Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System

Kramer, Manuel; Ellmann, Stephan; Allmendinger, Thomas; Eller, Achim; Kammerer, Ferdinand J.; May, Matthias; Baigger, João F.; Uder, Michael; Lell, Michael

doi:10.1097/md.0000000000001058

Cited by 19 publications

(16 citation statements)

References 27 publications

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“…Although the ALARA (as low as reasonably achievable) principles are used for CTA, the balance between radiation and image quality is difficult. 19 Despite the less invasive nature of Doppler studies, the most distal PA of the ICA would not have been identified without the adjunctive use of CTA in this patient. When imaging of the distal carotid vessels is required, it is recognized that CTA or MRA should be used in addition to Doppler.…”

Section: Discussionmentioning

confidence: 84%

Diagnosing Pseudoaneurysm of the Extracranial Carotid Arteries Using Doppler Ultrasonography: A Case Report

Evans

Birk

Antoniou

2018

Journal for Vascular Ultrasound

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Carotid artery pseudoaneurysms are a rare complication of carotid endarterectomy, with few recorded in the literature. We describe a case of a 56-year-old man who presented with symptoms of left hemispheric transient ischemic attack and subsequently underwent a carotid endarterectomy. The patient returned to Accident and Emergency department with an ipsilateral neck swelling found to be an extracranial pseudoaneurysm. Doppler ultrasound imaging was used throughout the management of this patient from preendarterectomy to postpseudoaneurysm bypass. This report discusses the importance of ultrasonography in the diagnosis and follow-up of carotid pseudoaneurysms.

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Section: Discussionmentioning

confidence: 84%

Diagnosing Pseudoaneurysm of the Extracranial Carotid Arteries Using Doppler Ultrasonography: A Case Report

Evans

Birk

Antoniou

2018

Journal for Vascular Ultrasound

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“…Of note, the noise-insertion tool used herein has been previously validated and allows for a reliable simulation of radiation-dose reduction in CT [ 12 ]. This allows for the assessment of radiation-dose thresholds in regards to diagnostic yield in a clinical setting while not exposing patients to additional radiation.…”

Section: Discussionmentioning

confidence: 99%

“…The calibration data were transferred into the ReconCT software and defined as the standard for the noise simulation process. Reconstructions with simulated dose levels of 100%, 50%, 10%, 5% and 1% of initial dose were performed using a validated noise-insertion tool (RawData Noise Insertion, ReconCT 13.8.2.0, Siemens Healthineers) [ 12 ]. All reconstructions were performed with iterative reconstruction (SAFIRE, Level 3) in axial orientation (3-mm slice thickness) using a medium smooth kernel (I30f) and a sharp kernel (I70f).…”

Section: Patient Materials and Methodsmentioning

confidence: 99%

Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction?

et al. 2018

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BackgroundTo evaluate the detection rate and image quality in CT-body-packer-screening at different radiation-dose levels and to determine a dose threshold that enables a reliable detection of incorporated body packs and incidental findings with a maximum of dose saving.Materials and methodsWe retrospectively included 27 individuals who underwent an abdominal CT with automated exposure control due to suspected body packing. CT images were reconstructed at different radiation-dose levels of 50%, 10, 5% and 1% using iterative reconstructions. All 135 CT reconstructions were evaluated by three independent readers. Reviewers determined the presence of foreign bodies and evaluated the image quality using a 5-point ranking scale. In addition, visualization of incidental findings was assessed.ResultsA threshold of 5% (effective dose 0.11 ± 0.07 mSv) was necessary to correctly identify all 27 patients with suspected body packing. Extensive noise insertion to a dose level of 1% (0.02 ± 0.01 mSV) led to false-positive solid cocaine findings in three patients. Image quality was comparable between 100 and 50%. The threshold for correct identification of incidental findings was 10% of the initial dose (effective dose 0.21 ± 0.13 mSv).ConclusionsOur results indicate that dose of abdominal CT for the detection of intracorporeal cocaine body packets can be markedly reduced to up to 5% of the initial dose while still providing sufficient image quality to detect ingested body packets. However, a minimum effective dose of 0.21 mSv (10% of initial dose) seems to be required to properly identify incidental findings.

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“…The proprietary reconstruction platform ReconCT (version 14.2.0.40998, Siemens Healthineers, Forchheim, Germany) was used to simulate the raw datasets of the CT examinations. It has already been shown in several studies that it is possible to simulate CT examinations with reduced mAs and, thus, lower doses using ReconCT [ 17 , 18 , 19 ]. Low-dose datasets were generated using three different dose levels: 25%, 50%, and 75% of the original dose.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Performance of Different Simulated Low-Dose Levels in Patients with Suspected Cervical Abscess Using a Third-Generation Dual-Source CT Scanner

Winkelmann¹,

Afat²,

Walter³

et al. 2020

Diagnostics

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The aim of this study was to investigate the effects of dose reduction on diagnostic accuracy and image quality of cervical computed tomography (CT) in patients with suspected cervical abscess. Forty-eight patients (mean age 45.5 years) received a CT for suspected cervical abscess. Low-dose CT (LDCT) datasets with 25%, 50%, and 75% of the original dose were generated with a realistic simulation. The image data were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) (strengths 3 and 5). A five-point Likert scale was used to assess subjective image quality and diagnostic confidence. The signal-to-noise ratio (SNR) of the sternocleidomastoid muscle and submandibular gland and the contrast-to-noise ratio (CNR) of the sternocleidomastoid muscle and submandibular glandular fat were calculated to assess the objective image quality. Diagnostic accuracy was calculated for LDCT using the original dose as the reference standard. The prevalence of cervical abscesses was high (72.9%) in the cohort; the mean effective dose for all 48 scans was 1.8 ± 0.8 mSv. Sternocleidomastoid and submandibular SNR and sternocleidomastoid muscle fat and submandibular gland fat CNR increased with higher doses and were significantly higher for ADMIRE compared to FBP, with the best results in ADMIRE 5 (all p < 0.001). Subjective image quality was highest for ADMIRE 5 at 75% and lowest for FBP at 25% of the original dose (p < 0.001). Diagnostic confidence was highest for ADMIRE 5 at 75% and lowest for FBP at 25% (p < 0.001). Patient-based diagnostic accuracy was high for all LDCT datasets, down to 25% for ADMIRE 3 and 5 (sensitivity: 100%; specificity: 100%) and lower for FBP at 25% dose reduction (sensitivity: 88.6–94.3%; specificity: 92.3–100%). The use of a modern dual-source CT of the third generation and iterative reconstruction allows a reduction in the radiation dose to 25% (0.5 mSv) of the original dose with the same diagnostic accuracy for the assessment of neck abscesses.

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Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System

Cited by 19 publications

References 27 publications

Diagnosing Pseudoaneurysm of the Extracranial Carotid Arteries Using Doppler Ultrasonography: A Case Report

Diagnosing Pseudoaneurysm of the Extracranial Carotid Arteries Using Doppler Ultrasonography: A Case Report

Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction?

Diagnostic Performance of Different Simulated Low-Dose Levels in Patients with Suspected Cervical Abscess Using a Third-Generation Dual-Source CT Scanner

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