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Multi-detector row computed tomography angiography of peripheral arterial disease

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      Abstract

      With the introduction of multi-detector row computed tomography (MDCT), scan speed and image quality has improved considerably. Since the longitudinal coverage is no longer a limitation, multi-detector row computed tomography angiography (MDCTA) is increasingly used to depict the peripheral arterial runoff. Hence, it is important to know the advantages and limitations of this new non-invasive alternative for the reference test, digital subtraction angiography. Optimization of the acquisition parameters and the contrast delivery is important to achieve a reliable enhancement of the entire arterial runoff in patients with peripheral arterial disease (PAD) using fast CT scanners. The purpose of this review is to discuss the different scanning and injection protocols using 4-, 16-, and 64-detector row CT scanners, to propose effective methods to evaluate and to present large data sets, to discuss its clinical value and major limitations, and to review the literature on the validity, reliability, and cost-effectiveness of multi-detector row CT in the evaluation of PAD.

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      Most cited references 58

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      Use of an automatic exposure control mechanism for dose optimization in multi-detector row CT examinations: clinical evaluation.

      To prospectively compare dose reduction and image quality achieved with an automatic exposure control system that is based on both angular (x-y axis) and z-axis tube current modulation with dose reduction and image quality achieved with an angular modulation system for multi-detector row computed tomography (CT). The study protocol was approved by the institutional review board, and oral informed consent was obtained. In two groups of 200 patients, five anatomic regions (ie, the thorax, abdomen-pelvis, abdomen-liver, lumbar spine, and cervical spine) were examined with this modulation system and a six-section multi-detector row CT scanner. Data from these patients were compared with data from 200 patients who were examined with an angular modulation system. Dose reduction by means of reduction of the mean effective tube current in 600 examinations, image noise in 200 examinations performed with each modulation system, and subjective image quality scores in 100 examinations per-formed with each modulation system were compared with Wilcoxon signed rank tests. Mean dose reduction for the angular and z-axis tube current modulation system and for the angular modulation system was as follows: thorax, 20% and 14%, respectively; abdomen-liver, 38% and 18%, respectively; abdomen-pelvis, 32% and 26%, respectively; lumbar spine, 37% and 10%, respectively; and cervical spine, 68% and 16%, respectively. These differences were statistically significant (P < .05). There was no significant difference in image noise and mean image quality scores between modulation systems, with the exception of cervical spinal examinations (P < .001 for both), where the examinations with angular modulation resulted in better scores. There is good correlation between the mean effective tube current level and the body mass index of patients with the new modulation system. Correlation was as follows: thorax, 0.77; abdomen-pelvis, 0.83; abdomen-liver, 0.84; lumbar spine, 0.8; and cervical spine, 0.6. This correlation was not observed with the angular modulation system. An automatic exposure control mechanism that is based on real-time anatomy-dependent tube current modulation delivers good image quality with a significantly reduced radiation dose. RSNA, 2005
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        Multi-detector row CT systems and image-reconstruction techniques.

        The introduction in 1998 of multi-detector row computed tomography (CT) by the major CT vendors was a milestone with regard to increased scan speed, improved z-axis spatial resolution, and better utilization of the available x-ray power. In this review, the general technical principles of multi-detector row CT are reviewed as they apply to the established four- and eight-section systems, the most recent 16-section scanners, and future generations of multi-detector row CT systems. Clinical examples are used to demonstrate both the potential and the limitations of the different scanner types. When necessary, standard single-section CT is referred to as a common basis and starting point for further developments. Another focus is the increasingly important topic of patient radiation exposure, successful dose management, and strategies for dose reduction. Finally, the evolutionary steps from traditional single-section spiral image-reconstruction algorithms to the most recent approaches toward multisection spiral reconstruction are traced. Copyright RSNA, 2005
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          Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose.

          The aim of the study was to implement an abdominal CT angiography protocol using 100 kVp and to compare SNR and CNR, as well as subjective image quality, to a standard CT angiography protocol using 120 kVp on a 16 detector-row CT scanner. Forty-eight patients were referred for routine abdominal CT angiography on a 16 detector-row CT scanner. Patients were scanned using either 120 or 100 kVp at constant mAs settings. Vessel opacification was provided by automated contrast injection using similar injection protocols. Density measurements were performed along the aorto-iliac axis with SNR and CNR calculation. In addition, the estimated effective patient radiation dose was calculated. Results of both protocols were compared. The 100-kVp protocol (432+/-80 HU) showed a significantly higher vessel density than the 120-kVp (333+/-90 HU; P<0.001) protocol, corresponding to an average increase in signal intensity of 30.7%. SNR (36.0 vs 37.0) and CNR (31.1 vs 31.7) for the 100-kV protocol were not significantly lower that those for the standard protocol (P=0.79 and P=0.87), whilst the average estimated dose was significantly lower using the 100-kVp protocol (6.7+/-0.4 vs 10.1+/-1.2 mSv; P<0.0001). Tube kVp reduction from 120 to 100 kVp allows for significant reduction of patient dose in abdominal CT angiography, without significant change in SNR,CNR and image quality.
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            Author and article information

            Affiliations
            [1 ]Department of Radiology, Room HS 210K, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
            [2 ]Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands
            [3 ]Department of Health Policy and Management, Harvard School of Public Health, Boston, MA USA
            Contributors
            +31-10-4639222 , +31-10-4634033 , m.kock@erasmusmc.nl
            Journal
            Eur Radiol
            European Radiology
            Springer-Verlag (Berlin/Heidelberg )
            0938-7994
            1432-1084
            20 September 2007
            December 2007
            : 17
            : 12
            : 3208-3222
            2077918
            17882427
            729
            10.1007/s00330-007-0729-4
            © Springer-Verlag 2007
            Categories
            Vascular-Interventional
            Custom metadata
            © European Society of Radiology 2007

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