Cranial and spinal computed tomography (CT) angiography with photon-counting detector CT: comparison with angiographic and operative findings.

The clinical imaging features of photon-counting detector (PCD) computed tomography (CT) are mainly known as dose reduction, improvement of spatial resolution, and reduction of artifacts compared to energy-integrating detector CT (EID-CT). The utility of cranial and spinal PCD-CT and PCD-CT angiography (CTA) has been previously reported. CTA is a widely used technique for noninvasive evaluation. Cranial CTA is important in brain tumors, especially glioblastoma; it evaluates whether the tumor is highly vascularized prior to an operation and helps in the diagnosis and assessment of bleeding risk. Spinal CTA has an important role in the estimation of feeders and drainers prior to selective angiography in the cases of spinal epidural arteriovenous fistulas and spinal tumors, especially in hemangioblastoma. So far, EID-CTA is commonly performed in an adjunctive role prior to selective angiography; PCD-CTA with high spatial resolution can be an alternative to selective angiography. In the cases of cerebral aneurysms, flow diverters are important tools for the treatment of intracranial aneurysms, and postoperative evaluation with cone beam CT with angiography using diluted contrast media is performed to evaluate stent adhesion and in-stent thrombosis. If CTA can replace selective angiography, it will be less invasive for the patient. In this review, we present representative cases with PCD-CT. We also show how well the cranial and spinal PCD-CTA approaches the accuracy of angiographic and intraoperative findings.

Photon-Counting Detector CT: Potential for 75% Reduction in Contrast Medium Amount: A Phantom Study.

This study aimed to evaluate the potential reduction in contrast medium utilization using photon-counting detector computed tomography (PCD-CT). One PCD-CT scan (CT1) and three conventional (non-PCD-CT) CT scans (CT2-CT4) were performed using a multi-energy CT phantom that contained eight rods with different iodine concentrations (0.2, 0.5, 1, 2, 5, 10, 15, and 20 mg/ml). The CT values of the seven groups (CT1 for 40, 50, 60, and 70 keV; and CT2-4) were measured. Noise and contrast-to-noise ratio (CNR) were assessed for the eight rods at various iodine concentrations. CT2 and CT1 (40 keV) respectively required 20 mg/ml and 5 mg/ml of iodine, indicating that a comparable contrast effect could be obtained with approximately one-fourth of the contrast medium amount. The standard deviation values increased at lower energy levels irrespective of the iodine concentration. The CNR exhibited a decreasing trend with lower iodine concentrations, while it remained relatively stable across all iodine levels (40-70 keV). This study demonstrated that virtual monochromatic 40 keV images offer a similar contrast effect with a reduced contrast medium amount when compared to conventional CT systems at 120 kV.

Diagnostic improvements of calcium-removal image reconstruction algorithm using photon-counting detector CT for calcified coronary lesions.

OBJECTIVE: To investigate the diagnostic performance of a calcium-removal image reconstruction algorithm with photon-counting detector-computed tomography (PCD-CT), a technology that hides only the calcified plaque from the spectral data in coronary calcified lesions. METHODS: This retrospective study included 17 patients who underwent PCD-coronary CT angiography (CCTA) with at least one significant coronary stenosis (≥50 %) with calcified plaque by CCTA and invasive coronary angiography (ICA) performed within 60 days of CCTA. A total of 162 segments with calcified plaque were evaluated for subjective image quality using a 4-point scale. Their calcium-removal images were reconstructed from conventional images, and both images were compared with ICA images as the reference standard. The contrast-to noise ratios for both images were calculated. RESULTS: Conventional and calcium-removal images had a subjective image quality of 2.7 ± 0.5 and 3.2 ± 0.9, respectively (p < 0.001). The percentage of segments with a non-diagnostic image quality was 32.7 % for conventional images and 28.3 % for calcium-removal images (p < 0.001). The segment-based diagnostic accuracy revealed an area under the receiver operating characteristic curve of 0.87 for calcium-removal images and 0.79 for conventional images (p = 0.006). Regarding accuracy, the specificity and positive predictive value of calcium-removal images were significantly improved compared with those of conventional images (80.5 % vs. 69.5 %, p = 0.002 and 64.1 % vs. 52.0 %, p < 0.001, respectively). The objective image quality of the mean contrast-to-noise ratio did not differ between the images (13.9 ± 3.6 vs 13.3 ± 3.4, p = 0.356) CONCLUSIONS: Calcium-removal images with PCD-CT can potentially be used to evaluate diagnostic performance for calcified coronary artery lesions.

Evaluation of the ear ossicles with photon-counting detector CT.

Recently, computed tomography with photon-counting detector (PCD-CT) has been developed to enable high-resolution imaging at a lower radiation dose. PCD-CT employs a photon-counting detector that can measure the number of incident X-ray photons and their energy. The newly released PCD-CT (NAEOTOM Alpha, Siemens Healthineers, Forchheim, Germany) has been in clinical use at our institution since December 2022. The PCD-CT offers several advantages over current state-of-the-art energy-integrating detector CT (EID-CT). The PCD-CT does not require septa to create a detector channel, while EID-CT does. Therefore, downsizing the anode to achieve higher resolution does not affect the dose efficiency of the PCD-CT. CT is an indispensable modality for evaluating ear ossicles. The ear ossicles and joints are clearly depicted by PCD-CT. In particular, the anterior and posterior legs of the stapes, which are sometimes unclear on conventional CT scans, can be clearly visualized. We present cases of congenital anomalies of the ossicular chain, ossicular chain dislocation, tympanosclerosis, and cholesteatoma in which PCD-CT was useful. This short article reports the usefulness of PCD-CT in the 3D visualization of the ear ossicles.

[Influence of Calculated Equivalent Doses and Effective Dose due to Differences in Software Version on Radiation Dose Management System].

PURPOSE: To verify the influence of the software version of the dose control system on the equivalent dose and effective dose calculation values. METHODS: We performed chest CT and liver to pelvic CT imaging with a human phantom placed on a CT bed. After the imaging was completed, the radiation dose structured reports (RDSRs) generated by the equipment were transferred to several dose management systems with different software versions for equivalent dose and effective dose calculations. RESULTS: The equivalent and effective doses calculated from the same RDSR differed depending on the software version of the dose management system with a difference of approximately 2 times for the effective dose and up to 50 times for the equivalent dose. CONCLUSION: It is considered that the voxel phantom geometry and dose calculation algorithm may differ depending on the software version of the dose management system. Careful attention should be paid in handling the dose calculation values because the exposure explanations and risk assessments using the equivalent doses, and effective dose calculated by the dose management systems may be overestimated.

Association between higher pericoronary adipose tissue attenuation measured by coronary computed tomography angiography and nonalcoholic fatty liver disease: A matched case-control study.

ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiac mortality. Pericoronary adipose tissue (PCAT) attenuation, expressed by the fat attenuation index on coronary computed tomography angiography, reflects pericoronary inflammation. We aimed to investigate the association between PCAT attenuation and NAFLD.This is a single-center cohort study comprising of patients who underwent coronary computed tomography angiography for suspected stable coronary artery disease between January and December 2020. Patient characteristics and coronary computed tomography angiography findings were analyzed between patients with NAFLD (n = 78) and a propensity score-matched cohort of patients without NAFLD (n = 78). PCAT attenuation was assessed in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery.The mean PCAT attenuation in LAD and right coronary artery were significantly higher in patients with NAFLD than those without NAFLD. When patients were divided into 2 groups using the median LAD-PCAT attenuation of -72.5 HU, the high PCAT attenuation group had more males (82% vs 67%, P = .028) and NAFLD patients (63% vs 37%, P = .001) compared to the low PCAT attenuation group. No differences in age, body mass index, conventional cardiovascular risk factors, or the presence of high-risk plaque were observed between the 2 groups. In the multivariate logistic analysis, NAFLD was independently associated with high PCAT attenuation (odds ratio 2.912, 95% confidence interval 1.386 to 6.118, P = .005).NAFLD is associated with high PCAT attenuation on coronary computed tomography angiography. This finding suggests that pericoronary inflammation is involved in the increased cardiac mortality in NAFLD patients.

Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia.

BACKGROUND: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultra-high-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventional-resolution CT (CRCT) and micro-CT ex vivo. METHODS: We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test. RESULTS: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024- and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm3 and 63.5 mg/cm3 versus 20.8 mg/cm3), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm3 and 0.74 l/mm3 versus 0.02 l/mm3, respectively). In vivo, the 512- and 1024-matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm3 versus 0.22 l/mm3, respectively). CONCLUSIONS: We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

Technical Note: Performance comparison of ultra-high-resolution scan modes of two clinical computed tomography systems.

PURPOSE: Two ultra-high-resolution (UHR) computed tomography (CT) scanners are clinically available. One is achieved by a CT system with a 0.25 mm × 160 row detector (Detector-UHR), whereas the other is with a 0.6 mm × 32 row detector with in-plane comb filtering in a dual source CT (Comb-UHR). We compared radiation dose efficiencies of the two UHR modes to that of a routine scan mode (RS), using physical image quality measures for an assumed condition of abdominal CT angiography (CTA). METHODS: A wire phantom, a 300-mm cylindrical water bath phantom, and a microdisk phantom were used for measuring the modulation transfer function (MTF), noise power spectrum (NPS), and slice sensitivity profiles (SSP), respectively, at CTDIvol of 20 mGy. Images with minimal slice thicknesses were reconstructed by filtered back projection methods. System performance functions (SPF2 ) based on the prewhitening theorem were calculated by dividing MTF2 by NPS measurements. The ideal observer's detectability index (d'2 ) was also estimated for a task corresponding to a 1-mm diameter vessel. Furthermore, a bar-pattern phantom placed in a water phantom resembling an adult abdomen was scanned, and the visibility of the bars was observed. RESULTS: System performance function (SPF2 ) results showed that Comb-UHR has a 70% dose efficiency compared to RS and provides better than twofold SPF2 compared to Detector-UHR. The d'2 values of Detector-UHR, Comb-UHR, and RS were 6.5, 14.7, and 16.0, respectively. Although the bar-pattern phantom images were consistent with the SPF results, bar widths < 1.0 mm for Detector-UHR and < 0.75 mm for Comb-UHR and RS were not resolved. CONCLUSIONS: Though both the UHR modes exhibited system performances extending to 2.6 cycles/mm, they appeared not to be advantageous compared to RS in the conditions applicable to abdominal CTA, because of their insufficient dose efficiencies.

A rapid caliber change in the inferior vena cava during multiphasic contrast-enhanced computed tomography may signal an acute anaphylactic reaction to nonionic contrast medium.

Severe anaphylactic reactions to an intravenous nonionic iodine contrast medium (NICM) are uncommon but can result in permanent morbidity or death if not managed appropriately. An anaphylactic reaction to an NICM typically manifests as clinical symptoms that include an itchy nose, sneezing, and skin redness. To our knowledge, a rapid change in the caliber of the inferior vena cava (IVC) during multiphasic contrast-enhanced computed tomography (CT) has not been reported. Here, we report the computed tomographic findings in three cases of hypovolemic shock caused by an anaphylactic reaction to an NICM. We suspect that a decrease in caliber of the IVC during multiphasic contrast-enhanced CT may be a predictor of an allergic-like reaction to an NICM. Patients in whom physicians and radiographers detect a rapid caliber change in the IVC during multiphasic contrast-enhanced CT should be managed carefully.

Image Evaluation of Free-breathing Navigator Echo and Triggered Cardiac-gated Delayed Myocardial Enhancement Magnetic Resonance Imaging in Sedated Infants.

We validated a navigator-echo-triggered sequence that drives magnetization before cardiac-gated inversion recovery T1 turbo field echo acquisition, in the sedated free-breathing pediatric population. Cardiac magnetic resonance imaging was performed on sedated infants with single ventricle. We calculated the signal-to-noise ratios and contrast-to-noise ratios of 2 groups of images obtained using respiratory triggering with and without navigator echo. All images were then visually assessed by 2 observers. The signal-to-noise ratio and the contrast-to-noise ratio were significantly higher with than without navigator echo (p<0.01; p<0.05). The visual assessment scores were also consistently better with than without navigator echo (p<0.01). Free-breathing navigator echo was found to have the advantage of decreasing the motion artifact caused by respiration. Cardiacgated inversion recovery T1 turbo field echo sequence for free-breathing navigator-echo-triggered respiration allows for the acquisition, in sedated infants, of diagnostic images whose quality exceeds that of the non-navigator-echo-triggered alternative.

Small bowel neoplasms: enhancement patterns and differentiation using post-contrast multiphasic multidetector CT.

PURPOSE: The purpose of the present study was to analyze the enhancement patterns of small bowel neoplasms on post-contrast multiphasic multidetector CT and to assess the diagnostic capacity for differentiating five tumor types. METHODS: We performed a retrospective study of data on 92 small bowel neoplasms. The neoplasms were categorized into five groups according to pathology findings, not imaging findings (23 adenocarcinomas; 22 lymphomas; 19 metastases; 18 gastrointestinal stromal tumors [GIST]; 10 neuroendocrine tumors [NET]). RESULTS: GIST and NET demonstrated a hypervascular pattern in the multiphasic dynamic study. Adenocarcinoma and lymphoma showed a delayed enhancement pattern. Metastasis was classified as an intermediate enhancement pattern. The receiver operating characteristic analyses revealed that attenuation thresholds could be set with acceptable accuracies for most of the small bowel neoplasms. CONCLUSIONS: Multiphasic dynamic studies may have the potential to improve the diagnostic capacity of multidetector CT for small bowel neoplasms.

Image Quality of Coronary Computed Tomography Angiography with 320-Row Area Detector Computed Tomography in Children with Congenital Heart Disease.

The objective of this study was to assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)-gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. Altogether, 96 of 112 segments (85.7 %) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 ± 11.6 months) and had lower body weight (5.9 ± 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 ± 13.8 months and 8.4 ± 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of ≤5.6 kg and an optimal age cutoff of ≤12.5 months. Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries.

Differential association of visceral adipose tissue with coronary plaque characteristics in patients with and without diabetes mellitus.

BACKGROUND: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood. METHODS: We retrospectively evaluated 456 patients (60% male, age 64 ± 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification). RESULTS: Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM. CONCLUSIONS: The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.

Safety and efficacy of a bolus injection of landiolol hydrochloride as a premedication for multidetector-row computed tomography coronary angiography.

BACKGROUND: We evaluated the safety and efficacy of a bolus injection of landiolol hydrochloride, an ultrashort-acting ß1-selective antagonist, as an additional treatment after premedication with an oral ß-blocker to reduce heart rate prior to multidetector-row computed tomography (MDCT) coronary angiography (CAG). METHODS AND RESULTS: A total of 458 patients who underwent MDCT CAG were retrospectively enrolled. Image quality and hemodynamic parameters were compared in patients before and after approval of landiolol hydrochloride. If heart rate reduction was insufficient after premedication with an oral ß-blocker, a bolus injection of landiolol hydrochloride (n=66) or other drugs (n=30) was used. The percentage of evaluable images per segment in patients after approval of landiolol (99.3%) was greater than that in patients before approval of landiolol (97.4%, P<0.01). Heart rates before scanning in patients receiving landiolol hydrochloride were similar to those receiving other drugs. Heart rate was significantly reduced approximately 5 min after injection of landiolol hydrochloride and increased shortly. No decrease in systolic blood pressure or other adverse effects was observed. CONCLUSIONS: Bolus injection of landiolol hydrochloride sufficiently reduced heart rate without significantly reducing systolic blood pressure and produced a high percentage of evaluable images, suggesting that bolus injection of landiolol hydrochloride as an additional pretreatment is feasible in MDCT CAG.

Interruption of the aortic arch: diagnosis with multidetector computed tomography.

PURPOSE: We investigated retrospectively the usefulness of multidetector computed tomography (MDCT) in the preoperative diagnosis of interruption of the aortic arch (IAA). MATERIALS AND METHODS: Seven neonates with IAA underwent enhanced MDCT before a surgical repair operation between April 2006 and March 2010. The MDCT procedures were performed using either a 16- or 64-MDCT scanner without electrocardiographic gating or respiratory arrest. RESULTS: High-quality CT images were obtained in all cases. One patient was diagnosed to be IAA type A, and 6 were diagnosed to be IAA type B (Celoria and Patton classification). The Celoria and Patton classification of IAA types and subtype classification by MDCT were confirmed by surgery. CONCLUSION: Our results show that the information from MDCT was sufficient for a preoperative diagnosis of IAA and allowed omission of a cardiac catheter examination before surgery.

[Report on the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America--analysis of radiation dose by a change of a scan parameter of multi-slice computed tomography by a film method].

PURPOSE: It is for a purpose of this study to measure radiation dose by analyzing a dose profile of multi-slice computed tomography varying with helical pitch and a row slice thickness difference complicatedly. MATERIALS AND METHODS: We used multi-slice computed tomography, and helical pitch and row slice thickness change and scanned the helical scan. I used CTDI phantom of a diameter of 25 cm and I inserted roentgen diagnosis use film UR-2(new) which I put between my own phantom in center and 1 cm away from the outer surface and scanned it. And the provided level profile was converted into a dose profile with the dose-density curve which I made beforehand. I analyzed radiation dose than the dose profile. RESULT: In multi-slice computed tomography, radiation dose varied with assembly of row slice thickness and helical pitch. The change of a dose profile changed in a phantom surface part complicatedly. The maximum dose by the measurement of this time was 29 mGy in row slice thickness 0.5 mm, assembly of helical pitch 2.5. In addition, the minimum dose was 6.8 mGy in row slice thickness 3.0 mm, assembly of helical pitch 5.5. And, as for the difference of maximum dose in the same dose profile and the smallest dose, there were about 20 % in row slice thickness 1.0 mm, assembly of helical pitch 5.5. CONCLUSION: The dosimetry of multi-slice computed tomography by a film method enabled it to measure a change of a dose profile by a difference of a scan parameter by high interest solution ability. In addition, it is a method more superior in dosimetry of multi-slice computed tomography spreading through a Z-axis direction broadly than determination by computed tomography use ionization chamber dosimeter. Because radiation dose increases by a scan in thin row slice thickness and small helical pitch, care is necessary.

[Study of gradient echo (GRE) Dixon image using low-field MRI scanner for examination of metastatic bone marrow tumors: comparison of double and single echo sequences].

We evaluated the gradient echo (GRE) Dixon method in metastatic bone tumors using a low-field MRI scanner (0.2 Tesla). This method is characterized by the double echo sequence of in-phase and opposed-phase. Studies were carried out on a phantom, 14 healthy volunteers, and clinical examples (33 vertebral bodies) using the T(1)-weighted spin echo, T(2)-weighted turbo spin echo, and GRE Dixon methods. Further, we obtained addition and subtraction images from the double echo sequence. In the clinical examples, the contrast-to-noise ratio (CNR) of the subtraction images (51.3+/-24.1) was significantly better than that of the T(1)-SE images (6.7+/-3.1, p<0.0001). For the examination of metastatic bone marrow tumors using a low-field MRI scanner (0.2 Tesla), subtraction images are thought to be the most effective.