Table Of ContentMedical 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
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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
