Newsletter - September, 2013   send this newsletter to a colleague
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Reviewed for You

Coronary CT angiography in individuals suspected of having coronary disease without modifiable risk factors: is CT the key prognostic tool?

J.F. Paul
Findings from an international cohort study suggest that persons without typical risk factors for coronary artery disease, but with symptoms or a family history of the disease, are more likely to have major adverse cardiovascular events than previously thought.
Prof. J.F. Paul comments on the study, published in Radiology, and on its implications for the MDCT community.

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Technical considerations / Cardiovascular
During coronary CT angiography, the use of prospective ECG-triggering enables scanning only during a quiescent period of the cardiac cycle, thereby reducing radiation dose. Typically, this period is taken to be mid-late diastole, but emerging evidence suggests that fewer motion artifacts occur with end-systole imaging. According to a new study (Lee AM et al. Int J Cardiovasc Imaging. 2013 Aug;29(6):1361-70), radiation dose and image quality are more constant across a range of heart rates and rhythms with systolic than with diastole imaging.

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Abdomen and Pelvis
Data from a small retrospective study (Schieda N et al. Eur Radiol. 2013 Jul;23(7):1891-900) suggest that, in the diagnostic workup of patients with suspected acute mesenteric ischemia, the non-enhanced CT scan can be omitted to reduce radiation exposure without compromising on diagnostic accuracy.

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CT Colonography
The prospect that healthcare systems (and insurance policies) will reimburse the use of CT colonography for screening purposes implies that the need for skilled interpreters of colonographic images will increase. This realization has prompted research into the possibility that non-radiologists could assist, or substitute for, radiologists in reading these CT images. A new study published in Insights in Imaging (Lauridsen C et al. Insights Imaging. 2013 Aug;4(4):491-7) found that the accuracy of polyp detection was comparable between radiologists and radiographers.

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Further titles
Vazquez JL, Pombar MA, Pumar JM, del Campo VM. Optimised low-dose multidetector CT protocol for children with cranial deformity. Eur Radiol. 2013 Aug;23(8):2279-87

Pellegrin A., Stocca Y., Belgrano M. et al. Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy. Abdom Imaging. 2013 Aug;38(4):785-92

Nanashima A, Abo T, Murakami G et al. Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics. Radiol Med. 2013 Aug;118(5):732-743

Ahmed S., Johnson PT, Fishman EK. Defining vascular signatures of malignant hepatic masses: role of MDCT with 3D rendering. Abdom Imaging. 2013 Aug;38(4):763-73

Ahmed S., Johnson PT, Fishman EK. Defining vascular signatures of benign hepatic masses: role of MDCT with 3D rendering. Abdom Imaging. 2013 Aug;38(4):755-62

Razek AA, Ezzat A., Azmy E., Tharwat N. Role of whole-body 64-slice multidetector computed tomography in treatment planning for multiple myeloma. Radiol Med. 2013 Aug;118(5):799-805

Spina JC, Ulla M., Yeyati EL et al. MDCT findings after hepatic chemoembolization with DC-beads: What the radiologist needs to know. Abdom Imaging. 2013 Aug;38(4):778-84

Nakazato R., Shalev A., Doh JH et al. Quantification and characterisation of coronary artery plaque volume and adverse plaque features by coronary computed tomographic angiography: a direct comparison to intravascular ultrasound. Eur Radiol. 2013 Aug;23(8):2109-17

Loffroy R. Multidetector CT angiography for the detection of colonic diverticular bleeding: when, how, and why? Dig Dis Sci. 2013 Jul;58(7):1822-4

Fujiwara H., Momoshima S., Akiyama T., Kuribayashi S. Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT. Neuroradiology. 2013 Jul;55(7):837-43

Kilburn-Toppin F., Arthurs OJ, Tasker AD, Set P. Detection of pulmonary nodules at paediatric CT: maximum intensity projections and axial source images are complementary. Pediatr Radiol. 2013 Jul;43(7):820-6

Thierfelder KM, Sommer WH, Baumann AB et al. Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke. Neuroradiology. 2013 Jul;55(7):827-35

Kondo M., Hatakenaka M., Higuchi K. Feasibility of low-radiation-dose CT for abdominal examinations with hybrid iterative reconstruction algorithm: low-contrast phantom study. Radiol Phys Technol. 2013 Jul;6(2):287-92

Becce F., Ben Salah Y., Verdun FR et al. Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low-dose protocol using filtered back-projection and iterative reconstructiony. Skeletal Radiol. 2013 Jul;42(7):937-45

A selection of recent cases from our regularly updated column

Abdomen and pelvis

Flank pain, hematuria and orthostatic proteinuria

Boy, 15 years old
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Brain, head and neck

Reduced level of consciousness in an immunosuppressed patient

Woman, 45 years old
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Progressive shortness of breath

Man, 67 years old
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Aborted sudden cardiac death

Man, 30 years old
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CT Colonography

Positive FOBT and alternating bowel habit

Woman, 79 years old
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Abdominal pain and diarrhea

Man, 67 years old
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