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.     

Prospective versus retrospective ECG gating for 320-detector CT of the coronary arteries: comparison of image quality and patient radiation dose

Purpose

To compare image quality and patient radiation dose in a group of patients who underwent 320-detector computed tomography coronary angiography performed with prospective electrocardiogram (ECG) gating with image quality and radiation dose in a group of patients matched for clinical features who underwent 320-detector computed tomographic (CT) coronary angiography performed with retrospective ECG gating.

Materials and Methods

This study was approved by our institutional human research committee. All patients had clinical indications for coronary computed tomography angiography (CTA). Two independent reviewers separately scored coronary artery segment image quality for 480 cardiac CT studies in prospective group and retrospective group (240 in each group). Reviewer variability was calculated. Estimated effective radiation dose was compared for prospective versus retrospective ECG gating.

Results

The two groups matched well for clinical characteristics and CT parameters. There was good agreement for coronary artery segment image quality scores between the independent reviewers (k=0.73). Of the 6408 coronary artery segments scored, there were no coronary artery segments that could not be evaluated in each group. Image quality scores were not significantly different (P>.05). Mean patient radiation dose was 76.50% lower for prospective gating (4.2 mSv) than for retrospective gating (18.1 mSv) (P<.01).

Conclusion

Use of 320-detector CT coronary angiography performed with prospective ECG gating has similar subjective image quality scores but 76.50% lower patient radiation dose when compared with use of retrospective ECG gating.     

64排螺旋CT冠状动脉成像的前瞻性与回顾性心电门控技术的图像质量及辐射剂量的比较研究

目的 研究前瞻性心电门控触发(prospective ECG-triggering)与回顾性心电门控(retrospective ECG gating)两种技术方法行冠状动脉CTA检查时,对冠状动脉图像质量及辐射剂量的比较。方法 33名疑似冠状动脉疾病的患者分两组进行对比研究。前瞻组16例为前瞻性心电门控成像,心率小于65次/min;回顾组17例为回顾性心电门控成像,心率小于75次/min。记录两组的辐射剂量并统计分析,同时进行图像质量评价。结果 两组图像质量比较,差异无统计学意义(P＞0.05)。前瞻性心电门控冠状动脉CTA的平均DLP 234.4mGy·cm,占回顾性心电门控冠状动脉CTA的平均DLP974.4mGy·cm的24.1%。前瞻性心电门控冠状动脉CTA的患者的平均有效剂量为3.2mSv,回顾心电门控冠状动脉CTA患者的为13.6mSv,降低76.47%。结论 64排螺旋CT在前瞻性心电门控冠状动脉CTA与回顾性心电门控冠状动脉CTA比较可以获得相似的图像质量,可大幅降低患者的有效剂量对于不能接受高辐射剂量且心率较低的受检人群具有重要的临床价值。     

Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation

Our objective was to evaluate image quality and radiation exposure of retrospectively ECG-gated multislice helical CT (MSCT) investigations of the heart with ECG-controlled tube current modulation. One hundred patients underwent MSCT scanning (Somatom VolumeZoom, Siemens, Forchheim, Germany) for detection of coronary artery calcifications. A continuous helical data set of the heart was acquired in 50 patients (group 1) using the standard protocol with constant tube current, and in 50 patients (group 2) using an alternative protocol with reduced radiation exposure during the systolic phase. The standard deviations (SD) of predefined regions of interest (ROIs) were determined as a measure of image noise and were tested for significant differences. There was no significant difference between group 1 and group 2 with respect to image noise. Radiation exposure with and without tube current modulation was 1.0 and 1.9 mSv (p<0.0001), respectively, for males and 1.4 and 2.5 mSv (p<0.0001), respectively, for females; thus, there was a mean dose reduction of 48% for males and 45% for females, respectively. The ECG-controlled tube current modulation allows significant dose reduction when performing retrospectively ECG-gated MSCT of the heart. Electronic Publication     

Whole tumour perfusion of peripheral lung carcinoma: evaluation with first-pass CT perfusion imaging at 64-detector row CT

AIM: To prospectively assess the feasibility of a whole-tumour perfusion technique using 64-detector row computed tomography (CT) and to analyse the variation of CT perfusion parameters in different histological types, sizes, and metastases in patients with peripheral lung carcinoma. METHODS AND MATERIALS: Ninety-seven pathologically proved peripheral lung carcinomas (less than 5 cm in largest diameter) underwent dynamic contrast-enhanced CT using a 64-detector row CT machine. Small amounts of iodinated contrast medium with a sharp bolus profile (50 ml, 6-7 ml/s), and 12 repeated fast acquisitions encompassing the entire tumour lesion were adopted to quantify perfusion of the whole-tumour during first-pass of contrast medium. Four kinetic parameters, including perfusion, peak enhancement intensity (PEI), time to peak (TTP), and blood volume (BV), were measured and statistically compared among different histological types, sizes, and metastases. RESULTS: Mean values for perfusion, PEI, TTP, and BV of the 97 lung carcinomas were 57.5+/-45.4 ml/min/ml (range 5.9-243 ml/min/ml), 53.4+/-40.6 HU (range 10.3-234.4 HU), 34+/-11s (range 11-60s), and 30.1+/-21.7 ml/100g (range 3.9-113.4 ml/100g), respectively. No statistical differences were found between the histological types regarding the perfusion parameters (p>0.05). Perfusion, PEI, and BV of stage T2 tumours were significantly lower than those of stage T1 tumours (all p < 0.05), whereas no statistically significant differences was found between other stages of tumours (all p>0.05). Perfusion of the tumours with distant metastasis was significantly higher than that of the tumours without distant metastasis (p<0.05), but there was no statistically significant difference between nodal metastasis positive and negative groups (p>0.05). CONCLUSION: The present study of first-pass perfusion imaging using 64-detector row CT could provide a feasible method for assessment of whole-tumour perfusion. CT perfusion parameters of peripheral lung carcinoma may be associated with tumour size and distant metastasis.     

Age related changes of human aortic distensibility: evaluation with ECG-gated CT

Aortic distensibility is a parameter to grade vascular diseases and age-related effects because it is related to the elastic properties of the vessel wall. In this study vascular cross-sectional area changes have been determined using ECG-gated CT to analyse the age dependency of aortic distensibility. Distensibility measurements of the aorta were performed in 31 subjects (28 to 85 years). Time-resolved images were acquired either with a 4- or 16-detector row CT system using a modified CT angiography protocol. Cross-sectional area changes of the aorta were calculated by semiautomatic segmentation, and distensibility values were obtained using additional systemic blood pressure measurements. The aorta could be segmented successfully in all subjects. A decrease of aortic distensibility with age was found (r=0.50). Below (above) the renal arteries, the annual decrease was Δ D _infrarenal =(−2.1±0.7)·10⁻⁷ Pa⁻¹a⁻¹, (D _suprarenal Δ=(−3.5±1.1)·10⁻⁷ Pa⁻¹a⁻¹). Differences between the ages, the youngest third and oldest third studied, were found to be significant (P _suprarenal =0.003; P _infrarenal =0.025). An age-dependent decrease of aortic wall elasticity can be determined in a modified routine CT angiography study.     

64层螺旋CT选择性三维血管重建技术在颅内占位性病变中的应用

目的:探讨64层螺旋CT选择性三维重建后处理技术在显示颅内异常血管方面的应用价值。方法:对18例CT脑血管造影病例进行多种后处理重建,包括选择性容积再现成像(VR),选择性最大密度投影成像(MIP)。结果:18例病人中10例脑动脉瘤,2例动静脉畸形,4例脑肿瘤,2例颅神经肿瘤。对常规VR、MIP重建显示失败或者结果不理想者,采用选择性三维重建均能够清晰准确显示病变的整体和细节。结论:颅内异常血管选择性三维重建图像质量优于常规三维重建图像,在显示病变的整体结构及细节方面能够提供更多信息。     

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

The purpose of this study was to evaluate image quality of low-dose electrocardiogram (ECG)-gated multislice helical computed tomography (CT) angiograms of the chest. One hundred and five consecutive patients with a regular sinus rhythm (72 men; 33 women) underwent ECG-gated CT angiographic examination of the chest without administration of beta blockers using the following parameters: (a) collimation 32×0.6 mm with z-flying focal spot for the acquisition of 64 overlapping 0.6-mm slices, rotation time 0.33 s, pitch 0.3; (b) 120 kV, 200 mAs; (c) use of two dose modulation systems, including adjustment of the mAs setting to the patient’s size and anatomical shape and an ECG-controlled tube current. Subjective and objective image quality was evaluated by two radiologists in consensus on 3-mm-thick scans reconstructed at 55% of the response rate (RR) interval. The population and protocol characteristics included: (a) a mean [±standard deviation (SD)] body mass index (BMI) of 24.47 (±4.64); (b) a mean (±SD) heart rate of 72.04 (±15.76) bpm; (c) a mean (±SD) scanning time of 18.3 (±2.73) s; (d) a mean (±SD) dose-length product (DLP) value of 260.57 (±83.67) mGy/cm; (e) an estimated average effective dose of 4.95 (±1.59) mSv. Subjective noise was depicted in a total of nine examinations (8.5%), always rated as mild. Objective noise was assessed by measuring the standard deviation of pixel values in a homogeneous region of interest within the trachea and descending aorta; SD was 15.91 HU in the trachea and 22.16 HU in the descending aorta, with no significant difference in the mean value of the standard deviations between the four categories of BMI except for obese patients, who had a higher mean SD within the aorta. Interpolation artefacts were depicted in 22 patients, with a mean heart rate significantly lower than that of patients without interpolation artifacts, rated as mild in 11 patients and severe in 11 patients. The severity of 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.     

First-pass perfusion imaging of solitary pulmonary nodules with 64-detector row CT: comparison of perfusion parameters of malignant and benign lesions

The purpose of this study was to determine the usefulness of first-pass whole nodule perfusion imaging in the differentiation of benign and malignant solitary pulmonary nodules (SPNs). 77 patients with non-calcified SPNs (46 malignant, 22 benign and 9 active inflammatory) underwent first-pass perfusion imaging with a 64-detector row CT scanner. Perfusion, peak enhancement intensity (PEI), time to peak (TTP) and blood volume (BV) were measured and statistically compared among different groups. Mean perfusion, PEI and BV for benign SPNs were significantly lower than those for malignant nodules (p<0.05) and active infections (p<0.05), but the differences were not statistically significant between malignant tumours and active infections (p>0.05). Receiver operating characteristic (ROC) curve analysis showed that SPNs with perfusion greater than 30.6 ml min^–1 ml^–1, PEI higher than 23.3 HU or BV larger than 12.2 ml per 100 g were more likely to be malignant. In conclusion, first-pass perfusion imaging with 64-detector row CT is a feasible way of assessing whole nodule perfusion and helpful in differentiating benign from malignant SPNs.The differentiation of solitary pulmonary nodules (SPNs) as benign or malignant remains a diagnostic challenge for thoracic radiology. During the past decade, promising results for more specific differentiation of malignant and benign nodules using dynamic contrast material-enhanced CT have been reported [1–6]. Techniques in these studies rely on single-level acquisition with long time intervals, which were considered to be problematic for quantitative assessment of whole tumour perfusion because the blood flow within tumours is spatially and temporally heterogeneous [7, 8]. Nevertheless, current technological advances in multidetector row CT (MDCT), specifically sequential volume acquisition and data processing, allow for more accurate evaluation of tissue haemodynamics than that attainable with previous CT techniques. A recent study on MDCT perfusion techniques assessed whole tumour perfusion with the volume coverage of 40 mm in patients with non-small-cell lung carcinoma and achieved good measurement reproducibility [8]. To the best of our knowledge, no data exist on the application of first-pass perfusion CT for the differentiation of benign and malignant SPNs [1–6, 8]. The purpose of our study, therefore, was to determine the utility of first-pass whole nodule perfusion imaging in the differentiation of benign and malignant SPNs.     

Comparison between coronal reformatted images and direct coronal CT images of the swine lung specimen: assessment of image quality with 64-detector row CT

The aims of this study were to compare the image quality of coronal multiplanar reconstruction (MPR) images from axial spiral images with that of direct coronal spiral and sequential images, and to estimate and analyse the effect of an incremental change on the image quality using 64-detector row CT. 12 swine lungs were used. Five kinds of images from each lung specimen were obtained using 64-detector row CT. All images were analysed by categories and grades, and the direct coronal sequential images were used as the reference standard for the image quality. Statistical analysis was performed for the following categories: (i) inter-observer reliability, (ii) interaction between the observers and images, (iii) image analysis, (iv) anatomical structural analysis of each observer, (v) stair-step artefact and (vi) background noise. The overall image quality and the image quality of all anatomical structures of coronal MPR images with 0.67 mm slice increments were inferior to the image quality of the other images; this difference was statistically significant (p<0.05). Stair-step artefact was detected on coronal MPR images, and was more prominent on coronal MPR images with 0.67 mm slice increments than on coronal MPR images with 0.34 mm slice increments. The most severe background noise was detected on the direct coronal sequential images, but there was no significant difference between the direct coronal sequential images and the direct coronal spiral images. Background noise was least prominent on coronal MPR images with 0.67 mm slice increments. The increment process is important for improving the image quality of MPR images even when using 64-detector row CT. Coronal MPR images with 0.34 mm slice increments using 64-detector row CT showed a similar image quality to that obtained from the direct coronal images, and can be used instead. This means that the coronal MPR images obtained with 64-detector row CT could be as useful for evaluating the lung parenchyma as the axial high-resolution CT images.     

Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters

Objective

To determine the radiation doses and image quality of different dual-source computed tomography coronary angiography (CTCA) protocols tailored to the heart rate (HR) and body mass index (BMI) of the patients.

Materials and methods

Two hundred consecutive patients (68 women; mean age 61 ± 9 years) underwent either helical CTCA with retrospective ECG-gating or sequential CT with prospective ECG-triggering: 50 patients (any BMI, any HR) were examined with a standard, non-tailored protocol (helical CTCA, 120 kV, 330 mAs), whereas the other 150 patients were examined with a tailored protocol: 40 patients (group A, BMI ≤ 25 kg/sqm, HR ≤ 70 bpm) with sequential CTCA (100 kV, 190 mAs_ref), 43 patients (group B, BMI ≤ 25 kg/sqm, HR > 70 bpm) with helical CTCA (100 kV, 220 mAs), 28 patients (group C, BMI > 25 kg/sqm, HR ≤ 70 bpm) with sequential CTCA (120 kV, 330 mAs_ref), and 39 patients (group D, BMI > 25 kg/sqm, HR > 70 bpm) with helical CTCA (120 kV, 330 mAs). The effective radiation dose estimates were calculated from the dose-length-product for each patient. Image quality was classified as being diagnostic or non-diagnostic in each coronary segment.

Results

Image quality was diagnostic in 2403/2460 (98%) and non-diagnostic in 57/2460 (2%) of all coronary segments. No significant differences in image quality were found among all five CTCA protocols (p = 0.78). The non-tailored helical CTCA protocol was associated with a radiation dose of 9.0 ± 1.0 mSv, being significantly higher compared to that using sequential CTCA (group A: 1.3 ± 0.3 mSv, p < 0.001; group C: 2.9 ± 0.6 mSv, p < 0.001), and helical CTCA at reduced tube voltage and tube current (group B: 4.2 ± 0.6 mSv, p < 0.01). No significant differences were found compared to the non-tailored CTCA protocol in patients with HR > 70 bpm (group D: 8.5 ± 0.9 mSv, p = 0.51).

Conclusions

Dual-source CTCA is associated with radiation doses ranging between 1.3 and 9.0 mSv, depending on the protocol used. Tailoring of the CTCA protocol to the HR and BMI of the individual patient results in dose reductions of up to 86%, while maintaining a diagnostic image quality of the examination.     

Electrocardiography-triggered high-resolution CT for reducing cardiac motion artifact: evaluation of the extent of ground-glass attenuation in patients with idiopathic pulmonary fibrosis

Purpose The aim of this study was to evaluate the decreasing of cardiac motion artifact and whether the extent of ground-glass attenuation of idiopathic pulmonary fibrosis (IPF) was accurately assessed by electrocardiography (ECG)-triggered high-resolution computed tomography (HRCT) by 0.5-s/rotation multidetector-row CT (MDCT). Materials and methods ECG-triggered HRCT were scanned at the end-diastolic phase by a MDCT scanner with the following scan parameters; axial four-slice mode, 0.5 mm collimation, 0.5-s/rotation, 120 kVp, 200 mA/rotation, high-frequency algorithm, and half reconstruction. In 42 patients with IPF, both conventional HRCT (ECG gating(−), full reconstruction) and ECG-triggered HRCT were performed at the same levels (10-mm intervals) with the above scan parameters. The correlation between percent diffusion of carbon monoxide of the lung (%DLCO) and the mean extent of ground-glass attenuation on both conventional HRCT and ECG-triggered HRCT was evaluated with the Spearman rank correlation coefficient test. Results The correlation between %DLCO and the mean extent of ground-glass attenuation on ECG-triggered HRCT (observer A: r = −0.790, P < 0.0001; observer B: r = −0.710, P < 0.0001) was superior to that on conventional HRCT (observer A: r = −0.395, P < 0.05; observer B: r = −0.577, P = 0.002) for both observers. Conclusion ECG-triggered HRCT by 0.5 s/rotation MDCT can reduce the cardiac motion artifact and is useful for evaluating the extent of ground-glass attenuation of IPF.     

MR flow measurements for assessment of the pulmonary, systemic and bronchosystemic circulation: impact of different ECG gating methods and breathing schema

PURPOSE: Different ECG gating techniques are available for MR phase-contrast (PC) flow measurements. Until now no study has reported the impact of different ECG gating techniques on quantitative flow parameters. The goal was to evaluate the impact of the gating method and the breathing schema on the pulmonary, systemic and bronchosystemic circulation. MATERIAL AND METHODS: Twenty volunteers were examined (1.5 T) with free breathing phase-contrast flow (PC-flow) measurements with prospective (free-prospective) and retrospective (free-retrospective) ECG gating. Additionally, expiratory breath-hold retrospective ECG gated measurements (bh-retrospective) were performed. Blood flow per minute; peak velocity and time to peak velocity were compared. The clinically important difference between the systemic and pulmonary circulation (bronchosystemic shunt) was calculated. RESULTS: Blood flow per minute was lowest for free-prospective (6 l/min, pulmonary trunc) and highest for bh-retrospective measurements (6.9 l/min, pulmonary trunc). No clinically significant difference in peak velocity was assessed (82-83 cm/s pulmonary trunc, 109-113 cm/s aorta). Time to peak velocity was shorter for retro-gated free-retrospective and bh-retrospective than for pro-gated free-prospective. The difference between systemic and pulmonary measurements was least for the free-retrospective technique. CONCLUSION: The type of gating has a significant impact on flow measurements. Therefore, it is important to use the same ECG gating method, especially for follow-up examinations. Retrospective ECG gated free breathing measurements allow for the most precise assessment of the bronchosystemic blood flow and should be used in clinical routine.     

Thin-section CT of the lung: influence of 0.5-s gantry rotation and ECG triggering on image quality

The aim of this study was to determine if ECG triggering and a shorter acquisition time of 0.5-s rotation decrease cardiac motion artifacts of thin-section CT of the lung. In 25 patients referred for thin-section thoracic CT, 1-mm thin-section slices were performed with a scanning time of 0.5 s with ECG gating, 0.5 s and 1 s during the diastolic phase of the heart at five identical anatomical levels from the aortic arch to lung basis. At each anatomical level and for each lung, cardiac motion artifacts were graded independently on a four-point scale by three readers. Patients were divided into two groups according to their heart rate. A four-way analysis of variance was used to assess differences between the three modalities. Mean cardiac motion artifacts scores were rated 1.23+/-0.02, 1.47+/-0.02, and 1.79+/-0.02, at 0.5 s with ECG gating, 0.5 s without ECG gating, and 1 s, respectively (F=139, p<0.0001). At the four anatomical levels below the aortic arch, the left lung scores were greater than the right lung score for the three modalities. For the modality 0.5 s with ECG gating no difference of scores was found between patients grouped according to their cardiac frequency. The 0.5-s gantry rotation with or without ECG gating scans reduces cardiac motion artifacts on pulmonary thin-section CT images and is mainly beneficial for the lower part of the left lung.     

Prospective versus retrospective ECG gating for dual source CT of the coronary stent: Comparison of image quality, accuracy, and radiation dose

Objective

To compare image quality, diagnostic accuracy and radiation dose of prospective and retrospective electrocardiogram (ECG) gated dual source computed tomography (DSCT) for the evaluation of the coronary stent, using conventional coronary angiography (CA) as a standard reference.

Design, setting and patients

Sixty patients (heart rates ≤70 bpm) with previous stent implantation who were scheduled for CA were divided in two groups, receiving either prospective or retrospective ECG gated DSCT separately. Two reviewers scored coronary stent image quality and evaluated stent lumen.

Results

There was no significant difference in image quality between the two groups. In the prospective group, there were 86.4% (51/59) stents with interpretable images, in the retrospective group, there were 87.5% (49/56) stents with interpretable images. Image quality was not influenced by age, body mass index or heart rate in either group, but heart rate variability had a weak impact on the image quality of the prospective group. Image noise was higher in the prospective group, but this difference reached statistical significance only by using a smooth kernel reconstruction. Per-stent based sensitivity, specificity, and positive and negative predictive value were 100%, 84.1%, 68.2%, and 100%, respectively, in the prospective CT angiography group and 94.4%, 86.8%, 77.3%, and 97.1%, respectively, in the retrospective CT angiography group. There was a significant difference in the effective radiation dose between the two groups, mean effective dose in the prospective and retrospective group was 2.2 ± 0.5 mSv (1.5-3.2 mSv) and 14.6 ± 3.3 mSv (10.0-20.4 mSv) (p < .001) respectively.

Conclusions

Compared with retrospective CT angiography, prospective CT angiography has a similar performance in assessing coronary stent patency, but a lower effective dose in selected patients with regular heart rates ≤70 bpm.     

Perfusion measurement of the whole upper abdomen of patients with and without liver diseases: initial experience with 320-detector row CT

Objectives

To report initial experience of upper abdominal perfusion measurement with 320-detector row CT (CTP) for assessment of liver diseases and therapeutic effects.

Materials and methods

Thirty-eight patients who were suspected of having a liver disease underwent CTP. There were two patients with liver metastases, two with hemangiomas, and four with cirrhosis (disease group). CTP was repeated for four patients with cirrhosis or hepatocellular carcinoma (HCC) after therapy. Hepatic arterial and portal perfusion (HAP and HPP) and arterial perfusion fraction (APF), and arterial perfusion (AP) of pancreas, spleen, stomach, and intra-portal HCC were calculated. For disease-free patients (normal group), the values were compared among liver segments and among pancreatic and gastric parts. The values were compared between groups and before and after therapy.

Results

No significant differences were found in the normal group except between APFs for liver segments 3 and 5, and fundus and antrum. Mean HAP and APF for the disease group were significantly higher than for the normal group. APF increased after partial splenic embolization or creation of a transjugular intrahepatic portosystemic shunt. HPP increased and AP of intra-portal HCC decreased after successful radiotherapy.

Conclusions

320-Detector row CT makes it possible to conduct perfusion measurements of the whole upper abdomen. Our preliminary results suggested that estimated perfusion values have the potential to be used for evaluation of hepatic diseases and therapeutic effects.     

Influence of detector collimation and beam pitch for identification and image quality of ground-glass attenuation and nodules on 16- and 64-detector row CT systems: experimental study using chest phantom

OBJECTIVE: The purpose of the present study was to determine the influence of detector collimation and beam pitch for identification and image quality of ground-glass attenuation (GGA) and nodules on 16- and 64-detector row CTs, by using a commercially available chest phantom. MATERIALS AND METHODS: A chest CT phantom including simulated GGAs and nodules was scanned with different detector collimations, beam pitches and tube currents. The probability and image quality of each simulated abnormality was visually assessed with a five-point scoring system. ROC-analysis and ANOVA were then performed to compare the identification and image quality of either protocol with standard values. RESULTS: Detection rates of low-dose CTs were significantly reduced when tube currents were set at 40mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32mmx1.0mm for low pitch, and at 100mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32mmx1.0mm for high pitch (p<0.05). Image qualities of low-dose CTs deteriorated significantly when tube current was set at 100mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32x1.0mm for low pitch, and at 150mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32x1.0mm for high pitch (p<0.05). CONCLUSION: Detector collimation and beam pitch were important factors for the image quality and identification of GGA and nodules by 16- and 64-detector row CT.     

Correlation of 64 row MDCT,echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease

Objective

To study the correlation of low-dose 64-row multi-detector computed tomography (MDCT) with echocardiography and cardiac catheterization angiography (CCA) in the assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease (CCHD).

Materials and methods

This prospective study included 105 children (74 males, 31 females) with CCHD, in the age group of 2 months to 20 years, who underwent 64-row MDCT examination (low-dose CT protocol), echocardiography and CCA for the assessment of pulmonary arteries, including visualization, presence of confluence, stenosis and collaterals. Statistical analysis was performed using the non-parametric statistical analysis test to evaluate the concordance or discordance between echocardiography, MDCT and CCA.

Results

64-row MDCT detected significantly more main and branch pulmonary arteries, patent pulmonary confluences, and more cases of pulmonary artery stenosis. CCA detected more major aorto-pulmonary collaterals than MDCT, whereas echocardiography failed to identify these major aorto-pulmonary collaterals. The effective CT radiation dose to patients less than 2 years of age was in the range of 0.7–2.5 mSv, where as the dose in patients more than 2 years of age ranged from that of 2.1 to 4.2 mSv, which is much less than the radiation dose reported in cardiac catheterization angiography.

Conclusion

In cases where cardiac MRI cannot be performed, or is not sufficiently informative, low-dose 64-row MDCT correlates well with CCA and can provide adequate information about pulmonary arterial anatomy in children with cyanotic congenital heart disease, and can replace invasive cardiac catheterization angiography with markedly reduced radiation dosage to the patient.