Continuous computed tomographic (CT) scanning of organ volumes during a single breath hold was studied. The authors modified the table feed mechanism of a continuously rotating CT scanner to allow patient transport at low, but accurately controlled, speeds (0.1-11.0 mm/sec) during continuous 1-second scanning. An algorithm was designed to reconstruct artifact-free images for arbitrary table positions from the helical data by interpolating between adjacent scans. Section sensitivity profiles were enlarged; the section width for a 10-mm section and a speed of 10.0 mm/sec was increased by a factor of 1.3, compared with the nominal value. Clinical examples were presented for studies of lung nodules and studies enhanced with contrast medium. Major advantages are the possibility of continuous scanning of extended volumes within a breath-hold period and retrospective, arbitrary selection of anatomic levels.

We report the evaluation of a prototype dual-energy implementation using rapid kVp switching on a clinical computed tomographic scanner. The method employs prereconstruction basis material decomposition of the dual-energy projection data. Each dual-energy scan can be processed into conventional single-kVp images, basis material density images, and monoenergetic images. Phantom studies were carried out to qualitatively and quantitatively evaluate and validate the approach.

The aim of this study was to assess the in vivo measurement precision of a software tool for volumetric analysis of pulmonary nodules from two consecutive low-dose multi-row detector CT scans. A total of 151 pulmonary nodules (diameter 2.2-20.5 mm, mean diameter 7.4+/-4.5 mm) in ten subjects with pulmonary metastases were examined with low-dose four-detector-row CT (120 kVp, 20 mAs (effective), collimation 4x1 mm, normalized pitch 1.75, slice thickness 1.25 mm, reconstruction increment 0.8 mm; Somatom VolumeZoom, Siemens). Two consecutive low-dose scans covering the whole lung were performed within 10 min. Nodule volume was determined for all pulmonary nodules visually detected in both scans using the volumetry tool included in the Siemens LungCare software. The 95% limits of agreement between nodule volume measurements on different scans were calculated using the Bland and Altman method for assessing measurement agreement. Intra- and interobserver agreement of volume measurement were determined using repetitive measurements of 50 randomly selected nodules at the same scan by the same and different observers. Taking into account all 151 nodules, 95% limits of agreement were -20.4 to 21.9% (standard error 1.5%); they were -19.3 to 20.4% (standard error 1.7%) for 105 nodules <10 mm. Limits of agreement were -3.9 to 5.7% for intraobserver and -5.5 to 6.6% for interobserver agreement. Precision of in vivo volumetric analysis of nodules with an automatic volumetry software tool was sufficiently high to allow for detection of clinically relevant growth in small pulmonary nodules.

Background and Purpose-We aimed to determine the diagnostic value of perfusion computed tomography (PCT) and CT angiography (CTA) including CTA source images (CTA-SI) in comparison with perfusion-weighted magnetic resonance imaging (MRI) (PWI) and diffusion-weighted MRI (DWI) in acute stroke Ͻ6 hours. Methods-Noncontrast-enhanced CT, PCT, CTA, stroke MRI, including PWI and DWI, and MR angiography (MRA), were performed in patients with symptoms of acute stroke lasting Ͻ6 hours. We analyzed ischemic lesion volumes on patients' arrival as shown on NECT, PCT, CTA-SI, DWI, and PWI (Wilcoxon, Spearman, Bland-Altman) and compared them to the infarct extent as shown on day 5 NECT. Results-Twenty-two stroke patients underwent CT and MRI scanning within 6 hours. PCT time to peak (PCT-TTP) volumes did not differ from PWI-TTP (Pϭ0.686 for patients who did not undergo thrombolysis/Pϭ0.328 for patients who underwent thrombolysis), nor did PCT cerebral blood volume (PCT-CBV) differ from PWI-CBV (Pϭ0. Pϭ0.0047, rϭ1.0/Pϭ0.0046, rϭ0.819). Conclusions-In hyperacute stroke, the combination of PCT and CTA can render important diagnostic information regarding the infarct extent and the perfusion deficit. Lesions on PCT-TTP and PCT-CBV do not differ from lesions on PWI-TTP and PWI-CBV; lesions on CTA source images do not differ from lesions on DWI. The combination of noncontrast-enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA) can render additional information within Ͻ15 minutes and may help in therapeutic decision-making if PWI and DWI are not available or cannot be performed on specific patients.

Dual-energy material density images obtained by prereconstruction-basis material decomposition techniques offer specific tissue information, but they exhibit relatively high pixel noise. It is shown that noise in the material density images is negatively correlated and that this can be exploited for noise reduction in the two-basis material density images. The algorithm minimizes noise-related differences between pixels and their local mean values, with the constraint that monoenergetic CT values, which can be calculated from the density images, remain unchanged. Applied to the material density images, a noise reduction by factors of 2 to 5 is achieved. While quantitative results for regions of interest remain unchanged, edge effects can occur in the processed images. To suppress these, locally adaptive algorithms are presented and discussed. Results are documented by both phantom measurements and clinical examples.

Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity. Key Points • DCE-CT can robustly assess tumour vascular support • DCE-CT has reached technical maturity for use in therapeutic trials in oncology • This paper presents consensus guidelines for using DCE-CT in assessing tumour vascularity.

Computed tomographic (CT) coronary angiography is a well-established, noninvasive imaging modality for detection of coronary stenosis, but it has limited accuracy in demonstrating whether a coronary stenosis is hemodynamically significant. An additional functional test is often required because both anatomic and functional information is needed for guiding patient care. Recent developments in CT technology allow CT evaluation of myocardial perfusion during vasodilator stress, thereby providing information about myocardial ischemia. Investigators in several single-center studies have established the feasibility of performing stress myocardial perfusion CT imaging in small groups of patients and have shown that stress myocardial perfusion CT in combination with CT coronary angiography improved the diagnostic accuracy in comparison with CT coronary angiography alone. However, CT perfusion acquisition protocols must be optimized in terms of acquisition and reconstruction parameters, contrast material protocol injections, and radiation dose. Further research is needed to establish the clinical usefulness of this novel technique. The purpose of this review is to (a) provide an overview of the physiology of coronary circulation and myocardial perfusion; (b) describe the technical prerequisites, challenges, and mathematic modeling related to CT perfusion imaging; (c) note recent advances in CT scanners and CT perfusion protocols; and (d) discuss the interpretation of CT perfusion images. Finally, a review and summary of the current literature are provided, and future directions for research are discussed.

Background and Purpose-Besides the delineation of hypoperfused brain tissue, the characterization of ischemia with respect to severity is of major clinical relevance, because the degree of hypoperfusion is the most critical factor in determining whether an ischemic lesion becomes an infarct or represents viable brain tissue. CT perfusion imaging yields a set of perfusion related parameters which might be useful to describe the hemodynamic status of the ischemic brain. Our objective was to determine whether measurements of the relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative time to peak (rTP) can be used to differentiate areas undergoing infarction from reversible ischemic tissue. Methods-In 34 patients with acute hemispheric ischemic stroke Ͻ6 hours after onset, perfusion CT was used to calculate rCBF, rCBV, and rTP values from areas of ischemic cortical and subcortical gray matter. Results were obtained separately from areas of infarction and noninfarction, according to the findings on follow-up imaging studies. The efficiency of each parameter to predict tissue outcome was tested. Results-There was a significant difference between infarct and peri-infarct tissue for both rCBF and rCBV but not for rTP.Threshold values of 0.48 and 0.60 for rCBF and rCBV, respectively, were found to discriminate best between areas of infarction and noninfarction, with the efficiency of the rCBV being slightly superior to that of rCBF. The prediction of tissue outcome could not be increased by using a combination of various perfusion parameters. Conclusions-The assessment of cerebral ischemia by means of perfusion parameters derived from perfusion CT provides valuable information to predict tissue outcome. Quantitative analyses of the severity of ischemic lesions should be implemented into the diagnostic management of stroke patients.