Pediatric multidetector computed tomography using tube current modulation and a patient image gallery.

BACKGROUND: Dose reduction is crucial in pediatric multidetector computed tomography (MDCT). PURPOSE: To perform pediatric 16-slice MDCT using tube current modulations and to adjust prospectively the tube current using a patient image gallery (IG) providing simulated dose-reduced protocols; and to evaluate and compare the image quality of the IG and the clinical MDCT. MATERIAL AND METHODS: 30 examinations (thorax, n = 15; abdomen, n = 8; pelvis, n = 7) in 20 patients (nine male, age 8.05 +/- 7.33 years, weight 29.8 +/- 24.02 kg) were performed according to an IG on a 16-slice MDCT with additional use of online tube current modulation (CARE Dose). Three radiologists visually assessed image quality from the IG and actual 16-slice MDCT scans. For objective analysis, image noise was determined. RESULTS: Statistical analysis showed moderate concordance in objective (K = 0.68-0.78) and subjective (K = 0.33-0.64) image assessment between the IG and clinical 16-slice MDCT scans. Depending on the weight group and clinical question, no or only minor dose reductions in the chest, but moderate to considerable reductions in the abdominal/pelvic 16-slice MDCT scans compared to previously used pediatric protocols were achieved. Extra dose reduction was achieved due to additional use of CARE Dose depending on age group and scan region (mean 8.6-23.9%). CONCLUSION: The IG enabled us to prospectively reduce the tube current and adapt the required image quality to the clinical question. Additional dose reduction was achieved with application of CARE Dose; nevertheless, the images are comparable to the simulated images of the IG.

[Trabecular bone mineral density measured by quantitative CT of the lumbar spine in children and adolescents: reference values and peak bone mass]. / Trabekuläre Knochendichte der Lendenwirbelsäule bei Kindern und Jugendlichen in der quantitativen CT: Referenzwerte und Peak Bone Mass.

PURPOSE: The aim of this study was to assess bone density values in the trabecular substance of the lumbar vertebral column in children and young adults in Germany from infancy to the age of peak bone mass. MATERIALS AND METHODS: We performed quantitative computed tomography (QCT) on the first lumbar vertebra in 28 children and adolescents without diseases that may influence bone metabolism (15 boys, 13 girls, mean ages 11 and 8 years, respectively). We also measured 17 healthy young adults (9 men, 8 women, mean ages 20 and 21 years). We used a Somatom Balance Scanner (Siemens, Erlangen) and the Siemens Osteo software. Scan parameters: Slice thickness 1 cm, 80 kV, 81 or 114 mAs. We measured the trabecular bone density and the area and height of the vertebra and calculated the volume and content of calcium hydroxyapatite (Ca-HA) in the trabecular substance of the first lumbar vertebra. RESULTS: Prepubertal boys had a mean bone density of 148.5 (median [med] 150.1, standard deviation [SD] 15.4) mg/Ca-HA per ml bone, and prepubertal girls had a mean density of 149.5 (med 150.8, SD 23.5) mg/ml. We did not observe a difference between prepubertal boys and girls. After puberty there was a significant difference (p < 0.001) between males and females: Mean density (male) 158.0, med 162.5, SD 24.0 mg/ml, mean density (female) 191.2, med 191.3, SD 17.7 mg/ml. The Ca-HA content in the trabecular bone of the first lumbar vertebra was 1.1 (med 1.1, SD 0.5) g for prepubertal boys and 1.1 (0.9, 0.4) g for prepubertal girls. For post-pubertal males, the mean Ca-HA content was 3.5 g, med 3.5, SD 0.5 g, and for post-pubertal females, the mean content was 2.8, med 2.7, SD 0.4 g. CONCLUSION: The normal trabecular bone mineral density is 150 mg/ml with a standard deviation of 20 mg/ml independent of age or gender until the beginning of puberty. Peak bone mass (bone mineral content) in the trabecular substance of the lumbar vertebral column is higher in males than in females, and peak bone density is higher in young female adults than in young male adults.