Dual-energy CT pulmonary angiography: a novel technique for assessing acute and chronic pulmonary thromboembolism

Hoey, Edward T.D.; Gopalan, Deepa; Ganesh, Vijayakumar; Agrawal, Shashank; Qureshi, Nagmi R.; Tasker, A.D.; Clements, L.; Screaton, Nicholas

doi:10.1016/j.crad.2008.11.007

Cited by 43 publications

(26 citation statements)

References 9 publications

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“…Thereby, DECT holds the potential to provide simultaneous information on the presence of endoluminal thrombus and lung perfusion impairment by generating iodine distribution maps of the lung parenchyma (▶ Fig. 4) [11,12,14,20,28,29]. The most recent technical advancements in DECT include a new powerful X-ray tube (Vectron tube, Siemens) in third generation scanners which allows for dual-energy examinations utilizing a new 90/Sn150 kV scan ▶ Table 5 Computed tomography pulmonary angiography: SSCT, DSCT, DECT.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Petritsch¹,

Kosmala²,

Gassenmaier³

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Das Potential der Dritt-Generation Dual-Source CT (DSCT) in der Lungenemboliediagnostik wurde bis dato noch nicht ausführlich untersucht. Ziel dieser Studie war es, Strahlendosisparameter sowie subjektive und objektive Bildqualität des aktuellsten DSCT Scanners im Single-Energy und Dual-Energy (DE) Modus mit einem herkömmlichen pulmonalen Standard CTA Protokoll am 64-Zeilen CT (SSCT) zu vergleichen. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Material und Methoden▪ Die Dual-Energy CT bietet potentiell zusätzliche Informationen durch die Erstellung von farbcodierten Jod-Karten. ABSTR AC TPurpose To compare radiation dose, subjective and objective image quality of 3 rd generation dual-source CT (DSCT) and dual-energy CT (DECT) with conventional 64-slice singlesource CT (SSCT) for pulmonary CTA.Materials and Methods 180 pulmonary CTA studies were performed in three patient cohorts of 60 patients each. Group 1: conventional SSCT 120 kV (ref.); group 2: single-energy DSCT 100 kV (ref.); group 3: DECT 90/Sn150 kV. CTDIvol, DLP, effective radiation dose were reported, and CT attenuation (HU) was measured on three central and peripheral levels. The signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. Two readers assessed subjective image quality according to a five-point scale.Results Mean CTDIvol and DLP were significantly lower in the dual-energy group compared to the SSCT group (p < 0.001 [CTDIvol]; p < 0.001 [DLP]) and the DSCT group (p = 0.003 [CTDIvol]; p = 0.003 [DLP]), respectively. The effective dose in the DECT group was 2.79 ± 0.95 mSv and significantly smaller than in the SSCT group (4.60 ± 1.68 mSv, p < 0.001) and the DSCT group (4.24 ± 2.69 mSv, p = 0.003). The SNR and CNR were significantly higher in the DSCT group (p < 0.001).Subjective image quality did not differ significantly among the three protocols and was rated good to excellent in 75 % (135/180) of cases with an inter-observer agreement of 80 %.Conclusion Dual-energy pulmonary CTA protocols of 3 rd generation dual-source scanners allow for significant reduction of radiation dose while providing excellent image quality and potential additional information by means of perfusion maps. Key Points:▪ Dual-energy CT with 90/Sn150 kV configuration allows for significant dose reduction in pulmonary CTA. ▪ Subjective image quality was similar among the three evaluated CT-protocols (64-slice SSCT, single-energy DSCT, 90/Sn150 kV DECT) and was rated good to excellent in 75% of cases.

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Section: Discussionmentioning

confidence: 99%

“…However, the potential of the latest (third) generation scanners to further decrease radiation dose while maintaining image quality has scarcely been assessed so far [18]. Concerning first and second generation DSCT scanners, DECT was reported to carry a radiation dose similar to that of conventional single-source CT (SSCT) [10,11,19,20].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Petritsch¹,

Kosmala²,

Gassenmaier³

et al. 2017

Fortschr Röntgenstr

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“…Differential absorption of these energy spectra by iodinated contrast media is exploited to generate a parenchymal perfusion map in addition to standard greyscale images. Scan technique is very similar to conventional CTPA with the main difference being use of a saline flush to help minimise beam hardening artefact from neat contrast medium in the superior vena cava which can simulate a perfusion defect [10].…”

Section: Ct Techniquementioning

confidence: 99%

Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

et al. 2009

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The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease.

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“…Recently, some authors [14][15][16][17] reported that simultaneous information on the presence of endoluminal thrombus and lung perfusion impairment could be obtained with DECT. Because of practical clinical concerns, these reports used either CT pulmonary angiography (CTPA) [14] or nuclear perfusion scintigraphy (PS) [15] rather than pathological results as the standard of reference for the diagnosis of pulmonary emboli, leading to some uncertainty as to the accuracy of the final diagnoses of DECT perfusion imaging.…”

Section: Introductionmentioning

confidence: 99%

Detection of pulmonary embolism by dual energy CT: correlation with perfusion scintigraphy and histopathological findings in rabbits

Zhang

Xue

Wu³

et al. 2009

Eur Radiol

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The purpose of the study was to compare the ability of dual energy CT (DECT) and perfusion scintigraphy (PS) to detect pulmonary embolism (PE) in a rabbit model. Gelfoam (n = 20) or saline (n = 4) was injected into the femoral vein of rabbits. After 2 h, DECT pulmonary angiography (CTPA) was used to create blood flow imaging (BFI) and fusion images. The rabbits then underwent PS. Pathological determination of locations and numbers of lung lobes with PE was recorded. The sensitivity and specificity for BFI, CTPA, fused images and PS were calculated using the pathological results as reference standards. Compared with pathological evaluation, CTPA correctly identified PE in 40 lobes and absence of emboli in 80 lobes, corresponding to a sensitivity and specificity of 100%. BFI and fused images correctly identified PE in 40 lobes and the absence of emboli in 78 lobes, corresponding to a sensitivity and specificity of 100% and 98%, respectively. PS correctly detected 27 lobes with PE and 65 lobes without PE, corresponding to a sensitivity and specificity of 68% and 81%, respectively. BFI, CTPA and fused images derived from a single contrast-enhanced DECT provide a higher diagnostic accuracy of detecting PE than PS in a rabbit model.

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Dual-energy CT pulmonary angiography: a novel technique for assessing acute and chronic pulmonary thromboembolism

Cited by 43 publications

References 9 publications

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

Detection of pulmonary embolism by dual energy CT: correlation with perfusion scintigraphy and histopathological findings in rabbits

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