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To explore the image quality and radiation exposure associated with coronary angiography obtained with a third-generation dual-source computed tomography, using body mass index (BMI)- and heart rate (HR)-adapted protocols in real-world patients.Three scan protocols were implemented with regard to HR: prospective turbo high-pitch spiral, sequential, and retrospective spiral modes. We adapted the reference kilovoltage value according to BMI. Image quality was evaluated using a 4-point scale, and effective dose estimates were calculated using the dose-length product.Among the 896 patients, 417 (46.54%), 433 (48.32%), and 45 (5.02%) were imaged using prospective turbo high-pitch spiral, sequential, and retrospective spiral modes, respectively. The median BMI was 27.3 (25-30.4) kg/m2, and the effective dose was 0.65 mSv (interquartile range, 0.33-1.56 mSv). Only 32 of 896 examinations (3.5%) had poor image quality.Computed tomography angiography with BMI- and HR-tailored protocols offers good image quality with low radiation dose in unselected patients.

Transcatheter aortic valve implantation (TAVI) is a safe treatment option for elderly patients with aortic stenosis (AS) with high or intermediate surgical risk. The anomalous origin of coronaries from a single Valsalva sinus has a higher risk of coronary obstruction during the TAVI procedure, so prior knowledge of these anatomical variants is of paramount importance as it can change the surgical strategy. In this report, we present the case of an adult patient suffering from severe aortic stenosis and incidentally diagnosed with an anomalous malignant variant of right coronary artery (RCA) by pre-procedural Computed Tomography (CT) Angiography. In TAVI planning, the use of electrocardiography (ECG) gated Dual Source CT (DSCT) enables accurate coronary and aorto-iliac vascular study, useful for detecting congenital coronary anomalies.

To investigate chest respiratory artefact reduction using High Pitch Dual Source Computed Tomography (HPCT) compared to conventional CT (CCT) in symptomatic patients with shortness of breath.Forty patients were prospectively examined on a second-generation Dual Source scanner. They were randomly divided into two groups: twenty patients underwent an experimental HPCT protocol and twenty control cases CCT protocol. Respiratory artefacts were evaluated using an ordinal score (0, 1 and 2) assigned by two readers with five and thirty years of experience. A qualitative assessment was performed using two categorical groups, group 1 = acceptable and group 2 = unacceptable. Dose Length Product (DLP) was compared.The two groups showed a statistical difference in artefacts reduction (p 0.0001). HPCT demonstrated no artefacts in 82% of cases, while CCT showed no artefacts in 39% of cases. DLP showed no statistical differences (p = 0.6) with mean = 266.9 for HPCT and mean = 282.65 for CCT. HPCT provides high table speed in the z-direction allowing a high temporal resolution, which reduces respiratory artefacts during free-breathing acquisition. Despite the use of two x-ray tubes, the HPCT did not increase the dose to the patient but provided the highest images quality.In the emergency setting, HPCTs have been critical for achieving good image quality in uncooperative patients.Acute respiratory failure is a common emergency department presentation, and the choice of high-speed acquisition CT may increase image quality.

Wei-Guo Zhang,1,* Jia-Ping Liu,2,* Xiu-Qin Jia,1 Ji-Yang Zhang,1 Xiang-Nan Li,1 Qi Yang1 1Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Department of Radiology, Beijing Xiongke Hospital, Capital Medical University, Beijing, 100049, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qi YangDepartment of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, People’s Republic of ChinaTel/Fax +86-85231928Email qiyang856@163.comObjective: This study aimed to investigate the effects of the Sn100 kVp tube voltage mode on the image quality and radiation dose of computed tomography pulmonary angiography (CTPA).Methods: A total of 145 patients who underwent CTPA were randomly divided into five groups: control group (120 kVp, 150 mAs), test group A (Sn100 kVp, 270 mAs), test group B (120 kVp, 30 mAs), test group C (70 kVp, 150 mAs), and test group D (80 kVp, 70 mAs). After image post-processing, the image quality and radiation dose of each group were analyzed.Results: The computed tomography values of images in the four test groups were more than 250 HU, which met the criteria for diagnosis. The signal-to-noise ratio and contrast-to-noise ratio of the images in the four test groups were lower than those in the control group. The radiation dose in each test group was lower than in the control group. The radiation dose was lowest in test group A.Conclusion: The Sn100 kVp energy spectrum purification protocol can meet the requirements for clinical diagnosis, ensure image quality, and reduce the dose of radiation that patients receive.Keywords: Sn100 kVp, CTPA, radiation dose, pulmonary embolism, dual-source CT

To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure. 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1-299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information. Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3-4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26-0.39 mSv). High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose. · High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.. · Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.. · Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low..· Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 - 558.ZIEL: Bewertung der Sensitivität, Spezifität und Interrater-Reliabilität der High-Pitch-Dual-Source-Computertomografie-Angiografie (CTA) in der Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit angeborenen Herzfehlern und Bewertung der damit verbundenen Strahlenbelastung. In diese retrospektive Studie wurden 78 Lungenvenen aus 17 konsekutiv untersuchten Säuglingen mit angeborenen Herzfehlern eingeschlossen (6 Mädchen, 11 Jungen; Medianalter 6 Tage, Range 1–299 Tage). Bei allen Patienten wurde eine High-Pitch-Dual-Source-CTA des Thorax bei niedriger Röhrenspannung (70 kV) durchgeführt. Das Vorliegen von Pulmonalvenenfehlmündungen wurde von 2 Radiologen unabhängig voneinander bewertet. Sensitivität, Spezifität, positive (PPV) und negative prädiktive Vorhersagewerte (NPV) sowie die Interrater-Reliabilität wurden bestimmt. Als Referenzstandard diente die Kombination aus CT-Scans, Befunden der Echokardiografie, klinischen Berichten sowie Operationsberichten, die von einem erfahrenen Kinderradiologen in Zusammenschau ausgewertet wurden. Dieser entschied im Fall inkongruenter Befunde über die korrekte Interpretation. Die Detektion von Pulmonalvenenfehlmündungen mit der High-Pitch-Dual-Source-CTA gelang mit guter Sensitivität (91 %) und Spezifität (99 %), bei PPV und NPV von 98 % und 97 %. Die Interrater-Reliabilität war nahezu perfekt (Kappa = 0,84). Der Median des DLP betrug 3,8 mGy*cm (IQR 3,3–4,7 mGy*cm), die effektive Dosis betrug im Median 0,33 mSv (IQR 0,26–0,39 mSv). Die High-Pitch-Dual-Source-CTA bei Säuglingen mit angeborenen Herzfehlern ermöglicht eine genaue und zuverlässige Detektion von Lungenvenenfehlmündungen bei niedriger Strahlendosis. · Die High-Pitch-Dual-Source-CTA ermöglicht die Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit hoher Sensitivität.. · Die Interrater-Reliabilität bei der Erkennung von Pulmonalvenenfehlmündungen mit High-Pitch-Dual-Source-CTA ist hoch.. · Die Strahlendosis der High-Pitch-Dual-Source-CTA bei der kardialen Untersuchung von Säuglingen ist gering..

Clinical use of dual-energy computed tomography (DECT) and dual-source computed tomography (DSCT) has been well established for more than a decade. Improved software and decreased postprocessing time have increased the advantages and availability of DECT and DSCT imaging. In this article, we will provide a practical guide for implementation of DECT and DSCT in clinical practice and discuss automated processing and selection of CT protocols in neurologic, cardiothoracic, vascular, body, and musculoskeletal imaging.

To evaluate the variability of quantitative measurements of metastatic liver lesions by using a multi-radiation-dose-level and multi-reader comparison. Twenty-three study subjects (mean age, 60 years) with 39 liver lesions who underwent a single-energy dual-source contrast-enhanced staging CT between June 2015 and December 2015 were included. CT data were reconstructed with seven different radiation dose levels (ranging from 25 to 100%) on the basis of a single CT acquisition. Four radiologists independently performed manual tumor measurements and two radiologists performed semi-automated tumor measurements. Interobserver, intraobserver, and interdose sources of variability for longest diameter and volumetric measurements were estimated and compared using Wilcoxon rank-sum tests and intraclass correlation coefficients. Inter- and intraobserver variabilities for manual measurements of the longest diameter were higher compared to semi-automated measurements (p

The purpose of this work was to develop and validate a Monte Carlo model for a Dual Source Computed Tomography (DSCT) scanner based on the Monte Carlo N-particle radiation transport computer code (MCNP5). The geometry of the Siemens Somatom Definition CT scanner was modeled, taking into consideration the x-ray spectrum, bowtie filter, collimator, and detector system. The accuracy of the simulation from the dosimetry point of view was tested by calculating the Computed Tomography Dose Index (CTDI) values. Furthermore, typical quality assurance phantoms were modeled in order to assess the imaging aspects of the simulation. Simulated projection data were processed, using the MATLAB software, in order to reconstruct slices, using a Filtered Back Projection algorithm. CTDI, image noise, CT-number linearity, spatial and low contrast resolution were calculated using the simulated test phantoms. The results were compared using several published values including IMPACT, NIST and actual measurements. Bowtie filter shapes are in agreement with those theoretically expected. Results show that low contrast and spatial resolution are comparable with expected ones, taking into consideration the relatively limited number of events used for the simulation. The differences between simulated and nominal CT-number values were small. The present attempt to simulate a DSCT scanner could provide a powerful tool for dose assessment and support the training of clinical scientists in the imaging performance characteristics of Computed Tomography scanners.

Purpose: This study aimed at evaluating the image quality characteristics of advanced noise-optimized and traditional virtual monochromatic images compared with conventional 120-kVp images from second-generation Dual-Source CT. Materials and Methods: For spiral scans six syringes filled with diluted iodine contrast material (1, 2, 5, 10, 15, 20 mg I/ml) were inserted into the test phantom and scanned with a second-generation dual-source CT in both single-energy (120-kVp) and dual-energy modes. Images set contain conventional single-energy 120-kVp, and virtual monochromatic were reconstructed with energies ranging from 40 to 190-keV in 1-keV steps. An energy-domain noise reduction algorithm was applied and the mean CT number, image noise, and iodine CNR were calculated. Results: The iodine CT number of conventional 120-kVp images compared with monochromatic of 40-, 50-, 60- and 70-keV images showed increase. The improvement ratio of image noise on Advanced Virtual Monochromatic Images (AVMIs) compared with the Traditional Virtual Monochromatic Images (TVMIs) at energies of 40-, 50-, 60, 70-keV was 52.9%, 35.7%, 8.1%, 2.1%, respectively. At AVMIs from 75- to 190-keV, the image noise value was less than conventional 120-kVp images. CNR improvement ratio at 20 mg/ml of iodinated contrast material for TVMIs and AVMIs compared to 120-kVp CT images and AVMIs compared to TVMI was 18.3% and 56.3%, 32.1% respectively. Conclusion: Both TVMIs (in energies ranging from 54 to 71-keV) and AVMIs (in energies ranging from 40 to 74-keV) represent improvement in the iodine contrast-to-noise ratio than conventional 120-kVp CT images for the same radiation dose. Also, AVMIs compared to TVMIs have been obtained considerable noise reduction and CNR improvement for low-energy virtual monochromatic images. In the present study, we show that virtual monochromatic image and its Advanced version (AVMI) may boost the dual-energy CT advantages by providing higher CNR images in the same exposure value compared to routinely acquired single-energy CT images.

Background: pulmonary atresia (PA) is a group of heterogeneous complex congenital heart disease which need more than one study modality to get correct diagnoses. This study aims to investigate the diagnostic power of low-dose dual-source computed tomography (DSCT) for all intracardiac and extracardiac anomalies in patients with PA compared with transthoracic echocardiography (TTE).Materials and methods: This retrospective study enrolled 73 patients and divided them into three groups according to their main diagnosis. All associated malformation and clinical information, including treatments, were recorded and compared among the three groups. The diagnostic power of DSCT and TTE on all associated anomalies were compared. The surgical index (McGoon ratio, pulmonary arterials index (PAI), and total neopulmonary arterial index) and radiation dose were calculated on the basis of DSCT.Results: Of the patients, 29, 29, and 15 were divide into the groups of PA with ventricular septal defect (VSD), PA with VSD and major aortopulmonary collateral arteries, and PA with other major malformations, respectively. Consequently, 178, 144, and 12 intracardiac, extracardiac, and other major anomalies were diagnosed, respectively. Moreover, DSCT showed a better diagnostic performance in extracardiac anomalies (137 vs 100, p = 0.000), whereas TTE could diagnose intracardiac anomalies better (158 vs 134, p = 0.001). The McGoon ratio, PAI, and treatment methods were significantly different among the three groups (p = 0.027, p = 0.035, and p = 0.041, respectively).Conclusion: More than one imaging modality should be used to make a correct diagnosis when clinically suspecting PA. DSCT is superior to TTE in diagnosing extracardiac anomalies and could be used to roughly calculate surgical indices to optimize treatment strategy.

Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still limited and often impaired by several technical issues, such as high heart rates, poor patient cooperation, and radiation dose exposure. Nonetheless, CT is becoming crucial in the noninvasive approach of children affected by coronary abnormalities and congenital heart disease. In some circumstances, CT might be preferred to other noninvasive techniques such as echocardiography and MRI for its lack of acoustic window influence, shorter acquisition time, and high spatial resolution. The introduction of dual-source CT has expanded the role of CT in the evaluation of pediatric cardiovascular anatomy and pathology. Furthermore, technical advances in the optimization of low-dose protocols represent an attractive innovation. Dual-source CT can play a key role in several clinical settings in children, namely in the evaluation of children with suspected congenital coronary artery anomalies, both isolated and in association with congenital heart disease. Moreover, it can be used to assess acquired coronary artery abnormalities, as in children with Kawasaki disease and after surgical manipulation, especially in case of transposition of the great arteries treated with arterial switch operation and in case of coronary re-implantation.

BackgroundTo assess the morphological features of persistent truncus arteriosus (PTA) on low-dose dual-source computed tomography (DSCT) and compare its diagnostic value for associated cardiovascular anomalies with that of transthoracic echocardiography (TTE).Methods:Twenty-four PTA patients were enrolled in this retrospective study. The types of PTA, diameters of the truncus artery (TA), main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and ventricular septal defect (VSD) on DSCT were recorded. Besides, all associated cardiovascular abnormalities were assessed. The diagnostic performance of DSCT and TTE for associated anomalies were compared. The effective doses of DSCT were calculated.Results:Four types were found: type A1(n=13/24, 54.17%), type A2(n=7/24, 29.16%), type A3（n=3/24, 12.50%）and type A4(n=1/24,4.17%). The mean diameter of VSD, TA, MPA, RPA, and LPA was 1.47±0.56cm, 3.92±1.56cm, 2.27±1.65cm, 1.48±0.74cm and 1.38±0.66cm, respectively. 78 associated cardiovascular anomalies were confirmed. The most common associated abnormalities were VSD (100%), right-sided aortic arch (33.33%) and aortopulmonary collateral vessels (29.17%). Although TTE was better at diagnosing intracardiac anomalies (accuracy:99.17% vs. 95%; sensitivity: 97.06% vs. 88.24%; specificity: 100% vs. 97.67%), DSCT had an advantage in diagnosing the associated cardiovascular abnormalities (accuracy: 98.61% vs. 96.07%; sensitivity: 94.87% vs. 82.05%; specificity: 99.44% vs. 99.15%). The estimated mean effective doses was 0.98±0.37mSv (＜1mSv). Conclusions:Low-dose DSCT could accurately confirm the morphological features of PTA. Compared to TTE, low-dose DSCT is a better diagnostic tool for associated cardiovascular abnormalities. Combining with TTE will be beneficial to provide more accurate information for clinical interventions.

Low-dose dual-source computed tomography (DSCT) protocols for the evaluation of lung diseases in children and adolescents are of importance since this age group is particularly prone to radiation damage. The aim of this study was to evaluate image quality of low-dose DSCT of the lung and to assess the potential of radiation dose reduction compared to digital radiographs (DR). Three groups, each consisting of 19 patients, were examined with different DSCT protocols using tin prefiltration (Sn96/64/32 ref. mAs at 100 kV). Different strengths of iterative reconstruction were applied (ADMIRE 2/3/4). DSCT groups were compared to 19 matched patients examined with posterior–anterior DR. Diagnostic confidence, detectability of anatomical structures and small lung lesions were evaluated on a 4-point Likert scale (LS 1 = unacceptable, 4 = fully acceptable, a value ≥ 3 was considered acceptable). Effective dose (ED) was 31-/21-/9-fold higher in Sn96/Sn64/Sn32 compared to DR. Diagnostic confidence was sufficient in Sn96/Sn64 (LS 3.4/3.2), reduced in Sn32 (LS 2.7) and the worst in DR (LS 2.4). In DSCT, detectability of small anatomical structures was always superior to DR (p &lt, 0.05). Mean lesion size ranged from 5.1–7 mm, detectability was acceptable in all DSCT groups (LS 3.0–3.4) and superior to DR (LS 1.9, p &lt, 0.05). Substantial dose lowering in DSCT of the pediatric lung enables acceptable detectability of small lung lesions with a radiation dose being about 10-fold higher compared to DR.

Introduction: Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of hemodynamically significant coronary artery disease (CAD). However, no prospective multicenter study has assessed the performance of combined coronary computed tomography angiography (CTA) and dynamic CTP. Hypothesis: In this prospective multicenter study, we assessed the hypothesis that dynamic CTP can provide an incremental diagnostic value over CTA detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR). Methods: Seven centers enrolled 165 patients with suspected or known CAD, who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT prior to ICA. FFR was done as part of ICA in case of 26-90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as of FFR Results: The study protocol was completed in 157 participants and hemodynamically significant stenosis was detected in 112 of 442 vessels (25%) and 123 of 157 patients (78%). According to receiver operating characteristic curve analysis, CTA showed an area under the curve (AUC) of 0.81 (95% confidence interval [CI], 0.73-0.86) on the patient level and 0.80 (95% CI, 0.76-0.84) on the vessel level. Adding dynamic CTP to CTA significantly increased the AUC to 0.85 (95% CI, 0.78-0.90; p=0.027) on the patient level and to 0.84 (95% CI, 0.80-0.87; p=0.002) on the vessel level. In the subgroups of patients with 1-, 2- and 3-vessel disease by CTA, the addition of dynamic CTP to CTA significantly increased AUC from 0.80 to 0.84 (p=0.041) in 2-vessel disease and from 0.65 to 0.73 (p=0.022) in 3-vessel disease, but not in 1-vessel disease (from 0.84 to 0.87, p=0.265). Conclusion: In this first prospective multicenter study on dynamic CTP, the combination of anatomical assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate detection of hemodynamically significant coronary artery stenosis. Improved diagnostic performance with dynamic CTP was mainly obtained when multivessel disease was suspected by CTA.

OBJECTIVE The objective of this study was to investigate the feasibility of high-concentration iodinated contrast medium (CM) with 70 kVp tube voltage on high-pitch dual-source computed tomography (DSCT) in children with congenital heart disease (CHD). METHODS Fifty-eight CHD patients underwent high-pitch DSCT in 2 protocols: 70 kVp tube voltage, 1.0 mL/kg CM volume, 370 mg I/mL concentration (group A); 80 kVp tube voltage, 1.5 mL/kg CM volume, 350 mg I/mL concentration (group B). The diagnostic accuracy, image quality, iodine delivery rate, iodine dose, and radiation dose were compared. RESULTS There was no significant difference in the diagnostic accuracy (P > 0.05), image quality (P > 0.05) and iodine delivery rate (P > 0.05) between the 2 groups. The iodine dose (P < 0.05) and radiation dose (P < 0.05) in group A were significantly lower than those in group B. CONCLUSIONS Reduction in iodine dose and radiation exposure can be achieved with 70 kVp high-pitch DSCT by administering a smaller volume of high-concentration CM in children with CHD.

Background: There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report herein the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations. Methods: This prospective observational study was carried out during the period January 2016 - June 2017. Children underwent CTCA on 128-slice Dual Source CT (DSCT) scanner (Somatom Definition Flash, Siemens; Germany), and 2D-echocardiography on the same day. Results: Mean age at time of diagnosis was 6.52±3.13 years; range 2-14 years. Mean age at time of study was 11.03±5.10 years; range 3.75 - 23.30 years. Mean interval between diagnosis of KD and time of present study was 3.84±2.27 years. None of the patients showed any coronary artery abnormalities on either 2D-echocardiography or CTCA. While assessment of proximal segments of left main coronary artery, proximal right coronary artery, and left anterior descending artery was comparable on both 2D-echocardiography and CTCA, left circumflex artery and distal right coronary artery could be clearly visualized only on CTCA. Conclusion: In our experience, patients with KD who have spontaneous defervescence during the acute stage and do not receive IVIg may not have significant long-term coronary sequelae. CTCA is a useful imaging modality for delineation of coronary artery in patients with KD on long term follow-up especially in older children with thick chest walls and poor acoustic windows. Keywords: Kawasaki disease; Spontaneous defervescence; Dual Source computed tomography coronary angiography; Coronary artery abnormalities; 2D-echocardiography

ObjectiveTo compare the radiation dose, objective and subjective image quality, and diagnostic performances of 80 kVp and 80/150 kVp with tin filter (80/Sn150 kVp) computed tomography (CT) in oncology patients.MethodsOne hundred forty-five consecutive oncology patients who underwent third-generation dual-source dual-energy CT of the abdomen for evaluation of malignant visceral, peritoneal, extraperitoneal, and bone tumor were retrospectively recruited. Two radiologists independently reviewed each observation in 80 kVp CT and 80/Sn150 kVp CT. Modified line-density profile of the tumor and contrast-to-noise ratio (CNR) were measured. Diagnostic confidence, lesion conspicuity, and subjective image quality were calculated and compared between image sets.ResultsModified line-density profile analysis revealed higher attenuation differences between the tumor and the normal tissue in 80 kVp CT than in 80/Sn150 kVp CT (127 vs. 107, P = 0.05). The 80 kVp CT showed increased CNR in the liver (8.0 vs. 7.6) and the aorta (18.9 vs. 16.3) than the 80/Sn150 kVp CT. The 80 kVp CT yielded higher enhancement of organs (4.9 ± 0.2 vs. 4.7 ± 0.4, P < 0.001) and lesion conspicuity (4.9 ± 0.3 vs. 4.8 ± 0.5, P = 0.035) than the 80/Sn150 kVp CT; overall image quality and confidence index were comparable. The effective dose reduced by 45.2% with 80 kVp CT (2.3 mSv ± 0.9) compared to 80/Sn150 kVp CT (4.1 mSv ± 1.5).ConclusionsThe 80 kVp CT performed similar or better than 80/Sn150 kVp CT for abdominal tumor evaluation with 45.2% radiation dose reduction in oncology patients.

To evaluate the image features and diagnostic agreement for anomalous pulmonary venous connection (APVC) by dual-source computed tomography (DSCT) before surgery when compared with trans-thoracic echocardiography (TTE).A total of one hundred and twenty-three patients were enrolled in this study. The associated malformation was analyzed between 39 total anomalous pulmonary venous connections (TAPVC) and 84 partial anomalous pulmonary venous connections (PAPVC). For 75 patients who received surgical treatment, the diagnostic agreement between the surgical findings of DSCT and TTE was evaluated. The dimensions of the four chambers of the heart were also measured by DSCT and TTE.Atrial septal defect is the most common anomaly associated with APVC (86/123, 69.9%), which has a higher incidence in TAPVC compared to that in PAPVC (100% vs. 56.0%, p0.001). Of 75 operative patients, discrepancies in diagnostic sensitivity existed between DSCT and TTE for different drainage sites, supracardiac (94.4% vs. 82.2%, p=0.001), cardiac (98.7% vs. 91.1%, p=0.089), and infracardiac (100% vs. 57.1%, p=0.096), respectively, and for different venous origins, right superior pulmonary vein (98.4% vs. 87.1%, p=0.871), right inferior pulmonary vein (100% vs. 87.3%, p=0.006), left superior pulmonary vein (100% vs. 93.1%, p=0.246), left inferior pulmonary vein (100% vs. 95.7%, p=0.500), and atypical pulmonary vein (66.7% vs. 44.4%, p=0.011), respectively. Good agreement was obtained between DSCT and TTE for measurements of left atrium, left ventricle, right atrium, and right ventricle sizes (bias 0.3±5.05mm, -0.3±4.50mm, 5.8±14.15mm, and 1.1±5.95mm, respectively).DSCT can provide optimal and accurate anatomy details for patients with APVC, and serves as a promising accessary imaging modality after TTE to achieve a better and comprehensive preoperative imaging evaluation.

The objective of the present study was to evaluate image quality and radiation dosage using a low-dose prospectively electrocardiogram (ECG)-gated computed tomography (CT) protocol for dual-source angiography in children with complex congenital heart disease. A total of 206 patients with complex congenital heart disease were equally assigned into two groups at random. The children in group A underwent low-dose retrospective ECG-gated CT scanning with an ECG-pulsing technique, and group B underwent prospective ECG-gated scanning with an ECG-pulsing technique. Radiation dose volume computed tomography dose index (CTDI vol), dose length product (DLP) and effective dose (ED) were recorded after scanning. Raw data were transferred to workstations for post-processing, diagnosis, grading, comparison with intra-operation findings or cardiac catheterisation, and the coincidence, false negative rate and misdiagnosis rates of groups A and B, respectively, were subsequently recorded. The results of the present study indicated that the height, age and weight of the children in the two groups exhibited no significant differences. The image quality of group A was graded as 3.94±0.08, whereas the grade for the image quality in group B was 4.05±0.08; no significant difference was detected. The coincidence rates of groups A and B were 89.37 and 88.48%, respectively; the false negative rates of groups A and B were 9.66 and 10.60%, respectively; the misdiagnosis rates of groups A and B were 0.97 and 0.92%. No significant differences between the two groups were detected. The CTDI value of group A was 3.24±1.62 mGy, the DLP value was 47.53±33.28 mGy·cm2, the ED value was 0.93±0.42 mSv. By contrast, the CTDI value of group B was 2.27±0.94 mGy, the DLP value was (27.03±17.64) mGy·cm2, and the ED value was 0.53±0.23 mSv. Significant differences were detected between the two groups (CTDI t=5.287, P

To compare coronary computed tomography angiography (CTA) and coronary angiography (CAG) with regard to luminal graphic definition of calcified segments using 128-slice dual-source computed tomography (DSCT), specifically for patients with an Agatston score >400. Of 1148 consecutive patients who underwent coronary CTA using a 128-slice DSCT, 132 subjects had severe calcification with an Agatston score >400. Thirty-nine of the 132 patients who had undergone CAG within 3 months before or after coronary CTA were included. We investigated the distribution of calcification, and we visually evaluated significant stenosis in the calcified and all segments. Results were compared with CAG. The target group in this study had a very high mean Agatston score of 1771 ± 1724. Results for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 247 calcified vs all 325 segments were as follows: sensitivity 93.2 vs 92.2%, specificity 83.9 vs 87.5%, PPV 70.8 vs 69.6%, and NPV 96.7 vs 97.3%, respectively. 128-slice DSCT has potential for evaluation of calcified segments in the lumen, even in patients whose Agatston score exceeds 400.

BACKGROUND: Dual source computed tomography (DSCT) plays an important role in the diagnosis of congenital heart diseases (CHD). However, the issue of radiation-related side effects constitutes a wide public concern. The aim of the study was to explore the differences in diagnostic accuracy, radiation dose and image quality between a prospectively ECG - triggered high - pitch spiral acquisition (flash model) and a retrospective ECG-gated protocol of DSCT used for the detection of CHD. MATERIAL AND METHODS: The study included 58 patients with CHD who underwent a DSCT examination, including two groups of 29 patients in each protocol. Then, both subjective and objective image quality, diagnostic accuracy and radiation dose were compared between the two protocols. RESULTS: The image quality and the total as well as partial diagnostic accuracy did not differ significantly between the protocols. The radiation dose in the flash model was obviously lower than that in the retrospective model (P

Objectives To evaluate the efficacy of dual-source computed tomography (DSCT) in assessing the morphological features, quantitative features, and associated coronary artery lesions among patients with coronary artery fistula (CAF) before surgery. Methods We enrolled 34 patients with CAF that were morphologically and quantitatively analyzed by DSCT and compared the analyses with surgical results (reference standard). The associated coronary artery lesions were also assessed. Results By DSCT, we identified 15 patients (44.1%) with left-sided CAF, 9 (26.5%) with right-sided CAF, and 10 (29.4%) with bilateral CAF; the left anterior descending coronary artery (50.0%) was most frequently involved. Drainage was most commonly in the main pulmonary artery (41.2%), and those with right-sided CAF had larger feeding coronary arteries and drainage sites than those with left-sided or bilateral CAF ( p r =0.95–0.98, p Conclusions DSCT is an alternative noninvasive imaging method that enables accurate assessment of morphological features, quantitative features, and associated coronary artery lesions in patients with CAF. It can be used to provide comprehensive information for determining surgical strategies.

Supplemental Digital Content is available in the text, Rationale: Unlike invasive coronary angiography and echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging allow a coronary artery fistula (CAF) comprehensive evaluation focusing on both coronary and myocardial findings. Patient concerns: We present the case of an asymptomatic patient suspected for CAF and referred to our structure for cardiovascular evaluation. Diagnosis: The patient was diagnosed a CAF without coronary artery disease on the basis of CMR and CCT. Interventions: The patient underwent an invasive coronary angiography after which the medical staff decided not to surgically treat the CAF. Therefore, a conservative treatment was chosen with strict temporal monitoring. Outcomes: After less than 1 year follow-up, the patient presented stable conditions without complaints. Lessons: Multimodal non-invasive imaging has a key role in patient assessment for disease diagnosis providing better understanding for prognosis and treatment.

Background: The aim of this study was to investigate the correlation of the dual energy CT measured iodine concentration and total iodine content with blood measured thyroid parameters. Methods: 43 patients with normal thyroid function at our hospital from August 2017 to October 2019 were included in this retrospective study. Dual energy CT was used to scan the neck of thyroid patients. The mean iodine concentration and thyroid tissue volume were measured to calculate the total iodine content of the thyroid. Relevant tests of triiodothyronine (FT3), total triiodothyronine (TT3), total thyroxine (TT4), free thyroxine (FT4), and thyroid hormone (TSH) were conducted. The correlation of the thyroid mean iodine concentration and total iodine content with blood-measured thyroid function was analysed. Result: The total iodine content in the thyroid was positively correlated with FT3 but negatively correlated with TSH. The mean iodine concentration of the thyroid was positively correlated with both FT3 and TT3. Conclusion: The thyroid iodine content measured by dual energy CT can be used to determine the human iodine nutritional status and evaluate thyroid function, which will facilitate the diagnosis and treatment of thyroid diseases.

Background The major concerns with coronary computed tomography angiography (CCTA) is the amount of contrast media (CM) injected and the radiation dose. Purpose To establish low radiation CCTA with low amount of contrast media. Methods Consecutive 60 patients (body weight ≤70mg or less and Agatston score ≤400) who were scheduled coronary computed tomography angiography were enrolled. Dual-source scanner (SOMATOM Force, Siemens, Germany) was used and CM used was Iopamidol 370mg/I (Bayer, Germany). Coronary CT angiography was performed with Turbo Flash Spiral and Sinogram Affirmed Iterative Reconstruction was done. The dose of contrast media was decided according to our original predicting system for 300HU. This study was approved by the local ethics committee and all patients gave written, informed consent. Exclusion criteria for CCTA were low Agatston score ( Results All patients successfully performed CCTA. Age averaged 46±15 yo (mean±S.D.) and body mass index averaged 22.5±3.0. Used CM was 12±7ml and intracoronary CT number 329±28HU. Dose-length product averaged 21.7±15.0 mGy cm and effective dose averaged 0.30±0.21mSv. Image quality averaged 4.8±0.7. CCTA with the lowest effective dose was 0.04mSv and CCTA with the lowest CM was 4ml. Conclusions Ultra-low dose 70kV-CCTA with low dose of contrast media can be performed using dual source computed tomography in patients with body weight ≤70mg or less and Agatston score ≤400.

Purpose This study aimed to validate standard deviations of lung densities obtained using high-pitch dual-source computed tomography (DSCT) densitometry as indices of bronchopulmonary dysplasia (BPD) severity in premature infants. Methods Data of preterm, late preterm group, and early term groups were evaluated. Mean and median standard deviations (SDmean, SDmedian) of CT lung density (CTLD) were calculated from CT images. Results SDmean of CTLD in infants with severe BPD was significantly higher than that of infants without BPD (198.1 vs. 140.9, respectively; P =.002). Conclusions Study results support using high-pitch DSCT for BPD diagnosis and quantitative evaluation in prematurity.

Introduction:Left Main Compression Syndrome (LMCS) represents an entity described as the extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) trunk. We examined the presence of LMCS in patients with pulmonary hypertension (PH) using dual-source computed tomography (DSCT), as a non-invasive diagnostic tool.Methods:The following parameters were measured: PA trunk diameter (PAD), the distance between PAD and LMCA (LMPA) and the distance between PA and aorta (AoPA). These measurements were related with demographic, echocardiographic, hemodynamic and clinical parameters. Angiography was performed in two patients with LMCS suspected by cardiac computed tomographic angiography. Patients without PH but with angina were examined as controls, using DSCT cardiac angiography to assess the same measurements and to detect the prevalence of coronary artery disease.Results:PA diameter value over 40.00 mm has been associated with PH and LMCS. Furthermore, LMCS did not occur at a distance smaller than 0.50 mm between the PA and the LMCA, and did not correlate with the distance between the PA and the aorta or with cardiac index and NT-proBNP.Conclusion:DSCT may represent the initial testing modality in PH patients with dilated PA trunk to exclude LMCS. A periodical rule-out of this rare entity, as assessed by DSCT, in patients with a severely dilated PA seems to be mandatory for PH patients contributing to survival improvement.

Purpose: The aim of this study was to systematically reinvestigate the first human mummy that was ever analyzed with X-ray imaging in 1896, using dual-source computed tomography (DSCT) in order to compare the earliest and latest imaging technologies, to estimate preservation, age at death, sex, anatomical variants, paleopathological findings, mummification, embalming and wrapping of the child mummy from ancient Egypt. Radiocarbon dating was used to determine the mummy’s age and to specify the child’s living period in the Egyptian chronology. Material and methods: The ancient Egyptian child mummy is kept in the Senckenberg Museum of Natural History in Frankfurt am Main, Germany. An accelerator mass spectrometer (MICADAS) was used for radiocarbon dating. DSCT was performed using a 2 × 64 slice dual-source CT system (Siemens Healthineers, Forchheim, Germany). A thorough visual examination of the mummy, a systematic radiological evaluation of the DICOM datasets, and established methods in physical anthropology were applied to assess the bio-anthropological data and the post mortem treatment of the body. Results: Radiocarbon dating yielded a calibrated age between 378 and 235 cal BC (95.4% confidence interval), corresponding with the beginning of the Ptolemaic period. The mummy was a male who was four to five years old at the time of death. Remnants of the brain and inner organs were preserved by the embalmers, which is regularly observed in ancient Egyptian child mummies. Skin tissue, inner organs, tendons and/or musculature, cartilage, nerves and vasculature could be identified on the DSCT dataset. The dental health of the child was excellent. Anatomical variants and pathological defects included a congenital Pectus excavatum deformity, hepatomegaly, Harris lines, and longitudinal clefts in the ventral cortices of both femora. Conclusion: Our results highlight the enormous progress achieved form earliest to latest imaging technology for advanced mummy research using the first human mummy investigated with X-ray. With the application of DSCT, detailed knowledge regarding age at death, sex, diseases, death, and mummification of a child from Ptolemaic Egypt are revealed while considering the temporary rites of body treatment and burial for children. Keywords: X-ray, Dual-energy computed tomography, Child mummy, Ancient Egypt, Pectus excavatum deformity, Hepatomegaly

To evaluate the quantitative accuracy of dual-source computed tomography (DSCT) on measurements of pulmonary artery in pediatric patients with cyanotic congenital heart diseases (CCHDs) when compared with transthoracic echocardiography (TTE).Thirty-five patients (mean age: 27.88 ± 28.27 months) with CCHDs underwent DSCT and TTE for evaluating the diameter of the main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA). Surgical measurements were obtained and served as the reference standard. The agreement was tested by linear regression analysis, Pearson's correlation coefficient, and Bland-Altman analysis. The intra- and extracardiac malformations were also observed.There was a markedly positive correlation between DSCT and surgical measurements of the MPA, RPA, and LPA (r=0.95-0.97; all p0.001), although the overestimation of the measurements of MPA, RPA, and LPA (bias 0.15 ± 0.95, 0.31 ± 0.63 and 0.35 ± 0.68 mm, respectively) was observed. However, there was a moderate correlation between TTE and surgical measurements of MPA, RPA, and LPA (r=0.61-0.84; all p0.001), and the underestimation of the measurements of MPA, RPA, and LPA (bias-1.20 ± 1.69, -1.80 ± 1.77, and -1.50 ± 2.30 mm, respectively) was observed. In addition, DSCT was more efficient in finding associated malformations than TTE (40/40 vs. 33/40).As a reliable, noninvasive and radiation-save imaging modality, DSCT can provide more accurate pulmonary artery measurements than TTE in cardiac surgical procedures.

A 23-year-old asymptomatic woman was referred to our hospital for further examination of a systolic ejection murmur with fixed splitting of the second heart sound auscultated at the third left sternal border. Initial echocardiography could not detect the cause. Subsequently performed low-dose computed tomography, however, ruled out the possibility of any congenital heart diseases, but revealed a markedly shortened anteroposterior diameter of the chest, which led us to a diagnosis of straight back syndrome. A vertically oriented “pancake” appearance of the heart, straight vertebral column, and compression of the right ventricular outflow tract were clearly demonstrated on the reconstructed images.

Purpose:To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA).Methods:Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed.Results:Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001.Conclusion:The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.

Evaluate the feasibility and determinants of image quality of ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography (CTA) for cardiovascular assessment in Children.All children that underwent ECG-triggered High-Pitch Dual-Source CTA between August 2014 and September 2017 were identified. Scanner parameters and patients' information were retrieved. Objective image quality was evaluated measuring the Hounsfield units (HU) and standard deviation of regions of interests in the left ventricle, ascending and descending aorta. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Qualitative image quality was recorded independently by two pediatric radiologist blinded using a three-point scale: 1 - good image quality, 2 - mild artifacts, 3 - poor image quality. Continuous variables were presented as mean ± standard deviation. The interobserver agreement and non-parametric test were used.93 patients (mean age 5.6 ± 7.1 years) were selected. Average cardiovascular attenuation, SNR and CNR were 406.2 ± 146.3 HU, 24.2 ± 16.0 HU and 52.1 ± 38.6 HU, respectively. Average image quality was 1.51 ± 0.48 and the inter-observer agreement was excellent (k = 0.8). Worse subjective quality scores were associated with lower age, height, weight, BSA, lower contrast dose and slower injection rates (p0.05). Higher heart rate was associated with high attenuation (p0.05), however, SNR and CNR did not show an association with heart rate (p = 0.80).ECG-triggered High-Pitch Dual-Source cardiac CTA is feasible and provides good or excellent image quality for the evaluation of cardiovascular diseases in children.