CT of the Retroperitoneum: From Conventional to Multi-energy Imaging PDF
Preview CT of the Retroperitoneum: From Conventional to Multi-energy Imaging
Giorgio Ascenti Angelo Vanzulli Carlo Catalano Rendon C. Nelson CT of the Retroperitoneum From Conventional to Multi-energy Imaging 123 CT of the Retroperitoneum Giorgio Ascenti Angelo Vanzulli • Carlo Catalano Rendon C. Nelson • CT of the Retroperitoneum From Conventional to Multi-energy Imaging 123 GiorgioAscenti CarloCatalano Department of BiomedicalSciences Department of Radiological, and Morphological andFunctional Oncological andPathological Sciences Imaging Sapienza Universityof Rome Universityof Messina Rome Messina Italy Italy RendonC. Nelson Angelo Vanzulli Department of Radiology Department of Radiology DukeUniversity Medical Center NiguardaGeneral Hospital Durham Milan USA Italy ISBN 978-88-470-5468-4 ISBN 978-88-470-5469-1 (eBook) DOI 10.1007/978-88-470-5469-1 SpringerMilanHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2013943334 (cid:2)Springer-VerlagItalia2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeor part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway, andtransmissionorinformationstorageandretrieval,electronicadaptation,computersoftware, orbysimilarordissimilarmethodologynowknownorhereafterdeveloped.Exemptedfromthis legalreservationarebriefexcerptsinconnectionwithreviewsorscholarlyanalysisormaterial suppliedspecificallyforthepurposeofbeingenteredandexecutedonacomputersystem,for exclusiveusebythepurchaserofthework.Duplicationofthispublicationorpartsthereofis permitted only under the provisions of the Copyright Law of the Publisher’s location, in its currentversion,andpermissionforusemustalwaysbeobtainedfromSpringer.Permissionsfor use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liabletoprosecutionundertherespectiveCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthis publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesare exemptfromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateof publication, neither the authors nor the editors nor the publisher can accept any legal responsibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty, expressorimplied,withrespecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Foreword For a long time, retroperitoneal organs and its associated myriad of abnormalities represented a ‘‘sanctuary of inaccessibility’’ for early medical imaging, with the pathologists being the only umpire in these scenarios. With early detection and precise disease characterization, the advent of CT first, and then multidetector CT—with isotropic voxel technol- ogy—hasrepresentedthetransitionfromblack-and-whitetocolorsfor a number of retroperitoneal affections. Over the subsequent years, the radiologists’ community has assisted to a sprout of innovations which has, more recently, led to dual energy CT with multi-energy applications. Theeditorsofthisvolume,expertsofhighinternationalprofileinthe field of abdominal imaging and, particularly, in Dual Energy CT applications, have to be commended for their outstanding job and for realizing an up-to-date guide to the use of most recent advances in multi-energy imaging. It is with enormous pleasure I ‘‘lead off the dancing’’ to this volume which, I am confident, will spark fervid interest of readers to new MDCT approaches in retroperitoneal disease. Prof. Antonio Rotondo (Chief of the Chair of Radiology at the Second University of Naples ‘‘Department of Clinical and Experimental Internal Medicine, F. Magrassi–A. Lanzara’’) Chief of the I/II Department of Radiology at the University Hospital Second University of Naples Naples, Italy v Preface Thetransitionfromsingle-detectortomultidetectorrowCT(MDCT)in the early 2000s has dramatically changed the imaging approach to abdominal organs. MDCT implies the simultaneous activation of mul- tiple detector rows arranged along the z-axis with acquisition of inter- weavinghelicalsections.By exploiting the increasedcoverage along the z-axis and taking full advantage of the rapid image acquisition, body MDCT imaging relies on scanning the abdominal viscera with a mul- tiphasicapproach,before andaftercontrastmedium administration.In particular, timing of the contrast medium bolus can be optimized for accomplishing different diagnostic abdominal tasks, including a syn- chronous assessment of vascular and parenchymal compartments. Theneedforprotocoloptimization,controllingradiationexposureto patients, and managing the large amount of data generated, represent theothersideofthecoinofMDCTwithwhichthebodyradiologisthas to face and needs to be sensitized. However the constraint to a merely attenuation-based approach represents the main drawback of modern MDCT imaging which does not exceed calculation of materials linear attenuation coefficients in Hounsfield Units (HU). Byobtainingdataatdifferentphotonenergiesand,therebydetecting differences in material composition based on differences in photon absorption, dual energy CT recently raised to prime time for its numerous applications in body imaging. Although this technique had beenalreadyinvestigatedinthelate1970s,owingtolimitationsofearly prototypes (eg., the need for two separate scans with consequent radi- ationdoseincreaseandimagemisregistration)dualenergyCThasbeen pushed aside. Tremendouseffortsscannermanufacturershavedevotedtowardsthe development of new hardware and software strategies, as well as a growing interest in the scientific imaging community have led to an impressive expansion of dual energy CT technology which is no longer confined to a few academic institutions. As opposed to conventional MDCT imaging, dual-energy CT may represent a paradigm-shift from an attenuationbased to a material-specific quantitative approach. The general excitement for this imaging technology, however, has been paralleled by concerns about the increase in radiation exposure and costs, as well as by prejudices on a presumptive complexity of its vii viii Preface applications.AnoverallstreamliningofdualenergyCTworkflowanda substantialreductionofthecostsrepresentfuturedirectionsformoving forward. Theobjectiveofthisvolumeistoprovidethereaderwithanoverview of conventional MDCT approach for retroperitoneal organs, as well as to show, in the same clinical scenarios, how dual energy and multi energy CT applications can enhance the diagnoses of retroperitoneal diseases. Prof. Giorgio Ascenti Contents 1 Introduction and Technical Principles . . . . . . . . . . . . . . . . 1 Angelo Vanzulli and Diana Artioli 1.1 Dual-Energy CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Dual-Source CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.4 Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.5 Rapid kVp Switching or Gemstone Spectral Imaging. . . . 5 1.6 Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.7 Sequential Dual Energy . . . . . . . . . . . . . . . . . . . . . . . . 6 1.8 Multi-Energy CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2 Dual-, Multi-, and Mono-Energy CT & Iodine: Basic Concepts and Clinical Applications. . . . . . . . . . . . . . . . . . . 11 Carlo Catalano and Daniel Geiger 2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2 Basic Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2.1 Compton, Photoelectric Effect, and the ‘‘K-edge’’. . . . . . . . . . . . . . . . . . . . . . . 11 2.3 DECT and Iodinated CM in Clinical Practice. . . . . . . . . 12 2.4 Spectral Imaging and Iodine. . . . . . . . . . . . . . . . . . . . . 14 2.5 Low-kVp Protocols and Iodine: Conspicuity and Dose Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3 Renal Masses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Giorgio Ascenti, Achille Mileto, Bernhard Krauss, Silvio Mazziotti, Carmelo Sofia and Emanuele Scribano 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.2 State of the Art of Conventional (Multi-detector) CT. . . . 21 3.3 Spectral CT: Study Protocols and Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 ix x Contents 4 CT Urography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Achille Mileto, Carmelo Sofia, Silvio Mazziotti, Alfredo Blandino, Emanuele Scribano and Giorgio Ascenti 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 State of the Art of Conventional (Multi-detector) CT. . . . 43 4.3 Spectral CT: Study Protocols and Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5 Urinary Stones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Achille Mileto, Bernhard Krauss, Silvio Mazziotti, Alfredo Blandino, Carmelo Sofia and Giorgio Ascenti 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 5.2 State of the Art of Conventional (Multi-detector) CT. . . . 54 5.3 Spectral CT: Study Protocols and Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6 Adrenal Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Achille Mileto, Daniele Marin, Lisa M. Ho and Rendon C. Nelson 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.2 State of the Art Conventional (Multi-detector) CT. . . . . . 69 6.3 Spectral CT: Study Protocols and Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7 Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Achille Mileto, Daniele Marin and Rendon C. Nelson 7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 7.2 State of the Art of Conventional (Multi-detector) CT. . . . 84 7.3 Spectral CT: Study Protocols and Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Contributors Diana Artioli Department of Radiology, Niguarda General Hospital, Milan, Italy Giorgio Ascenti DepartmentofBiomedicalSciencesandMorphological and Functional Imaging, University of Messina, Policlinico ‘‘G. Marti- no’’,Messina,Italy Alfredo Blandino Department of Biomedical Sciences and Morpho- logical and Functional Imaging, University of Messina, Policlinico ‘‘G. Martino’’, Messina, Italy Carlo Catalano Department of Radiological, Oncological and Patho- logical Sciences, Sapienza University of Rome, Rome, Italy Daniel Geiger Department of Radiological, Oncological and Patho- logical Sciences, Sapienza University of Rome, Rome, Italy LisaM.HoDepartmentofRadiology,DukeUniversityMedicalCenter, Durham, NC, USA BernhardKraussSiemensAG,HealthcareSector,Imaging&Therapy Division, Forchheim, Germany Daniele Marin Department of Radiology, Duke University Medical Center, Durham, NC, USA SilvioMazziottiDepartmentofBiomedicalSciencesandMorphological and Functional Imaging, University of Messina, Policlinico ‘‘G. Mar- tino’’, Messina, Italy Achille Mileto Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico ‘‘G. Mar- tino’’, Messina, ItalyDepartment of Radiology, Duke University Med- ical Center, Durham, NC, USA Rendon C. Nelson Departmentof Radiology, Duke University Medical Center, Durham, NC, USA Emanuele Scribano Department of Biomedical Sciences and Morpho- logical and Functional Imaging, University of Messina, Policlinico ‘‘G. Martino’’, Messina, Italy xi
The list of books you might like
