The Utility of Dual Energy Computed Tomography in Musculoskeletal Imaging

Khanduri, Sachin; Goyal, Arun; Singh, Bheeshma Pratap; Chaudhary, Mriganki; Sabharwal, Tushar; Jain, Shreshtha; Sharma, Hritik

doi:10.4103/jcis.jcis_46_17

Cited by 11 publications

(4 citation statements)

References 41 publications

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“…Streak artifacts changed from more inflow artifacts in aDE, due to the early contrast timing, to more spine artifacts in vDE. We attribute this most likely to be due to an increased beam hardening effect, provoked by the lower main tube voltage (70 kV vs. 80 kV) in the portal venous phase protocol [12,13]. Future protocols could overcome these problems by using a tri-phasic injection protocol on one side and by increasing the tube voltage to 80 or 90 kV on the other [14,15].…”

Section: Discussionmentioning

confidence: 99%

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

et al. 2021

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Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE.

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Section: Discussionmentioning

confidence: 99%

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

et al. 2021

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“…4 DECT also offers superior metallic artifact reduction and thus improves in image quality of soft tissue adjacent to metallic implants or devices (e.g., pelvic structure adjacent to metallic hip prosthesis). 5 In clinical practice, DECT is widely used in cardiovascular imaging, especially in evaluating pulmonary thromboembolism and myocardial ischaemia. 6 Other common uses of DECT include the identification of tophi in gouty arthritis and determining renal calculi composition.…”

Section: Introductionmentioning

confidence: 99%

“…6 Other common uses of DECT include the identification of tophi in gouty arthritis and determining renal calculi composition. 5 Studies have demonstrated improvement in detecting and characterization of various renal, adrenal, hepatic, and pancreatic abnormalities. 3 In addition, current dual-energy scanners offer an improved temporal resolution, which is very helpful for CT angiography (CTA), and increased photon flux that improves image quality in large or obese patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of Dual-Energy CT in Abdominal Interventions

Tripathy

Patel

Chandel

et al. 2022

Journal of Gastrointestinal and Abdominal Radiology

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Dual-energy computed tomography (DECT) is an emerging CT technique based on data acquisition at two different settings. Various postprocessing techniques generate different sets of images, each with unique advantages. With DECT, it is possible to obtain virtual unenhanced images from monochromatic reconstructions and attenuation maps of different elements, thereby improving the detection and characterization of a variety of lesions. Presently, DECT is widely used to evaluate pulmonary embolism, characterize abdominal masses, determine the composition of urinary calculi, and detect tophi in gout. CT angiography is an essential prerequisite for endovascular intervention. DECT allows a better quality of angiographic images with a lesser dose of contrast. Various postprocessing techniques in DECT also help in a better evaluation of response to locoregional therapy. Virtual noncontrast images and iodine map differentiate residual or recurrent tumors from intrinsically hyperdense materials. Superior metallic artifact reduction allows better evaluation of vascular injuries adjacent to bony fractured fragments or previously deployed embolization coils. In addition to metal artifacts reduction, virtual monochromatic spectral imaging could further mitigate metal artifacts during CT-guided biopsy, providing an improved depiction of lesions and safe and versatile access for long puncture pathways. This article reviews and illustrates the different applications of DECT in various abdominal interventions. Familiarity with the capabilities of DECT may help interventional radiologists to improve their practice and ameliorate patient care.

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“…Resuscitation is also associated with thoracic vertebral trauma [35]. However, CT may not always reveal relevant pathologies or subtle trauma of the spinal ligaments [36].…”

Section: Introductionmentioning

confidence: 99%

Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT

Chatzaraki

Tappero

Thali

et al. 2018

Forensic Sci Med Pathol

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During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon's bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon's bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon's bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon's bleedings are present.

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The Utility of Dual Energy Computed Tomography in Musculoskeletal Imaging

Cited by 11 publications

References 41 publications

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

Utility of Dual-Energy CT in Abdominal Interventions

Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT

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