CT of the Retroperitoneum: From Conventional to Multi-energy Imaging

109 Pages·2014·5.871 MB·English

by  Giorgio Ascenti, Angelo Vanzulli, Carlo Catalano, Rendon C. Nelson (auth.)

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
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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