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The purpose of this study was to evaluate the currently used effective doses in CT colonography (CTC) and to search for trends in time. A Pubmed search for articles and a search for congress abstracts concerning CTC was performed. Research institutions were sent a CTC dose questionnaire concerning the type of CT system employed and the CT parameters used. With the ImPACT CT Dosimetry Spreadsheet effective doses were calculated. Of 83 institutions, 34 returned a complete questionnaire; 21 (62%) used 64-detector row CT and 17 (50%) used dose modulation. The median effective dose per institution was 5.7 mSv (2.8 mSv supine; 2.5 mSv prone) for screening protocols and 9.1 mSv (5.2 and 3.0 mSv, respectively) for daily practice protocols (p<0.05). Doses did not differ significantly between CT machines with different numbers of detector rows. In 17 institutions incorporated in a study in 2004 as well, the median dose for daily practice protocols changed from 11 mSv in 2004 to 9.7 mSv now (n.s.). Median effective dose for CTC is significantly lower for screening than for daily practice protocols. Although the number of CTC protocols with dose modulation increased substantially since 2004, no significant decrease in effective dose was found. [ABSTRACT FROM AUTHOR]

The introduction of digital radiography not only has revolutionized communication between radiologists and clinicians, but also has improved image quality and allowed for further reduction of patient exposure. However, digital radiography also poses risks, such as unnoticed increases in patient dose and suboptimum image processing that may lead to suppression of diagnostic information. Advanced processing techniques, such as temporal subtraction, dual-energy subtraction and computer-aided detection (CAD) will play an increasing role in the future and are all targeted to decrease the influence of distracting anatomic background structures and to ease the detection of focal and subtle lesions. This review summarizes the most recent technical developments with regard to new detector techniques, options for dose reduction and optimized image processing. It explains the meaning of the exposure indicator or the dose reference level as tools for the radiologist to control the dose. It also provides an overview over the multitude of studies conducted in recent years to evaluate the options of these new developments to realize the principle of ALARA. The focus of the review is hereby on adult applications, the relationship between dose and image quality and the differences between the various detector systems. [ABSTRACT FROM AUTHOR]

Aim: To assess the feasibility of colorectal cancer detection using dual-energy computed tomography with iodine mapping and without bowel preparation or bowel distension., Materials and Methods: Consecutive patients scheduled for preoperative staging computed tomography (CT) because of diagnosed or high suspicion for colorectal cancer were prospectively included in the study. A single contrast-enhanced abdominal CT acquisition using dual-source mode (100 kV/140 kV) was performed without bowel preparation. Weighted average 120 kV images and iodine maps were created with post-processing. Two observers performed a blinded read for colorectal lesions after being trained on three colorectal cancer patients. One observer performed an unblinded read for lesion detectability and placed a region of interest (ROI) within each lesion., Results: In total 21 patients were included and 18 had a colorectal cancer at the time of the CT acquisition. Median cancer size was 43 mm [interquartile range (IQR) 27-60 mm] and all 18 colorectal cancers were visible on the 120 kV images and iodine map during the unblinded read. During the blinded read, observers found 90% (27/30) of the cancers with 120 kV images only and 96.7% (29/30) after viewing the iodine map in addition (p = 0.5). Median enhancement of colorectal cancers was 29.9 HU (IQR 23.1-34.6). The largest benign lesions (70 and 25 mm) were visible on the 120 kV images and iodine map, whereas four smaller benign lesions (7-15 mm) were not., Conclusion: Colorectal cancers are visible on the contrast-enhanced dual-energy CT without bowel preparation or insufflation. Because of the patient-friendly nature of this approach, further studies should explore its use for colorectal cancer detection in frail and elderly patients., (Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

This article reviews two important aspects of CT-colonography, namely colonic distension and scan parameters. Adequate distension should be obtained to visualize the complete colonic lumen and optimal scan parameters should be used to prevent unnecessary radiation burden. For optimal distension, automatic carbon dioxide insufflation should be performed, preferably via a thin, flexible catheter. Hyoscine butylbromide is - when available - the preferred spasmolytic agent because of the positive effect on insufflation and pain/burden and its low costs. Scans in two positions are required for adequate distension and high polyp sensitivity and decubitus position may be used as an alternative for patients unable to lie in prone position. The great intrinsic contrast between air or tagging and polyps allows the use of low radiation dose. Low-dose protocol without intravenous contrast should be used when extracolonic findings are deemed unimportant. In patients suspected for colorectal cancer, normal abdominal CT scan protocols and intravenous contrast should be used in supine position for the evaluation of extracolonic findings. Dose reduction can be obtained by lowering the tube current and/or voltage. Tube current modulation reduces the radiation dose (except in obese patients), and should be used when available. Iterative reconstructions is a promising dose reducing tool and dual-energy CT is currently evaluated for its applications in CT-colonography. This review also provides our institution's insufflation procedure and scan parameters., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Rationale and Objectives: Radiation dose is an important drawback of computed tomography (CT) colonography, especially for its use as a screening tool for colorectal cancer. It is therefore important to know the present radiation dose. Our objective is to assess the effective radiation doses used for CT colonography and its trend over time., Materials and Methods: Institutions performing CT colonography research were asked to provide their CT colonography protocols. Median effective doses were calculated and compared with a 2007 inventory. Separate analyses were performed for protocols using intravenous contrast medium and for academic versus nonacademic institutions. Differences in effective dose were tested for significance, using Wilcoxon rank-sum or Wilcoxon signed-rank test., Results: Sixty-two of 109 (57%) institutions responded, providing protocols for 58 institutions. Median effective dose for daily practice protocols was 7.6 mSv (4.3 mSv and 2.0 mSv for supine and prone, respectively) and for screening 4.4 mSv (2.6 mSv and 2.0 mSv, respectively; P = .01). For daily practice with and without contrast medium, the median effective doses were 10.5 mSv and 4.0 mSv (P < .001), respectively. Academic and nonacademic institutions used similar doses (all comparisons P > .05). For institutions also participating in the 2007 inventory, effective dose for both daily practice and screening protocols were similar (P > .05)., Conclusion: In 2011 the median effective radiation dose for daily practice protocols was 7.6 mSv and for screening 4.4 mSv. Median effective doses have not decreased as compared to 2007. Academic and nonacademic institutions use similar radiation dose., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

Objective: Endocrine deficiencies, like GH and estrogen deficiencies, are likely candidates to explain increased visceral to subcutaneous fat ratio in patients with pituitary insufficiency. However, recent reports pointed to cranial radiotherapy (CRT) as an additional determinant of an unfavorable fat distribution. Therefore, we determined the effect of CRT on abdominal fat distribution in men with treated pituitary insufficiency., Design: Cross-sectional study., Methods: Thirty-five consecutive male subjects (16 men with and 19 men without CRT aged 62±12 and 56±14 years respectively, P=0.175) visiting our Endocrine Outpatient Clinic for pituitary insufficiency were invited to participate in this study. A standardized single-slice abdominal CT scan at the level of fourth lumbar vertebra was performed to determine visceral fat area, subcutaneous fat area, and visceral to subcutaneous fat ratio. In addition, we assessed body mass index, total fat percentage with bioelectrical impedance analysis, resting energy expenditure with indirect calorimetry, calorie intake using a diary, and serum hormone concentrations., Results: Subjects with CRT had a smaller subcutaneous fat area (225.1 (71.1-480.7) vs 269.0 (133.2-59.9) cm(2), P=0.022) and a higher visceral to subcutaneous fat ratio (0.79 (0.39-1.55) vs 0.63 (0.23-0.88), P=0.001) than subjects without CRT. Both the groups were comparable for body mass index, waist-hip ratio, resting energy expenditure, and calorie intake. Importantly, serum hormone concentrations were similar., Conclusion: In men treated for pituitary insufficiency, previous CRT is associated with a higher visceral to subcutaneous fat ratio.

Purpose: Computed tomography angiography (CTA) is often used to determine the degree of stenosis in patients that suffer from carotid artery occlusive disease. Accurate and precise measurements of the diameter of the stenosed internal carotid artery are required to make decisions on treatment of the patient. However, the inherent blurring of images hampers a straightforward measurement, especially for smaller vessels. The authors propose a model-based approach to perform diameter measurements in which explicit allowance is made for the blurring of structures in the images. Three features of the authors' approach are the use of prior knowledge in the fitting of the model at the site of the stenosis, the applicability to vessels both with circular and noncircular cross-section, and the ability to deal with additional structures close to the arteries such as calcifications., Methods: Noncircular cross-sections of vessels were modeled with elliptic Fourier descriptors. When calcifications or other high-intensity structures are adjacent to the lumen, both the lumen and the high-intensity structures were modeled in order to improve the diameter estimates of the vessel. Measurements were performed in CT scans of a phantom mimicking stenosed carotids and in CTA scans of two patients with an internal carotid stenosis. In an attempt to validate the measurements in CTA images, measurements were also performed in three-dimensional rotational angiography (3DRA) images of the same patients., Results: The validity of the approach for diameter measurements of cylindrical arteries in CTA images is evident from phantom measurements. When prior knowledge about the enhancement and the blurring parameter was used, accurate and precise diameter estimates were obtained down to a diameter of 0.4 mm. The potential of the presented approach, both with respect to the extension to noncircular cross-sections and the modeling of adjacent calcifications, appears from the patient data. The accuracy of the size estimates in the patient images could not be unambiguously established because no gold standard was available and the quality of the 3DRA images was often suboptimal., Conclusions: The authors have shown that the inclusion of a priori information results in accurate and precise diameter measurements of arteries with a small diameter. Furthermore, in patient data, the assumption of a circular cross-section often appears to be too simple. The extension to noncircular cross-sections and adjacent calcifications paves the way to realistic modeling of the carotid artery.

Objectives: Computed tomography venography (CTV) has proven to be a reliable imaging method in the evaluation of cerebral venous thrombosis with good correlation to magnetic resonance (MR) imaging and digital subtraction angiography (DSA). It is fast and widely accessible, especially in the emergency setting. For better visualization of vascular structures bone is often removed from the images. The purpose of this study was to evaluate the quality of a fully automatic bone removal method, matched mask bone elimination (MMBE), and to assess the interobserver variability of the CTV technique., Patients and Methods: Fifty patients with clinical suspicion of cerebral venous thrombosis underwent multislice CTV with MMBE post-processing. Axial source images and maximum intensity projections were retrospectively evaluated by two neuroradiologists for quality of bone removal and for the presence or absence of thrombosis in nine dural sinuses and five deep cerebral veins. A per sinus/vein and a per patient analysis (thrombosis in at least one sinus or vein) was performed and interobserver agreement was assessed., Results: Both observers considered bone removal good in all patients (100%). Interobserver agreement per patient was excellent (kappa=0.83), with a full agreement in 47 of 50 patients (94%). The interobserver agreement per sinus or vein was good (kappa=0.76), with a full agreement in 679 of 700 sinuses or veins (97%)., Conclusion: CTV aided with MMBE is a robust technique for visualization of the intracranial venous circulation, removing bone effectively. CTV has high interobserver agreement for presence or absence of cerebral venous thrombosis.

CT perfusion (CTP) examinations of the brain are performed increasingly for the evaluation of cerebral blood flow in patients with stroke and vasospasm after subarachnoid hemorrhage. Of the same patient often also a CT angiography (CTA) examination is performed. This study investigates the possibility to obtain CTA images from the CTP examination, thereby possibly obviating the CTA examination. This would save the patient exposure to radiation, contrast, and time. Each CTP frame is a CTA image with a varying amount of contrast enhancement and with high noise. To improve the contrast-to-noise ratio (CNR) we combined all 3D images into one 3D image after registration to correct for patient motion between time frames. Image combination consists of weighted averaging in which the weighting factor of each frame is proportional to the arterial contrast. It can be shown that the arterial CNR is maximized in this procedure. An additional advantage of the use of the time series of CTP images is that automatic differentiation between arteries and veins is possible. This feature was used to mask veins in the resulting 3D images to enhance visibility of arteries in maximum intensity projection (MIP) images. With a Philips Brilliance 64 CT scanner (64 x 0.625 mm) CTP examinations of eight patients were performed on 80 mm of brain using the toggling table technique. The CTP examination consisted of a time series of 15 3D images (2 x 64 x 0.625 mm; 80 kV; 150 mAs each) with an interval of 4 s. The authors measured the CNR in images obtained with weighted averaging, images obtained with plain averaging, and images with maximal arterial enhancement. The authors also compared CNR and quality of the images with that of regular CTA examinations and examined the effectiveness of automatic vein masking in MIP images. The CNR of the weighted averaged images is, on the average, 1.73 times the CNR of an image at maximal arterial enhancement in the CTP series, where the use of plain averaging increases the CNR only with a factor of 1.49. The quality of the weighted averaged images approaches that of CTA images, although in the present study the image quality of CTA was not quite reached. The automatic masking of veins is effective and only small remnants of veins were sometimes present in the masked images. Weighted averaging makes it possible to create CTA images from a CTP examination with a CNR considerably higher than that of images with maximal arterial enhancement. The quality of the resulting images approaches that of CTA images and offers the additional advantages to automatically differentiate between arteries and veins.

Objective: The purpose of this study was to determine the influence of tagged material on the minimal radiation dose needed to detect colorectal polyps at CT., Materials and Methods: The study was conducted in two phases. In the first, three experienced observers determined the visibility of sessile polyps (6 mm) at five contrast levels (300, 480, 790, and 1,040 HU and air) and five tube charge levels (10, 14, 20, 28, and 40 mAs) in an anthropomorphic phantom. Each polyp was present in one of eight possible locations. The mean tube charge threshold for 90% correct responses was determined for each contrast level. Blinded observers performed independent 2D readings. In the second phase of the study, three 150-cm virtual colons were evaluated at two contrast levels (300 and 480 HU) and at five tube charge levels between 20 and 80 mAs. The three colons contained 18 randomly located polyps. The mean tube charge threshold for 90% sensitivity was determined for each contrast level., Results: In the first phase of the study, the estimated tube charge thresholds for 300, 480, and 790 HU were 24.0, 16.3, and 6.2 mAs. At 1,040 HU and in air, all polyps were detected at the lowest tube charge setting (10 mAs). In the second phase, the tube charge thresholds for 90% sensitivity at 300 and 480 HU were 70 and 35 mAs, respectively., Conclusion: If polyps are covered by fecal material, a considerably higher tube charge setting is needed for adequate visualization than is needed for polyps in a completely cleansed colon, especially when the density of the tagged residue is low.

Objective: The purpose of this study was to assess the accuracy and measurement variability of automated lesion measurement on CT colonography in comparison with manual 2D and 3D techniques under varying scanning conditions., Materials and Methods: The study included phantoms (23 phantom objects) and patients (16 polyps). Measurement with sliding calipers served as the reference for the phantom data. The mean of two independent colonoscopic measurements was the reference for the polyps. The automated measurement was developed for a computer-aided detection scheme, and the size of any detected object was obtained from measurement of its largest diameter. The automated measurement was compared with manual 2D and 3D measurements by two experienced observers., Results: For phantom data, the measurement variability of the automated method was significantly less than that of the two observers (p < 0.05), except for the 3D measurement by observer 1, as follows: automated, 0.86 mm; observer 1, 1.76 mm (2D), 0.96 (3D); observer 2, 1.34 mm (2D), 1.45 mm (3D). The variability of the automated method did not differ significantly from that of manual methods in measurement with patient data. The automated method had a systematic error for phantom data (1.9 mm)., Conclusion: For phantoms, the automated method has less measurement variability than manual 2D and 3D techniques. For true polyps, the measurement variability of the automated method is comparable with that of manual methods. The automated method does not suffer from intraobserver variability. Because systematic error can be calibrated, automated size measurement may contribute to a practical evaluation strategy.

Objective: Our objective was to measure insulin sensitivity and body composition in antipsychotic-naive patients with DSM IV schizophrenia and/or schizoaffective disorder compared with matched controls., Design: Seven antipsychotic medication-naive patients fulfilling the DSM IV A criteria for schizophrenia/schizoaffective disorder were matched for body mass index, age, and sex with seven control subjects. We measured endogenous glucose production and peripheral glucose disposal using a hyperinsulinemic euglycemic clamp (plasma insulin concentration approximately 200 pmol/liter) in combination with stable isotopes. Fat content and fat distribution were determined with a standardized single-slice computed tomography scan and whole body dual-energy x-ray absorptiometry., Results: Endogenous glucose production during the clamp was 6.7 micromol/kg x min (sd 2.7) in patients vs. 4.1 micromol/kg x min (sd 1.6) in controls (P = 0.02) (95% confidence interval -5.2 to 0.006). Insulin-mediated peripheral glucose uptake was not different between patients and controls. The amount of sc abdominal fat in patients was 104.6 +/- 28.6 cm(3) and 63.7 +/- 28.0 cm(3) in controls (P = 0.04) (95% confidence interval 4.4-77.2). Intraabdominal fat and total fat mass were not significantly different., Conclusions: Antipsychotic medication-naive patients with schizophrenia or schizoaffective disorder display hepatic insulin resistance compared with matched controls. This finding cannot be attributed to differences in intraabdominal fat mass or other known factors associated with hepatic insulin resistance and suggests a direct link between schizophrenia and hepatic insulin resistance.

Background and Purpose: Our aim was to determine the diagnostic accuracy of multisection CT angiography combined with matched mask bone elimination (CTA-MMBE) for detection of intracranial aneurysms compared with digital subtraction angiography (DSA) and 3D rotational angiography (3DRA)., Materials and Methods: Between January 2004 and February 2006, 108 patients who presented with clinically suspected subarachnoid hemorrhage underwent both CTA-MMBE and DSA for diagnosis of an intracranial aneurysm. Two neuroradiologists, independently, evaluated 27 predefined vessel locations in the CTA-MMBE images for the presence of an aneurysm. After consensus, diagnostic accuracy of CTA was calculated per predefined location and per patient. Interobserver agreement was calculated with kappa statistics., Results: In 88 patients (81%), 117 aneurysms (82 ruptured, 35 unruptured) were present on DSA. CTA-MMBE detected all ruptured aneurysms except 1. Overall specificity, sensitivity, positive predictive value, and negative predictive value of CTA-MMBE were 0.99, 0.90, 0.98, and 0.95 per patient and 0.91, 1.00, 0.97, and 0.99 per location, respectively. Sensitivity was 0.99 for aneurysms >/=3 mm and 0.38 for aneurysms <3 mm. Interobserver agreement for aneurysm detection was excellent (kappa value of 0.92 per location and 0.80 per patient)., Conclusion: CTA-MMBE is accurate in detecting intracranial aneurysms in any projection without overprojecting bone. CTA-MMBE has limited sensitivity in detecting very small aneurysms. Our data suggest that DSA and 3DRA can be limited to the vessel harboring the ruptured aneurysm before endovascular treatment, after detection of a ruptured aneurysm with CTA.

The purpose was to evaluate low-dose CT colonography without cathartic cleansing in terms of image quality, polyp visualization and patient acceptance. Sixty-one patients scheduled for colonoscopy started a low-fiber diet, lactulose and amidotrizoic-acid for fecal tagging 2 days prior to the CT scan (standard dose, 5.8-8.2 mSv). The original raw data of 51 patients were modified and reconstructed at simulated 2.3 and 0.7 mSv levels. Two observers evaluated the standard dose scan regarding image quality and polyps. A third evaluated the presence of polyps at all three mSv levels in a blinded prospective way. All observers were blinded to the reference standard: colonoscopy. At three times patients were given questionnaires relating to their experiences and preference. Image quality was sufficient in all patients, but significantly lower in the cecum, sigmoid and rectum. The two observers correctly identified respectively 10/15 (67%) and 9/15 (60%) polyps > or =10 mm, with 5 and 8 false-positive lesions (standard dose scan). Dose reduction down to 0.7 mSv was not associated with significant changes in diagnostic value (polyps > or =10 mm). Eighty percent of patients preferred CT colonography and 13% preferred colonoscopy (P<0.001). CT colonography without cleansing is preferred to colonoscopy and shows sufficient image quality and moderate sensitivity, without impaired diagnostic value at dose-levels as low as 0.7 mSv.

For clear visualization of vessels in CT angiography (CTA) images of the head and neck using maximum intensity projection (MIP) or volume rendering (VR) bone has to be removed. In the past we presented a fully automatic method to mask the bone [matched mask bone elimination (MMBE)] for this purpose. A drawback is that vessels adjacent to bone may be partly masked as well. We propose a modification, multiscale MMBE, which reduces this problem by using images at two scales: a higher resolution than usual for image processing and a lower resolution to which the processed images are transformed for use in the diagnostic process. A higher in-plane resolution is obtained by the use of a sharper reconstruction kernel. The out-of-plane resolution is improved by deconvolution or by scanning with narrower collimation. The quality of the mask that is used to remove bone is improved by using images at both scales. After masking, the desired resolution for the normal clinical use of the images is obtained by blurring with Gaussian kernels of appropriate widths. Both methods (multiscale and original) were compared in a phantom study and with clinical CTA data sets. With the multiscale approach the width of the strip of soft tissue adjacent to the bone that is masked can be reduced from 1.0 to 0.2 mm without reducing the quality of the bone removal. The clinical examples show that vessels adjacent to bone are less affected and therefore better visible. Images processed with multiscale MMBE have a slightly higher noise level or slightly reduced resolution compared with images processed by the original method and the reconstruction and processing time is also somewhat increased. Nevertheless, multiscale MMBE offers a way to remove bone automatically from CT angiography images without affecting the integrity of the blood vessels. The overall image quality of MIP or VR images is substantially improved relative to images processed with the original MMBE method.

Current methods of image-based thickness measurement in thin sheet structures utilize second derivative zero crossings to locate the layer boundaries. It is generally acknowledged that the nonzero width of the point spread function (PSF) limits the accuracy of this measurement procedure. We propose a model-based method that strongly reduces PSF-induced bias by incorporating the PSF into the thickness estimation method. We estimated the bias in thickness measurements in simulated thin sheet images as obtained from second derivative zero crossings. To gain insight into the range of sheet thickness where our method is expected to yield improved results, sheet thickness was varied between 0.15 and 1.2 mm with an assumed PSF as present in the high-resolution modes of current computed tomography (CT) scanners [full width at half maximum (FWHM) 0.5-0.8 mm]. Our model-based method was evaluated in practice by measuring layer thickness from CT images of a phantom mimicking two parallel cartilage layers in an arthrography procedure. CT arthrography images of cadaver wrists were also evaluated, and thickness estimates were compared to those obtained from high-resolution anatomical sections that served as a reference. The thickness estimates from the simulated images reveal that the method based on second derivative zero crossings shows considerable bias for layers in the submillimeter range. This bias is negligible for sheet thickness larger than 1 mm, where the size of the sheet is more than twice the FWHM of the PSF but can be as large as 0.2 mm for a 0.5 mm sheet. The results of the phantom experiments show that the bias is effectively reduced by our method. The deviations from the true thickness, due to random fluctuations induced by quantum noise in the CT images, are of the order of 3% for a standard wrist imaging protocol. In the wrist the submillimeter thickness estimates from the CT arthrography images correspond within 10% to those estimated from the anatomical sections. We present a method that yields virtually unbiased thickness estimates of cartilage layers in the submillimeter range. The good agreement of thickness estimates from CT images with estimates from anatomical sections is promising for clinical application of the method in cartilage integrity staging of the wrist and the ankle.

The aim of our study was to compare primary three-dimensional (3D) and primary two-dimensional (2D) review methods for CT colonography with regard to polyp detection and perceptive errors. CT colonography studies of 77 patients were read twice by three reviewers, first with a primary 3D method and then with a primary 2D method. Mean numbers of true and false positives, patient sensitivity and specificity and perceptive errors were calculated with colonoscopy as a reference standard. A perceptive error was made if a polyp was not detected by all reviewers. Mean sensitivity for large (> or = 10 mm) polyps for primary 3D and 2D review was 81% (14.7/18) and 70%(12.7/18), respectively (p-values > or = 0.25). Mean numbers of large false positives for primary 3D and 2D were 8.3 and 5.3, respectively. With primary 3D and 2D review 1 and 6 perceptive errors, respectively, were made in 18 large polyps (p = 0.06). For medium-sized (6-9 mm) polyps these values were for primary 3D and 2D, respectively: mean sensitivity: 67%(11.3/17) and 61%(10.3/17; p-values > or = 0.45), number of false positives: 33.3 and 15.6, and perceptive errors : 4 and 6 (p = 0.53). No significant differences were found in the detection of large and medium-sized polyps between primary 3D and 2D review.

Background and Purpose: Routine CT of the brain is traditionally performed with sequential CT. We assessed whether sequential CT can be replaced with thinly collimated multisection spiral CT without loss of image quality., Materials and Methods: An observer study was conducted using data from 23 patients who were scanned with both a sequential (collimation, 4 x 5 mm) and a spiral technique (collimation, 4 x 1 mm; pitch, 0.875). Each sequential image was registered with 4 combined spiral CT images at 1.2 mm distance. Two neuroradiologists blindly scored 232 image pairs on 6 aspects: streak artifacts, visualization of brain tissue near skull, visualization of hypoattenuated lesions, gray/white matter differentiation, image noise, and overall image quality. A 5-point scale (range, -2 to 2) was used to score the preferences. The 23 pairs of complete scans were scored likewise. In this case, no registration was performed., Results: Virtually all mean scores were positive (ie, showed a preference for the spiral technique). For the comparison of image pairs, the preferences with respect to streak artifacts (mean score, 1.36), visualization of brain tissue near the skull (mean score, 0.69), and overall image quality (mean score, 0.95) were significant (P < .001). With respect to visualization of hypo-attenuated lesions, image noise, and gray/white matter differentiation (mean scores, 0.18, 0.27, and 0.13), the preferences for spiral CT were not significant. The preferences for the spiral technique were also present at the comparison of the complete scans., Conclusion: Thinly collimated multisection spiral CT of the brain with image combining is superior to thickly collimated sequential CT.

Introduction: Delayed ischemic neurologic deficits secondary to vasospasm are a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Treatment of vasospasm after SAH is associated with complications, and reliable techniques for evaluating effects of treatment of vasospasm in such patients are warranted. We present the use of perfusion computed tomography (PTC) to evaluate the effect of transluminal percutaneous angioplasty in a with SAH and vasospasm-induced ischemia., Methods: Dynamic PCT with deconvolution produced maps of time-to-peak, mean transit time, regional cerebral blood flow, and regional cerebral blood volume, with a computerized automated map of the infarct and penumbra. CT scanners with quadruple detector array were used before and after angioplasty., Results: Before angioplasty and intraarterial papaverine, PCT showed normal to decreased cerebral blood flow and increased cerebral blood volume and mean transit time in the middle cerebral artery territory of the left hemisphere. After angioplasty and intraarterial papaverine, PCT showed normalization of perfusion parameters., Conclusion: PCT can be a useful technique in monitoring angioplasty treatment effects in patients with vasospasm after SAH.

Purpose: Despite severe abnormalities of the corneal endothelium in the iridocorneal endothelial (ICE) syndrome, the cornea can remain clear and maintain its normal thickness for years before corneal decompensation occurs. The aim of this study is to analyze this discrepancy by studying corneal hydration control in the ICE syndrome., Methods: In four subjects with unilateral ICE syndrome, without signs of corneal decompensation, a "corneal stress test" was performed in both the affected and the unaffected eye. The stress test measures the recovery of corneal thickness after swelling induced by wearing a soft contact lens with the eyes closed. Corneal thickness was measured by noncontact pachymetry., Results: Mean baseline corneal thickness of affected eyes (535+/-56 microm) was not different from unaffected eyes (526+/-39 microm). On the other hand, the corneal stress test showed a smaller induced swelling in affected eyes (33+/-15 microm) compared with unaffected eyes (67+/-11 microm) and a slower recovery of corneal thickness in affected eyes. In one of four subjects, the cornea of the affected eye was calculated not yet to have recovered its original thickness before midnight. After this finding, although the cornea of this subject did not show any signs of clinical decompensation, the study was discontinued., Conclusions: Corneal hydration control is altered in the ICE syndrome. The ICE cornea can maintain its normal thickness despite severe morphologic abnormalities of the endothelium. Because we found that recovery of corneal thickness can be extremely slow, it cannot be guaranteed that such corneal "stress tests" are completely safe for subjects with the ICE syndrome, and we therefore feel that they should no longer be performed in these subjects.

The purpose of this study was to estimate the effective dose that is currently used in CT colonography using scan parameters that were collected for this purpose, and to investigate trends in time. PubMed was systematically searched from 1996 until January 2004 for studies investigating CT colonography. Research institutions were contacted and asked for their current scan protocol. Thirty-six institutions published 74 studies. Twenty-eight of the 36 institutions provided their current protocol. The median effective dose in 2004 was 5.1 mSv (range 1.2-11.7 mSv) per position. Most institutions (93%) scan in both the supine and prone positions. The median mAs value was 67 mAs (range 20-200), median collimation was 2.5 mm (range 0.75-5). From 1996 until 2004 a significant decrease in mAs and collimation (P=0.006, P<0.0001, respectively) was observed, while institutions that used a multislice scanner increased (P<0.0001). The effective dose remained constant (P=0.76). In 2004 the median effective dose for a complete CT colonography was 10.2 mSv. Despite the increasing use of multislice scanners, which are slightly less dose-efficient, the median effective dose remained approximately constant between 1996 and 2004. This is mainly caused by the use of lower mAs settings.

Virtual colonoscopy is a relatively new method for the detection of colonic polyps. Their size, which is measured from reformatted CT images, mainly determines diagnosis. We present an automatic method for measuring the polyp size. The method is based on a robust segmentation method that grows a surface patch over the entire polyp surface starting from a seed. Projection of the patch points along the polyp axis yields a 2D point set to which we fit an ellipse. The long axis of the ellipse denotes the size of the polyp. We evaluate our method by comparing the automated size measurement with those of two radiologists using scans of a colon phantom. We give data for inter-observer and intra-observer variability of radiologists and our method as well as the accuracy and precision.

In multi-slice spiral computed tomography (CT) images interpolation artifacts are present. The relationship between the x-ray tube rotation angle and these artifacts is demonstrated. A head phantom was repeatedly scanned with a four-slice CT scanner at different pitch values. Two scans, made with identical scan parameters, nearly always have different x-ray tube starting angles. Consequently, artifacts appeared differently and residual artifacts appeared when subtractions were made. We conclude that only if the x-ray tube starting angle is equal for both scans or if a very low pitch is used, images are highly reproducible.

In maximum intensity projection (MIP) images of CT angiography (CTA) scans, the arteries are often obscured by bone. A bone removal method is presented that uses an additional, nonenhanced scan to create a mask of the bone by thresholding and dilation. After registration of the CTA scan and the additional scan, the bone in the CTA scan is masked. As the cervical area contains bones that can move with respect to each other, these bones are separated first using a watershed algorithm, and then registered individually. A phantom study was performed to evaluate and quantify the tradeoff between the removal of the bone and the preservation of the arteries contiguous to the bone. The influence of algorithm parameters and scan parameters was studied. The method was clinically evaluated with data sets of 35 patients. Best results were obtained with a threshold of 150 HU and a dilation of 8 in-plane voxels and two out-of-plane voxels. The mean width of the soft tissue layer, which is also masked, was approximately 1 mm. The mAs value of the nonenhanced scan could be reduced from 250 mAs to 65 mAs without a loss of quality. In 32 cases the bones were registered correctly and removed completely. In three cases the bone separation was not completely successful, and consequently the bone was not completely removed. The piecewise matched mask bone elimination method proved to be able to obtain MIP images of the cervical arteries free from overprojecting bone in a fully automatic way and with only a slight increase of radiation dose.

In a feasibility study, the authors compared polyp detection and interobserver variability at computed tomographic (CT) colonography in 15 patients with doses ranging from medium to very low (12.00-0.05 mSv). At levels down to 2% of the medium dose, the mean detection of polyps 5 mm or larger remained at least 74%, while the number of false-positive results decreased and the interobserver agreement remained constant. Initial observations indicate that it is feasible to reduce the radiation dose required for CT colonography. Further studies are needed, however, to investigate the clinical value of very low-dose CT colonography., (Copyright RSNA, 2004)

Matched mask bone elimination (MMBE) is a technique for the automatic removal of bone pixels from CT angiography data sets. We describe the use of this technique in two patients with the clinical suspicion of dural sinus thrombosis. We conclude that multisection CT venography with MMBE is a useful adjunct for the visualization of the intracranial venous circulation by removing bone from the image. In contrast to techniques described previously, MMBE is fully automated and operator independent.

CT Angiography (CTA) is an established technique for the minimally invasive imaging of arteries. The technique of maximum intensity projection (MIP) is often used to get a comprehensive overview of the vascular anatomy. On a MIP, however, arterial wall calcifications may hinder the visualization of the arterial lumen. These calcifications are in direct contact with the contrast-enhanced blood, which makes removal difficult. We present a local subtraction method for the automatic removal of these calcifications. In our approach a second CT scan has to be made, prior to contrast injection. The calcifications in both scans are registered prior to subtraction to compensate for displacements in between the two scans. Local subtraction results are compared with results obtained by thresholding. The method was tested in a phantom and with data from four patients. The phantom represented an artery with different types of stenosis. Data were used from patients for which CTA of the renal arteries was performed. For two patients the electrocardiogram (ECG) was recorded during the CTA examination, making retrospective cardiac gated reconstructions possible. Both the phantom and the patient study showed that the local subtraction method is capable of removing calcifications and visualizing the residual lumen. In the patient study it appeared that some artifacts remained for higher pitch values. We conclude that the local subtraction method is less subjective and more accurate than thresholding. Best results are obtained by use of a small pitch, at the expense of the volume covered during a single breath hold.

Purpose: Techniques have been developed very recently with which it is possible to quantify accurately in vivo 3-dimensional (3-D) carpal kinematics. The aim of this study was to evaluate the feasibility of our novel 3-D registration technique by comparing our data with data found in the literature., Method: The right wrists of 11 healthy volunteers were imaged by spiral computed tomography (CT) during radial-ulnar deviation and 5 of those wrists were imaged also during flexion-extension motion. With a matching technique relative translations and rotations of the carpal bones were traced. We compared our in vivo results with data presented in the literature., Results: We found our in vivo data largely to concur with in vitro data presented in the literature. In vivo studies revealed only larger out-of-plane motions within the proximal carpal row than described in most in vitro studies. In vivo studies also showed larger interindividual variations., Conclusions: A single functional model of carpal kinematics could not be determined. We expect that in vivo 3-D CT studies on carpal kinematics, especially when applied to dynamic wrist motion, will have future diagnostic applications and provide information on long-term results of surgical interventions.

The purpose of this study was to quantify 3-dimensional (3-D) in vivo scaphoid kinematics during flexion-extension motion (FEM) and radial-ulnar deviation (RUD) of the hand. The right wrists of 11 healthy volunteers were imaged by spiral computed tomography during RUD and 5 of those wrists also during FEM. With a matching technique, relative translations and rotations of the scaphoids were traced. Our results showed a broad spectrum of kinematic patterns of the scaphoid during RUD, with small intercarpal motions within the proximal carpal row. Some scaphoids rotated basically around the flexion-extension axis only whereas others rotated almost entirely around the deviation axis during RUD. During FEM we found highly uniform scaphoid motion patterns with large intercarpal motions within the proximal carpal row. These findings suggest that current theories cannot sufficiently explain wrist kinematics and stress the need for more in vivo studies on 3-D carpal kinematics.

Objective: The purpose of this study was to accurately quantify three-dimensional in vivo kinematics of all carpal bones in flexion and extension and radial and ulnar deviation., Design and Methods: The right wrists of 11 healthy volunteers were imaged by spiral CT with rotational increments of 5 degrees during ulnar-radial deviation and of five of them also during flexion-extension motion. One regular-dose scan was used and the subsequent scans during wrist motion were performed with one-tenth of the regular dose. A three-dimensional matching technique using the internal structure of the bones was developed to trace the relative translations and rotations of the carpal bones very accurately., Results: Most of our results are in concordance with previously published in vitro data. We could, among others, substantiate proof to the statement that there is more than one kinematic pattern of the scaphoid. Furthermore, we could accurately describe small adaptive intercarpal motions in vivo of the distal carpal row., Conclusions: To our knowledge, this is the first time the three-dimensional in vivo kinematics of all eight carpal bones is quantified accurately and non-invasively., Relevance: Kinematics of an injured wrist can be compared to these reference data. It may become possible that in this way a ligament lesion can be detected with high specificity and sensitivity, and that no other diagnostic modality will be needed. With these data we made animations with which the complex movements of the bones during different motions of the wrist can be viewed. In the future it may become possible that this analysis provides valuable information on the long-term results of operative interventions and possibly predicts results of operative techniques., (Copyright 2002 Elsevier Science Ltd.)

We developed a new triangulated deformable surface model, which is used to detect the boundary of the bones in three-dimensional magnetic resonance (MR) and computed tomography (CT) images of the wrist. This surface model is robust to initialization and provides wide geometrical coverage and quantitative power. The surface is deformed by applying one-dimensional (1-D) radial Lagrangian dynamics. For initialization a tetrahedron is placed within the bone to be segmented. This initial surface is inflated to a binary approximation of the boundary. During inflation, the surface is refined by the addition of vertices. After the surface is fully inflated, a detailed, accurate boundary detection is obtained by the application of radial scale-space relaxation. In this optimization stage, the image intensity is filtered with a series of 1-D second-order Gaussian filters. The resolution of the triangulated mesh is adapted to the width of the Gaussian filter. To maintain the coherence between the vertices, a resampling technique is applied which is based on collapsing and splitting of edges. We regularized the triangulated mesh by a combination of volume-preserving vertex averaging and equi-angulation of edges. In this paper, we present both qualitative and quantitative results of the surface segmentations in eight MR and ten CT images.

Purpose: To investigate the sensitivity and specificity of polyp detection and the image quality of computed tomographic (CT) colonography at different radiation dose levels and to study effective doses reported in literature on CT colonography., Materials and Methods: CT colonography and colonoscopy were performed with 100 mAs in 50 consecutive patients at high risk for colorectal cancer; 50- and 30-mAs CT colonographic examinations were simulated with controlled addition of noise to raw transmission measurements. One radiologist randomly evaluated all original and simulated images for the presence of polyps and scored image quality. Differences in image quality were assessed with the Wilcoxon rank test. Scan protocols from the literature and recent (unpublished) updates were collected., Results: In nine of 10 patients with polyps 5 mm in diameter or larger (sensitivity, 90%) and in seven of 17 patients with polyps smaller than 5 mm, polyps were correctly identified with CT colonography at all dose levels. Specificity for patients without polyps 5 mm or larger was 53%-60% at all dose levels and for patients without any polyps was 26% (at 100 and 50 mAs) and 48% (at 30 mAs). Image quality decreased significantly as the dose level decreased. The median effective doses (supine and prone positions) calculated from protocols reported in the literature and updates were 7.8 and 8.8 mSv, respectively., Conclusion: Although image quality decreases significantly at 30 mAs (3.6 mSv), polyp detection remains unimpaired. The median dose for CT colonography at institutions that perform CT colonographic research is currently 8.8 mSv.

The purpose of this study was to quantify in vivo pisiform kinematics. Wrists of healthy volunteers were imaged by spiral computed tomography during ulnar-radial deviation (n = 11) and during flexion-extension (n = 5). Relative translations and rotations of the carpal bones were determined by using a 3-dimensional matching technique. The error of this registration procedure was less than 0.5 mm for translation and 0.4 degrees for rotation. With radial wrist deviation the pisiform flexes while the triquetrum extends; with ulnar deviation the triquetrum shows more ulnar deviation and extension. With wrist extension the pisiform translates over the distal part of the triquetrum while being pressed against it. With flexion the pisiform moves away from the triquetrum while translating proximally. These in vivo findings provide a further explanation for certain clinical entities, such as degenerative changes of the pisotriquetral joint, and may be used as a reference for normal kinematics of the pisiform.

Purpose: The purpose of this work was to explore the reproducibility of fat-fraction measurements using Dixon quantitative chemical shift imaging (QCSI) in the lumbar spine (L3, L4, and L5) of healthy volunteers., Method: Sixteen healthy volunteers were examined at 1.5 T two times to obtain a repeated measurement in the same slice and a third time in three parallel slices. Single slice, two point Dixon SE (TR/TE 2,500/22.3) sequences were used, from which fat-fraction images were calculated. The fat-fraction results are presented as averages over regions of interest, which were derived from the contours of the vertebrae. Reproducibility measures related to repeated measurements on different days, slice position, and contour drawing were calculated., Results: The mean fat fraction was 0.37 (SD 0.08). The SD due to repeated measurement was small (sigmaR = 0.013-0.032), almost all of which can be explained by slice-(re)-positioning errors., Conclusion: When used to evaluate the same person longitudinally in time, Dixon QCSI fat-fraction measurement has an excellent reproducibility. It is a powerful noninvasive tool in the evaluation of bone marrow composition.

Results are reported of a feasibility study in which bone pixels are eliminated from computed tomographic (CT) angiographic images with a method that enables the construction of maximum intensity projection (MIP) images without interference by bone. The method proved to be successful in six patients. Two observers blinded to the bone elimination method judged the image quality of MIP images to be considerably higher than that of standard subtraction MIP images. This method is an effective means to remove bone from CT angiographic images with only a slight increase in radiation dose.

The purpose of this study was to obtain quantitative information of the relative displacements and rotations of the carpal bones during movement of the wrist. Axial helical CT scans were made of the wrists of 11 volunteers. The wrists were imaged in the neutral position with a conventional CT technique, and in 15-20 other postures (flexion-extension, radial-ulnar deviation) with a low-dose technique. A segmentation of the carpal bones was obtained by applying a deformable surface model to the regular-dose scan. Next, each carpal bone, the radius, and ulna in this scan was registered with the corresponding bone in each low-dose scan using a three-dimensional matching technique. A detailed definition of the surfaces of the carpal bones was obtained from the regular-dose scans. The low-dose scans provided sufficient information to obtain an accurate match of each carpal bone with its counterpart in the regular-dose scan. Accurate estimates of the relative positions and orientations of the carpal bones during flexion and deviation were obtained. This quantification will be especially useful when monitoring changes in kinematics before and after operative interventions, like mini-arthrodeses. This technique can also be applied in the quantification of the movement of other bones in the body (e.g., ankle and cortical spine).

Purpose: To investigate whether coronal multiplanar reconstruction (MPR) images of the petrosal bone from axial spiral computed tomographic (CT) data obtained with 0.5-mm collimation can replace direct coronal sequential CT scans obtained with 0.5- or 1.0-mm collimation., Materials and Methods: The differences in diagnostic quality between thin-section coronal sequential CT scans of 24 petrosal bones in 12 patients and matched MPR images were assessed by five observers. The matched MPR images were calculated with both trilinear and tricubic interpolation. Image resolution was determined by measuring the three-dimensional point spread function., Results: All observers preferred tricubically interpolated MPR images over trilinearly interpolated images. Subjective differences in image quality between direct coronal scans and matched tricubically interpolated MPR images were small. Only the direct coronal scans with the highest image quality (0.5-mm collimation, 465 mAs) were judged to be slightly better than the matched MPR images. With regard to direct coronal scans obtained at 245 mAs and/or 1.0-mm collimation, either there was no preference or the MPR images were preferred., Conclusion: Coronal MPR images from axial spiral CT obtained with 0.5-mm collimation can replace direct coronal sequential CT scans.

Purpose: To introduce a new model describing human in vivo corneal deswelling after hypoxic contact lens wear, based on a damped harmonic oscillator, which can describe an overshoot in corneal deswelling, to compare this new model with the currently used exponential model, and also to test whether a diurnal variation in baseline corneal thickness exists that would have to be taken into consideration when calculating corneal deswelling curves., Methods: In nine healthy young adults, corneal thickness was measured every 30 minutes for 11.5 hours on average using modified optical pachometry (natural test). On another day, corneal deswelling was monitored for 11.1 hours on average after 2 hours of hypoxic contact lens wear (stress test). The damped harmonic oscillator model and the exponential model were used to calculate best-fitting deswelling curves. Natural test data were analyzed for the presence of a trend. Goodness of fit of the curves to the experimental data was analyzed using the F test., Results: In 82% of the deswelling curves the new damped harmonic oscillator model provided a better fit to the data than the exponential model (P < 0.05). An average overshoot in corneal thickness recovery of 5 microm (range, 0-11 microm) was found. In 50% of the natural tests significant trends were found, without any consistent similarities. The overshoot could not be explained by these trends., Conclusions: The new damped harmonic oscillator model describes corneal deswelling after hypoxic contact lens wear more accurately than the exponential model. No consistent diurnal variation could be demonstrated.

In this paper we consider the problems encountered when applying snake models to detect the contours of the carpal bones in 3-D MR images of the wrist. In order to improve the performance of the original snake model introduced by Kass [1], we propose a new image force based on one-dimensional (1-D) second-order Gaussian filtering and contrast equalization. The improved snake is less sensitive to model initialization and has no tendency to cut off contour sections of high curvature, because 1-D radial scale-space relaxation is used. Contour orientation is used to minimize the influence of neighboring image structures. Due to 1-D contrast equalization an intensity insensitive measure of external energy is obtained. As a consequence a good balance between internal and external energetic contributions of the snake is established, which also improves convergence. By incorporating this new image force into the snake model, we succeed in accurate contour detection, even when relatively high noise levels are present and when the contrast varies along the contours of the bones.

The value of laparoscopic ultrasonographic criteria for distinguishing benign from malignant lymph nodes was assessed. The following criteria were evaluated in 41 lymph nodes: (1) long axis diameter, (2) short axis diameter, (3) long axis-short axis ratio, (4) nodal border delineation, (5) presence of hyperechoic hilar reflection, (6) echogenicity, and (7) inhomogeneity. Pathologic examination showed malignant infiltration in 11 lymph nodes and the absence of malignant infiltration in 30 lymph nodes. The presence of a hyperechoic center or a long axis-short axis ratio more than 2 suggested the absence of malignant infiltration, whereas inhomogeneity was suggestive of malignant infiltration. The other criteria did not seem useful in distinguishing benign from malignant lymph nodes.

Triphalangeal thumb (TPT) is a rare congenital disorder characterised by a long, finger-like thumb with three phalanges instead of two. It can occur as an isolated defect, in association with other abnormalities of the hands and feet, or as a part of a syndrome. Sporadic cases have been described, but it is usually inherited as an autosomal dominant trait. In order to examine skeletal morphology in different phenotypic variations of this disorder, we performed metacarpophalangeal pattern profile analysis in one kindred with this disorder. A characteristic profile occurred in all affected people, based on the individual lengthening or shortening of the thumb bones. Comparison of the affected and unaffected people from this family with people with a different genetic background suggests that the described profile is specific for TPT and could be used as a helpful diagnostic tool in syndromes which include TPT.

Purpose: To determine the predictive value of several clinical and radiologic parameters for recurrence of laryngeal cancer., Materials and Methods: Eighty previously untreated patients underwent magnetic resonance (MR) imaging before radiation therapy with curative intent. Tumor volume was calculated from T1-weighted MR images. Cartilage was considered invaded by pathologic tissue if it had intermediate signal intensity on T1-weighted spin-echo (SE) MR images and high signal intensity on T2-weighted SE MR images. The minimum follow-up was 2 years., Results: Parameters such as age, sex, histopathologic findings, and invasion of the vocal muscle or pre-epiglottic space were not significantly correlated with tumor recurrence. Logistic regression analysis showed three relevant contributors: cord mobility, as judged clinically, and tumor volume and, more significantly, cartilage invasion, as seen at MR imaging., Conclusion: For untreated laryngeal cancer, MR imaging findings of tumor volume and cartilage invasion allow better patient selection for either radiation therapy or surgery. MR imaging is mandatory for T staging of laryngeal cancer.

The analysis of Gates and Betz (1993 Anat. Rec., 236:381-389) of the spatial distribution of two different populations of muscle fibers in the lumbrical muscle of the rat is discussed. The conclusion that muscle fibers belonging to a single motor unit are distributed at random in most muscles appears to need reconsideration. A new technique is applied to some examples to show that the amount of clustering of fiber types in a muscle cross section can be quantified.