Optimization of scan timing for aortic computed tomographic angiography using the test bolus injection technique.

BACKGROUND: With fast computed tomography (CT), it is possible for the scanning to outpace the contrast medium bolus during aortic CT angiography (CTA). PURPOSE: To evaluate the effectiveness of a new method for reducing the risk of outpacing in which the scan start timing (ST) and speed can be estimated from the peak enhancement time measured at the femoral artery using a single test-bolus injection (femoral artery test injection method [FTI method]). MATERIAL AND METHODS: In 30 cases of aortic CTA, we measured the time to peak enhancement at the femoral artery (TPF) and the ascending aorta (TPA) with test-bolus injection performed twice in each examination. From the resultant linear relationship between TPF and transit time (TT = TPF - TPA), we developed a method for determining the ST and TT from TPF. One hundred patients were assigned to two groups: FTI and bolus tracking (BT), each with 50 patients. CT values were measured in main vessels (ascending aorta, descending aorta, femoral artery). The CT values of the vessels and the rate of cases with more than 300 HU (good cases) were compared between the two groups. RESULTS: The enhancement in the FTI method was significantly higher than that of the BT method (average CT values: FTI, 388.3 ± 52.4; BT, 281.2 ± 59.1; P < 0.001). The rates of good cases for FTI and BT were 86.0% and 46.0%, respectively. CONCLUSION: The FTI method was very effective in reducing the risk of outpacing of the contrast medium transit in aortic CTA without the need for an additional contrast medium dose.

Comparison of physical image qualities and artifact indices for head computed tomography in the axial and helical scan modes.

This study aimed to validate the clinically demonstrated equivalency of the axial and helical scan modes (AS and HS, respectively) for head computed tomography (CT) using physical image quality measures and artifact indices (AIs). Two 64-row multi-detector row CT systems (CT-A and CT-B) were used for comparing AS and HSs with detector rows of 64 and 32. The modulation transfer function (MTF), noise power spectrum (NPS), and slice sensitivity profile were measured using a CT dose index corresponding to clinical use. The system performance function (SPF) was calculated as MTF2/NPS. The AI of streak artifacts in the skull base was measured using an image obtained of a head phantom, while the AI of motion artifacts was measured from images obtained during the head phantom was in motion. For CT-A, the 50%MTFs were 7% to 9% higher in the HS than the AS, and the higher MTFs of HS associated NPS increases. For CT-B, the MTFs and NPSs were almost equivalent between the AS and HS, respectively. Consequently, the SPFs of AS and HS were nearly identical for both CT systems. For both CT systems, the skull base AI did not differ significantly between AS and HS, while the motion AIs of HS were significantly better than of AS. The superior motion AI in the HS indicated the effectiveness of HS on moving patients.

Three-dimensional computed tomography in laparoscopic surgery for colorectal carcinoma.

AIM: To evaluate the usefulness of three-dimensional computed tomography (3DCT) in laparoscopic surgery for colorectal carcinoma. METHODS: Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group (LG), while 56 patients underwent conventional open surgery, open group (OG). At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery (IMA) by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery (SMA)/superior mesenteric vein (SMV), ileocecal artery (ICA), middle colic artery (MCA), and inferior mesenteric vein (IMV). We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS: The mean length of the incision in LG was 4.625+/-0.89 cm, which was significantly shorter than that in OG (P<0.001). The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage. CONCLUSION: Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma.

Efficacy of multislice computed tomography for gastroenteric and hepatic surgeries.

AIM: To determine the efficacy of multislice CT for gastroenteric and hepatic surgery. METHODS: Dual-phase helical computed tomography was performed in 50 of 51 patients who underwent gastroenteric and hepatic surgeries. Twenty-eight, eighteen and four patients suffering from colorectal cancer, gastric cancer, and liver cancer respectively underwent colorectal surgery (laparoscopic surgery: 6 cases), gastrectomy, and hepatectomy. Three-dimensional computed tomography imaging of the inferior mesenteric artery, celiac artery and hepatic artery was performed. And in the follow-up examination of postoperative patients, multiplanar reconstruction image was made in case of need. RESULTS: Scans in 50 patients were technically satisfactory and included in the analysis. Depiction of major visceral arteries, which were important for surgery and other treatments, could be done in all patients. Preoperative visualization of the left colic artery and sigmoidal arteries, the celiac artery and its branches, and hepatic artery was very useful to lymph node dissection, the planning of a reservoir and hepatectomy. And multiplanar reconstruction image was helpful to diagnosis for the postoperative follow-up of patients. CONCLUSION: Three-dimensional volume rendering or multiplanar reconstruction imaging performed by multislice computed tomography was very useful for gastroenteric and hepatic surgeries.

[Effectiveness of deep breath-hold SPECT in torso area: examination concerning improvement of resolution].

Because SPECT images are acquired under normal respiration, the respiratory motion induces artifacts and decreases resolution. In this study we developed a novel method of acquiring SPECT data during deep inhalation breath-hold (BrST) and assessed its efficacy in reducing motion artifacts and improving resolution. Reproducibility studies found that variations in SPECT image homogeneity were reduced using the BrST method to within a clinically non-problematic range. An experiment using a custom-built respiration phantom showed almost complete elimination of motion artifacts and significant improvement in resolution using the BrST method. Clinical assessment confirmed a significant reduction in motion artifacts along with the improvement in resolution. The BrST method enabled visualization of lesions that previously had been impossible to detect by standard acquisition under normal respiration. The BrST method is expected to both significantly reduce motion artifacts and improve resolution.

[Novel method of noise power spectrum measurement for computed tomography images with adaptive iterative reconstruction method].

Adaptive iterative reconstruction techniques (IRs) can decrease image noise in computed tomography (CT) and are expected to contribute to reduction of the radiation dose. To evaluate the performance of IRs, the conventional two-dimensional (2D) noise power spectrum (NPS) is widely used. However, when an IR provides an NPS value drop at all spatial frequency (which is similar to NPS changes by dose increase), the conventional method cannot evaluate the correct noise property because the conventional method does not correspond to the volume data natures of CT images. The purpose of our study was to develop a new method for NPS measurements that can be adapted to IRs. Our method utilized thick multi-planar reconstruction (MPR) images. The thick images are generally made by averaging CT volume data in a direction perpendicular to a MPR plane (e.g. z-direction for axial MPR plane). By using this averaging technique as a cutter for 3D-NPS, we can obtain adequate 2D-extracted NPS (eNPS) from 3D NPS. We applied this method to IR images generated with adaptive iterative dose reduction 3D (AIDR-3D, Toshiba) to investigate the validity of our method. A water phantom with 24 cm-diameters was scanned at 120 kV and 200 mAs with a 320-row CT (Acquilion One, Toshiba). From the results of study, the adequate thickness of MPR images for eNPS was more than 25.0 mm. Our new NPS measurement method utilizing thick MPR images was accurate and effective for evaluating noise reduction effects of IRs.

[Examination of motion artifacts for helical and non-helical scanning modes in head CT].

For head computed tomography (CT), non-helical scanning has been recommended even in the widely used multi-slice CT (MSCT). Also, an acute stroke imaging standardization group has recommended the non-helical mode in Japan. However, no detailed comparison has been reported for current MSCT with more than 16 slices. In this study, we compared the non-helical and helical modes for head CT, focusing on temporal resolution and motion artifacts. The temporal resolution was evaluated by using temporal sensitivity profiles (TSPs) measured using a temporal impulse method. In both modes, the TSPs and temporal modulation transfer factors (MTFs) were measured for various pitch factors using 64-slice CT (Aquilion 64, Toshiba). Two motion phantoms were scanned to evaluate motion artifacts, and then quantitative analyses for motion artifacts and helical artifacts were performed by measuring multiple regions of interest (ROIs) in the phantom images. In addition, the rates of artifact occurrence for retrospective clinical cases were compared. The temporal resolution increased as the pitch factor was increased. Remarkable streak artifacts appeared in the non-helical images of the motion phantom, in spite of the equivalent effective temporal resolution. In clinical analysis, results consistent with the phantom studies were shown. These results indicated that the low pitch helical mode would be effective for emergency head CT with patient movement.

[Evaluation of low-contrast detectability in low-dose chest computed tomography].

We investigated whether low-contrast resolution evaluation can be applied to chest (lung field) computed tomography (CT) images that are commonly reconstructed using filter kernels with strong frequency emphasis and displayed at wide window widths. We assumed low dose chest CT examinations and set the current-time product to 5 and 10 mAs. The visual detection study was performed by five radiological technologists using water phantom images in which the simulated low contrast objects (disc objects) were implanted. In addition, values of the low contrast detectability index (LCDI) based on a signal-to-noise ratio theorem were calculated from the modulation transfer factor, noise power spectrum, and the object's spectrum for each combination of object size, contrast, current-time product, and kernel. The detectability results correlated well with the LCDI values and correlated less well with the contrast-to-noise ratio results. These results were consistent with the results of past reports on abdomen images. Therefore, our results indicated that low contrast sensitivity can be applied to chest CT images as well as abdominal ones.