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Comparison of spiral-acquisition computed tomography and conventional computed tomography in the assessment of pulmonary metastatic disease.

In a prospective study, spiral-acquisition computed tomography (SACT) of the thorax was evaluated in 104 patients with extrathoracic malignancy and suspected pulmonary metastases, and was directly compared with conventional computed tomography (CCT) in 23 patients. The following parameters were assessed: lesion detectability; the effect on lesion detectability of reconstruction of scans at 5 mm and 10 mm slice increments; breathing artefact and slice misregistration. The radiation dose of the two techniques was measured using thermoluminescent dosimeters placed within an anthropomorphic chest phantom, and the visibility of simulated metastases inserted into the phantom was also compared using CCT, standard SACT and SACT with pitch greater than 1.0. Where metastases were present, SACT scans showed significantly better lesion detectability than CCT scans (p < 0.001). Image reconstruction of SACT data at 5 mm increments conferred no significant advantage in lesion detectability over 10 mm increment reconstructions. Compared with CCT, SACT scans showed reduced breathing artefact, and a complete absence of slice misregistration (p < 0.01). Phantom measurements of radiation dose and resolution were similar for both techniques. Increasing the pitch of the spiral in SACT caused only a small decrease in phantom resolution, but with the advantage of a reduction in the radiation dose. Spiral-acquisition CT is superior to conventional CT for the assessment of pulmonary metastatic disease.

Adolescent↗

Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography.

OBJECTIVES: Radiation doses were determined to balance risks against usefulness of the different modalities available for the imaging of the facial skeleton. METHODS: An Alderson Rando Phantom, armed with lithium fluoride thermoluminescent dosemeters (TLDs) was exposed using a set of four conventional radiographs (orbital view, modified Waters view, orthopantomography, skull posterior--anterior 0 degrees ), two different cone beam computed tomography (CBCT) (NewTom 9000 and Siremobil Iso-C3D), and multislice computed tomography (CT) modalities (Somatom VolumeZoom and Somatom Sensation 16). TLDs from 14 well defined anatomical sites lying within the primary beam as well as the TLD corresponding to the thyroid gland were evaluated. RESULTS: Multislice CT showed the highest exposure values. Exposure levels of the CBCT systems lay between CT and conventional radiography. Dose measurement for the 16-slice CT revealed nearly the same radiation exposure as the 4-slice system when adapted examination protocols were used. CONCLUSIONS: Selection of the most appropriate imaging modality should be performed in view of the delivered doses, required image quality and information and the clinical circumstances.

Facial Bones↗

Precision and accuracy of peripheral quantitative computed tomography (pQCT) in the mouse skeleton compared with histology and microcomputed tomography (microCT).

UNLABELLED: pQCT was evaluated for accuracy of phenotypic characterization of mouse bone in vivo. Bones (tibia, femur, spine) of 27 animals were measured ex vivo with pQCT, microCT, and histomorphometry and of 23 mice in vivo (pQCT). pQCT yielded satisfactory in vivo precision and accuracy in skeletal characterization. INTRODUCTION: Important aspects of modern skeletal research depend on the phenotypic characterization of genetically manipulated mice, with some approaches requiring in vivo measurement. Peripheral quantitative computed tomography (pQCT) is applicable in vivo and provides opportunities to determine a large variety of bone parameters. Here we test the ex vivo and in vivo reproducibility of pQCT, and its accuracy in comparison with histomorphometry and microcomputed tomography (microCT). MATERIALS AND METHODS: We examined the tibia, femur, and lumbar spine of 27 mice ex vivo with high-resolution pQCT, using two mouse models (wild-type and ob/ob) with known differences in bone density. Measurements were repeated three times at different days in nine animals. In a second experiment, 23 animals (10 wild-type and 13 bGH transgenic mice) were repeatedly measured in vivo at 12 and 13 weeks of age, respectively. RESULTS: Among metaphyseal sites, the ex vivo precision was highest at the distal femur (RMS CV < 1% for density and < 2% for area). The correlation between density (pQCT) and bone volume fraction (histomorphometry) was r2 = 0.79 (tibia, femur, and spine), and that with microCT was r2 = 0.94 (femur). At the diaphysis, the precision was highest at the femur (< 2% for total and cortical area), and the correlation with microCT was r2 > 0.77. The in vivo precision for bone density (distal femur) was 2.3-5.1%, and that for absolute and relative cortical area (tibia) was 3.1% and 2.2%. CONCLUSIONS: The results show that pQCT can yield satisfactory precision and accuracy in skeletal characterization of mouse bones, if properly applied. The potential advantage of pQCT is that it provides a large set of parameters on bone properties and that it can be used in vivo, extending the available methodological repertoire for genetic studies.

Animals↗

Dynamic perfusion computerized tomography in cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a comparison with technetium-99m-labeled ethyl cysteinate dimer-single-photon emission computerized tomography.

OBJECT: The aim of this study was to correlate cerebral blood flow (CBF) and mean transient time (MTT) measured on dynamic perfusion computerized tomography (CT) with CBF using (99m)Tc ethyl cysteinate dimer-single-photon emission computerized tomography (SPECT) in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). METHODS: Thirty-five patients with vasospasm following aneurysmal SAH (12 men and 23 women with a mean age of 49.3 +/- 10.1 years) underwent imaging studies; thus, 35 perfusion CT scans and 35 SPECT images were available for comparison. The CBF and MTT values in 12 different brain regions were defined relative to the interhemispheric occipital cortex values using perfusion CT scans and were compared with qualitative relative (rel)CBF estimated on SPECT images. In brain regions with normal, mild (relCBF 71-85%), moderate (relCBF 50-70%), and severe (relCBF < 50%) hypoperfusion on SPECT, the mean relCBF values measured on perfusion CT were 1.01 +/- 0.08, 0.82 +/- 0.22, 0.6 +/- 0.15, and 0.32 +/- 0.08, respectively (p < 0.0001); the mean relMTT values were 1.04 +/- 0.14, 1.4 +/- 0.31, 2.16 +/- 0.46, and 3.3 +/- 0.54, respectively (p < 0.0001). All but one brain region (30 regions) with severe hypoperfusion on SPECT images demonstrated relCBF values less than 0.6 and relMTT values greater than 2.5 on perfusion CT scans. CONCLUSIONS: Relative CBF and MTT values on perfusion CT showed a high concordance rate with estimated relCBF on SPECT in patients with vasospasm following aneurysmal SAH. Given its logistical advantages, perfusion CT may be a valuable method of assessing perfusion abnormality in the acute setting of vasospasm and in patients with an unstable condition following aneurysmal SAH.

Adult↗

A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma.

BACKGROUND AND OBJECTIVES: Bone lesions in multiple myeloma (MM) have been traditionally detected by whole body X-ray (WBXR) survey although magnetic resonance imaging (MRI) has become the gold standard for detecting MM involvement of the spine and pelvis. The aim of this study was to compare a new technique, positron emission tomography (PET) with 18F fluorodeoxyglucose (FDG) integrated with computed tomography (18F-FDG PET-CT), with MRI and WBXR for baseline assessment of bone disease in MM. DESIGN AND METHODS: We prospectively compared 18F-FDG PET-CT, MRI of the spine-pelvis and WBXR in a series of 46 patients with newly diagnosed MM. In 23 patients who received up front autologous transplantation, we also compared post-treatment PET-CT scans with MR images of the spine and pelvis. RESULTS: Overall, PET-CT was superior to planar radiographs in 46% of patients, including 19% with negative WBXR. In 30% of patients, PET-CT scans of the spine and pelvis failed to show abnormal findings in areas in which MRI revealed an abnormal pattern of bone marrow involvement, more frequently of diffuse type. In contrast, in 35% of patients PET-CT enabled the detection of myelomatous lesions in areas which were out of the field of view of MRI. By combining MRI of the spine- pelvis and 18F-FDG PET-CT, the ability to detect sites of active MM, both medullary and extramedullary, was as high as 92%. Following transplantation, 15 patients had negative PET-CT scans (including 13 with a very good partial response or at least a near complete response), but only 8 had normal MRI. INTERPRETATION AND CONCLUSIONS: MRI of the spine and pelvis still remains the gold standard imaging technique for the detection of bone marrow involvement in MM. 18F-FDG PET-CT provides additional and valuable information for the assessment of myeloma bone disease in areas not covered by MRI.

Adult↗

[Three-dimensional computed tomography angiography of coronary artery bypass graft with electron beam tomography].

OBJECTIVES: Assessment of coronary artery bypass graft patency by three-dimensional reconstructed computed tomography angiography (3D-CTA) derived from electrocardiography-gated contrast-enhanced electron beam tomography (EBT) was evaluated. METHODS: Thirty-nine patients with 99 grafts (45 arterial grafts and 54 venous grafts) underwent 3D-CTA and selective coronary angiography within a 3-week interval. 3D-CTA images of the coronary bypass grafts were compared with the coronary angiography images used as the control. RESULTS: 3D-CTA defined 42 of 44 arterial grafts as patent (sensitivity: 95%), all 47 venous grafts as patent (sensitivity: 100%) and all 7 venous grafts as occlusive (specificity: 100%). The overall sensitivity and specificity were 98% and 88%, respectively. CONCLUSIONS: 3D-CTA is an useful noninvasive technique with adequate sensitivity and specificity to assess coronary artery bypass graft patency.

Aged↗

[From morphology to function: progress in integrated lung imaging using computerized tomography and magnetic resonance tomography].

During the last two decades diagnostic imaging of the pulmonary system has been improved dramatically with computed tomography (CT). Especially with high-resolution computed tomography techniques it has become possible to document the various forms of interstitial lung disease in detail. Magnetic resonance imaging (MRI) has been accepted for investigating abnormalities of the Mediastinum and of the chest wall. Magnetic resonance imaging of the lung parenchyma, however, is performed in experimental settings and is not yet used routinely in clinical practice.

Humans↗

Flat-panel detector computed tomography for the assessment of coronary artery stents: phantom study in comparison with 16-slice spiral computed tomography.

PURPOSE: The evaluation of coronary artery stents is a major limitation of cardiac multislice spiral computed tomography (MSCT). The development of flat-panel detector computed tomography (FPCT) with truly isotropic spatial resolution may overcome this limitation. Thus, we evaluated the use of FPCT in comparison to MSCT for the assessment of coronary artery stents. MATERIAL AND METHODS: Eight different coronary artery stents with a diameter of 3 mm each were placed in a static chest phantom. The phantom was positioned in the CT gantry at angles of 0 degrees , 45 degrees , and 90 degrees toward the z-axis and examined with the prototype of a FPCT (Siemens, Forchheim, Germany) and a commercially available 16-detector row MSCT (Sensation 16, Siemens). Slice thickness was 0.25 mm with FPCT whereas for MSCT, an effective slice thickness of 1 mm with a reconstruction increment of 0.5 mm was used. Image quality was assessed visually using a 5-point grading scale. Stent diameters were measured and compared using a repeated-measures analysis of variance. RESULTS: When compared with MSCT, artificial lumen reduction was significantly less using FPCT. On average the visible stent lumen was reduced by 16.1% with FPCT, whereas the mean of the lumen reduction was 47.2% with 16-detector row MSCT. Visible lumen diameter as well as image noise significantly increased using FPCT (P < 0.001). With FPCT delineation of the different stent struts became possible. CONCLUSION: FPCT proved to be superior when compared with 16-detector row MSCT for the in vitro assessment of coronary artery stents. Improved spatial resolution allows for a detailed assessment of the coronary artery stent lumen.

Coronary Angiography↗

Computed tomography and high-resolution computed tomography of pneumoconioses.

The traditional imaging technique used in the assessment of patients suspected of having silicosis or asbestos-related disease has been the chest radiograph. However, computed tomography and high-resolution computed tomography have become widely available for these assessments. The relative merits of these techniques in the diagnosis of these diseases warrant review.

Asbestosis↗

[Soft tissue diagnosis of the shoulder joint using sonography, computerized tomography and magnetic resonance tomography (MRT)].

Injuries and degenerative alterations of the shoulder predominantly affect the soft tissue. To investigate this area we use a multitude of diagnostic examinations: apart from clinical and functional diagnosis also the image reproductive methods of arthrography, ultrasound and computer tomography in addition to the classical X-ray. To ascertain pathological changes to shoulder soft tissue the simplest and quickest, least dangerous and most straightforward examination is the sonograph as it includes dynamic movement procedures. Warning: a high degree of experience and anatomical knowledge is a must! Computer- and especially nuclear spin tomography--being static examining forms a comprehensive picture of every anatomic structure and its pathology--may well represent a valuable addition to shoulder diagnostics. Nevertheless, as yet the clinical and material requirements are still enormous.

Humans↗

[The importance of computed tomography and magnetic resonance tomography in shockwave cholelithotripsy].

With shockwave-lithotripsy a new method of therapy has been introduced, whose efficiency is essentially determined by that of the accompanying imaging diagnostics. This poses several new problems for the diagnostic radiologist. While sonography and conventional cholegraphy have an important place in connection with shockwave-lithotripsy, the role of computed tomography (CT) and magnetic resonance tomography (MRT) has not yet been established. According to our experiences and experimental data pre-interventional CT improves the accuracy for measurements of the calcium content of concrements and gives the best survey on the topography of the upper abdomen of patients with biliary concrements. MRT before lithotripsy does not yield important additional information. Applied after intervention it at least equals CT. Besides localization and description of the diseased gall-bladder the detection of complications with CT and MRT is one of the tasks of the radiologist in connection with shockwave-lithotripsy.

Cholelithiasis↗

Instrumentation in positron emission tomography. Council on Scientific Affairs. Report of the Positron Emission Tomography Panel.

Positron emission tomography (PET) is a three-dimensional medical imaging technique that noninvasively measures the concentration of radiopharmaceuticals in the body that are labeled with positron emitters. With the proper compounds, PET can be used to measure metabolism, blood flow, or other physiological values in vivo. The technique is based on the physics of positron annihilation and detection and the mathematical formulations developed for x-ray computed tomography. Modern PET systems can provide three-dimensional images of the brain, the heart, and other internal organs with resolutions on the order of 4 to 6 mm. With the selectivity provided by a choice of injected compounds, PET has the power to provide unique diagnostic information that is not available with any other imaging modality. This is the first of five reports on the nature and uses of PET that have been prepared for the American Medical Association's Council on Scientific Affairs by an authoritative panel.

Brain↗

Value and limitation of stress thallium-201 single photon emission computed tomography: comparison with nitrogen-13 ammonia positron tomography.

The diagnostic value of exercise 201Tl single photon emission computed tomography (SPECT) for assessing coronary artery disease (CAD) was comparatively evaluated with exercise [13N] ammonia positron emission tomography (PET). Fifty-one patients underwent both stress-delayed SPECT imaging using a rotational gamma camera and stress-rest PET imaging using a high resolution PET camera. Of 48 CAD patients, SPECT showed abnormal perfusion in 46 patients (96%), while PET detected perfusion abnormalities in 47 (98%). The sensitivity for detecting disease in individual coronary arteries (greater than 50% stenosis) was also similar for SPECT (81%) and PET (88%). When their interpretations were classified as normal, transient defect, and fixed defect in 765 myocardial segments, SPECT and PET findings were concordant in 606 segments (79%). However, 66 segments showed a fixed defect by SPECT but a transient defect by PET, whereas there were only nine segments showing a transient defect by SPECT and a fixed defect by PET. PET identified transient defects in 34% of the myocardial segments showing a fixed defect by SPECT. We conclude that both stress SPECT and PET showed high and similar sensitivities for detecting CAD and individual stenosed vessels. Since stress-delayed SPECT with single tracer injection detected fewer transient defects, it may underestimate the presence of myocardial ischemia, compared with high resolution PET imaging with two tracer injections.

Adult↗

[Exercise 13NH3-positron emission computed tomography (PET) versus exercise single photon emission computed tomography (SPECT)].

The value of exercise positron emission computed tomography (PET) was determined by comparing it with exercise T1-201 single photon emission computed tomography (SPECT) using graded ergometer exercise in 10 anginal patients with left anterior descending coronary (LAD) involvement (stenosis greater than or equal to 75%) with or without other coronary stenosis. The distribution of N-13 ammonia or T1-201 was determined and expressed as percent count ot the highest count on the circumferential profile curve (CPC) in the transaxial image. Two standard deviations below the mean counts of six normal hearts for PET and ten for SPECT were considered as the lower limit of normal, and these were determined separately during exercise and at rest. The ischemic areas per total myocardial areas (%C), the accuracy in diagnosing coronary involvement and the identification of coronary branch involvement were determined by CPC analysis in three corresponding slices. Regional analyses revealed that accuracy in diagnosing proximal left anterior descending artery (LAD) involvement was higher with PET (9/10) than with SPECT (7/10), but the difference was not statistically significant. The accuracy in diagnosing right coronary or circumflex artery stenosis was 9/10 with PET and 8/10 with SPECT (NS); the %C was significantly higher with PET than with SPECT during exercise (PET: mean +/- SD = 56 +/- 21%, SPECT: 35 +/- 21%, p less than .01) in spite of smaller double products (x10(3] (PET: 18.9 +/- 4.7, SPECT: 23.5 +/- 5.7, p less than .02). Thus, exercise PET was more reliable in evaluating regional ischemia and in semiquantifying the ischemic area in the myocardium.

Ammonia↗

[Computerized tomography (CT) and nuclear magnetic resonance tomography (MRT) in the diagnosis of liver metastasis].

Sonography and computer-tomography (CT) are the "gold-standard" in the imaging of liver-metastasis larger than 1 to 2 cm in diameter (overall-accuracy: greater than 90%). The magnetic resonance tomography (MRT) also allows the imaging of liver-metastasis due to the different relaxation-times of normal liver-tissue and metastasis. In agreement with other authors MRT shows an almost equal accuracy in the diagnosis of liver-metastasis as CT (16 patients, average age 58 years). The significantly reduced detail-resolution of MRT in comparison with CT is overcome by the gain in contrast-resolution. The smaller imaging extent in MRT is disadvantageous in the evidence of pleural effusions, bone-metastasis or lymph-node enlargements. A pathognomic differential-diagnosis of liver-metastasis by MRT is impossible. In the near future MRT of liver-metastasis can be improved by "flash"-images and may replace CT. On the other hand screening for liver-metastasis with sonography is unchallenged by MRT.

Adolescent↗

[Value of conventional tomography and computer tomography in therapy-resistant diseases of the paranasal sinuses].

The informational value of conventional tomography as primary diagnostic method is pointed out in diseases of nasal sinuses resistant to therapy. 5 cases demonstrate the additional information gained by CT-differentiation of soft tissue structures, intraorbital and intracranial expansion. In 78.4% of the examined group of 51 patients conventional tomography allowed the diagnosis of a process limited to the nasal sinuses, further evidence by CT could be omitted. In 11 patients examined by CT additionally, the expansion of the process was defined more precisely and the assumed intraorbital and intracranial growth confirmed.

Adolescent↗

[Myocardial positron computed tomography using N-13 ammonia for evaluating coronary artery disease: comparison with thallium-201 emission computed tomography].

To assess myocardial perfusion in patients with coronary artery disease (CAD), N-13 ammonia positron computed tomography (PCT) was performed for 32 cases, and the PCT images were compared with those of single-photon emission computed tomography (SPECT) using thallium-201. Myocardial perfusion images were obtained with a whole-body multislice PCT device following the intravenous injection of 10 to 20 mCi N-13 ammonia at rest (32 cases) and during exercise (23 cases). Eleven cases underwent serial 15-20 second dynamic studies immediately following the N-13 ammonia injection. Serial dynamic study showed the blood-pool images in the first scan, and enabled assessment of tracer washout from the blood-pool, and the lung as well as washin into the myocardium. PCT provided clear resting myocardial perfusion images in all cases. PCT images were of higher quality than those of SPECT due to higher spatial resolution with less statistical noise, allowing delineation of the right ventricular myocardium and papillary muscles in many cases. Both PCT and SPECT detected perfusion abnormalities in 18 of the 19 cases with myocardial infarction, without false positive findings. PCT yielded stress myocardial images and permitted comparative evaluations of myocardial perfusions at rest and during exercise in all 23 cases. Perfusion abnormalities were detected in 14 cases (74%) at rest and in 18 cases (95%) during exercise among 19 patients with CAD. No false positives were observed, either by resting or stress PCT imaging. Stress myocardial PCT identified regional perfusion abnormalities in 30 of the 34 regions supplied by stenosed vessels (88%). High resolution PCT images enabled precise evaluation of myocardial perfusions which proved valuable for assessing myocardial perfusions before and after aorto-coronary bypass surgery. The present study proved advantages of N-13 ammonia PCT in creating three-dimensional high resolution images of the myocardium, which facilitates precise evaluation of myocardial perfusions. Furthermore, its potential capabilities in quantifying coronary reserve function will be very useful. This method should provide valuable pathophysiological information for CAD, as well as for metabolic PCT imaging.

Ammonia↗

[Diagnostic imaging potentialities of nuclear resonance tomography. Changes in vertebrae, ligaments and intervertebral disks in comparison with computed tomography].

This is a study of 49 patients with lesions of the spine excluding primary tumors of the spinal cord. All patients were examined by computed tomography and magnetic resonance imaging. Comparing both methods we observed slight diagnostic advantages for magnetic resonance imaging in inflammatory and neoplastic disease. Especially for evaluation of the spinal cord and subarachnoid space MR-imaging is far superior to computed tomography.

Adult↗