Asunto(s)
Derrame Pericárdico/etiología , Enfermedad de Still del Adulto/diagnóstico , Diagnóstico Diferencial , Electrocardiografía , Ferritinas/sangre , Fiebre/etiología , Humanos , Infecciones/diagnóstico , Masculino , Mialgia/etiología , Pericardiocentesis , Faringitis/etiología , Enfermedad de Still del Adulto/complicaciones , Adulto JovenRESUMEN
PURPOSE: To evaluate beam-hardening (BH) artifact reduction in coronary computed tomography (CT) angiography with dual-energy CT, to define the optimal monochromatic-energy levels for coronary and myocardial signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in dual-energy CT, and to compare these levels with single-energy CT. MATERIALS AND METHODS: The study was approved by the institutional review board and/or ethics committee at each site. Patients provided informed consent. Thirty-nine patients were prospectively enrolled to undergo dual-energy CT, and 25 also underwent single-energy CT. Myocardial and coronary SNR, CNR, and iodine concentration were measured across multiple segments at varying monochromatic energy levels (40-140 keV). BH was defined as signal decrease in basal inferior wall versus midinferior wall, and signal increase in midseptum versus midinferior wall. Generalized estimating equation was used to identify optimal monochromatic-energy levels and compare them with single-energy CT. RESULTS: BH was noted at single-energy CT with basal inferior wall mean reduction of 19.7 HU ± 29.2 (standard deviation) and midseptum increase of 46.3 HU ± 36.3. There was reduction in this artifact at 90 keV or greater (1.7 HU ± 18.4 in basal inferior wall and 20.1 HU ± 37.5 in midseptum at 90 keV; P < .05). SNR and CNR were higher in the myocardium and coronary arteries at 60-80 keV than single-energy CT (myocardium: SNR, 3.02 vs 2.39, and CNR, 6.73 vs 5.16; coronary arteries: SNR, 10.83 vs 7.75, and CNR, 13.31 vs 9.54; P < .01). Mean iodine concentration in resting myocardium was 2.19 mg/mL ± 0.57. CONCLUSION: Rapid kilovolt peak-switching dual-energy CT resulted in significant BH reduction and improvements in SNR and CNR in the myocardium and coronary arteries.
Asunto(s)
Algoritmos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
This article reviews the multidetector-row computed tomography (MDCT) imaging appearance of common entities that are part of the wide spectrum of diseases involving the thoracic aorta. Electrocardiogram-gated MDCT is poised to become the reference standard method in assessing the thoracic aorta. Reproducible images of the aorta can be acquired independent of operator skill.
Asunto(s)
Aorta Torácica/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Tomografía Computarizada Multidetector , HumanosRESUMEN
A 57-year-old man with a history of DVT and pulmonary embolism, transient ischemic attacks, prior 60 pack-year smoking history, and oxygen-dependent COPD presented with insidiously worsening dyspnea associated with new pleuritic chest and back pain.