Dual energy CT for the assessment of lung perfusion—Correlation to scintigraphy

Thieme, Sven F.; Becker, Christoph R.; Hacker, Marcus; Nikolaou, Konstantin; Reiser, Maximilian; Johnson, Thorsten R. C.

doi:10.1016/j.ejrad.2008.07.031

Cited by 264 publications

(186 citation statements)

References 20 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%

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%

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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“…The six-minute walk test, quantifying the achievable walking distance, is commonly used as a measure of a patient's global functional impairment in CTEPH [9]. Among many other applications [10 -13], dual-energy CTPA (DE-CTPA) can be used to generate iodine distribution maps of pulmonary parenchyma [14 -16] which correspond well with pulmonary perfusion on scintigraphy [17] and SPECT [18] in acute PE. A good correlation of DE-CTPA iodine distribution maps with lung perfusion scintigraphy has been specifically demonstrated in patients with CTEPH [19].…”

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confidence: 99%

Automated Quantification of Pulmonary Perfused Blood Volume by Dual-Energy CTPA in Chronic Thromboembolic Pulmonary Hypertension

Meinel¹,

Graef²,

Thierfelder³

et al. 2013

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Zusammenfassung !Zielsetzung: Ziel der Studie war es zu untersuchen, ob die automatisierte Quantifizierung des perfundierten Lungenblutvolumens (PBV) in der dual-energy CT Pulmonalis-Angiografie (DE-CTPA) zur Beurteilung des Schweregrades einer chronisch-thromboembolischen pulmonalen Hypertonie (CTEPH) genutzt werden kann. Methoden: Die automatisierte Quantifizierung des PBV wurde bei 25 konsekutiven Patienten mit CTEPH durchgeführt, die mittels DE-CTPA untersucht wurden. Die PBV-Werte wurden mit Parametern aus Rechtsherzkatheteruntersuchung (pulmonalarterieller Druck, Herzindex und pulmonalem Gefäßwiderstand) sowie der 6-Minuten-Gehstrecke korreliert. Hierbei wurde der Korrelationskoeffizient nach Pearson verwendet und mittels multivariater linearer Regression für Alter und Geschlecht adjustiert. Ergebnisse: Die aus der DE-CTPA ermittelten PBVWerte korrelierten negativ mit dem systolischen (r = -0,64, p = 0,001) und mittleren (r = -0,57, p = 0,004) pumonalarteriellen Blutdruck. Es zeigte sich ein Trend zu einer negativen Korrelation zwischen PBV-Werten und dem pulmonalen Gefäßwiderstand (r = -0,20, p = 0,35). Zwischen PBV und Herzindex sowie 6-Minuten-Gehstrecke wurden keine signifikanten Korrelationen gefunden. Durch multivariate lineare Regression wurde bestätigt, dass diese Korrelationen von Alter und Geschlecht unabhänig waren. Schlussfolgerung: Die DE-CTPA kann bei Patienten mit CTEPH für eine automatisierte Quantifizierung des perfundierten Lungenblutvolumens genutzt werden. Deren Ergebnisse korrelieren invers mit systolischem und mittlerem pulmonalarteriellen Druck und können daher den Schweregrad der pulmonalen Hypertonie bei diesen Patienten abschätzen. Abstract !Objectives: The aim of the study was to determine whether automated quantification of pulmonary perfused blood volume (PBV) in dual-energy computed tomography pulmonary angiography (DE-CTPA) can be used to assess the severity of chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Automated quantification of PBV was performed in 25 consecutive CTEPH patients undergoing DE-CTPA. PBV values were correlated with cardiac index and pulmonary vascular resistance quantified by right heart catheterization and walking distance in the 6-minute walk test using Pearson's correlation coefficient and multivariate linear regression analysis to control for age and gender. Results: DE-CTPA derived PBV values inversely correlated with systolic (r = -0.64, p = 0.001) and mean (r = -0.57, p = 0.004) pulmonary arterial pressure. There was a trend for PBV values to inversely correlate with pulmonary vascular resistance (r = -0.20, p = 0.35). No significant correlation was found between PBV values and cardiac index or 6-minute walking distance. These correlations were confirmed to be independent of age and gender on multivariate linear regression analysis. Conclusion: DE-CTPA can be used for an automated quantification of pulmonary PBV in chronic thromboembolic pulmonary hypertension. PBV values correlate inversely with systolic and mean pulmonary arteria...

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“…Acute pulmonary embolism in one 17-year-old man A) axial, B) coronal, and C) right sagittal lung vessel images show the pulmonary emboli in the right lower pulmonary artery color coded as red Furthermore, pulmonary CTA and DECT lung perfusion could assist in the detection of pulmonary emboli that are not evident by conventional MDCT pulmonary angiography. Thieme et al [Thieme SF ,2008] found that corresponding perfusion defects were observed in DECT and scintigraphy in two patients in whom there was no evidence of intravascular clots in angiographic CT images. They proposed that the observed pulmonary perfusion defects probably corresponded to segments of prior embolism with re-perfused, segmental vessels and residual peripheral thrombosed vessels that were too small to visualize in CTPA.…”

Section: Acute Pe Detectionmentioning

confidence: 99%

“…On a per segment basis, the sensitivity and specificity ranged from 60%-66.7% and from 99.5%-99.8%; CTPA was used in this study as the standard of reference in 24 patients with suspected PE, 4 of whom actually had PE. With scintigraphy as the standard of reference, Thieme et al [ Thieme SF ,2008] reported 75% sensitivity and 80% specificity on a per patient basis and 83% sensitivity and 99% specificity on a per segment basis in a small group of patients with DECT. A group of 117 patients was examined by Pontana et al [Pontana F, 2008] to investigate the accuracy of DECT in the depiction of perfusion defects in patients with acute PE, concluding that simultaneous information on the presence of endoluminal thrombus and lung perfusion impairment can be obtained with…”

Section: Acute Pe Detectionmentioning

confidence: 99%