Dual Energy CT in Clinical Practice PDF
Preview Dual Energy CT in Clinical Practice
Medical Radiology Diagnostic Imaging Series Editors A. L. Baert, Leuven M. F. Reiser, München H. Hricak, New York M. Knauth, Göttingen For further volumes: http:/www.springer.com/series/4354 Medical Radiology Diagnostic Imaging Editorial Board Andy Adam, London Fred Avni, Brussels Richard L. Baron, Chicago Carlo Bartolozzi, Pisa George S. Bisset, Houston A. Mark Davies, Birmingham William P. Dillon, San Francisco D. David Dershaw, New York Sam Sanjiv Gambhir, Stanford Nicolas Grenier, Bordeaux Gertraud Heinz-Peer, Vienna Robert Hermans, Leuven Hans-Ulrich Kauczor, Heidelberg Theresa McLoud, Boston Konstantin Nikolaou, München Caroline Reinhold, Montreal Donald Resnick, San Diego Rüdiger Schulz-Wendtland, Erlangen Stephen Solomon, New York Richard D. White, Columbus Thorsten R.C. Johnson • Christian Fink • Stefan O. Schönberg • Maximilian F. Reiser (Eds.) Dual Energy CT in Clinical Practice Foreword by M.F. Reiser Editors Priv. Doz. Dr. med. Thorsten R. C. Johnson Prof. Dr. med. Stefan O. Schönberg Institut für Klinische Radiologie Institut für Klinische Radiologie und Klinikum der Universität München Nuklearmedizin Campus Großhadern Universitätsmedizin Mannheim Marchioninistr. 15 Theodor-Kutzer-Ufer 1-3 81377 München 68167 Mannheim Germany Germany [email protected] [email protected] Prof. Dr. med. Christian Fink Prof. Dr. med. Dr. h.c. Maximilian F. Reiser, Institut für Klinische Radiologie und FACR, FRCR Nuklearmedizin Institut für Klinische Radiologie Universitätsmedizin Mannheim Klinikum der Universität München Theodor-Kutzer-Ufer 1-3 Campus Großhadern 68167 Mannheim Marchioninistr. 15 Germany 81377 München [email protected] Germany [email protected] ISSN: 0942-5373 ISBN: 978-3-642-01739-1 e-ISBN: 978-3-642-01740-7 DOI: 10.1007/978-3-642-01740-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010937236 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli- cation contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword It is a great pleasure to introduce this new volume of the Diagnostic Imaging series on Dual Energy CT in Clinical Practice. It is amazing how rapidly this emerging technology is gaining importance and diagnostic value for daily clinical practice, and it is great to see how many aspects are already covered in this textbook. With the development of Multi Detector Row CT, image quality, scan speed, and diagnostic utility of CT have greatly improved. Moreover, new applications such as cardiac imaging, CT angiography, and CT urography have become viable clinical diagnostic methods. Functional tests such as perfusion scanning added valuable information to the high resolution display of morphology provided by CT. With Dual Energy CT, another dimension has opened up: The spectral differentiation of molecu- lar substances makes an identification and characterization of pathologic substances or tissue feasible and allows to directly visualize the substrate of disease. Dual Energy CT also offers means to reduce the radiation exposure of patients by replacing multi- phase exams with more specific single acquisitions. This work represents a compre- hensive, up-to-date compilation of all technical and clinical aspects of this fascinating new imaging modality. I am greatly indebted to the other editors of this volume, T. R. C. Johnson, C. Fink, and S.O. Schoenberg, for their dedication and effort in composing and editing the chapters in a very brief period of time. I would also like to take this opportunity to thank the contributing authors – all renowned experts on CT technology or CT in clinical radiology – for sharing their knowledge and providing comprehensive practi- cal advice in their area of exceptional expertise. This book will help the readers to rapidly grasp the technical background, it will provide technicians with a reference for suitable settings and parameters and it will support radiologists with advice on practical clinical interpretation. I am confident that this volume will fulfil the expectations of the readers and meet the same success as other volumes of this series. M.F. Reiser v Preface Dual Energy Computed Tomography is one of the most exciting evolving fields in radiology. The possibility to acquire CT scans with different x-ray spectra to enhance material differentiation had already been realized and tested in the 1970s. However, only since the introduction of Dual Source CT in 2006 the method has achieved clini- cal significance and widespread application. Nowadays, several CT vendors have implemented Dual Energy CT with different technical approaches, and the integra- tion and the clinical applications are continuously making progress. The editors have been among the first radiologists to explore this new technology and want to share their experience and enthusiasm with others. This book has several aims. First, it wants to inform about the physical back- ground and the different approaches of technical implementation. To cover this aspect, there is one chapter giving a general physical introduction, three chapters elucidating the different CT vendors’ approaches, and another chapter explaining how to post-process CT data to obtain spectral information. A second main aim is to provide practical advice for clinical application. In this respect, there are 15 chapters presenting different clinical applications. Each chapter describes the substrate being imaged and the concept how this helps to characterize a certain disease. Tables pro- vide scan protocol settings for practical utilization. A third aim of this book is to give account of unbiased scientific data on the clinical value of the different applications. Most of the authors of the clinical chapters are scientists who have published several articles in peer-reviewed scientific literature. They were asked to give account of their scientific evidence and to also include data from other groups working in the respec- tive field. Thus, the reader should get an impression of the actual clinical value of each application. We would like to take this opportunity to express our sincere gratitude to all the authors who have contributed to this book. We are proud and thankful that we have been able to obtain contributions from the CT development departments of the three CT vendors that have implemented Dual Energy CT. Renowned CT physicists have contributed chapters on physical background and post-processing. And clinical col- leagues, mainly radiologists and experienced scientists, have compiled an impressing and helpful combination of practical advice and scientific evidence. We hope that this book will provide a sufficient and comprehensive physical and technical background to a medical reader and that the practical advice and scientific evidence in the clinical chapters are helpful for clinical application and interpretation. Munich and Mannheim T.R.C. Johnson, C. Fink April 2010 S.O. Schoenberg, M.F. Reiser vii Contents Part I Physical Implementation Physical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Thorsten R.C. Johnson and Willi A. Kalender Dual Source CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Bernhard Krauss, Bernhard Schmidt, and Thomas G. Flohr Dual Layer CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Alain Vlassenbroek Gemstone Detector: Dual Energy Imaging via Fast kVp Switching . . . 35 Naveen Chandra and David A. Langan Dual-Energy Algorithms and Postprocessing Techniques . . . . . . . . . . . 43 Cynthia H. McCollough, Bernhard Schmidt, Xin Liu, Lifeng Yu, and Shuai Leng Part II Vascular System Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Dominik Morhard and Susanne Jochum Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Wieland H. Sommer Peripheral Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Wieland H. Sommer and Carolin Brockmann Plaque Differentiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Hatem Alkadhi, Paul Stolzmann, Sebastian Leschka, Philippe Cattin, Gabor Székely, and Stefan Saur ix x Contents Part III Thoracic Imaging Lung Perfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Radko Krissak and Christian Fink Lung Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Sven F. Thieme, Sandra Högl, and Thorsten R.C. Johnson Pulmonary Nodules and Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Thomas Henzler, Gerald Schmid-Bindert, and Christian Fink Myocardial Perfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Markus Weininger, U. Joseph Schoepf, Doo Kyoung Kang, Thomas Henzler, and Balasz Ruzsics Part IV Neuroradiological Imaging Neurological Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Otto Rapalino, Shervin Kamalian, Rajiv Gupta, Catherine Phan, Stuart Pomerantz, Javier Romero, Mukta C. Joshi, and Michael Lev Part V Abdominal Imaging Liver Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Christian Fink Kidney Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Anno Graser Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Ralf W. Bauer Kidney Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Andrew N. Primak, Terri J. Vrtiska, Mingliang Qu, and Cynthia H. McCollough Part VI Extremities Tendons and Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Susanne Jochum Gout ....................................................... 199 Savvas Nicolaou, Steven John Co, and Daniel James Hou Index ...................................................... 215 Part I Physical Implementation Physical Background Thorsten R.C. Johnson and Willi A. Kalender Contents Abstract › There had been attempts to utilize spectral 1 History ................................... 3 information for tissue characterization soon 2 X-ray Spectra .............................. 4 after the invention of Computed Tomography, but only recently Dual Energy CT has achieved 3 Detector Technology......................... 4 a significant role in clinical radiology. 4 Tissue Properties ........................... 5 › To perform Dual Energy CT, it is necessary to 5 Dual-Source CT ............................ 5 generate x-rays with different energies, mostly 6 Rapid Voltage Switching ..................... 6 as polychromatic spectra. On the other hand, the detector has to be capable to differentiate 7 Layer Detector ............................. 7 x-ray quanta of different energies. There are 8 Sequential Acquisition....................... 7 four technical approaches to meet these require- 9 Radiation Exposure ......................... 8 ments, of which the Dual Source CT, the rapid 10 Clinical Applications ........................ 8 voltage switching and the layer detector tech- nology are available or being implemented. 11 Summary.................................. 8 › To obtain relevant diagnostic information, References..................................... 8 there have to be substances with spectral prop- erties which reflect the pathology by their pres- ence or distribution. Most important is the photoelectric effect of elements like uric acid, iron, calcium, iodine or xenon gas, which are present in pathological structures or can be administered as contrast material. The identifi- cation and quantification of these elements can be used to diagnose several diseases. 1 History T.R.C. Johnson () Department of Clinical Radiology, University of Munich, Grosshadern Hospital, Marchioninistrasse 15, First attempts to use spectral information in computed 81377 Munich, Germany e-mail: [email protected] tomography date back to the late 1970s (Millner et al. 1979; Avrin et al. 1978; Chiro et al. 1979; Genant and W.A. Kalender Boyd 1977). At that time, two separate scans were Institute of Medical Physics, University of Erlangen, Henkestrasse 91, 91052 Erlangen, Germany acquired and either projection data or reconstructed T.R.C. Johnson et al. (eds.), Dual Energy CT in Clinical Practice, Medical Radiology, DOI: 10.1007/174_2010_43 © Springer-Verlag Berlin Heidelberg 2011
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