Introduction Of Multidetector Row Computed Tomography Research Articles

Sa1675 Diagnosis of T Stage and Histological Type of Gastric Cancer by Virtual Endoscopy With Multiplanar Reconstruction Images

The introduction of multidetector-row CT has allowed thinner collimation and faster scanning, which has remarkably improved imaging resolution and facilitated three-dimensional image reconstruction. Furthermore, contrast-enhanced multiplanar reconstruction (MPR) images provide useful Information on the gastric wall and tumor status. Therefore, diagnostic performance of virtual endoscopy using multidetector-row CT has been improved. However, clinical application of virtual endoscopy has not been progressing in upper gastrointestinal tract area.

Coronary CT angiography and CT myocardial perfusion - challenges still ahead

Recent technical advances have set the stage for multi-detector CT as a comprehensive technique for assessment of coronary artery disease. Cardiac CT became a possibility in the mid 1990s, and with the introduction of multi-detector row CT, non-invasive coronary CT angiography (cCTA) is now an established technique for the assessment of coronary heart disease. Further advancements in CT techniques such as increased number of detector arrays and reconstruction algorithms have set the stage for CT to have a role of in the evaluation of myocardial perfusion and viability. However, there are concerns for using CT as a screening and diagnostic tool because of the inherent risk of radiation dose received during cardiac assessment. This prompted further modifications in CT scanners and refinement of scanning techniques to reduce radiation dose received. The work has paid off significantly, and recently published data show that cCTA can be performed with doses as low as 1–2 mSv (1–3). In this issue of Imaging, two excellent reviews discuss the current status of cCTA and myocardial perfusion imaging and their clinical utility and future directions (4,5). cCTA fills the need for a non-invasive alternative to invasive coronary angiography for evaluation of coronary artery disease. The quality of cCTA is also dependent on patient factors such as body weight, age, heart rate and rhythm. The negative predictive value of cCTA is very high, which may obviate the need for an invasive catheter angiography. Despite the high negative predictive value, the concern of radiation, especially in asymptomatic individuals has limited its application widely. Apfaltrer et al. (4) describe the technical evolutions in cCTA and the methods to keep radiation dose minimised without compromising imaging quality. However, the major hurdle lies in the lack of evidence of cost effectiveness and on the patient outcome following a cCTA. Therefore, now the focus is on evaluating and optimising radiation dose reduction techniques, the cost effectiveness and impact of cCTA on patient management and outcomes. Prospective long-term studies comparing traditional diagnostic pathways in coronary artery disease to those incorporating cCTA are lacking, and the effects of cCTA implementation on patient management and outcomes are not well known. Expanding the role of CT beyond cCTA is in characterisation of atherosclerotic plaques, myocardial attenuation deficits and left ventricular wall motion and function. These are promising, but still in investigative stage and needs more clinical validation. MDCT is well suited to evaluate myocardial viability; however, the challenges are similar to cCTA, and when used as a comprehensive imaging study including cCTA, the radiation exposure is substantial, which is currently prohibitive. The high isotropic resolution of MDCT is very useful for studying the perfusion and therefore the interest in this technique by researchers. Magnetic Resonance Imaging (MRI) is the current reference standard for evaluation of myocardial perfusion. MRI has no ionising radiation and provides excellent soft tissue characterisation, which makes it very attractive. However, state of the art MRI scanners may not be available in all places and is contraindicated in patients with pacemakers or defibrillators. In the second review by Marcus et al. (5), the emerging application of CT for myocardial perfusion is described, and overviews of the current competing techniques are nicely outlined. In the past decade, there have been substantial improvements in image acquisition, reconstruction, work flow and analysis of cardiac CT images. The major limitation due to radiation dose is probably abated to a certain extent by the dose reduction strategies. These advances have made cardiac CT a suitable alternative to current techniques; however, clinical experience is limited, and therefore one has to wait for more results from larger clinical trials. Long-term cost-benefit analysis studies are probably the best bet to overcome this challenge and establish the role of cCTA and Cardiac CT imaging in coronary artery disease. None declared.

The Holy Grail in diagnostic neuroradiology: 3T or 3D?

Many technical developments keep occurring in the field of MRI that could benefit image acquisition in the field of diagnostic neuroradiology. While there is much focus on the potential advantages of 3T and higher field strengths, it is often unclear whether these are cosmetic only, or convey clinically relevant diagnostic value. The increased signal-to-noise at 3T is certainly beneficial in different ways particularly for the acquisition of isotropic 3D sequences like FLAIR. Single-slab 3D sequences can now be obtained with multiple contrasts in clinically attainable data acquisition times and could revolutionize MRI to evolve into a fundamentally multi-planar technique, rather similar to what has happened with the introduction of multi-detector row CT.

Comparison of 4- and 64-slice CT scanning in the diagnosis of pulmonary embolism

With the introduction of multi-detector row CT (MDCT), sensitivity to diagnose pulmonary embolism (PE) has greatly improved. The use of newer generation CT-scans may lead to a higher prevalence and a different distribution of PE. We compared 64-slice with 4-slice MDCT regarding prevalence and distribution of PE, the number of inconclusive test results and inter-reader variability. CT-scans from a random sample of 110 consecutive patients who underwent 4-slice CT-scanning were compared with 64-slice CT-scans from 107 patients from a second cohort. Three radiologists independently reassessed all CT-scans. Consensus was reached in case of disagreement between the readers. Final diagnosis of PE was categorised as central, segmental or subsegmental by the thrombus' most proximal end. The prevalence of PE was 24% (26/110, 95% confidence interval [CI] 17-32%) and 22% (24/107, 16-31%) for the 4-slice and 64-slice cohort, respectively. The prevalence of isolated subsegmental emboli was 2/26 (7.7%; 2.1-24%) and 5/24 (21%; 9.2-41%), respectively (p=0.424). The number of inconclusive scans was 10% in both cohorts, mostly due to movement artefacts and suboptimal intravascular contrast, respectively. The inter-reader agreement between the three readers was 0.70 for the 4-slice scans and 0.68 for the 64-slice scans. Although absolute prevalence of PE was equal in both cohorts, there was a trend towards more subsegmental PE with 64-slice CT. In a multi-reader setting, the number of inconclusive examinations was higher than quoted for clinical management studies, indicating that the diagnosis of PE with MDCT could be less straightforward than assumed.

Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

Objective The purpose of this study was to assess the efficacy of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI) by analyzing morphology and diameter of superior mesenteric artery (SMA). We assessed whether MDCT was as useful as angiography for the diagnosis of NOMI. Materials and methods Four patients who were diagnosed with NOMI were retrospectively analyzed. All patients had 8-row MDCT followed by laparotomy. Two of them underwent angiography after MDCT. The morphology and diameter of SMA of these cases was analyzed on multi-planar reconstructed (MPR) images. The mean diameter of SMA of NOMI cases was compared to that of 13 control cases. Results MPR images of all NOMI cases showed irregular narrowing of the SMA, spasm of the arcades of SMA, and poor demonstration of intramural vessels. MPR images of two patients who had angiography were concordant with their angiograms. The mean diameter of SMA of NOMI patients was 3.4 ± 1.1 mm, which was statistically smaller than that of 13 control patients, 6.0 ± 1.5 mm ( P < 0.05, Wilcoxon rank sum tests). Conclusion Angiography has been recognized essential for the diagnosis of NOMI. This study shows the possibility of MDCT to be an equivalently useful modality compared to angiography for the diagnosis of NOMI by interpreting morphologic appearance and diameter of SMA. Introduction of MDCT in the decision tree of NOMI treatment may bring the benefit of prompt diagnosis and subsequent early and efficient initiation of therapy, which may improve the mortality.

Pulmonary Artery CTA

The latest with the introduction of multidetector row computed tomography (MDCT), CT has been firmly established as the modality of choice for imaging the pulmonary arteries, particularly as the de facto first line test for imaging patients with suspected acute pulmonary embolism (PE). Before the introduction of MDCT, remaining concerns regarding CTs accuracy for diagnosis of isolated peripheral emboli had prevented the unanimous acceptance of this test as the reference standard for imaging PE. After a decade of uncertainty, there is now conclusive evidence that CT, if positive, provides reliable confirmation of the presence of PE and, more importantly, if negative effectively rules out clinically significant PE. Current endeavors to streamline and facilitate workflow for CT diagnosis of PE will further improve the acceptance, utility, and importance of this test. Examples include improvements in workflow, CT derivation of right ventricular function parameters for triage and prognostication of patients with acute PE and the comprehensive assessment of patients with acute chest pain for PE, coronary disease, aortic disease, and pulmonary disease by means of a single, contrast enhanced, ECG-synchronized CT scan. Although the diagnosis or exclusion of acute PE is the most common and important application of CT pulmonary angiography, the ease of scan acquisition and the high spatial resolution of modern CT techniques make this test ideally suited for the greatest majority of congenital and acquired, acute and chronic disorders of the pulmonary arteries.

Multiphasic contrast-enhanced multidetector-row CT of liver: Contrast-enhancement theory and practical scan protocol with a combination of fixed injection duration and patients’ body-weight-tailored dose of contrast material

The introduction of multidetector-row CT (MDCT) has provided the abdominal radiologists with dramatic changes for the imaging of the liver. At just present, establishment of new and optimal injection protocol in multiphasic contrast-enhanced MDCT of the liver has been yearned because the difficulty and the importance to optimize the scan timing for each phase imaging have obviously increased because of the extremely rapid scan speed with MDCT scanners. Among technical factors employed in an injection protocol for multiphasic contrast-enhanced MDCT of the liver, to make an injection duration of contrast material fixed is the most important for the precise estimation of the scan timing for each phase imaging. With the fixed injection duration, the peak enhancement time of the aorta, portal vein, and liver constantly appear approximately 10, 20, and 30 s after the any fixed injection durations (completion of injection of contrast material), respectively. Moreover, using a combination of the fixed injection duration and patients’ body-weight-tailored dose of contrast material, similarity of time–density curves of each organ in shape and pattern can be achieved for individual patient with different body weight. In this issue, we will attempt to determine an ultimately optimal, but practical injection/scan protocol to successfully realize multiphasic contrast-enhanced MDCT of the liver based on the contrast-enhancement theory.

The Age of CT Pulmonary Angiography

With the introduction of multi detector-row CT (MDCT), computed tomography (CT) has been firmly established as the de facto first line test for imaging patients with suspected pulmonary embolism (PE). However, remaining concerns regarding CT's accuracy for diagnosis of isolated peripheral emboli have prevented the unanimous acceptance of this test as the standard of reference for imaging PE. Consequently, many patients with a chest CT scan negative for PE undergo additional testing for a definitive rule-out of PE, increasing radiation burden, risk of complications, and health care cost. After a decade of uncertainty, there is now conclusive evidence that computed tomography (CT), if positive, provides reliable confirmation of the presence of PE and, more importantly, if negative effectively rules out clinically significant PE. Current endeavors to streamline and facilitate workflow for CT diagnosis of PE will further improve the acceptance, utility, and importance of this test. Thus, rather than seeking further confirmation for the accuracy of CT for PE diagnosis, future efforts ought to be directed at harnessing the unique strengths of this test. Examples include improvements in workflow, CT derivation of right ventricular function parameters for triage and prognostication of patients with acute PE, and the comprehensive assessment of patients with acute chest pain for PE, coronary disease, aortic disease, and pulmonary disease by means of a single, contrast enhanced, ECG-synchronized CT scan. At the same time, efforts must be directed at refining clinical pathways to ensure appropriate use and avoid overutilization of this test.

Multidetector-row CT angiography of upper- and lower-extremity peripheral arteries

With the introduction of multidetector-row CT (MDCT) technology indications for MDCT angiography have expanded to include assessment of the peripheral arteries of the upper and lower extremities. Combined with patient- and scanner-adjusted CT data acquisition and contrast medium application strategies, an accurate and reliable evaluation of the peripheral arteries of the upper and lower extremities is possible. MDCT angiography is cost-effective and accurate for detection of arterial stenosis and occlusion in patients with peripheral arterial disease (PAD). MDCT angiography allows postoperative assessment of peripheral arterial bypass grafts, including bypass graft stenosis and occlusion, as well as presence of aneurysms or arteriovenous fistulas. In addition, MDCT angiography is helpful in particular for visualization of arterial bypass grafts with a complicated extra-anatomical course. Furthermore, pre-operative peripheral vascular mapping can be performed by using MDCT angiography. Finally, due to the integration of MDCT scanners in many trauma centres, MDCT angiography is increasingly being used for assessment of traumatic arterial injuries. This article gives an overview of technical aspects of peripheral MDCT angiography, including scanning parameters, contrast medium application, image postprocessing and radiation exposure, and summarizes the most frequent acute and non-acute indications of MDCT angiography for assessment of the upper- and lower-extremity peripheral arteries.

MDCT imaging of the aorta and peripheral vessels

Since its clinical introduction in 1991, volumetric CT scanning using spiral or helical scanners has resulted in a revolution for diagnostic imaging. Helical CT has improved over the past 8 years with faster gantry rotation, more powerful X-ray tubes, and improved interpolation algorithms, but the greatest advance has been the recent introduction of multi detector-row CT (MDCT) scanners [J. Comput. Assist. Tomogr. 23 (1999) S83]. Currently capable of acquiring four channels of helical data simultaneously, MDCT scanners have achieved the greatest incremental gain in scan speed since the development of helical CT and have profound implications for clinical CT scanning. Fundamental advantages of MDCT include substantially shorter acquisition times, retrospective creation of thinner or thicker sections from the same raw data, and improved three-dimensional (3-D) rendering with diminished helical artifacts. While these features will likely be important to many applications of CT scanning, including the characterization of focal lung and liver lesions through the creation of thin sections retrospectively, the greatest impact has been on CT angiography. The implication for CT angiography is that scans can be performed approximately three-times faster than is possible with the fastest single-detector CT scanner. For example a 1.25 mm nominal thick section (1.6 mm effective section thickness) can be acquired with a table speed of 9.4 mm/s, and a 2.5 mm nominal thick section (3.2 mm effective section thickness) can be acquired with an 18.8 mm/s table speed. The advantages of MDCT for imaging the vascular system can be broken down into three fundamental improvements over single detector-row CT scanners speed (faster), distance (longer), and section thickness (better). The focus of this article will be how multidetector-row CT technology has substantially improved aortoiliac and lower extremity arterial imaging.

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies.

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films--bowel obstruction, pneumoperitoneum, and the search of ureteral calculi--are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain.

Dose evaluation and effective dose estimation from multi detector CT.

Computed tomography (CT) has evolved remarkably through device improvement and advancement of peripherals, including computers. In 1999, multi detector-row CT (MDCT) appeared and rapid high-speed scanning became possible. However, usefulness of MDCT in actual clinical application cannot be assessed until the exposure doses are assessed appropriately. Since CT examinations need a comparatively high dose, it is necessary to evaluate patient exposure for introduction of MDCT. Patient doses by three types of MDCTs were evaluated for cases of scanning of the chest and abdomen-pelvis. The examination conditions were the same as those in actual clinical examinations. The obtained effective doses were 9.4-28 mSv for the chest examination and 13-28 mSv for the abdomen-pelvis. The average surface doses varied between 16-43 mGy for the chest examination and 20-37 mGy for the abdomen-pelvis. The highest surface dose was 57 mGy for the abdomen-pelvis examination. The exposed doses differed according to scanning method and imaging conditions such as tube current, slice thickness and so on. It seemed that there is room for dose reduction by proper adjustment of scan conditions in MDCT examinations.

Multi-detector row CT of mesenteric ischemia: can it be done?

Mesenteric ischemia is a complicated disorder whose prevalence in the United States is increasing as the population ages. It is often difficult to diagnose, both clinically and radiologically. In the past, computed tomography (CT) has allowed only limited success in the early detection of ischemia. However, with the introduction of multi-detector row CT and three-dimensional (3D) imaging, it is now possible to perform a detailed CT examination of the small bowel and mesenteric vessels. Multi-detector row CT allows routine studies to be performed much faster than with single-detector CT scanners and makes available new applications, especially in the field of CT angiography. Its increased speed and narrower collimation, coupled with the use of water as an oral contrast agent, improve visualization of the bowel wall and mesenteric vasculature. Multi-detector row CT with 3D reformatting may improve the ability to make an early diagnosis and identify the cause of disease in patients with suspected acute or chronic mesenteric ischemia. In many cases, this examination has eliminated the need for additional imaging studies such as Doppler ultrasonography or angiography. Further investigation will be needed to determine the scope of the utility of multi-detector row CT in this clinical setting.