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BACKGROUND. Use of virtual monoenergetic images (VMIs) from multienergy CT scans can mitigate inconsistencies in traditional attenuation measurements that result from variation in scan-related factors. Photon-counting detector (PCD) CT systems produce VMIs as standard image output under flexible scanning conditions. OBJECTIVE. The purpose of this article was to evaluate the consistency of monoenergetic attenuation measurements obtained from a clinical PCD CT scanner across a spectrum of scanning paradigms. METHODS. A phantom with 10 tissue-simulating inserts was imaged using a clinical dual-source PCD CT scanner. Nine scanning paradigms were obtained across combinations of tube voltages (90, 120, and 140 kVp) and image quality (IQ) levels (80, 145, and 180). Images were reconstructed at VMI levels of 50, 60, 70, and 80 keV. Consistency of attenuation measurements was assessed, using the 120 kVp with IQ level of 145 scanning paradigm as the reference scan. RESULTS. For all scanning paradigms, attenuation measurements showed intra-class correlation of 0.999 and higher with respect to the reference scan. Across inserts, mean bias relative to the reference scan ranged from -14.9 to 13.6 HU, -2.7 to 1.7 HU, and -3.9 to 3.8 HU at tube voltages of 90, 120, and 140 kVp, respectively; and from -14.9 to 13.6 HU, -6.4 to 3.8 HU, -3.7 to 1.4 HU, and -7.2 to 4.3 HU at VMI levels of 50, 60, 70, and 80 keV, respectively. Thus, mean bias did not exceed 5 HU for any insert at tube potentials of 120 kVp and 140 kVp, nor for any insert at a VMI level of 70 keV. At a VMI level of 50 keV and tube potential of 90 kVp, mean bias exceeded 5 HU for 14 of 30 possible combinations of inserts and scanning paradigms and exceeded 10 HU for four of 30 such combinations. At VMI levels of both 60 and 80 keV, mean bias exceeded 5 HU for only two combinations of inserts and scanning paradigms, all at a tube potential of 90 kVp. CONCLUSION. PCD CT generally provided consistent attenuation measurements across combinations of scanning paradigms and VMI levels. CLINICAL IMPACT. PCD CT may facilitate quantitative applications of CT data in clinical practice.

This work aims to demonstrate that radial acquisition with k-space variant reduced-FOV reconstruction can enable real-time cardiac MRI with an affordable computation cost. Due to non-uniform sampling, radial imaging requires k-space variant reconstruction for optimal performance. By converting radial parallel imaging reconstruction into the estimation of correlation functions with a previously-developed correlation imaging framework, Cartesian k-space may be reconstructed point-wisely based on parallel imaging relationship between every Cartesian datum and its neighboring radial samples. Furthermore, reduced-FOV correlation functions may be used to calculate a subset of Cartesian k-space data for image reconstruction within a small region of interest, making it possible to run real-time cardiac MRI with an affordable computation cost. In a stress cardiac test where the subject is imaged during biking with a heart rate of >100 bpm, this k-space variant reduced-FOV reconstruction is demonstrated in reference to several radial imaging techniques including gridding, GROG and SPIRiT. It is found that the k-space variant reconstruction outperforms gridding, GROG and SPIRiT in real-time imaging. The computation cost of reduced-FOV reconstruction is ~2 times higher than that of GROG. The presented work provides a practical solution to real-time cardiac MRI with radial acquisition and k-space variant reduced-FOV reconstruction in clinical settings., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Adverse effects of intravenous contrast media (CM) in patients with renal risk factors and acute kidney injury are still controversially discussed. The aim of this study was to investigate whether dual-energy (DE) pulmonary CT angiography (CTPA) in combination with a noise optimized virtual monoenergetic imaging algorithm allows for a reduction of CM. This IRB-approved study comprised 150 patients with suspected pulmonary embolism (78 male; mean age 65 ± 17years). 50 patients with acute/chronic renal failure were examined on a 3 rd generation dual-source CT with an optimized DE CTPA protocol and a low CM injection protocol (5.4 g iodine). 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). For the DE CTPA virtual monoenergetic spectral datasets (40-100 keV) were reconstructed. Main pulmonary arteries at 50 keV and peripheral pulmonary arteries at 40 keV datasets provided the highest contrast-to-noise-ratio (CNR) for both the standard DE CTPA and the optimized protocol, with significantly higher CNR values for the standard DE CTPA protocol (p < 0.05). No pulmonary embolism was missed on the optimized CM protocol. DE CTPA utilizing image reconstruction at 40/50 keV allowed for a reduction of 84% in iodine load while maintaining CNR, which is especially important in patients with acute/chronic renal failure.

Objectives: To prospectively intra-individually compare image quality of a 3rd generation Dual-Source-CT (DSCT) spiral cranial CT (cCT) to a sequential 4-slice Multi-Slice-CT (MSCT) while maintaining identical intra-individual radiation dose levels., Methods: 35 patients, who had a non-contrast enhanced sequential cCT examination on a 4-slice MDCT within the past 12 months, underwent a spiral cCT scan on a 3rd generation DSCT. CTDIvol identical to initial 4-slice MDCT was applied. Data was reconstructed using filtered backward projection (FBP) and 3rd-generation iterative reconstruction (IR) algorithm at 5 different IR strength levels. Two neuroradiologists independently evaluated subjective image quality using a 4-point Likert-scale and objective image quality was assessed in white matter and nucleus caudatus with signal-to-noise ratios (SNR) being subsequently calculated., Results: Subjective image quality of all spiral cCT datasets was rated significantly higher compared to the 4-slice MDCT sequential acquisitions (p<0.05). Mean SNR was significantly higher in all spiral compared to sequential cCT datasets with mean SNR improvement of 61.65% (p*Bonferroni0.05<0.0024). Subjective image quality improved with increasing IR levels., Conclusion: Combination of 3rd-generation DSCT spiral cCT with an advanced model IR technique significantly improves subjective and objective image quality compared to a standard sequential cCT acquisition acquired at identical dose levels.

Objectives: To prospectively evaluate radiation dose and image quality of a third generation dual-source CT (DSCT) without z-axis filter behind the patient for temporal bone CT., Methods: Forty-five patients were either examined on a first, second, or third generation DSCT in an ultra-high-resolution (UHR) temporal bone-imaging mode. On the third generation DSCT system, the tighter focal spot of 0.2 mm(2) removes the necessity for an additional z-axis-filter, leading to an improved z-axis radiation dose efficiency. Images of 0.4 mm were reconstructed using standard filtered-back-projection or iterative reconstruction (IR) technique for previous generations of DSCT and a novel IR algorithm for the third generation DSCT. Radiation dose and image quality were compared between the three DSCT systems., Results: The statistically significantly highest subjective and objective image quality was evaluated for the third generation DSCT when compared to the first or second generation DSCT systems (all p < 0.05). Total effective dose was 63%/39% lower for the third generation examination as compared to the first and second generation DSCT., Conclusions: Temporal bone imaging without z-axis-UHR-filter and a novel third generation IR algorithm allows for significantly higher image quality while lowering effective dose when compared to the first two generations of DSCTs., Key Points: • Omitting the z-axis-filter allows a reduction in radiation dose of 50% • A smaller focal spot of 0.2 mm (2) significantly improves spatial resolution • Ultra-high-resolution temporal-bone-CT helps to gain diagnostic information of the middle/inner ear.

Purpose: To prospectively evaluate radiation and contrast medium requirements for performing high-pitch coronary computed tomographic (CT) angiography at 70 kV using a third-generation dual-source CT system in comparison to a second-generation dual-source CT system., Materials and Methods: All patients gave informed consent for this institutional review board-approved study. Forty-five patients (median age, 52 years; 27 men) were imaged in high-pitch mode with a third-generation dual-source CT system at 70 kV (n = 15) or with a second-generation dual-source CT system at 80 or 100 kV (n = 15 for each). Tube voltage was based on body mass index: 80 or 70 kV for less than 26 kg/m(2) versus 100 kV for 26-30 kg/m(2). For the 80- and 100-kV protocols, 80 mL of contrast material was injected, versus 45 mL for the 70-kV protocol. Data were reconstructed by using a second-generation iterative reconstruction algorithm for second-generation dual-source CT and a recently introduced third-generation iterative reconstruction algorithm for third-generation dual-source CT. Objective image quality was measured for various regions of interest, and subjective image quality was evaluated with a five-point Likert scale., Results: The signal-to-noise ratio of the coronary CT angiography studies acquired with 70 kV was significantly higher (70 kV: 14.3-17.6 vs 80 kV: 7.1-12.9 vs 100 kV: 9.8-12.9; P < .0497) than those acquired with the other two protocols for all coronary arteries. Qualitative image quality analyses revealed no significant differences between the three CT angiography protocols (median score, 5; P > .05). The mean effective dose was 75% and 108% higher (0.92 mSv ± 0.3 [standard deviation] and 0.78 mSv ± 0.2 vs 0.44 mSv ± 0.1; P < .0001), respectively, for the 80- and 100-kV CT angiography protocols than for the 70-kV CT angiography protocol., Conclusion: In nonobese patients, third-generation high-pitch coronary dual-source CT angiography at 70 kV results in robust image quality for studying the coronary arteries, at significantly reduced radiation dose (0.44 mSv) and contrast medium volume (45 mL), thus enabling substantial radiation dose and contrast medium savings as compared with second-generation dual-source CT.

Rationale and Objectives: To compare in dual-energy CT (DECT) conventionally reconstructed polyenergetic images (PEI) at 120 kVp to virtual monoenergetic images (MEI) at different kiloelectron volt (keV) levels for evaluation of liver and gastrointestinal stromal tumor (GIST) hepatic metastases with regard to objective (IQob) and subjective image quality (IQsub) assessed by two readers of varying experience. Image quality was correlated to patient size and compared between PEI and MEI., Materials and Methods: From 50 examinations of 17 GIST patients (12 with hepatic metastases) undergoing abdominal dual-source DECT for staging, therapy monitoring or follow-up, PEI and nine MEI in 10-keV intervals from 40 to 120 keV were reconstructed. Liver contrast-to-noise ratios (CNR) and metastasis-to-liver ratios were calculated. MEI reconstructions with the highest IQob were compared to PEI for IQsub by one experienced reader (ER) and one inexperienced reader (IR). Patients' diameters were correlated to IQob and IQsub ratings., Results: MEI at 70 keV had the highest IQob with equal liver CNR and metastasis-to-liver ratio compared to PEI. The ER rated 70-keV MEI and PEI equally high (median 4), whereas the IR rated IQsub best in 70-keV MEI (median 5). Unlike in PEI, IQsub ratings in 70-keV MEI were not correlated to patient size., Conclusions: MEI at 70 keV provided an IQob equivalent to PEI. Regarding the IR, IQsub was improved in 70-keV MEI compared to PEI and less dependent on patient size. Therefore, IRs might improve their diagnostic confidence in the assessment of hepatic GIST metastases by evaluating MEI reconstructions at 70 keV., (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate diagnostic accuracy of high, low and mixed voltage dual energy computed tomography (DECT) for detection of prior myocardial infarction (MI)., Methods: Twenty-four consecutive patients (88% male, mean age 65 ± 11 years old) with clinically documented prior MI (> 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI. Computed tomography (CT) examinations were performed using a dual source CT system (64-slice Definition or 128-slice Definition FLASH, Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions. Using the 17-segment model, regional systolic function was analyzed using first pass CT as normal or abnormal (hypokinetic, akinetic, dyskinetic). Regions with abnormal systolic function were identified as infarct segments. Late phase DE scans were reconstructed into: 140 kVp, 100 kVp, mixed (120 kVp) images and iodine-only datasets. Using the same 17-segment model, each dataset was evaluated for possible (grade 2) or definite (grade 3) late phase myocardial enhancement abnormalities. Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores., Results: All patients reported prior history of documented myocardial infarction, with most occurring more than 5 years prior (n = 18; 75% of cohort). Fifty-five of 408 (13%) segments demonstrated abnormal wall motion and were classified as infarct. The remaining 353 segments were classified as non-infarcted segments. A total of 1692 segments were analyzed for late phase enhancement abnormalities, with 91 (5.5%) segments not interpretable due to artifact. Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated. Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy (87%; 95%CI: 80%-90%), sensitivity (86%-93%; 95%CI: 54%-78%) and specificity (90%; 95%CI: 86%-93%) compared to the other reconstructions. For sensitivity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.0005), 100 kVp vs mixed (P < 0.0001), and 100 kVp vs iodine only (P < 0.005) using combined grade 2 and grade 3 perfusion abnormalities. For specificity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.005), and 100 kVp vs mixed (P < 0.01) using combined grades 2 and 3 perfusion abnormalities., Conclusion: Low voltage acquisition CT, 100 kVp in this study, demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.

Background and Purpose: Recently introduced fpVCT scanners can capture volumetric (4D) time-varying projections enabling whole-organ dynamic CTA imaging. The main objective of this study was to assess the temporal resolution of dynamic CTA in discriminating various phases of rapid and slow time-dependent neurovascular pathologies in animal models., Materials and Methods: Animal models were created to assess phasic blood flow, subclavian steal phenomena, saccular aneurysms, and neuroperfusion under protocols approved by the SRAC. Animals with progressively increasing heart rate-Macaca sylvanus (~100 bpm), Oryctolagus cuniculus (NZW rabbit) (~150 bpm), Rattus norvegicus (~300 bpm), Mus musculus (~500 bpm)-were imaged to challenge the temporal resolution of the system. FpVCT, a research prototype with a 25 × 25 × 18 cm coverage, was used for dynamic imaging with the gantry rotation time varying from 3 to 5 seconds. Volumetric datasets with 50% temporal overlap were reconstructed; 4D datasets were analyzed by using the Leonardo workstation., Results: Dynamic imaging by using fpVCT was capable of demonstrating the following phenomena: 1) subclavian steal in rabbits (ΔT ≅ 3-4 seconds); 2) arterial, parenchymal, and venous phases of blood flow in mice (ΔT ≅ 2 seconds), rabbits (ΔT ≅ 3-4 seconds), and Macaca sylvanus (ΔT ≅ 3-4 seconds); 3) sequential enhancement of the right and left side of the heart in Macaca sylvanus and white rabbits (ΔT ≅ 2 seconds); and 4) different times of the peak opacification of cervical and intracranial arteries, venous sinuses, and the jugular veins in these animals (smallest, ΔT ≅ 1.5-2 seconds). The perfusion imaging in all animals tested was limited due to the fast transit time through the brain and the low contrast resolution of fpVCT., Conclusions: Dynamic imaging by using fpVCT can distinguish temporal processes separated by >1.5 seconds. Neurovascular pathologies with a time constant >1.5 seconds can be evaluated noninvasively by using fpVCT.

Purpose: The aim of this study was (a) to compare arterial enhancement in simultaneously acquired high- and low-kilovoltage images; and (b) to determine whether low tube-voltage imaging would permit PE evaluation on routine chest CT studies or CTPA studies performed with a low volume of contrast media., Materials and Methods: We compared 20 CTPA studies (CTPA group), 20 routine thoracic CT studies (RT group) and 10 CTPA studies performed with reduced volume of contrast media (RC group). HU values were measured in all groups at 80 kVp and 140 kVp images in multiple pulmonary arterial segments bilaterally. The diagnostic quality of the central and peripheral vascular enhancement and the image noise were evaluated at both energies using a five-point scale., Results: For all patients, the mean CT attenuation values were greater at 80 kVp than 140 kVp images (p<0.001). At 80 kVp, CTPA group attenuation values were greater than RT group (p=0.03) with a similar trend at 140 kVp (p=0.08). At both 140 kVp and 80 kVp, CTPA group attenuation values were greater than RC group (p=0.02 and p=0.03, respectively). Qualitative analysis showed that at 140 kVp CTPA studies had better global image quality scores than RT (p=0.003) and RC (p=0.001) groups. However, at 80 kVp, there was no significant difference of global image quality between CTPA and the other groups (p=0.4 and p=0.5, respectively). Although measurable image noise was greater at 80 kVp than 140 kVp (p<0.001), qualitative analysis revealed lower image noise at 80 kVp images., Conclusion: DECT at 80 kVp increases arterial enhancement in both CTPA and routine studies. For routine studies this results in central and peripheral enhancement quality equivalent to that of CTPA studies. Low tube-voltage imaging allows marked contrast volume reduction for CTPA. In selected cases, satisfactory lower radiation dose CT might be achievable using lower kVp imaging alone., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: The purpose of this study was to validate the utility of dual-source dual-energy MDCT in quantifying iodine concentration in a phantom and in renal masses., Materials and Methods: A series of tubes containing solutions of varying iodine concentration were imaged with dual-source dual-energy MDCT. Iodine concentration was calculated and compared with known iodine concentration. Single-phase contrast-enhanced dual-source dual-energy MDCT data on 15 patients with renal lesions then were assessed independently by two readers. Dual-energy postprocessing was used to generate iodine-only images. Regions of interest were placed on the iodine image over the lesion and, as a reference, over the aorta, for recording of iodine concentration in the lesion and in the aorta. Another radiologist determined lesion enhancement by comparing truly unenhanced with contrast-enhanced images. Mixed-model analysis of variance based on ranks was used to compare lesion types (simple cyst, hemorrhagic cyst, enhancing mass) in terms of lesion iodine concentration and lesion-to-aorta iodine ratio., Results: In the phantom study, there was excellent correlation between calculated and true iodine concentration (R(2) = 0.998, p < 0.0001). In the patient study, 13 nonenhancing (10 simple and three hyperdense cysts) and eight enhancing renal masses were evaluated in 15 patients. The lesion iodine concentration and lesion-to-aorta iodine ratio in enhancing masses were significantly higher than in hyperdense and simple cysts (p < 0.0001)., Conclusion: Iodine quantification with dual-source dual-energy MDCT is accurate in a phantom and can be used to determine the presence and concentration of iodine in a renal lesion. Characterization of renal masses may be possible with a single dual-source dual-energy MDCT acquisition without unenhanced images or reliance on a change in attenuation measurements.

Background: The adult practice for ECG-gated single-source 64-slice coronary CTA (CCTA) includes administering beta-blockers to reduce heart rate. There are limited data on this process in children., Objective: To evaluate the safety and efficacy of a drug regimen to decrease heart rate before performing CCTA in children., Materials & Methods: IV remifentanil and esmolol infusion were chosen to decrease heart rate in 41 children (mean age 6.5 years) while they were under general anesthesia (GA) for CCTA. Drug doses, changes in heart rate and procedural complications were recorded. CCTA image quality was graded on a scale of 1 to 5. The relationships between image quality and heart rate and image quality and age were evaluated. Patient effective radiation doses were calculated., Results: Heart rates were lowered utilizing esmolol (4 children), remifentanil (2 children) or both (35 children); 26 children received nitroglycerin for coronary vasodilation. The mean decrease in heart rate was 26%. There were no major complications. The average image-quality score was 4.4. Higher heart rates were associated with worse image quality (r = 0.67, P < 0.0001). Older age was associated with better image quality (r = 0.66, P < 0.0001). Effective radiation doses were 0.7 to 7.0 mSv., Conclusion: Heart rate reduction for pediatric CCTA can be safely and effectively achieved while yielding high-quality images.

Purpose: To evaluate the efficacy of dual-energy computed tomography (CT) in the differentiation of intracerebral hemorrhage (ICH) from iodinated contrast material in patients who received contrast material via intraarterial or intravenous delivery., Materials and Methods: This retrospective study was approved by the local institutional review board, which waived the informed consent requirement for the analysis. Sixteen patients with acute stroke and two with head trauma who had undergone intraarterial or intravenous administration of iodinated contrast material were evaluated by using dual-energy CT to differentiate areas of hyperattenuation secondary to contrast material staining from those representing ICH. A dual-energy CT scanner was used for imaging at 80 and 140 kV, and a three-material decomposition algorithm was used to obtain virtual unenhanced images and iodine overlay images. The sensitivity, specificity, and accuracy of dual-energy CT in the prospective differentiation of intraparenchymal contrast material from hemorrhage were obtained. Follow-up images were used as the standard of reference., Results: There were 28 intraparenchymal areas of hyperattenuation classified at dual-energy CT as iodinated contrast material staining (n = 20, 71%), hemorrhage (n = 5, 18%), or both (n = 3, 11%). Two of the three areas of hyperattenuation seen on both virtual unenhanced and iodine overlay images were related to mineralization. The sensitivity, specificity, and accuracy of dual-energy CT in the identification of hemorrhage were 100% (six of six areas), 91% (20 of 22 areas), and 93% (26 of 28 areas), respectively., Conclusion: Dual-energy CT can help differentiate ICH from iodinated contrast material staining with high sensitivity and specificity in patients who have recently received intraarterial or intravenous iodinated contrast material.

Purpose: The objectives of this study were (1) to evaluate the potential of low-peak kilovoltage (kVp) images acquired with dual-energy computed tomography (DECT) to improve aortic attenuation and reduce contrast agent utilization and (2) to evaluate the feasibility of material-specific DECT imaging for evaluating aortic disease., Materials and Methods: Aortic imaging characteristics of 2 groups of patients examined with DECT were compared. In the first group, CT angiography (CTA) was performed in patients with known or suspected aortic disease (CTA group: n = 20, 100-150 mL of contrast at 4.5 mL/s). In the second group, reduced contrast volume CTA was performed in patients with "routine" indications (RC group: n = 20, 50-60 mL at 3 mL/s followed by a saline chaser). In both groups, aortic attenuation and SD were measured at 80 and 140 kVp, and the image quality was analyzed using a 5-point scale. The use of DECT postprocessing techniques for assessing aortic pathology was also evaluated., Results: For all patients, the aortic attenuation was significantly higher at 80 kVp than at 140 kVp (P < 0.001). Image noise measured quantitatively was higher at 80 kVp (P < 0.001) but did not affect the perceived image quality (P = 0.3). Using low-peak kilovoltage allowed aortic CTA to be performed with a markedly reduced contrast volume and flow rate, with image quality similar to standard CTA (P = 0.2). In a series of cases with proved aortic disease, comparison of true precontrast and subtraction "virtual noncontrast" images showed the potential to eliminate aortic precontrast imaging, reducing radiation exposure., Conclusions: Single-acquisition DECT combines (1) the benefits of low-kVp vascular imaging (increased iodine conspicuity coupled with a contrast volume/rate reduction) and (2) the use of material-specific imaging techniques to uniquely characterize the aortic pathology.

Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future., (AA Georg Thieme Verlag KG Stuttgart A New York.)

Purpose: We assessed the accuracy and reproducibility of non-calcified plaque quantification as simulated by a low-density stenosis in vessel phantoms using diameter and area measures, as well as the influence of vessel size and motion on quantification accuracy in dual-source computed tomography (DSCT)., Methods: Four phantoms (2, 2.5, 3, and 4 mm in luminal diameter) made from a radiopaque Lucite (126 +/- 23 Hounsfield units, HU) simulating a fixed radiolucent concentric coronary stenosis (7 +/- 2 HU, 50% luminal narrowing) were connected to a cardiac motion simulator. Stenosis quantification was based on area and diameter measurements. All measurements were highly reproducible (all ICC > or =0.95, p < 0.001)., Results: The mean measured degree of stenosis was 38.0 +/- 11.7% for a single diameter measurement, resulting in a mean relative error of 22.0 +/- 18.7%, decreasing with increasing phantom size (31.9 +/- 22.1%; 25.2 +/- 20.9%; 16.3 +/- 12.8%; 14.5 +/- 11.4%; for 2-, 2.5-, 3-, and 4-mm phantoms, respectively; p < 0.0001). Measurement accuracy significantly increased to 13.3 +/- 13.9% by using area measurement (p < 0.0001). The degree of stenosis was not significantly different when comparing a motioned image with an image at rest., Conclusion: DSCT enables highly reproducible quantification of low density stenosis, but underestimates the degree of stenosis, especially in small vessels. Area-based measurements reflect the true degree of stenosis with higher accuracy than diameter.

Object: Imaging of intracranial aneurysms using conventional multidetector CT (MDCT) is limited because of nonvisualization of features such as perforating vessels, pulsatile blebs, and neck remnants after clip placement or coil embolization. In this study, a model of intracranial saccular aneurysms in rabbits was used to assess the ultra-high resolution and dynamic scanning capabilities of a prototype flat-panel volumetric CT (fpVCT) scanner in demonstrating these features., Methods: Ten New Zealand white rabbits underwent imaging before and after clipping or coil embolization of surgically created aneurysms in the proximal right carotid artery. Imaging was performed using a prototype fpVCT scanner, a 64-slice MDCT scanner, and traditional catheter angiography. In addition to the slice data and 3D views, 4D dynamic views, a capability unique to fpVCT, were also created and reviewed. The images were subjectively compared on 1) 4 image quality metrics (spatial resolution, noise, motion artifacts, and aneurysm surface features); 2) 4 posttreatment features reflecting the metal artifact profile of the various imaging modalities (visualization of clip or coil placement, perianeurysmal clip/coil anatomy, neck remnant, and white-collar sign); and 3) 2 dynamic features (blood flow pattern and aneurysm pulsation)., Results: Flat-panel volumetric CT provided better image resolution than MDCT and was comparable to traditional catheter angiography. The surface features of aneurysms were demonstrated with much higher resolution, detail, and clarity by fpVCT compared with MDCT and angiography. Flat-panel volumetric CT was inferior to both MDCT and angiography in terms of image noise and motion artifacts. In fpVCT images, the metallic artifacts from clips and coils were significantly fewer than those in MDCT images. As a result, clinically important information about posttreatment aneurysm neck remnants could be derived from fpVCT images but not from MDCT images. Time-resolved dynamic sequences were judged slightly inferior to conventional angiography but superior to static MDCT images., Conclusions: The spatial resolution, surface anatomy visualization, metal artifact profile, and 4D dynamic images from fpVCT are superior to those from MDCT. Flat-panel volumetric CT demonstrates aneurysm surface features to better advantage than angiography and is comparable to angiography in metal artifact profile. Even though the temporal resolution of fpVCT is not quite as good as that of angiography, fpVCT images yield clinically important anatomical information about aneurysm surface features and posttreatment neck remnants not attainable with either angiography or MDCT images.

Purpose: To determine inter-scan, inter-reader and intra-reader variability of trabecular structure analysis using flat-panel volume computed tomography (fp-VCT) in cadaver knee specimens., Methods: Five explanted knee specimens were imaged at three different time points using fp-VCT. Four parameters that quantify trabecular bone structure of the proximal tibia were measured by two observers at two different time points. Bland-Altman analysis was used to compute the inter-scan, inter-observer and intra-observer variability., Results: Inter-scan variability was low, with a mean difference of 0% and a standard deviation less than 8.4% for each of the four parameters. The inter-observer and intra-observer variability was less than 2.8% +/- 8.5%., Conclusion: Fp-VCT is a method for assessing trabecular structure parameters with low inter-scan, inter-reader and intra-reader variability.

Purpose: To qualitatively and quantitatively compare virtual nonenhanced (VNE) data sets derived from dual-energy (DE) computed tomography (CT) with true nonenhanced (TNE) data sets in the same patients and to calculate potential radiation dose reductions for a dual-phase renal multidetector CT compared with a standard triple-phase protocol., Materials and Methods: This prospective study was approved by the institutional review board; all patients provided written informed consent. Seventy one men (age range, 30-88 years) and 39 women (age range, 22-87 years) underwent preoperative DE CT that included unenhanced, DE nephrographic, and delayed phases. DE CT parameters were 80 and 140 kV, 96 mAs (effective). Collimation was 14 x 1.2 mm. CT numbers were measured in renal parenchyma and tumor, liver, aorta, and psoas muscle. Image noise was measured on TNE and VNE images. Exclusion of relevant anatomy with the 26-cm field of view detector was quantified with a five-point scale (0 = none, 4 = >75%). Image quality and noise (1 = none, 5 = severe) and acceptability for VNE and TNE images were rated. Effective radiation doses for DE CT and TNE images were calculated. Differences were tested with a Student t test for paired samples., Results: Mean CT numbers (+/- standard deviation) on TNE and VNE images, respectively, for renal parenchyma were 30.8 HU +/- 4.0 and 31.6 HU +/- 7.1, P = .29; liver, 55.8 HU +/- 8.6 and 57.8 HU +/- 10.1, P = .11; aorta, 42.1 HU +/- 4.1 and 43.0 HU +/- 8.8, P = .16; psoas, 47.3 HU +/- 5.6 and 48.1 HU +/- 9.3 HU, P = .38. No exclusion of the contralateral kidney was seen in 50 patients, less than 25% was seen in 43, 25%-50% was seen in 13, and 50%-75% was seen in four. Mean image noise was 1.71 +/- 0.71 for VNE and 1.22 +/- 0.45 for TNE (P < .001); image quality was 1.70 HU +/- 0.72 for VNE and 1.15 HU +/- 0.36 for TNE (P < .0001). In all but three patients radiologists accepted VNE images as replacement for TNE images. Mean effective dose for DE CT scans of the abdomen was 5.21 mSv +/- 1.86 and that for nonenhanced scans was 4.97 mSv +/- 1.43. Mean dose reduction by omitting the TNE scan was 35.05%., Conclusion: In patients with renal masses, DE CT can provide high-quality VNE data sets, which are a reasonable approximation of TNE data sets. Integration of DE scanning into a renal mass protocol will lower radiation exposure by 35%.

Recent technologic advances in multidetector computed tomography have allowed the performance of simultaneous acquisition dual-energy computed tomography (DECT). The advantages of this new technique include simultaneous visualization of lower voltage tube images with improved iodine conspicuity and the performance of material specific imaging, which attempts to differentiate specific materials in the generated images. In this article, we review the concepts and physical principles of DECT using congenital thoracic abnormalities as a substrate for depicting the versatility of DECT.

Flat-panel volume computed tomography (fpVCT) is a recent development in imaging. We discuss some of the musculoskeletal applications of a high-resolution flat-panel CT scanner. FpVCT has four main advantages over conventional multidetector computed tomography (MDCT): high-resolution imaging; volumetric coverage; dynamic imaging; omni-scanning. The overall effective dose of fpVCT is comparable to that of MDCT scanning. Although current fpVCT technology has higher spatial resolution, its contrast resolution is slightly lower than that of MDCT (5-10HU vs. 1-3HU respectively). We discuss the efficacy and potential utility of fpVCT in various applications related to musculoskeletal radiology and review some novel applications for pediatric bones, soft tissues, tumor perfusion, and imaging of tissue-engineered bone growth. We further discuss high-resolution CT and omni-scanning (combines fluoroscopic and tomographic imaging).

Flat-panel volume computed tomography (CT) systems have an innovative design that allows coverage of a large volume per rotation, fluoroscopic and dynamic imaging, and high spatial resolution that permits visualization of complex human anatomy such as fine temporal bone structures and trabecular bone architecture. In simple terms, flat-panel volume CT scanners can be thought of as conventional multidetector CT scanners in which the detector rows have been replaced by an area detector. The flat-panel detector has wide z-axis coverage that enables imaging of entire organs in one axial acquisition. Its fluoroscopic and angiographic capabilities are useful for intraoperative and vascular applications. Furthermore, the high-volume coverage and continuous rotation of the detector may enable depiction of dynamic processes such as coronary blood flow and whole-brain perfusion. Other applications in which flat-panel volume CT may play a role include small-animal imaging, nondestructive testing in animal survival surgeries, and tissue-engineering experiments. Such versatility has led some to predict that flat-panel volume CT will gain importance in interventional and intraoperative applications, especially in specialties such as cardiac imaging, interventional neuroradiology, orthopedics, and otolaryngology. However, the contrast resolution of flat-panel volume CT is slightly inferior to that of multidetector CT, a higher radiation dose is needed to achieve a comparable signal-to-noise ratio, and a slower scintillator results in a longer scanning time.

Purpose: To evaluate the possible radiation dose reduction facilitated by using dual-energy (DE) multidetector computed tomography (CT) after endovascular repair of abdominal aortic aneurysms (AAAs)., Materials and Methods: This prospective study was HIPAA compliant and institutional review board approved. Twenty-two patients who previously had undergone endovascular repair of AAAs underwent 24 DE multidetector CT examinations, which were performed with a 64-detector scanner. Initial nonenhanced CT was followed by arterial phase and venous phase acquisitions. Virtual nonenhanced, pure 80-kVp, and weighted-average peak voltage CT data sets were generated from the venous acquisition. Two independent readers interpreted the virtual nonenhanced and DE weighted-average CT data for the presence or absence of endoleaks. These interpretations were compared with the clinical interpretations of the data performed by a different radiologist by using true nonenhanced, arterial phase, and venous phase data. Region-of-interest measurements of the abdominal aorta and of the region of the endoleaks were obtained. Effective radiation dose was calculated., Results: Both independent readers' interpretations of the virtual nonenhanced and weighted-average venous CT data revealed six type II endoleaks. There were no false-positive or false-negative findings. Aortic attenuation during the arterial, 80-kVp venous, and weighted-average data acquisitions were 288, 213, and 150 HU, respectively. The attenuation of the endoleaks was higher during the 80-kVp acquisition (P < .03) than during the arterial phase and weighted-average venous phase acquisitions. The mean effective dose for DE venous phase CT was 11.1 mSv compared with 27.8 mSv for standard triple-phase CT with a single-source configuration., Conclusion: Preliminary observations suggest that obtaining DE multidetector CT data by using a single 60-second contrast material-enhanced acquisition may be all that is required for surveillance after endovascular repair of AAA., ((c) RSNA, 2008.)

The purpose of this study was to evaluate the achievable organ dose savings in low-dose multislice computed tomography (MSCT) of the heart using different tube voltages (80 kVp, 100 kVp, 120 kVp) and compare it with calculated values. A female Alderson-Rando phantom was equipped with thermoluminescent dosimeters (TLDs) in five different positions to assess the mean doses within representative organs (thyroid gland, thymus, oesophagus, pancreas, liver). Radiation exposure was performed on a 16-row MSCT scanner with six different routine scan protocols: a 120-kV and a 100-kV CT angiography (CTA) protocol with the same collimation, two 120-kV Ca-scoring (CS) protocols with different collimations and two 80-kV CS protocols with the same collimation as the 120-kV CS protocols. Each scan protocol was repeated five times. The measured dose values for the organs were compared with the values calculated by a commercially available computer program. Directly irradiated organs, such as the esophagus, received doses of 34.7 mSv (CTA 16x0.75 120 kVp), 21.9 mSv (CTA 16x0.75 100 kVp) and 4.96 mSv (CS score 12x1.5 80 kVp), the thyroid as an organ receiving only scattered radiation collected organ doses of 2.98 mSv (CTA 16x0.75 120 kVp), 1.97 mSv (CTA 16x0.75 100 kVp) and 0.58 mSv (CS score 12x1.5 80 kVp). The measured relative organ dose reductions from standard to low-kV protocols ranged from 30.9% to 55.9% and were statistically significant (P<0.05). The comparison with the calculated organ doses showed that the calculation program can predict the relative dose reduction of cardiac low photon-energy protocols precisely.

The aims of this study were to optimize image quality for indirect CT venography (sequential versus spiral), and to evaluate different image reconstruction parameters for patients with suspected deep venous thrombosis (DVT). Fifty-one patients (26/25 with/without DVT) were prospectively evaluated for pulmonary embolism (PE) with standard multidetector-row computed tomography (MDCT) protocols. Retrospective image reconstruction was done with different slice thicknesses and reconstruction increments in sequential and spiral modes. All reconstructions were read for depiction of DVT and to evaluate best reconstruction parameters in comparison with the thinnest reconstruction ("gold standard"). Image noise and venous enhancement were measured as objective criteria for image quality. Subjective image quality was rated on a four-point scale. Effective dose was estimated for all reconstructions. In sequential 10/50 reconstruction DVT was completely detected in 13/26 cases, partially in 10/26 cases and was not detected at all in 3/26 cases, and 15/26, 9/26 and 2/26 cases for the 10/20 reconstruction, respectively. DVT was completely detected in all spiral reconstructions. Image noise ranged between 14.8-29.1 HU. Median image quality was 2. Estimated effective dose ranged between 2.3 mSv and 11.8 mSv. Gaps in sequential protocols may lead to false negative results. Therefore, spiral scanning protocols for complete depiction of DVT are mandatory.

Noninvasive modalities like CTA are increasingly replacing selective angiography in the evaluation of carotid artery stenosis. Dedicated scan protocols and contrast injection techniques are mandatory for the morphological assessment of carotid artery stenosis. These protocols need to be adapted to different scanner types. The delineation of plaque components and the residual lumen is improved with high resolution scan protocols and dedicated reconstruction algorithms. The exact delineation of in-stent stenosis remains limited. Standardization of postprocessing is crucial in order to attain reproducible results. Multislice spiral CT allows reliable grading of carotid artery stenosis. Relevant venous opacification and pulsation artifacts have to be expected with 4-slice scanners, the short scan time of the latest CT scanners minimize these problems.

A collection of software applications dedicated to clinical x-ray computed tomography (CT) has been developed. These tools are designed for routine and scientific work and represent a complete platform, which is called syngo Explorer. The user can reconstruct, process, and view CT images in a personal computer environment independently of specialized hardware. To manage patient data and to allow full database access, the system uses the syngo platform (Siemens Medical Solutions, Erlangen, Germany), which serves as a framework for the management and visualization of Digital Imaging and Communications in Medicine (DICOM) images. Part of the philosophy behind syngo Explorer is to quickly provide specialized solutions and to be able to respond to user requests at once. Thus, syngo Explorer was built by choosing a modular setup that comprises standard and specific reconstruction algorithms as well as various artifact reduction techniques; it also helps one attain better insights into dose issues. Various raw data formats of commercial CT scanners are supported. Reconstruction algorithms equivalent to those on the manufacturer's scanner console are provided. A non-syngo Windows XP (Microsoft, Redmond, Wash) version of the application is available., (Copyright RSNA, 2004)