Dual Source CT Imaging

Seidensticker

Hofmann

(Eds.)

Dual Source CT Imaging

Peter R. Seidensticker, MD

Lars K. Hofmann, MD

With 209 Figures and 52 Tables

ISBN 978-3-540-77601-7

Springer Medizin Verlag Heidelberg

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Content

Foreword 7

The Dual Source CT Expert Panel 9

Authors 13

Dual Source CT Technology

Bernhard Schmidt, Christiane Bredenhoeller, Thomas Flohr 19

Iodinated Contrast Media: New Perspectives with Dual Source CT

Matthias Braeutigam, Ute Huebner-Steiner, Hubertus Pietsch, Ulrich Speck 35

Cardiovascular and Body Radiology DSCT Applications

Cardiac: Coronary CT Angiography

Stephan Achenbach, Axel Kuettner, Dieter Ropers – Erlangen-Nuremberg 50

Cardiac: Coronary Stents

Stephan G. Ruehm, Cesar Arellano, Christoph Panknin – Los Angeles 60

Cardiac: Coronary CTA in Obese Patients

Kavitha M. Chinnaiyan, Ralph Gentry, Gilbert L. Raff – Royal Oak 70

Cardiac: Valvular Function

Hatem Alkadhi, Sebastian Leschka, Hans Scheffel, Paul Stolzmann – Zurich 80

Cardiac: Morphology

Scott Harris, Cynthia McCollough, Eric Williamson – Rochester 90

Cardiac: Left / Right Ventricular Function

Kai Uwe Juergens, Harald Seifarth, Michael Puesken, Roman Fischbach – Münster 100

Cardiac: Atrial Fibrillation / Arrhythmia

Nico R. Mollet, Filippo Cademartiri, Gabriel P. Krestin – Rotterdam 110

Cardiac: Bypass Grafts

Pal Suranyi, Christian Thilo, Heon Lee, U. Joseph Schoepf – Charleston 120

Vascular: Extended Chest Pain Protocol

Thorsten R. C. Johnson, Konstantin Nikolaou, Christoph R. Becker – Munich-Grosshadern 130

Vascular: Pulmonary Veins

Harald Brodoefel, Martin Heuschmid, Andreas F. Kopp – Tübingen 140

Vascular: Aortic Runoff, Abdominal CTA

Andreas H. Mahnken, Joachim E. Wildberger, Marco Das – Aachen 150

Vascular: Renal CTA

Robert P. Hartman, Terri J. Vrtiska, Cynthia McCollough – Rochester 160

Vascular: Peripheral Runoff

Axel Kuettner, Katharina Anders, Michael Lell – Erlangen-Nuremberg 170

Vascular: Brain Perfusion

Harald Seifarth, Tobias Fischer, Roman Fischbach, Stephan P. Kloska – Münster 180

Body: Obese Mode

Elizabeth McDonald, Robert P. Hartman, Cynthia McCollough – Rochester 190

Dual Energy CT Applications

Dual Energy: CTA of Head and Neck

Dominik Morhard, Thorsten R. C. Johnson, Christoph R. Becker – Munich-Grosshadern 202

Dual Energy: CTA Aorta

Marco Das, Andreas H. Mahnken, Joachim E. Wildberger – Aachen 212

Dual Energy: CTA Runoff

Andrew Misselt, Cynthia McCollough, Eric Williamson – Rochester 222

Dual Energy: CTA Lung Perfusion (PE)

Thorsten R. C. Johnson, Christian Fink, Christoph R. Becker – Munich-Grosshadern 232

Dual Energy: Virtual Non-Contrast

Axel Kuettner, Katharina Anders, Michael Lell – Erlangen-Nuremberg 242

Dual Energy: Characterization of Kidney Stone Composition

Andrew Primak, Terri J. Vrtiska, Cynthia McCollough – Rochester 252

Dual Energy: Urography

Robert P. Hartman, Terri J. Vrtiska, Cynthia McCollough – Rochester 262

Dual Energy: Vascular Plaque Removal / Detection

Christoph Thomas, Harald Brodoefel, Martin Heuschmid, Andreas F. Kopp – Tübingen 272

Dual Energy: Tendons and Cartilage

Stephan G. Ruehm, Derek Lohan, Christoph Panknin – Los Angeles 282

Dual Energy: Gout

Thorsten R. C. Johnson, Sabine Weckbach, Christoph R. Becker – Munich-Grosshadern 292

Abbreviations 301

Editors 303

CME Instructions inside back cover

The introduction of Dual Source Computed Tomography (DSCT) in 2005 represented a giant leap in the

evolution of sectional imaging comparable to the introduction of spiral and later multi-detector CT.

The scientific community has responded with great interest and DSCT has opened entirely new clinical

fields to CT applications. Equipped with two x-ray sources and detectors mounted in one gantry, DSCT

enables many new applications ranging from heart rate independent coronary CT angiography

examinations to complete chest pain evaluation in one single scan. Because it is able to run both x-ray

sources simultaneously at different energy settings, DSCT is also the first scanner generation to enable

routine spiral dual energy imaging.

As today’s scanners become faster and more robust, contrast media delivery has become an

increasingly critical element of the contrast enhanced CT procedure. It has been necessary over the

years to significantly adapt injection protocols with each new scanner generation. This is particularly

relevant in the case of DSCT.

Siemens AG and Bayer Schering Pharma joined forces in early 2006 to provide you with a comprehensive

overview of DSCT’s capabilities together with reliable protocol recommendations for scanner use and

optimized contrast media injection parameters.

Based on their extensive experience in CT imaging, physicians from 12 global luminary sites were

selected to form the Dual Source CT Expert Panel. Over the course of 18 months and four panel

meetings, 25 clinical scan and contrast media injection protocols were developed. All protocols were

based on intense discussions among the panel members. To ensure the highest quality, the selected

protocols were tested by numerous sites, individually adapted and finally approved during a panel

consensus meeting.

This book will provide an introduction into DSCT technology as well as into the basics of contrast

media administration. You will find consensus protocols as well as individual considerations, such as

tricks and pitfalls, complemented by clinical examples from several of the world’s best radiologists

and cardiologists. We are confident it can help you to achieve consistently high image quality, optimal

patient care, and perhaps a solid starting point for the development of your own unique protocols.

Peter R. Seidensticker, MD Lars K. Hofmann, MD

Berlin / Germany Erlangen / Germany

Dear Colleagues

The Dual Source CT Expert Panel

Stephan Achenbach, MD, FESC, FACC

Professor of Cardiology

University of Erlangen-Nuremberg

Departments of Cardiology and Radiology

Ulmenweg 18

91054 Erlangen, Germany

Hatem Alkadhi, MD

University Hospital Zurich

Institute of Diagnostic Radiology

Raemistr. 100

8091 Zurich, Switzerland

Christoph R. Becker, MD

Associate Professor

University of Munich-Grosshadern

Department of Clinical Radiology

Marchioninistr. 15

81377 Munich, Germany

Harald Brodoefel, MD

Eberhard-Karls-University Tübingen

Department of Diagnostic and

Interventional Radiology

Hoppe-Seyler-Str. 3

72076 Tübingen, Germany

Roman Fischbach, MD

Associate Professor of Radiology

University of Münster

Department of Clinical Radiology

Albert-Schweitzer-Str. 33

48149 Münster, Germany

Martin Heuschmid, MD

Associate Professor

Eberhard-Karls-University Tübingen

Department of Diagnostic and

Interventional Radiology

Hoppe-Seyler-Str. 3

72076 Tübingen, Germany

Thorsten R. C. Johnson, MD

University of Munich-Grosshadern

Department of Clinical Radiology

Marchioninistr. 15

81377 Munich, Germany

Kai Uwe Juergens, MD

Assistant Professor

University of Münster

Department of Clinical Radiology

Albert-Schweitzer-Str. 33

48149 Münster, Germany

Andreas F. Kopp, MD

Professor of Radiology

Eberhard-Karls-University Tübingen

Department of Diagnostic and

Interventional Radiology

Hoppe-Seyler-Str. 3

72076 Tübingen, Germany

Axel Kuettner, MD

University of Erlangen-Nuremberg

Department of Radiology

Maximiliansplatz 1

91054 Erlangen, Germany

Andreas H. Mahnken, MD, MBA

University Hospital, RWTH Aachen University

Department of Diagnostic Radiology

Pauwelsstr. 30

52074 Aachen, Germany

Cynthia McCollough, PhD

Mayo Clinic College of Medicine

Department of Radiology

200 First Street SW

Rochester, MN 55905, USA

Nico R. Mollet, MD, PhD

Erasmus Medical Center Rotterdam

Department of Radiology

Room HS-207, Department of Radiology

PO Box 2040

3000 CA Rotterdam, Netherlands

Gilbert L. Raff, MD

William Beaumont Hospital

Department of Cardiology

3601 West Thirteen Mile Road

Royal Oak, MI 48073, USA

Dieter Ropers, MD, FESC

Professor of Cardiology

University of Erlangen-Nuremberg

Departments of Cardiology and Radiology

Ulmenweg 18

91054 Erlangen, Germany

Stephan G. Ruehm, MD, PhD

David Geffen School of Medicine at UCLA

Department of Radiology

Peter V Ueberroth Bldg., Suite 3371

10945 LeConte Avenue

Los Angeles, CA 90095-7206, USA

U. Joseph Schoepf, MD

Medical University of South Carolina

Departments of Radiology and Medicine

169 Ashley Ave., PO Box 250322

29425 Charleston, USA

Harald Seifarth, MD

University of Münster

Department of Clinical Radiology

Albert-Schweitzer-Str. 33

48149 Münster, Germany