The aim of this study was to report initial clinical experience with a 320-slice CT scanner and to perform an image quality evaluation. 26 patients with presumptive cerebrovascular pathology underwent 320-slice CT. Single-rotation CT of the head, incremental CT angiography (three-dimensional (3D) CTA) as well as four-dimensional whole-brain CTA (4D CTA) and whole-brain CT perfusion (CTP) were performed and the resulting images were assessed for quality and compared with those obtained with 64-slice CT protocols. 320-slice CT neuroimaging could be performed in all cases. The image quality of 320-slice CT of the head and 3D CTA was inferior to that of the 64-slice protocols. The image quality of 4D 320-slice CTA was rated as inferior to both 320- and 64-slice 3D CTA. 4D CTA-CTP imaging added information with pivotal clinical implications. 320-slice CT neuroimaging is feasible technique that permits whole-brain 4D imaging and has the potential to identify pathologies with altered haemodynamics. However, image quality is a limitation of this technique at present.
This phantom study shows that single-source DECT allows detection and characterization of crystal deposits when present in soft tissue at relatively low concentrations. Further studies in patients have to prove its benefits in diagnostic imaging and treatment monitoring as well as its significance compared with dual-source CT systems.
Purpose
The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model.
Methods
Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation.
Results
With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = −0.79 [confidence interval (CI), −0.85 to −0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.
For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of −2.00 HU/°C (95% CI, −1.58 to −2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below −20°C were distinguished with 65.3% accuracy.
Conclusions
Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.
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