac and mesenteric arterial

  8. Perfusion CT in acute stroke; Stellenwert der CT-Perfusion fuer die Therapie des Schlaganfalls

    Eckert, Bernd [Asklepios Klinik Altona (Germany). Radiologie und Neuroradiologie; Roether, Joachim [Asklepios Klinik Altona (Germany). Neurologische Abt.; Fiehler, Jens [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention; Thomalla, Goetz [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neurologie, Kopf- und Neurozentrum

    2015-06-15

    Modern multislice CT scanners enable multimodal protocols including non-enhanced CT, CT angiography, and CT perfusion. A 64-slice CT scanner provides 4-cm coverage. To cover the whole brain, a 128 - 256-slice scanner is needed. The use of perfusion CT requires an optimized scan protocol in order to reduce exposure to radiation. As compared to non-enhanced CT and CT angiography, the use of CT perfusion increases detection rates of cerebral ischemia, especially small cortical ischemic lesions, while the detection of lacunar and infratentorial stroke lesions remains limited. Perfusion CT enables estimation of collateral flow in acute occlusion of large intra- or extracranial arteries. Currently, no established reliable thresholds are available for determining infarct core and penumbral tissue by CT perfusion. Moreover, perfusion parameters depend on the processing algorithms and the software used for calculation. However, a number of studies point towards a reduction of cerebral blood volume (CBV) below 2 ml/100 g as a critical threshold that identifies infarct core. Large CBV lesions are associated with poor outcome even in the context of recanalization. The extent of early ischemic signs on non-enhanced CT remains the main parameter from CT imaging to guide acute reperfusion treatment. Nevertheless, perfusion CT increases diagnostic and therapeutic certainty in the acute setting. Similar to stroke MRI, perfusion CT enables the identification of tissue at risk of infarction by the mismatch between infarct core and the larger area of critical hypoperfusion. Further insights into the validity of perfusion parameters are expected from ongoing trials of mechanical thrombectomy in stroke.

  9. Radiation Dose and Image Quality from Coronary Angiography in 320-Detecor Row CT

    Introduction: Coronary Computed Tomography Angiography examinations are increasing rapidly. New Computed Tomography has been developed to improve image quality with the patient dose reduction. The purpose of this study is to evaluate radiation dose and image quality of Coronary Computed Tomography Angiography in patients using 320-detector row CT. Methods: Forty-one patients referred for cardiac CT examinations at King Chulalongkorn Memorial Hospital were included in this study. All coronary computed tomographic angiography (CCTA) examinations were performed on the 320-detector row CT, Toshiba Aquilion One. Scanning protocol was investigated on dose estimates and image quality. Patients were scanned base on heart rate (HR) by HR75 bpm use retrospective with dose modulation. Scanning parameters, kVp, mAs, HR, BMI, CTDIvol(mGy) and DLP(mGy.cm), were recorded to study the factors affecting the image quality and patient dose. And mA and kVp setting depend on BMI of the patient. Effective dose is calculated from DLP using specific conversion factor. The image quality was evaluated in 4 vessels by two radiologists. Noise assessment was also studied quantitatively. Results: The patient effective dose in prospective gating 70-80% was 3.6 ± 0.9 mSv, prospective gating 30-80% (1R-R) was 6.3 ± 1.9 mSv, and 30-80% (2R-R) was 10.8 ± 1.8 mSv and in retrospective with tube current modulation was 12.1± 7.7 mSv. Image noise was highest in PGT 70-80% 1R-R and decreased in RGT with tube current modulation, PGT 30-80% 1R-R and lowest in PGT 30-80% 2 R-R. And overall qualitative image quality was mostly good to excellent score. Discussion: The heart rate, heart rate variability and disease of the patient are affecting in the radiation dose and image quality so the suitable acquisition protocol used could be necessary. the effective dose and the image noise for the image quality. (author)

  10. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

    Marwa Sayed Meshaal

    Full Text Available Infective endocarditis (IE is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs. These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention.The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%. Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32% had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%. The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.Routine brain CT/CTA resulted in changes in the treatment plan in a significant

  11. Influence of observer experience and training on proficiency in coronary CT angiography interpretation

    Purpose: To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience. Methods and materials: Nine radiologist and cardiologist observers with varying prior CCTA experience ranging from novice to expert independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50–74%, 75–99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series. Diagnostic accuracy on a per-segment basis was compared for all readers and both case series, respectively. Results: Correlation coefficients between CCTA and catheter angiography initially ranged between good (r = 0.87) and poor (r = 0.26), depending on reader experience, and significantly (p < 0.05) improved in the second case series (range: r = 0.42 to r = 0.91). Diagnostic accuracy was significantly (p < 0.05) higher for more experienced readers (range: 96.5–97.8%) as compared to less experienced observers (range: 90.7–93.6%). After completion of the second case series for less experienced readers sensitivity and PPV significantly (p < 0.05) improved (range: 62.7–67.8%/51.4–84.1%), but still remained significantly (p < 0.05) lower as compared to more experienced observers (range: 89.8–93.3%/80.6–93.3%). Conclusion: The level of experience appears to be a strong determinant of proficiency in CCTA interpretation. Limited one-time training improves proficiency in novice readers, but not to clinically satisfactory levels

  12. Diagnostic accuracy of dual-source CT coronary angiography in patients with atrial fibrillation: Meta analysis

    Sun, Gang, E-mail: cjr.sungang@vip.163.com [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Li, Min [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Jiang, Zhi-wei [Department of Health Statistics, School of Public Health, Fourth Military Medical University, No. 169, Changle West Road, Xi’an, Shaanxi 710032 (China); Xu, Lin [Department of Medical Cardiology, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Peng, Zhao-hui; Ding, Juan; Li, Li [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Jin, Zhi-tao [Department of Cardiology, General Hospital of the Second Artillery, Beijing 100088 (China)

    2013-10-01

    Rationale and objective: To synthesize the available data to underscore the diagnostic accuracy of dual-source CT (DSCT) coronary angiography in patients with atrial fibrillation (AF). Materials and methods: We searched in the electronic databases of PubMed for all published studies that examined patients with AF using DSCT. We used an exact binomial rendition of the bivariate mixed-effects regression model to synthesize the diagnostic data. Results: The positive and negative likelihood ratios (LRs) at the patient level were 6.0 (CI, 3.6–10.1) and 0.03(CI, 0.004–0.2), respectively. The negative predictive values higher than 90% were available for a CAD prevalence <78%. The pooled vessel- and segment-level estimates showed higher positive and negative LRs than the patient-level estimates (15.3 [CI, 9.8–23.9] and 0.1 [CI, 0.07–0.3]; 25.1 [CI, 10.8–58.5] and 0.2 [CI, 0.2–0.3], respectively). No statistically significant heterogeneity between studies and publication bias were found at the patient level estimate. A sensitivity analysis showed that no study influenced the pooled results larger than 0.02. Conclusions: Cardiac angiography with DSCT can be applied as an imaging test for ruling out CAD in patient with AF. However, DSCT angiography may be not an effective tool for risk stratification for the high negative LR at the artery and segment levels.

  13. Diagnostic accuracy of dual-source CT coronary angiography in patients with atrial fibrillation: Meta analysis

    Rationale and objective: To synthesize the available data to underscore the diagnostic accuracy of dual-source CT (DSCT) coronary angiography in patients with atrial fibrillation (AF). Materials and methods: We searched in the electronic databases of PubMed for all published studies that examined patients with AF using DSCT. We used an exact binomial rendition of the bivariate mixed-effects regression model to synthesize the diagnostic data. Results: The positive and negative likelihood ratios (LRs) at the patient level were 6.0 (CI, 3.6–10.1) and 0.03(CI, 0.004–0.2), respectively. The negative predictive values higher than 90% were available for a CAD prevalence <78%. The pooled vessel- and segment-level estimates showed higher positive and negative LRs than the patient-level estimates (15.3 [CI, 9.8–23.9] and 0.1 [CI, 0.07–0.3]; 25.1 [CI, 10.8–58.5] and 0.2 [CI, 0.2–0.3], respectively). No statistically significant heterogeneity between studies and publication bias were found at the patient level estimate. A sensitivity analysis showed that no study influenced the pooled results larger than 0.02. Conclusions: Cardiac angiography with DSCT can be applied as an imaging test for ruling out CAD in patient with AF. However, DSCT angiography may be not an effective tool for risk stratification for the high negative LR at the artery and segment levels

  14. Use of spiral CT angiography to judge central pulmonary vascular involvement from lung cancer

    Objective: To evaluate the accuracy of spiral CT angiography (SCTA) in judging central pulmonary vascular involvement from lung cancer located in the hilum and correlate the resultant images with pathologic and surgical findings. Methods: SCTA was done in 33 patients who were preoperatively diagnosed as having lung carcinoma located in the hilum. Contrast medium was injected at a rate of 3 ml/sec with a power injector. The delay time was from 20 to 25 seconds. The pitch was 1 with 3 mm-collimation. Images of central pulmonary arteries and veins were reconstructed with shaded surface display (SSD), maximum intensity projection (MIP), curved planar reformation (CPR), and multi-planar reformation (MPR). Then the relation between tumor and vessels was assessed prospectively on both 3 mm interval axial CT and SCTA images with comparison to subsequent pathologic or surgical findings. Results: (1) In showing the integrity of central pulmonary arteries and veins, images reconstructed by different ways of SCTA had different strong and weak points. (2) The grading standard in this study, with which the relation between vessels and tumor was judged, reflected the basic and common characters of central pulmonary vascular involvement by tumor located in the hilum. compared with axial CT images, SCTA was more accurate in judging the relation between central pulmonary vessels and tumor, and the correlation of SCTA imaging features with pathological patterns and surgical findings was better than that of axial CT images, P < 0.05 and P < 0.0001, respectively. Conclusion: It was feasible to show the relation between central pulmonary vessel and lung cancer located in the hilum with SCTA. And the accuracy of judging the vascular involvement with SCTA was higher than that with axial CT

  15. CT angiography for the pre- and postoperative evaluation of the thoracic aorta; CT-Angiografie zur prae- und postoperativen Evaluation in der thorakalen Aortenchirurgie

    Pache, Gregor; Euringer, W.; Langer, M.; Blanke, P. [Universitaetsklinikum Freiburg (Germany). Radiology; Siepe, M. [Universitaetsklinikum Freiburg (Germany). Cardiovascular Surgery

    2011-04-15

    CT angiography is the imaging modality of choice for the pre- and postsurgical evaluation of patients with pathologies of the thoracic aorta. The purpose of this review is to familiarize the reader with the technical principle, recent technical developments and requirements for specific examination protocols and image interpretation, and to highlight common pathologies and findings. (orig.)

  16. Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

    Rajaram, Smitha [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Sheffield (United Kingdom); Swift, Andrew J.; Wild, Jim M. [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Sheffield Cardiovascular Biomedical Research Unit, Sheffield (United Kingdom); Capener, David; Telfer, Adam [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Davies, Christine; Hill, Catherine [Sheffield Teaching Hospitals Trust, Department of Radiology, Sheffield (United Kingdom); Condliffe, Robin; Elliot, Charles; Kiely, David G. [Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield (United Kingdom); Sheffield Cardiovascular Biomedical Research Unit, Sheffield (United Kingdom); Hurdman, Judith [Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield (United Kingdom)

    2012-02-15

    To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE). A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed. The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall. (orig.)

  17. Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

    To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE). A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed. The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall. (orig.)

  18. Clinical evaluation of automatic tube voltage selection in chest CT angiography

    Niemann, Tilo; Henry, Simon; Faivre, Jean-Baptiste; Yasunaga, Kanna; Bendaoud, Sofiane; Simeone, Ariana; Remy, Jacques [University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette (EA 2694), Lille (France); Duhamel, Alain [University Lille Nord de France, Department of Medical Statistics (EA 2694), Lille (France); Flohr, Thomas [Siemens Medical Systems, Department of Research and Development, Forchheim (Germany); Remy-Jardin, Martine [Hospital Calmette, Department of Thoracic Imaging, Lille cedex (France)

    2013-10-15

    To evaluate the clinical impact of automatic tube voltage selection on chest CT angiography (CTA). Ninety-three patients were prospectively evaluated with a CT protocol aimed at comparing two successive CTAs acquired under similar technical conditions except for the kV selection: (1) the initial CTA was systematically obtained at 120 kVp and 90 ref mAs; (2) the follow-up CTA was obtained with an automatic selection of the kilovoltage (Care KV; Siemens Healthcare) for optimised CTA. At follow-up, 90 patients (97 %) underwent CTA with reduced tube voltage, 100 kV (n = 26; 28 %) and 80 kV (n = 64; 69 %), resulting in a significant dose-length-product reduction (follow-up: 87.27; initial: 141.88 mGy.cm; P < 0.0001; mean dose reduction: 38.5 %) and a significant increase in the CNR at follow-up (follow-up: 11.5 {+-} 3.5 HU; initial: 10.9 {+-} 3.7 HU; P = 0.03). The increase in objective image noise at follow-up (follow-up: 23.2 {+-} 6.7 HU vs. 17.8 {+-} 5.1 HU; P < 0.0001) did not alter the diagnostic value of images. Automatic tube voltage selection reduced the radiation dose delivered during chest CT angiograms by 38.5 % while improving the contrast-to-noise ratio of the examinations. (orig.)

  19. The diagnosing value of reconstruction and virtual endoscopy of spiral CT angiography on aortic dissection

    Objective: To evaluate the value of reconstruction and virtual endoscopy of spiral CT angiography in diagnosing aortic dissection. Methods: Seventeen patients with aortic dissection were examined by spiral CT with contrast agent and the post processing included shaded surface display (SSD), maximum intensity projection (MIP), multiplanar reconstruction (MPR), curved planar reconstruction (CPR) and CT virtual endoscopy (CTVE). Results: The true and false lumen, exfoliate intima, calcification, and thrombus could be seen on axial imaging, SCTA, MPR and CTVE. Both the panorama of aortic lesion including exfoliate intima, true and false lumen and its extent, size and involvement of vascular branches could be preferably shown on MIP, CPR and SSD. Calcification of vascular wall could be clearly displayed on MIP. The true and false lumen, exfoliate intima, calcification, thrombus and crevasse could be revealed on MPR because the whole lesion could be reconstructed and observed from any angle on it. Some structures, which were not on the same plane, could be shown on the same two-dimensional plane, but their deep relations could not be done. The true and false lumen, exfoliate intima and crevasse could also be seen on CTVE. Conclusion: axial imaging combined with other imaging techniques of SCTA including MPR, MIP, CPR, SSD and CTVE will roundly display aortic dissection. SCTA will be a reliable and safe method in diagnosing aortic dissection and be able to replace invasive DSA on a certain extent

  20. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  1. Evaluation of stenotic lesions in the carotid arteries using ultrasonography and three-dimension CT angiography

    Indications for carotid endarterectomy (CEA) depend on the severity of carotid stenosis, as well as the surface characteristics of the stenotic lesion. The purpose of this study was to evaluate a diagnostic validity of three-dimensional CT angiography (3D-CTA) in patients with carotid stenosis, and to assess its applicability before CEA. Sixty-four patients with carotid artery stenosis were investigated pre-operatively by ultrasonography (US), 3D-CTA and digital subtraction angiography (DSA). The evaluation of the degree of carotid artery stenosis and its surface characteristics was done separately by each diagnostic modality. Thereafter, the data obtained by 3D-CTA were compared with those of US, DSA and pathological findings. The degree of carotid artery stenosis defined by 3D-CTA correlated well with those seen on DSA. However, arterial well irregularity, ulceration and calcifications were visualized more precisely on 3D-CTA. Assessment of surface properties of the stenostic lesion by 3D-CTA significantly correlated with data obtained by US. Comparing with other diagnostic modalities 3D-CTA provides much more precise information about the degree of the carotid artery stenosis and its surface properties. Therefore, 3D-CTA may be considered as a new alternative diagnostic tool for determination of indications for CEA. (author)

  2. CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage

    Shankar, Jai Jai Shiva [Dalhousie University, Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Center, Halifax (Canada); Tan, Irene Y.L.; Krings, Timo; Terbrugge, Karel; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2012-03-15

    Cerebral vasospasm (CV) is one of the most dreaded complications in patients who survive acute subarachnoid haemorrhage (SAH), and conventional cerebral angiography (DSA) is the gold standard for its diagnosis. We evaluated CT angiography (CTA) as a non-invasive alternative for diagnosis of CV and assessed if CTA could have a role in choosing appropriate treatment. Consecutive patients with SAH and suspected vasospasm were included when DSA was performed within 24 h from CTA. Two neuro-radiologists retrospectively analysed CTA and DSA studies independently. Assessment included presence of central and peripheral vasospasm and grading of severity of central CV. A treatment recommendation based on CTA was compared to actual treatment received. Final analysis included 34 patients. CTA was more accurate for diagnosis of central then for peripheral CV with high sensitivity (reader 1, 91%; reader 2, 92%), specificity (reader 1, 73%; reader 2, 90%), accuracy, positive predictive value and negative predictive value for central vasospasm. For grading the severity of CV CTA's sensitivity, specificity and accuracy were high for most central arteries. The reader's recommendation of angioplasty according to CTA was significantly predictive of actual receipt of angioplasty but overestimated actual receipt of triple H treatment. CTA is adequate for detecting central vasospasm in symptomatic SAH patients. A negative result should not prevent further investigation especially when evaluating arterial segments adjacent to metal artefacts from coils or clips. CTA is helpful in treatment decision making specifically regarding the need for balloon angioplasty. (orig.)

  3. Carotid stenosis degree in CT angiography: assessment based on luminal area versus luminal diameter measurements

    The aim of this study was to investigate CT angiography (CTA) luminal area measurements in the assessment of carotid artery stenosis compared with the current clinically used criteria based on lumen diameter measurements. Seventy-two vessels in 36 patients were evaluated by CTA and digital subtraction angiography (DSA). Two observers measured area and diameter stenosis degrees using automated 3D CTA analysis software. The ratio of the largest/smallest luminal diameter at the level of maximal stenosis (L/S ratio) was used to describe lumen morphology. Diagnostic agreement between CTA and DSA was calculated. For the assessment of area stenosis, interobserver and intraobserver correlation coefficients were 0.898 and 0.906 (p<0.001). The correlation coefficient between the diameter stenosis and area stenosis was lower in stenoses with extremely noncircular lumen (L/S ratio ≥1.5) (r=0.797, p<0.001) compared with stenoses with circular lumen (LS ratio <1.2) (r=0.978, p<0.001). Only satisfactory agreement (κ 0.54-0.77, p<0.001) was obtained between area stenosis on CTA and diameter stenosis on DSA. Assessment of stenosis degree with area measurements on 3D CTA proved to be reproducible. Area stenosis provides a less-severe estimate of the degree of carotid stenosis but might theoretically express the real hemodynamic significance of the lesion better than diameter stenosis, especially in stenoses with noncircular lumen. (orig.)

  4. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM

  5. Diagnostic imaging of acute aortic dissection; Evaluation of thrombosed type aortic dissection by CT and angiography

    Ohya, Tohru; Kumazaki, Tatsuo (Nippon Medical School, Tokyo (Japan))

    1991-01-01

    One hundred and nineteen patients with aortic dissection who underwent diagnostic imaging were reviewed and angiographic findings as well as those of CT were analysed. Thirty eight cases (43.1%) had non-contrast opacified false lumen, the type of which we call 'thrombosed type aortic dissection'. A comparative study of the thrombosed type with the patent type of false lumens was made particularly from the stand point of the characteristic diagnostic imagings (CT and angiography). At the same time, the pitfalls of these imagings in thrombosed type aortic dissection were studied. At the onset the average age of thrombosed type was 62.3 years old, while that of the patent type was 57.3. A statistical significance between the two groups was p<0.05. Thrombosed type in all cases was caused by atherosclerosis, whereas patent type was caused by the Marfan's syndrome in 11 cases. Other clinical findings, such as initial symptoms and blood pressure revealed no significant differences between the two groups. Pre-contrast CT in acute thrombosed type aortic dissection showed 'hyperdense crescent sign' in 89.4%. However, in 3 cases with thrombosed type in which the pre-contrast CT showed 'hyperdense crescent sign' contrast-enhanced CT detected no clear evidence of aortic dissection in the same site. This was due to obscurity induced by contrast medium. Angiographic findings of thrombosed type were classified into 3 groups: normal type, stenosed true lumen type and ulcer-like projection type. The incidence of normal type was estimated to be 48.4%, whereas stenosed true lumen type was 24.2% and ulcer-like projection was 27.7%. The present study concluded that thrombosed type is not rare in acute aortic dissection and contrast-enhanced CT as well as pre-contrast CT, is of great value in diagnosing thrombosed type. 'Hyperdense crescent sign' in pre-contrast CT is characteristic of intramural hematoma. (author).

  6. Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience

    Morsbach, Fabian; Gordic, Sonja; Husarik, Daniela; Frauenfelder, Thomas; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Desbiolles, Lotus; Leschka, Sebastian [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Kantonsspital St. Gallen, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Schmidt, Bernhard; Allmendinger, Thomas [Siemens AG, Healthcare Sector, Forchheim (Germany); Wildermuth, Simon [Kantonsspital St. Gallen, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland)

    2014-08-15

    To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). First, a cardiac motion phantom simulating heart rates (HRs) from 60-90 bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250 ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50 years) undergoing clinically indicated CCTA were included. In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1 mm or less. Distortion increased above 1 mm at HR of 80-90 bpm. Patients had a mean HR of 66 bpm (47-78 bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73 bpm. Average effective radiation dose in patients was 0.6 ± 0.3 mSv. Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75 bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6 mSv. (orig.)

  7. Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

    The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference. A total of 29 CTDSA/DSA from 25 patients with dAVF were retrospectively evaluated by two neuroradiologists. The presence, Cognard classification, and feeding arteries of dAVFs on CTDSA were assessed according to DSA. DSA depicted 33 dAVFs in 28 cases. By consensus reading, CTDSA correctly detected 32 dAVFs in 27 cases and properly graded 31 lesions. The intermodality agreement for the presence and classification of dAVFs was excellent (kappa = 0.955 and 0.921, respectively). CTDSA detected 77 of 109 feeding arteries (70.6 %) in 25 cases. The intermodality agreement for the feeding arteries was good (kappa = 0.713). Although CTDSA is limited in temporal and spatial resolution in comparison with DSA, it is an effective non-invasive tool for the detection and classification of dAVF. (orig.)

  8. Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

    Fujiwara, Hirokazu; Momoshima, Suketaka; Kuribayashi, Sachio [Keio University, Department of Diagnostic Radiology, School of Medicine, Tokyo (Japan); Akiyama, Takenori [Keio University, Department of Neurosurgery, School of Medicine, Tokyo (Japan)

    2013-07-15

    The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference. A total of 29 CTDSA/DSA from 25 patients with dAVF were retrospectively evaluated by two neuroradiologists. The presence, Cognard classification, and feeding arteries of dAVFs on CTDSA were assessed according to DSA. DSA depicted 33 dAVFs in 28 cases. By consensus reading, CTDSA correctly detected 32 dAVFs in 27 cases and properly graded 31 lesions. The intermodality agreement for the presence and classification of dAVFs was excellent (kappa = 0.955 and 0.921, respectively). CTDSA detected 77 of 109 feeding arteries (70.6 %) in 25 cases. The intermodality agreement for the feeding arteries was good (kappa = 0.713). Although CTDSA is limited in temporal and spatial resolution in comparison with DSA, it is an effective non-invasive tool for the detection and classification of dAVF. (orig.)

  9. Clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease

    Objective: To investigate the clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease, and to evaluate the relationship of the image quality and radiation dose between prospective ECG-gated and retrospective ECG-gated cardiac CT angiography (CTA). Methods: Sixty patients who doubt congenital heart disease underwent cardiac CTA, and they were randomly divided into two groups. Thirty patients in group A underwent prospective ECG-gated cardiac CTA, and thirty patients in group B underwent retrospective ECG-gated cardiac CTA. Then the homogeneous enhancement of vascular structures, stair-step artifact, overall image quality and radiation dose were evaluated. Results: The homogeneous enhancement of vascular structures were 2.8±0.3 and 2.7±0.6, respectively, in two groups; and there was no statistical significance (P>0.05). The stair-step artifact were 3.0±0.9 and 3.1±0.9, respectively, in two groups; and there was also no statistical significance (P>0.05). The overall image quality were 3.0±0.8 and 3.1±0.9, respectively, in two group; and there was statistical significance (P>0.05). However, the effective dose were (5.24±0.52) mSv and (16.68±1.49) mSv, respectively, in two groups; and there was statistical significance (P<0.001). Conclusion: Compared with retrospective ECG-gated cardiac CTA, prospective ECG-gated cardiac CTA can reduce radiation dose about 68.6% , while maintaining the image quality which could be made diagnosis. (authors)

  10. Multi-slice spiral CT angiography: clinical application and the evaluation

    Objective: To evaluate the clinical application of multi-slice spiral CT angiography (MSCTA) in diagnosis of vascular diseases. Methods: Imaging materials of multi-slice spiral CT angiography of 73 cases were retrospectively analyzed, including 27 cases of intracranial vascular CTA, 8 of carotid CTA, 10 of pulmonary artery CTA, 6 of coronary artery CTA, 11 of aortic CTA, and 11 of low extremity artery CTA. After the raw data was reconstructed by overlapping slice-chickness, the axial images were uploaded to workstation for post data processing, and were then evaluated and reconstructed using 3D software including maximum intensity projection (MIP), shaded surface display (SSD), and volume rendering technique (VRT). Results: The blood vessels were successfully demonstrated in 71 cases out of 73. Abnormality was found in 63 cases out of 71. The intracranial CTA showed aneurysm in 7 cases, arteriovenous malformation in 5, carotid-cavernous fistula in 2, cerebral vascular occlusion in 2, astrocytoma in 2, and meningioma in 3. The carotid CTA revealed carotid stenosis in 4 cases, vertebral artery stenosis in 2 and a post-bracket implantation subclavian artery. In pulmonary artery CTA, pulmonary artery embolism and 5 cases of pulmonary artery involved with lung cancer were seen in 3 cases. In coronary artery CTA, coronary artery stenosis were shown in 3 cases. The aortic CTA demonstrated aortic dissection in 4, aortic stenosis calcification in 5, aortic aneurysm in 2, liver cancer in 2, renal artery stenosis in 2, and Budd-Chiari syndrome in 2. CTA of low extremity artery revealed external iliac artery occlusion in 2 and femoral artery stenosis in 5. Conclusion: By combining axial images with various reconstructed with adjacent organs can also be evaluated. MSCTA is of convenience, reliability, safety and noninvasive. (authors)

  11. Contrast agent comparison for three-dimensional micro-CT angiography: A cadaveric study.

    Kingston, Mitchell J; Perriman, Diana M; Neeman, Teresa; Smith, Paul N; Webb, Alexandra L

    2016-07-01

    Barium sulfate and lead oxide contrast media are frequently used for cadaver-based angiography studies. These contrast media have not previously been compared to determine which is optimal for the visualisation and measurement of blood vessels. In this study, the lower limb vessels of 16 embalmed Wistar rats, and four sets of cannulae of known diameter, were injected with one of three different contrast agents (barium sulfate and resin, barium sulfate and gelatin, and lead oxide combined with milk powder). All were then scanned using micro-computed tomography (CT) angiography and 3-D reconstructions generated. The number of branching generations of the rat lower limb vessels were counted and compared between the contrast agents using ANOVA. The diameter of the contrast-filled cannulae, were measured and used to calculate the accuracy of the measurements by comparing the bias and variance of the estimates. Intra- and inter-observer reliability were calculated using intra-class correlation coefficients. There was no significant difference (mean difference [MD] 0.05; MD 95% confidence interval [CI] -0.83 to 0.93) between the number of branching generations for barium sulfate-resin and lead oxide-milk powder. Barium sulfate-resin demonstrated less bias and less variance of the estimates (MD 0.03; standard deviation [SD] 1.96 mm) compared to lead oxide-milk powder (MD 0.11; SD 1.96 mm) for measurements of contrast-filled cannulae scanned at high resolution. Barium sulfate-resin proved to be more accurate than lead oxide-milk powder for high resolution micro-CT scans and is preferred due to its non-toxicity. This technique could be applied to any embalmed specimen model. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27075920

  12. Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

    Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R. [Istituto di Radiologia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Gaetani, P.; Rodriguez y Baena, R. [Neurosurgery, Istituto Clinico ``Humanitas``, I-20089 Rozzano (Midway Islands) (Italy); Cecchini, A. [Servizio di Radiodiagnostica, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Infuso, L. [Neurochirurgia, Dipartimento di Chirurgia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy)

    1998-06-02

    We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 {+-} 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 {+-} 0.12 cm vs 1.09 {+-} 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients

  13. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost

    Waqas Shuaib

    2014-12-01

    Full Text Available Purpose: Vertebral artery injuries (VAIs can be seen in cervical injuries. This investigation was conducted to assess the impact of head and neck computed tomography (CT angiography (CTA on planning treatment of vertebral artery injuries, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast material. Methods: This retrospective review included all patients who underwent CT of the cervical spine and CTA of the head and neck from March 2011 to October 2012 at a single institution. Patients were divided into two groups, those with and those without cervical spine fracture appreciated on CT of the cervical spine. The frequency of vascular injury on CTA in those with a cervical fracture was assessed. The frequency of vascular injury treatment and modifications owed to a positive CTA of head and neck were also assessed. A study was considered appropriate if it was ordered in accordance with the modified Denver Screening criteria. Effective radiation dose (mSv was calculated by multiplying dose length product (DLP from the scanner with the standard conversion coefficient (k (k = 0.0021 mSv/mGy x cm.Results: In the 387 CTAs of head and neck, a cervical injury was recorded in 128 patients. Twenty CTA scans were correctly ordered for non-spinal indications, and 19 were ordered off protocol. CTA was found positive in 1 patient for whom the imaging was off protocol and 1 for whom the clinical indication was non-cervical. There were 19 positive CTA cases of head and neck, none of which underwent surgical intervention. CTA was positive in 13 of 48 patients who had suffered a C2 fracture; this accounted for 13 of the 19 positive CTA studies (p < 0.01. Estimated fee for CTA was $3783, and radiation exposure was 4 mSv with a standard deviation (±1.3. Conclusion: CTA of head and neck ordered off an institutional imaging protocol has a low probability of being positive. Adherence to protocols for CTA of

  14. Multimodality evaluation of dural arteriovenous fistula with CT angiography, MR with arterial spin labeling, and digital subtraction angiography: case report.

    Alexander, Matthew; McTaggart, Ryan; Santarelli, Justin; Fischbein, Nancy; Marks, Michael; Zaharchuk, Greg; Do, Huy

    2014-01-01

    Dural arteriovenous fistulae (DAVF) are cerebrovascular lesions with pathologic shunting into the venous system from arterial feeders. Digital subtraction angiography (DSA) has long been considered the gold standard for diagnosis, but advances in noninvasive imaging techniques now play a role in the diagnosis of these complex lesions. Herein, we describe the case of a patient with right-side pulsatile tinnitus and DAVF diagnosed using computed tomography angiography, magnetic resonance with arterial spin labeling, and DSA. Implications for imaging analysis of DAVFs and further research are discussed. PMID:23746119

  15. Helical CT for emergency patients with cerebrovascular diseases. Diagnosis of cerebral aneurysms with subarachnoid hemorrhage (SAH) by three-dimensional CT angiography (3D-CTA)

    Recently, the usefulness of three-dimensional CT angiography (3D-CTA) using helical CT has been reported. Although 3D-CTA has been applied for neurosurgical diseases, especially for surgical planning, it has not done for emergency patients because of the long time required for image reconstruction and location of a helical CT scanner. We studied emergency patients with SAH, and compared the 3D-CTA with angiography and surgical findings, using TOSHIBA X vigor. Twenty-two patients with SAH were evaluated. The helical CT was performed for 55 seconds with a bolus injection of 90 ml non-ionic, iodinated contrast medium at a rate of 3 ml/sec with a delay of 20 sec. Angiography was carried out immediately after the helical CT. Eighteen of 22 cases were operated on urgently. We were able to create the 3D-CTA in about 7 minutes, and diagnose aneurysms by the 3D-CTA before angiography. The 3D-CTA was able to demonstrate 30 of 31 aneurysms including 9 unruptured aneurysms. An unruptured internal carotid-posterior communicating artery aneurysm 1.3 mm in diameter and associated with a ruptured aneurysm was not detected by either the 3D-CTA or angiography. On the other hand, an unruptured Acom aneurysm 0.8 mm in diameter and associated with a ruptured aneurysm could be detected by the: 3D-CTA, but not by angiography. The 3D-CTA gave us useful information concerning the anatomical relationship of the aneurysm, its neck and parent artery, and the surrounding branches. There were no complications or side effects associated with the helical CT scan. Although the 3D-CTA requires further development of visualization of small arteries less than 1 mm in diameter, such as perforating arteries, subtraction technique of bony structure, and a method for checking cervical arteries, it is useful for diagnosis of emergency patients with SAH and urgent operations. We believe that an operation might be performed by only the 3D-CTA without the angiography in the near future. (author)

  16. Correlation of Color Doppler with Multidetector CT Angiography Findings in Carotid Artery Stenosis

    Živorad N. Savic

    2010-01-01

    Full Text Available The aim of this paper was to examine the correlation between the Color Doppler ultrasound (CD-US and multidetector CT angiography (MDCTA diagnostic methods, and to define the degree and extent of stenosis in patients with internal carotid artery stenosis. This was a cross-sectional study with a consecutive series of patients. All US examinations were always carried out by the same physician-angiologist, while all CT examinations were always carried out by the same physician-radiologist. Both worked independently from each other. The stenosis area was measured at the narrowest point by NASCET criteria for US/CT. Peak systolic velocity (PSV over 210 cm/sec and end diastolic velocity (EDV over 110 cm/sec criteria were applied for stenoses with lumen narrowed over 70%, while PSV under 130 cm/sec and EDV under 100 cm/sec criteria were applied for those with lumen narrowed under 70%. A total of 124 carotid arteries were observed; namely, 89 narrowed and 68 surgically treated. All patients were reviewed by US and then by MDCTA; patients with 70–99% stenosis underwent surgery. The correlation coefficient between stenosis degree measured by US and MDCTA was 0.922; p 0.05. The US and CT matching level for stenoses from 70 to 99% was very high (κ = 0.778, p < 0.01. In conclusion, there is a highly significant statistical correlation among both diagnostic methods when measuring stenosis degree and extent. US is more dependent on the physician, while MDCTA is more objective and independent from the physician. We think it would be appropriate to undertake an MDCTA exam for those patients who are candidates for carotid endarterectomy.

  17. Preliminary evaluation of the deep inferior epigastric artery perforator with CT angiography

    Objective: To evaluate the clinical value of multislice-CT angiography (MSCTA) in planning for the patients undergoing deep inferior epigastric artery perforator (DIEAP) flap operations. Methods: Eighteen patients were performed with a 16-slice CT scanner to evaluate the deep inferior epigastric artery perforator prior to DIEAP flap operations. Axial, multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendered( VR) images were analysed and the origins, calibers, courses and anatomic relationships of the deep inferior epigastric artery perforator were evaluated. The anastomosis between the superficial inferior epigastric artery and the main perforator was observed as well. The images were classified into three grades based on the vessels' appearance. A + indicated the vessel appeared clear, continuous and thick. A - indicated the vessel appeared foggy, discontinuous and thin or the vessel partly showed. B indicated no related vessel can be seen. Other 18 patients undergoing conventional abdomen-pelvis CT scans for other reasons were used for control group t o compare their CT findings of the deep inferior epigastric artery perforator. Results: MSCTA well showed the course of the deep inferior epigastric artery (DIEA). Of the 18 cases, 17 cases appeared as A +, another one A -. It precisely displayed the origins, subcutaneous and intramuscular courses, relations of the main perforators on all cases of showing A +. The exact points where the chosen perforator vessels emerged from the rectus abdominis muscle fascia were located precisely. The superficial inferior epigastric arteries were mostly displayed and the connection between the arteries and the largest-caliber perforator from the deep system could also be shown clearly. Strict concordance with operative findings was found in CTA. Conclusion: MSCTA can precisely locate the chosen perforator vessels emerging from the rectus abdominis muscle fascia and it may be a feasible, fast, safe

  18. 3D multislice CT angiography for the assessment of relevant stenoses in patients with peripheral artery occlusive disease

    Method/Materials: For this study we examined 31 patients with peripheral artery occlusive disease. All patients received a multislice helical CT angiography and arterial digital subtraction angiography. Multislice CT angiography was performed with a Somatom Plus 4 Volume Zoom (Siemens, Erlangen, Germany). After test bolus injection of 20 ml Ultravist 370 (Schering AG, Berlin) additional 150 ml were applied with a flow rate of 3 ml/sec and a scan delay between 20-35 sec depending on individual blood circulation time. Collimation was 4x2.5 mm with a pitch of 6. Reconstructed slice thickness was 3 mm. 3D reconstructions of arteries of pelvic and lower extremity arteries were performed in volume rendering technique on a 3D Virtuoso workstation (Siemens, Erlangen). Results: For the assessment of therapeutically relevant stenoses (over 50% reduction of luminal diameter) multislice CT achieved the following results compared to conventional angiography for the diagnosis of stenosis: sensitivity of 86%, specifity of 86% and an accuracy of 72%. (orig.)

  19. Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography

    Objective. To study the possibilities of the microsurgical management of ruptured intracranial aneurysms with the sole preoperative information provided by computed tomography angiography with three-dimensional reconstruction (3D-CTA). Methods. Patients were studied with 3D-CTA after diagnosis of subarachnoid hemorrhage. If the study had an adequate quality and revealed an aneurysm congruent with the clinical findings or neurological examination and/or with the location of the bleeding on computed tomography (CT) scan an early microsurgical clipping of the lesion was done. When the quality of the 3D-CTA study was not adequate or the quality being adequate displayed no lesions or the findings were not accurate enough to warrant direct microsurgical treatment, the patient was studied with cerebral digital substraction (DS) angiography. A total of 44 consecutive patients harboring a total of 47 intracranial aneurysms diagnosed by 3D-CTA and without preoperative DS angiography were submitted to microsurgical clipping and included in the study. Results. The overall mortality was 15.9 % and the favorable results evaluated 6 months after discharge by means of the Glasgow outcome scale reached 70.4 %. All lesions were successfully clipped. Surgery was done a mean of 4.1 days after the admission bleeding. A total of four microlesions undiagnosed by 3D-CTA were found at surgery and clipped. Postoperative DS angiography and necropsy findings were also used as control of the 3D-CTA findings but no additional information was provided excepting the finding in DS angiography of an asymptomatic intracavemous aneurysm. Therefore the sensitivity of the 3D-CTA for diagnosis of symtomatic aneurysms was 100 % and the overall sensitivity 90.4 %. Conclusions. We have reached similar results in patients operated on with or without preoperative angiography. 3D-CTA provides very valuable anatomical information, which has an additional value in the microsurgical treatment of aneurysms of the

  20. Coronary CT angiography: automatic cardiac-phase selection for image reconstruction

    Ruzsics, Balazs; Brothers, Robin L.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Gebregziabher, Mulugeta [Medical University of South Carolina, Department of Biostatistics, Bioinformatics, and Epidemiology, Charleston, SC (United States); Lee, Heon [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Seoul Medical Center, Department of Radiology, Seoul (Korea); Allmendinger, Thomas; Vogt, Sebastian [Siemens Medical Solutions, Division CT, Forchheim (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Charleston, SC (United States)

    2009-08-15

    We evaluated an algorithm for automatic selection of the cardiac phase with the least motion for image reconstruction at coronary computed tomography (CT) angiography (CCTA). We analyzed data of 100 patients (49 female, mean age 59 years) who had undergone retrospectively ECG-gated CCTA. Two experienced observers visually identified the most suitable end-systolic and end-diastolic phases using a series of image reconstructions in 5% increments across the RR cycle. The same data were then reconstructed using an automatic phase finding algorithm based on a 4D weighting function of cardiac motion. On average, the algorithm determined the most suitable systolic reconstruction phase at 40.11{+-}6.29% RR compared with 40.07{+-}5.58% RR by the human observers (p=NS). The most suitable diastolic phase was found at 72.71{+-}7.37% RR by the automatic algorithm, compared with 76.43{+-}6.35% RR by the observers (p<0.05). No statistically significant difference was found between automatically and visually determined reconstruction phases regarding motion and stair-step artifacts in either systole or diastole (p>0.05). Thus, there appears to be no relevant difference between an automatic phase finding algorithm and visual selection by experienced observers for determining the phase with the least cardiac motion for CCTA image reconstruction. The use of automatic phase finding may therefore facilitate the performance of cardiac CT and reduce human error. (orig.)

  1. Carotid stenosis assessment with multi-detector CT angiography: comparison between manual and automatic segmentation methods.

    Zhu, Chengcheng; Patterson, Andrew J; Thomas, Owen M; Sadat, Umar; Graves, Martin J; Gillard, Jonathan H

    2013-04-01

    Luminal stenosis is used for selecting the optimal management strategy for patients with carotid artery disease. The aim of this study is to evaluate the reproducibility of carotid stenosis quantification using manual and automated segmentation methods using submillimeter through-plane resolution Multi-Detector CT angiography (MDCTA). 35 patients having carotid artery disease with >30 % luminal stenosis as identified by carotid duplex imaging underwent contrast enhanced MDCTA. Two experienced CT readers quantified carotid stenosis from axial source images, reconstructed maximum intensity projection (MIP) and 3D-carotid geometry which was automatically segmented by an open-source toolkit (Vascular Modelling Toolkit, VMTK) using NASCET criteria. Good agreement among the measurement using axial images, MIP and automatic segmentation was observed. Automatic segmentation methods show better inter-observer agreement between the readers (intra-class correlation coefficient (ICC): 0.99 for diameter stenosis measurement) than manual measurement of axial (ICC = 0.82) and MIP (ICC = 0.86) images. Carotid stenosis quantification using an automatic segmentation method has higher reproducibility compared with manual methods. PMID:23135615

  2. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    Kun Tang

    2015-01-01

    Full Text Available Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA group and low voltage CTA (L-CTA group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. With the results of 3D-DSA as “gold standard,” the sensitivity, specificity, and accuracy of C-CTA and L-CTA in diagnosis of aneurysms were calculated and compared with each other. Results. Compared with group C-CTA, the CT dose index volume (CTDIvol of group L-CTA reduced by 35.65%. There were no significant differences between C-CTA and L-CTA groups regarding objective and subjective image qualities. The sensitivity, specificity, and accuracy of L-CTA in diagnosis of aneurysms were 95.16%, 99.72%, and 99.42%, respectively. There were no significant differences in sensitivity, specificity, and accuracy between the C-CTA and L-CTA groups. Conclusion. The value of cerebral CTA with 100 kV low tube voltage in detection of intracranial aneurysms is significant, and it should be recommended as a routine scan method.

  3. Prospective ECG-gated 320-row CT angiography of the whole aorta and coronary arteries

    Li, Yu.; Fan, Zhanming; Xu, Lei; Yang, Lin; Xin, Haiyan; Zhang, Nan [Capital Medical University, Department of Radiology, Beijing An Zhen Hospital, Beijing (China); Capital Medical University, Ministry of Education, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing (China); Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing An Zhen Hospital, Beijing (China)

    2012-11-15

    To investigate the feasibility of using a prospective ECG-gated wide-volume protocol in CT angiography (CTA) of the whole aorta and coronary arteries (CA). A total of 61 consecutive patients with suspected acute aortic diseases underwent CTA of the whole aorta using a prospective ECG-gated wide-volume CT protocol without heart rate (HR) control. The exposure window was set at 40-50 % of R-R interval (HR {>=}70 bpm) or 70-80 % of R-R interval (HR <70 bpm) in a single heartbeat. The image quality of the ascending aorta, aortic valve and CA was evaluated for motion artefacts. The mean attenuation was measured at different levels of the aorta. The radiation dose and contrast medium volume were recorded. All of the examinations were performed successfully. The image quality was acceptable in the ascending aorta, aortic valve (100 %) and CA (94.4 %). The mean radiation dose was 18.42 {+-} 5.02 mSv. Of 61 patients, 14 were diagnosed with aortic aneurysm and 35 were diagnosed with aortic dissection or intramural haematoma. Coronary artery stenosis was detected in 12 patients. For patients with aortic diseases, CTA of the whole aorta using a prospective ECG-gated wide-volume protocol has the potential to provide additional information about the CA and aortic valve with lower radiation exposure. (orig.)

  4. Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography

    Highlights: • CT cervico-cerebral angiography (CTCCA) is a commonly performed study for assessment of vascular pathologies of head and neck. • This study assessed the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. • This study demonstrated the presence of clinically significant incidental findings in 14% of patients undergoing CTCCA with 8% of these findings deemed to be highly significant. 19% of patients with highly clinically significant findings did not receive appropriate follow up. • A standardised method of reporting incidental findings, such as that used in this paper is suggested to aid radiologists and referring physicians in recording and communicating these findings. - Abstract: Introduction: CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. Materials and methods: A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1–EV4. EV1 = no incidental findings, EV2 = clinically insignificant incidental finding, EV3 = incidental finding of intermediate clinical significance, EV4 = highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management. Results: Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5

  5. Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography

    Crockett, Matthew Thomas, E-mail: crockettmt@gmail.com; Murphy, Blathnaid, E-mail: blathnaidmurphy@hotmail.com; Smith, Jennifer, E-mail: jennifer.js.smith@gmail.com; Kavanagh, Eoin Carl, E-mail: kavanaghec@gmail.com

    2015-08-15

    Highlights: • CT cervico-cerebral angiography (CTCCA) is a commonly performed study for assessment of vascular pathologies of head and neck. • This study assessed the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. • This study demonstrated the presence of clinically significant incidental findings in 14% of patients undergoing CTCCA with 8% of these findings deemed to be highly significant. 19% of patients with highly clinically significant findings did not receive appropriate follow up. • A standardised method of reporting incidental findings, such as that used in this paper is suggested to aid radiologists and referring physicians in recording and communicating these findings. - Abstract: Introduction: CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. Materials and methods: A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1–EV4. EV1 = no incidental findings, EV2 = clinically insignificant incidental finding, EV3 = incidental finding of intermediate clinical significance, EV4 = highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management. Results: Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5

  6. Transthoracic Doppler echocardiography to predict optimal tube pulsing window for coronary artery CT angiography

    Rationale and objective: To evaluate the feasibility of transthoracic Doppler echocardiography to determine the optimal pulsing windows for CT coronary angiography to narrow the pulsing windows further, especially in higher heart rate. Materials and methods: Doppler was performed on 135 patients before CT scanning. For Doppler, the intervals with minimal motion were evaluated during both systole and diastole integrating electrocardiogram (ECG) intervals. For CT scanning, the retrospective ECG-gating was applied and the optimal reconstruction intervals were determined. The accuracy of Doppler analysis to predict the optimal reconstruction intervals was tested. The predicted length of pulsing windows was compared between Doppler analysis and traditional prospective ECG-gating protocol (heart rate ≦ 65 bpm, 60–76%; 66–79 bpm, 30–77%; ≧80 bpm, 31–47%). Results: According to Doppler analysis, the mean length of intervals with minimal motion in systole was 106.4 ± 39.2 ms and 125.2 ± 92.0 ms in diastole. When the intervals with minimal motion during diastole > 90 ms, the optimal reconstruction intervals were located at diastole; otherwise, at systole (P < 0.001). The optimal reconstruction intervals in 93.8% (132/135) patients could be predicted accurately by Doppler analysis. If the optimal reconstruction intervals predicted by Doppler were applied as the exposure windows, the mean length of pulsing windows should has been 105.2 ± 69.4 ms (range: 26.9–510.3 ms), which was significantly shorter than that of traditional prospective ECG-gating protocol (232.0 ± 120.2 ms, range: 93.2–427.3 ms, P < 0.001). Conclusion: Doppler can help detecting the optimal pulsing windows accurately. Prospective ECG-gating incorporating Doppler analysis may narrow pulsing windows significantly while maintaining image quality

  7. Ways of improving three-dimensional CT angiography images of cervical and cerebral vascular lesions

    We evaluated various ways of improving the image clarity of three-dimensional CT angiography (3D-CTA) for the diagnosis of cervical and cerebral vascular disease in sixty-seven patients (36 males and 31 females). The mean age was 61.4 years, with a rang of 17 to 89 years. The patients were examined with a helical CT scanner (TCT-X vision GX) after intravenous bolus injection of 90 ml nonionic contrast medium (300 mgI/ml) at the rate of 3 ml/sec. Intracranial and cervical 3D-CTA were performed 60 and 12 times, respectively. Our findings were as follows: Reduction of the pre-scanning delay time from 18 to 10 sec after the injection of the contrast medium eliminates much of the cavernous sinus from the image and makes it easier to distinguish the intracavernous internal carotid artery in intracranial 3D-CTA. In cervical 3D-CTA, reduction of the pre-scanning delay time from 15 to 9 sec delays imaging of the jugular vein and makes it easy to distinguish the bifurcation of the common carotid artery. A subtraction image on 3D-CTA is useful for detecting of vascular lesions adjacent to bone, such as lesions on the internal carotid artery. By producing a stereo picture, a closer three-dimensional relationship between the vascular lesion and the vessel circumference organization can be recognized. Vascular lesions can be clearly visualized from inside the artery using a 3D-CT endoscopic image. We were able to obtain a great deal of detailed information from 3D-CTA images with these modifications and we believe they enhance diagnostic accuracy of the technique. (author)

  8. Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus

    Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. Among the 30 subjects included in the analysis (83 % male, mean age 70.0 ± 10.5 years, 83 % diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30 %). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100 % and 93.1 %, respectively) and MIP images (99 % and 91.8 %, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1 % vs. 99.2 vs. 90.9 %; respectively, p < 0.001). The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs. (orig.)

  9. Non-invasive 16-row multislice CT coronary angiography: usefulness of saline chaser

    The aim of this study was to investigate the usefulness of saline chaser in 16-row multislice CT (16-MSCT) coronary angiography. Forty-two patients were divided into two groups for contrast material (CM) administration: group 1 (140 ml at 4 ml/s) and group 2 (100 ml at 4 ml/s followed by 40 ml of saline chaser at 4 ml/s). All patients underwent retrospectively ECG-gated 16-MSCT coronary angiography. The attenuation at the origin coronary vessels was assessed. Three regions of interest (ROIs) were drawn throughout the data set: (a) ascending aorta (ROI 1); (b) descending aorta (ROI 2); and (c) pulmonary artery (ROI 3). The attenuation in the superior vena cava was recorded (ROI 4). The average attenuation and the slope were calculated in each ROI and differences were assessed with a Student's t test. The average attenuation in the coronary vessels was not significantly different in the two groups. The average attenuations in ROI 1 were 325 and 327 HU, in ROI 2 were 328 and 329 HU and in ROI 3 were 357 and 320 HU, for groups 1 and 2, respectively (p>0.05). The slopes in ROI 1 were -0.2 and 1.1, in ROI 2 were 2.8 and 2.1 (p>0.05) and in ROI3 were 3.9 and -9.0 (p<0.05), for groups 1 and 2, respectively. The average attenuations in ROI 4 were 927 and 643 HU (p<0.05), for groups 1 and 2, respectively. One hundred milliliters of CM with 40 ml of saline chaser provides the same attenuation as 140 ml of CM (35% less) with decreased hyper-attenuation in the superior vena cava. (orig.)

  10. Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization

    Ohtaki, Masafumi; Tanabe, Sumiyoshi; Uede, Teiji; Hashi, Kazuo [Sapporo Medical Univ. (Japan). School of Medicine

    1996-11-01

    The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to Jun 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r=0.987, p< 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination. (author)

  11. Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization

    The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to Jun 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r=0.987, p< 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination. (author)

  12. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography

    AIM: The aim of this study was to assess the usefulness of 16-row multislice CT angiography (CTA) in evaluating intracranial aneurysms, by comparison with conventional digital subtraction angiography (DSA) and intraoperative findings. METHODS: A consecutive series of 57 patients, scheduled for DSA for suspected intracranial aneurysm, was prospectively recruited to have CTA. This was performed with a 16-detector row machine, detector interval 0.75 mm, 0.5 rotation/s, table speed 10 mm/rotation and reconstruction interval 0.40 mm. CTA studies were independently and randomly assessed by two neuroradiologists and a vascular neurosurgeon blinded to the DSA and surgical findings. Review of CTA was performed on workstations with an interactive 3D volume-rendered algorithm. RESULTS: DSA or intraoperative findings or both confirmed 53 aneurysms in 44 patients. For both independent readers, sensitivity and specificity per aneurysm of DSA were 96.2% and 100%, respectively. Sensitivity and specificity of CTA were also 96.2% and 100%, respectively. Mean diameter of aneurysms was 6.3 mm (range 1.9 to 28.1 mm, SD 5.2 mm). For aneurysms of less than 3 mm, CTA had a sensitivity of 91.7% for each reader. Although the neurosurgeon would have been happy to proceed to surgery on the basis of CTA alone in all cases, he judged that DSA might have provided helpful additional anatomical information in 5 patients. CONCLUSION: The diagnostic accuracy of 16-slice CTA is promising and appears equivalent to that of DSA for detection and evaluation of intracranial aneurysms. A strategy of using CTA as the primary imaging method, with DSA reserved for cases of uncertainty, appears to be practical and safe

  13. Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography

    McKinney, Alexander M.; Casey, Sean O.; Teksam, Mehmet; Truwit, Charles L.; Kieffer, Stephen [University of Minnesota Medical School, Departments of Radiology, Minneapolis, MN (United States); Lucato, Leandro T. [Clinics Hospital, University of Sao Paulo, Sao Paulo (Brazil); Smith, Maurice [Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD (United States)

    2005-01-01

    The aim of this paper was to determine the correlation between calcium burden (expressed as a volume) and extent of stenosis of the origin of the internal carotid artery (ICA) by CT angiography (CTA). Previous studies have shown that calcification in the coronary arteries correlates with significant vessel stenosis, and severe calcification (measured by CT) in the carotid siphon correlates with significant (greater than 50% stenosis) as determined angiographically. Sixty-one patients (age range 50-85 years) underwent CT of the neck with intravenous administration of iodinated contrast for a variety of conditions. Images were obtained with a helical multidetector array CT scanner and reviewed on a three-dimensional workstation. A single observer manipulated window and level to segment calcified plaque from vascular enhancement in order to quantify vascular calcium volume (cc) in the region of the bifurcation of the common carotid artery/ICA origin, and to measure the extent of ICA stenosis near the origin. A total of 117 common carotid artery bifurcations were reviewed. A ''significant'' stenosis was defined arbitrarily as >40% (to detect lesions before they become hemodynamically significant) of luminal diameter on CTA using NASCET-like criteria. All ''significant'' stenoses (21 out of 117 carotid bifurcations) had measurable calcium. We found a relatively strong correlation between percent stenosis and the calcium volume (Pearson's r= 0.65, P<0.0001). We also found that there was an even stronger correlation between the square root of the calcium volume and the percent stenosis as measured by CTA (r= 0.77, P<0.0001). Calcium volumes of 0.01, 0.03, 0.06, 0.09 and 0.12 cc were used as thresholds to evaluate for a ''significant'' stenosis. A receiver operating characteristic (ROC) curve demonstrated that thresholds of 0.06 cc (sensitivity 88%, specificity 87%) and 0.03 cc (sensitivity 94%, specificity

  14. Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography

    The aim of this paper was to determine the correlation between calcium burden (expressed as a volume) and extent of stenosis of the origin of the internal carotid artery (ICA) by CT angiography (CTA). Previous studies have shown that calcification in the coronary arteries correlates with significant vessel stenosis, and severe calcification (measured by CT) in the carotid siphon correlates with significant (greater than 50% stenosis) as determined angiographically. Sixty-one patients (age range 50-85 years) underwent CT of the neck with intravenous administration of iodinated contrast for a variety of conditions. Images were obtained with a helical multidetector array CT scanner and reviewed on a three-dimensional workstation. A single observer manipulated window and level to segment calcified plaque from vascular enhancement in order to quantify vascular calcium volume (cc) in the region of the bifurcation of the common carotid artery/ICA origin, and to measure the extent of ICA stenosis near the origin. A total of 117 common carotid artery bifurcations were reviewed. A ''significant'' stenosis was defined arbitrarily as >40% (to detect lesions before they become hemodynamically significant) of luminal diameter on CTA using NASCET-like criteria. All ''significant'' stenoses (21 out of 117 carotid bifurcations) had measurable calcium. We found a relatively strong correlation between percent stenosis and the calcium volume (Pearson's r= 0.65, P<0.0001). We also found that there was an even stronger correlation between the square root of the calcium volume and the percent stenosis as measured by CTA (r= 0.77, P<0.0001). Calcium volumes of 0.01, 0.03, 0.06, 0.09 and 0.12 cc were used as thresholds to evaluate for a ''significant'' stenosis. A receiver operating characteristic (ROC) curve demonstrated that thresholds of 0.06 cc (sensitivity 88%, specificity 87%) and 0.03 cc (sensitivity 94%, specificity 76%) generated the best combinations of sensitivity and

  15. The role of 64-slice multi-detector computed tomography in the detection of subclinical atherosclerosis of the coronary artery.

    Jeong, Hae Chang; Ahn, Youngkeun; Ko, Jum Suk; Lee, Min Goo; Sim, Doo Sun; Park, Keun Ho; Yoon, Nam Sik; Youn, Hyun Ju; Hong, Young Joon; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Kim, Yun-Hyeon; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

    2010-12-01

    Multi-detector computed tomography (MDCT) has been used for detecting or excluding coronary atherosclerotic stenosis in symptomatic patients. However, the role of MDCT for routine medical examination in asymptomatic, high-risk patients has not been established. We therefore conducted the present study to test the hypothesis that MDCT could be a valuable method for detecting subclinical coronary artery stenosis in asymptomatic patients. An observational, retrospective, single-centre study was conducted with a cohort of 1,529 patients (mean age, 56.4 ± 8.3 years; 1,353 males) who had undergone MDCT as part of their general medical checkups from November 2005 to April 2008. The patients who had a past history of coronary artery disease, typical chest pain, or evidence of myocardial ischemia were excluded. During clinical follow up of these patients, the incidence of subclinical coronary stenosis and the usefulness of MDCT for routine medical examination in asymptomatic patients were investigated. Of the 1,529 enrolled patients, 42.3% had hypertension, 13.5% had diabetes mellitus, 7.7% had hyperlipidemia, and 40.4% were current smokers. Abnormal MDCT findings were noted in 560 (36.6%) patients, who were classified into two groups. One group had the presence coronary calcium with a luminal diameter stenosis of the coronary artery of bridge, and 23 patients (1.5%) presented with significant stenosis. The patients with significant stenosis underwent percutaneous coronary intervention (PCI) with stent implantation. Major adverse cardiac events occurred in only 2 patients who had been treated with PCI during a mean follow-up period of 387 ± 253 days. The incidence of significant subclinical coronary stenosis as detected by MDCT in a general medical check-up was 3.4%, and the false-positive rate of MDCT for detecting significant coronary artery stenosis was 55.8% (29/52). 64-Slice MDCT can be a useful tool for noninvasive evaluation of coronary arteries in

  16. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    Masih Saboori

    2011-05-01

    Full Text Available Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indications were operated."nAfter surgery and detecting the existence of aneurysms"nand their location, the data were recorded in a"nchecklist. Sensitivity, specificity, positive and negative"npredictive values were calculated and compared in"nboth methods."nResults: The mean age of the 30 patients were"n49.5±9.13 years. 57.9 % of the subjects were female"nand the others were male. On CTA reports 100% true"npositive, 0% false positive, 85% true negative, and 15%"nfalse negative were calculated. DSA reports were true"npositive, false positive, true negative and false negative"nin 100%, 0%, 69% and 31%, respectively. CTA showed"n89% of sensitivity, and 100% of specificity in contrast"nto 74% sensitivity and 100% specificity of DSA."nPositive predictive values of both methods were 100%,"nbut negative predictive values of CTA and DSA were"n85% and 69%, respectively."nConclusion: Based on our data, CTA is more preferable"ndiagnostic modality for the brain aneurysm's site and"nanatomy in patients with subarachnoid hemorrhage"nthan DSA."nKeywords: CT Scan Angiography, Digital Subtraction"nAngiography, Cerebral Aneurysm, Subarachnoid"nHemorrhage

  17. The relationship between cerebral infarctive CT findings and cervical carotid arterial abnormalities; The accumulation of contrast media in angiography and carotid angio-CT

    Hatanaka, Mitsuaki (Towada City Hospital, Aomori (Japan)); Shimizu, Toshio; Manabe, Hiroshi; Suzuki, Naoya

    1990-04-01

    The relationship between cervical carotid arterial changes and cerebral occlusive or ischemic disease was discussed in 120 consecutive cases (60 abnormal and 60 normal CT findings) which had been examined by means both of angiography and of brain CT. Even the low-grade stenosis of the carotid artery (less than 50%) had influence on the infarctive changes in CT; in these low-grade stenotic cases, clinico-pathological study sometimes revealed intimal damage, calcification, and clot formation on the damaged inner wall. Angiographically, the focal accumulation of contrast media in the carotid pathological region is a radiological expression of focal circulatory disturbance, a transient staying of the carotid blood flow, of clot-formation. More dynamic circulatory findings were revealed by Cine-Angiography. In cases of positive brain CT findings, cortical and multiple lesions more frequently had carotid changes and the accumulation of contrast media than did the basal ganglia and subcortical lesions. Even in the cases of negative brain CT findings, carotid changes were observed in about 20% of the cases. Angiographical study has the limitation that it cannot reveal the abnormality of the carotid arterial wall itself. On the other hand, carotid angio-CT was able to reveal carotid wall changes - for instance, calcification at a high density and atheromatous change at a low density: it can also investigate the range and degree. It is also useful in the follow-up study of pre-operative and post-operative changes, or anti-platelet therapy. (author).

  18. The comparative study between multi-slice spiral CT angiography and color flow ultrasonography in hepatic and splenic trauma

    Objective: To investigate the clinical value of multi-slice spiral CT angiography and color flow ultra- sonography in hepatic and splenic trauma. Methods Thirty-six cases of hepatic and splenic trauma were collected, the MSCT were analyzed and compared with that of color flow ultrasonography. Results: Seventeen cases were Hepatic trauma including nine cases of hepatic contusion, six cases of sub-envelope hematoma, two cases of both sub-envelope hematoma and hepatic contusion. Nineteen cases were splenic trauma including nine cases of splenic contusion, ten cases of sub-envelope hematoma. Conclusion: Multi-slice spiral CT angiography show hepatic and splenic trauma clearer than that of color flow ultrasonography, and can provide reliable basis for clinic diagnosis and therapy. (authors)

  19. Diagnostic Performance of Transluminal Attenuation Gradient and Noninvasive Fractional Flow Reserve Derived from 320-Detector Row CT Angiography to Diagnose Hemodynamically Significant Coronary Stenosis: An NXT Substudy.

    Ko, Brian S; Wong, Dennis T L; Nørgaard, Bjarne L; Leong, Darryl P; Cameron, James D; Gaur, Sara; Marwan, Mohamed; Achenbach, Stephan; Kuribayashi, Sachio; Kimura, Takeshi; Meredith, Ian T; Seneviratne, Sujith K

    2016-04-01

    Purpose To compare the diagnostic performance of 320-detector row computed tomography (CT) coronary angiography-derived computed fractional flow reserve (FFR; FFRCT), transluminal attenuation gradient (TAG; TAG320), and CT coronary angiography alone to diagnose hemodynamically significant stenosis as determined by invasive FFR. Materials and Methods This substudy of the prospective NXT study (no. NCT01757678) was approved by each participating institution's review board, and informed consent was obtained from all participants. Fifty-one consecutive patients who underwent 320-detector row CT coronary angiographic examination and invasive coronary angiography with FFR measurement were included. Independent core laboratories determined coronary artery disease severity by using CT coronary angiography, TAG320, FFRCT, and FFR. TAG320 is defined as the linear regression coefficient between luminal attenuation and axial distance from the coronary ostium. FFRCT was computed from CT coronary angiography data by using computational fluid dynamics technology. Diagnostic performance was evaluated and compared on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). Results Among 82 vessels, 24 lesions (29%) had ischemia by FFR (FFR ≤ 0.80). FFRCT exhibited a stronger correlation with invasive FFR compared with TAG320 (Spearman