3/20/2017 Disclosures ▪ None Spectral CT in Body Imaging Initial experience Gopal Punjabi Hennepin County Medical Center 1
3/20/2017 Conventional CT Image equivalent to any CT image Generated by combining high and low energy components Virtual non-contrast MonoE 70 keV (equivalent to Image with iodine removed conventional CT) Mono-energy image equivalent to 120kVp tube output (70keV) Less artifact Increased contrast 40 keV monoE 200 keV monoE 200 keV monoE Mono energy Attenuation as if a single monochromatic energy were used to scan 161 energy levels between 40-200 keV Iodine boost, CNR Artifact reduction 2
3/20/2017 Iodine density Iodine no water Material differentiation Material density image Iodine concentration mg/ml Removes calcium Shows iodine concentration (Also shows calcium) Contrast enhancing structures Iodine removed Effective Z Isolates pixels where iodine is present Used best as overlay Tissue differentiation Iodine uptake 3
3/20/2017 200 keV monoE Effective Z Uses of spectral CT ▪ Incidentaloma characterization ▪ Iodine detection ▪ Contrast dose reduction ▪ Perfusion marker ▪ Quantification ▪ Lesion characterization 4
3/20/2017 Incidentaloma characterization Virtual non-con Conventional Iodine no water Simple cyst, no iodine uptake Conventional Virtual non-con Conventional Iodine no water Hemorrhagic cyst, no iodine uptake Indeterminate kidney lesion 37 HU Iodine no water Conventional: 76 HU Virtual non-con: 29 HU Conventional HU: 24 Virtual non-con: 1.6 HU “ pseudoenhacement ” Renal cell in benign kidney cyst carcinoma Iodine no water Iodine no water 5
3/20/2017 Left: 42 vs 6 HU Right: 56 vs 11 HU Bilateral adrenal adenomas Virtual non-con: 5 HU Conventional: 57 HU Conventional Virtual non-con Conventional Indeterminate left adnexal lesion (24 HU) Virtual non-con Iodine no water Indeterminate nodule in urinary bladder Conventional Hemorrhagic cyst Iodine no water 40 keV monoE 6
3/20/2017 Conventional: 47 HU Virtual non-con: 24 HU Iodine detection Conventional 40 Kev monoE 7
3/20/2017 Conventional 40 Kev monoE MPA Muscle Conventional 115 52 40 keV MonoE 287 35 Iodine no water Conventional 40 keV monoE Pseudoaneurysm Conventional Conventional 40 keV monoE 40 keV monoE Conventional 40 keV monoE 8
3/20/2017 40 keV monoE Conventional Conventional, iodine density 40 keV monoE DWI, b 800 Pyelonephritis 40 keV monoE Conventional 9
3/20/2017 Conventional Iodine no water Iodine no water Acute DVT Conventional Contrast dose reduction Virtual non-contrast 10
3/20/2017 40 keV monoE CT aorta 25ml contrast 250 HU CT aorta prior exam 100 ml contrast 300 HU Conventional 37 mL Omnipaque 350 HCMC protocol (GFR <45) ▪ Injection volume: (Scan delay + Scan time) x 4 in mL ▪ Injection composition (contrast/saline mix): Body weight Contrast % <150 pounds 40% 150-250 pounds 50% >250 pounds 60% ▪ Injection rate: 4 mL/sec ▪ 30 mL saline chaser Conventional 40 keV monoE 19 mL Omnipaque 350 63 yo F GFR 38, BMI 51 28 mL Omnipaque 350 11
3/20/2017 45 keV monoE 37 mL Omnipaque 350 22 mL Omnipaque 350 Conventional 40 keV monoE Perfusion marker Conventional Iodine density 40 keV Mono-E Iodine density 12
3/20/2017 2 months prior… Conventional Iodine density Conventional Conventional Iodine no water 40 keV monoE Iodine no water Iodine no water We immediately saw a loop of ischemic small bowel, about 30 cm, that was bound by a very small thin adhesion. This adhesions was lysed with cautery and the bowel was untwisted. The bowel loop was clearly not viable. 13
3/20/2017 Conventional Findings concerning for bowel obstruction from sigmoid volvulus. While there is new ascites, there is no frank pneumatosis or free air at this time. Recommend surgical consult. Iodine no water Iodine density Conventional 14
3/20/2017 Conventional Conventional Iodine no water Iodine no water Quantification Conventional 40 keV monoE Patient with HIV, CAD with chronic angina, anxiety and depression Unclear why the pt acutely decompensated overnight. He had high ventilation demands, however, was had a minute ventilation around 24. The differential includes V/Q mismatch from mucous plugging vs pleural effusion . Provoked PE, hemodynamically stable, no RV strain Lovenox to Xarelto 15
3/20/2017 Normal Ischemic 2.1 +/- 1.03 0.3 +/- 0.18 2.4 +/- 0.8 0.4 +/- 0.35 Conventional Iodine no water Normal Ischemic 2.4 +/- 0.4 1.4 +/- 0.38 2.1 +/- 0.53 1.1 +/- 0.38 16
3/20/2017 Conventional Tissue Iodine uptake Normal pancreas 3.3 +/- 0.04 Spleen 4.1 +/- 0.05 Iodine density Liver 1.7 +/- 0.05 Appendix 1.4 +/- 0.1 Muscle 0.4 +/- 0.09 Cecum 0.8 +/- 0.1 Necrosis 0.9 +/- 0.05 Iodine density Conventional HU Iodine density Conventional Appendix 88 +/- 14 2.1 +/- 0.12 Cecum 71 +/- 8 1.5 +/- 0.05 Iodine density Lesion characterization 17
3/20/2017 Conventional Virtual non-contrast Iodine no water Conventional Conventional 40 keV monoE Virtual non-contrast Iodine no water Late arterial phase Delayed phase HU Iodine density Liver cyst 50 +/-12 0.2 +/- 0.06 Liver met 54 +/- 9 0.8 +/- 0.09 Pancreas ca 43 +/- 13 0.8 +/- 0.29 18
3/20/2017 Conventional 200 keV monoE Virtual non-contrast 19
3/20/2017 Conventional Iodine no water Endometrial thickening, mass versus hemorrhage Conventional Iodine no water Radiology: Volume 276: Number 3 Thank you! September 2015 20
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