Hypertrophic Pachymeningitis with Persistent Intrathecal Inflammation Secondary to Neurosarcoidosis Treated with Intraventricular Chemotherapy: A Case Report.

Hypertrophic pachymeningitis (HP) is a rare immune-mediated disease characterized by thickening of the dura mater with consecutive cranial neuropathy. While HP is usually treated with systemic immunotherapies, response to therapy is variable and may be limited by insufficient drug concentrations in the brain. We report on a 57-year-old patient with HP manifesting with vision and hearing loss who had sustained clinical progression despite various systemic immunotherapies. Intraventricular chemotherapy with methotrexate, cytarabine, and dexamethasone was initiated. We present clinical, imaging and cerebrospinal fluid (CSF) findings, including cytokine levels before and after intraventricular treatment: rapid decrease of cell count, lactate and profibrotic cytokine levels in the CSF following intraventricular chemotherapy was paralleled by a mild reduction of dura thickness in MRI. The already severely impaired visual acuity and hearing loss did not progress further. Treatment was complicated by exacerbation of previously subtle psychiatric symptoms. Follow-up was terminated after 6 months as the patient suffered from a fatal ischemic stroke. Autopsy revealed neurosarcoidosis as the underlying cause of HP. This case report suggests that intrathecal chemotherapy can reduce the inflammatory milieu in the CNS and should be considered for treatment-refractory HP before irreversible damage of cranial nerves has occurred.

Missed Radiological Diagnosis of Otosclerosis in High-Resolution Computed Tomography of the Temporal Bone-Retrospective Analysis of Imaging, Radiological Reports, and Request Forms.

Objectives: Several studies reported low detection rates of otosclerosis in high-resolution computed tomography (HRCT), especially when the scans were reviewed by non-specialized general radiologists. In the present study, we conducted a retrospective review of the detection of otosclerosis in HRCT by general radiologists and the impact of inadequately filled radiological request forms on the detection rate. Methods: Retrospective analysis of hospital records, HRCT reports, and radiological referral notes of 40 patients who underwent stapedotomy surgery for otosclerosis. HRCT imaging data sets were retrospectively reviewed by a blinded experienced neuroradiologist, whose reading served as the gold standard. Results: General radiologists reading HRCT scans had an overall detection rate of otosclerosis of 36.1% in this cohort (13 of 36 available HRCT reports). The neuroradiologist had a much higher detection rate of 82.5% (33 of 40 cases). Interobserver agreement between the general radiologists and the subspecialist neuroradiologist was poor (Cohen's kappa κ = 0.26). General radiologists missed the diagnosis in 15 of the 33 CT-positive scans, corresponding to a missed diagnosis rate of 45.4%. There was a highly significant association between a missed diagnosis and the lack of an explicitly mentioned clinical suspicion of otosclerosis in the request forms (Pearson's chi-squared test, p < 0.005). Conclusion: The diagnosis of otosclerosis is frequently missed by radiologists on HRCT scans of the temporal bone in a clinical setting. Possible reasons include a relative lack of experience of general radiologists with temporal bone imaging as well as the failure of clinicians to unambiguously communicate their suspicion of otosclerosis.

The Use of Intraoperative CT Hounsfield Unit Values for the Assessment of Bone Quality in Patients Undergoing Lumbar Interbody Fusion.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To evaluate the accuracy of intraoperatively measured computed tomography (CT) Hounsfield unit (HU) values by comparison with preoperative CT HU values and to compare the radiation exposure between preoperative and intraoperative CT scans. METHODS: HU values of lumbar vertebrae were measured and compared between preoperative and intraoperative CT scans in patients undergoing lumbar interbody fusion. In patient group one, Canon CT scanners were used preoperatively and the AIRO CT scanner was used intraoperatively. In patient group two, Canon CT scanners were used preoperatively and the O-arm Cone Beam CT (CBCT) scanner was used intraoperatively. In a subgroup analysis of patient group one, radiation by means of CT Dose Index (CTDI) was compared between Canon and AIRO CT scanners. RESULTS: In the first patient group, a total of 250 vertebrae were analysed in 74 patients showing a strong Pearson correlation of >.94 between pre- and intraoperative HU values. Bland-Altman analysis indicated consistency and equivalence with a bias of 3.9 and 95% limits of agreement from -27.17 to 34.97 when comparing all pre- and intraoperative HU values of L1-5. In the second patient group, a total of 27 vertebrae were analysed in 10 patients showing weak Pearson correlation and Bland-Altman analysis indicated no equivalence. CTDI did not differ between Canon and AIRO CT scanners. CONCLUSION: Correct and reliable CT HU measurement as mandatory key factor for the intraoperative assessment of bone quality and robotic-assisted surgery is feasible with intraoperative AIRO CT imaging without increase of radiation exposure.

Impaired recollection and initially preserved familiarity in a patient with bilateral fornix transection following third ventricle colloid cyst removal: A two-year follow-up study.

OBJECTIVE: Recognition memory is widely accepted as a dual process-based model, namely familiarity and recollection. However, the location of their specific neurobiological substrates remains unclear. Similar to hippocampal damage, fornix damage has been associated with recollection memory but not familiarity memory deficits. To understand the neural basis of recognition memory, determining the importance of the fornix and its hippocampal connections is essential. METHODS: Recognition memory was examined in a 45-year-old male who underwent a complete bilateral fornix section following the removal of a third ventricle colloid cyst. The application of familiarity and recollection for recognition memory decisions was investigated via an immediate and delayed associative recognition test and an immediate and delayed forced-choice task in the patient and a control group (N = 15) over a two-year follow-up period. Complete demographic, neuropsychological, neuropsychiatric, and neuroradiological characterizations of this patient were performed. RESULTS: Persistent immediate and delayed verbal recollection memory deficits were observed in the patient. Moreover, delayed familiarity-based recognition memory declined gradually over the follow-up period, immediate familiarity-based recognition memory was unaffected, and reduced non-verbal memory improved. CONCLUSION: The present findings support models that the extended hippocampal system, including the fornices, does not appear to play a role in familiarity memory but is particularly important for recollection memory. Moreover, our study suggests that bilateral fornix transection may be associated with relatively functional recovery of non-verbal memory.

MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases.

Object: Recent studies demonstrated that gross total resection of brain metastases cannot always be achieved. Subtotal resection (STR) can result in an early recurrence and might affect patient survival. We initiated a prospective observational study to establish a MRI-based risk assessment for incomplete resection of brain metastases. Methods: All patients in whom ≥1 brain metastasis was resected were prospectively included in this study (DRKS ID: DRKS00021224; Nov 2020 - Nov 2021). An interdisciplinary board of neurosurgeons and neuroradiologists evaluated the pre- and postoperative MRI (≤48h after surgery) for residual tumor. Extensive neuroradiological analyses were performed to identify risk factors for an unintended STR which were integrated into a regression tree analysis to determine the patients' individual risk for a STR. Results: We included 150 patients (74 female; mean age: 61 years), in whom 165 brain metastases were resected. A STR was detected in 32 cases (19.4%) (median residual tumor volume: 1.36ml, median EORrel: 93.6%), of which 6 (3.6%) were intended STR (median residual tumor volume: 3.27ml, median EORrel: 67.3%) - mainly due to motor-eloquent location - and 26 (15.8%) were unintended STR (uSTR) (median residual tumor volume: 0.64ml, median EORrel: 94.7%). The following risk factors for an uSTR could be identified: subcortical metastasis ≥5mm distant from cortex, diffuse contrast agent enhancement, proximity to the ventricles, contact to falx/tentorium and non-transcortical approaches. Regression tree analysis revealed that the individual risk for an uSTR was mainly associated to the distance from the cortex (distance ≥5mm vs. <5mm: OR 8.0; 95%CI: 2.7 - 24.4) and the contrast agent patterns (diffuse vs. non-diffuse in those with distance ≥5mm: OR: 4.2; 95%CI: 1.3 - 13.7). The preoperative tumor volume was not substantially associated with the extent of resection. Conclusions: Subcortical metastases ≥5mm distant from cortex with diffuse contrast agent enhancement showed the highest incidence of uSTR. The proposed MRI-based assessment allows estimation of the individual risk for uSTR and can help indicating intraoperative imaging.

Mechanical thrombectomy of acute occlusions of individual distal anterior cerebral artery branches.

To describe our experience with mechanical thrombectomy (MT) in distal anterior cerebral artery (ACA) occlusions regarding recanalization rates, MT techniques and procedural safety. From a prospectively maintained thrombectomy database all patients with distal ACA occlusions treated with MT between April 2013 and February 2021 were retrospectively identified. Imaging data and angiographic features as well as clinical data were collected. 41 patients were included in the study, including 23 patients (56.1%) with distal main stem occlusions (occlusions distal to the anterior communicating artery but proximal to the origin of the pericallosal and callosomarginal arteries) and 18 patients (46.3%) with distal individual branch occlusions (occlusions of the pericallosal or callosomarginal arteries and their ramifications). A stent retriever mediated technique was applied in 34 patients (82.9%), the ADAPT technique in 7 patients (17.1%). Successful (mTICI 2b/3) and complete recanalization (mTICI 3) rates did not differ for the distal ACA main stem occlusion group (82.6%/56.5%), and the individual branch occlusion group (83.3%/55.6%) (p ≫ 0.05). No severe complications specific to distal MT maneuvers were noted. MT for acute distal individual ACA branch occlusions beyond the common A2/3 trunk appears safe and technically effective in different clinical settings and occlusion patterns with high recanalization rates. However, further studies are required to determine the clinical effectiveness.

White Matter Lesions as Possible Predictors of Audiological Performance in Adults after Cochlear Implantation.

The presented prospective study investigated whether structural brain damage, measured with the Fazekas score, could predict hearing rehabilitation outcomes with cochlear implantation (CI). With a follow-up period of 24 months, this study included 49 bilaterally, postlingually hearing impaired CI candidates for unilateral CI (67.3 ± 8.7 years; 20 men, 29 women) older than 50 at the time of implantation. The differences in the predictive value between two age groups, 50-70 year-olds (mid-age; n = 26) and over 70-year-olds (elderly; n = 23), were analyzed. The patients were evaluated using speech perception (SP) measured in quiet (Freiburg monosyllabic test; FMT) and noise (Oldenburg sentence test; OLSA). The subjective hearing ability was assessed using Oldenburg inventory (OI). The Fazekas PVWM score predicted postoperative speech perception two years after CI in the mid-age population. The periventricular white matter lesions (PVWM) could explain 27.4% of the speech perception (FMT) variance. Our findings support the hypothesis about the influence of pre-existing WMLs on CI outcome. We recommend the evaluation of Fazekas score as a predictive factor for post-implantation hearing ability.

Mechanical thrombectomy of acute distal posterior cerebral artery occlusions.

To describe our experience with mechanical thrombectomy (MTE) of acute distal posterior cerebral artery (PCA) occlusions, either isolated or in combination with more proximal vessel occlusions regarding recanalization rates, MTE techniques, and procedural safety. From the prospectively maintained stroke thrombectomy databases of two institutions, all consecutive patients subjected to MTE of acute distal PCA occlusion (P2 and 3 segments) between July 2013 and May 2020 were retrospectively identified. Imaging data and angiographic features, as well as patients' demographic and clinical data were evaluated. 35 consecutive patients were included in the study. In 17 patients MTE of isolated acute distal PCA occlusion was performed. 9 patients had combined basilar artery (BA) and distal PCA occlusion on stroke imaging and 3 had embolic distal PCA occlusion following MTE for BA occlusion. 6 patients harbored distal PCA occlusions in combination with carotid-T occlusion and a dominant posterior communicating artery. The median NIHSS at presentation was 14 (IQR 8 - 27). 25 patients (71.4%) had occlusions of the P2 and 10 patients (28.6%) of the P3 segment. Successful recanalization (TICI 2b/3) was achieved in 31 patients (88.6%). 10 patients (28.6%) were treated with a direct contact aspiration technique, while a stent retriever was used in 25 patients (71.4%). No complication attributable to distal PCA MTE occurred. Good outcome (mRS ≤ 2) was achieved in 14 patients (46.7%) and mortality was 22.9%. MTE for acute distal PCA occlusion in the setting of different occlusion patterns appears both safe and angiographically effective. Yet, clinical effectiveness remains to be determined.

Comparison of diagnostic value of 68 Ga-DOTATOC PET/MRI and standalone MRI for the detection of intracranial meningiomas.

To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5-1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5-1.0 and 1.0-2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.

Reliability of NI-RADS criteria in the interpretation of contrast-enhanced magnetic resonance imaging considering the potential role of diffusion-weighted imaging.

OBJECTIVES: To assess inter- and intrareader agreement of the Neck Imaging Reporting and Data System (NI-RADS) used in contrast-enhanced magnetic resonance imaging (MRI) including analysis of diffusion-weighted imaging (DWI), which is currently not part of the NI-RADS criteria. METHODS: This retrospective study included anonymized surveillance contrast-enhanced MRI datasets of 104 patients treated for different head and neck cancers. Three radiologists experienced in head and neck imaging reported findings for the primary site and the neck using NI-RADS criteria in a first step and evaluated DWI sequences for the primary site in a second step. Thirty randomly selected imaging datasets were again presented to the readers. Kappa statistics and observed agreement (Ao) were calculated. RESULTS: Interreader agreement across all MRI datasets was moderate (κFleiss = 0.53) for NI-RADS categories assigned to the primary site, substantial for NI-RADS categories of the neck (κFleiss = 0.67), and almost perfect for DWI of the primary site (κFleiss = 0.83). Interreader agreement for the primary site was particularly low in cases of cancer recurrence (κFleiss = 0.35) and when categories 2a, 2b, and 3 were combined (κFleiss = 0.30). Intrareader agreement was considerably lower for NI-RADS categories of the primary site (range Ao = 53.3-70.0%) than for NI-RADS categories of the neck (range Ao = 83.3-90.0%) and DWI of the primary site (range Ao = 93.3-100.0%). CONCLUSION: Interreader agreement of NI-RADS for reporting contrast-enhanced MRI findings is acceptable for the neck but limited for the primary site. Here, DWI has the potential to serve as a reliable additional criterion. KEY POINTS: • NI-RADS was originally designed for contrast-enhanced computed tomography with or without positron emission tomography but can also be used for contrast-enhanced magnetic resonance imaging alone. • Overall interreader agreement was acceptable for NI-RADS categories assigned to the neck but should be improved for the primary site, where it was inferior to DWI; similar tendencies were found for intrareader agreement. • DWI is currently no criterion of NI-RADS, but has shown potential to improve its reliability, especially for categories 2a, 2b, and 3 of the primary site.

Neuroimaging Findings in Conjunction with Severe COVID-19.

PURPOSE: COVID-19 has a variable, but well-described course. However, some patients additionally present with neurological symptoms. Recent studies also show a broad range of neuroimaging features. The purpose of this study was to perform a snapshot analysis to approximate the frequency and types of neuroimaging findings on CT and MRI scans in a large cohort of SARS-CoV-2-positive patients in a level I COVID-19 center, both in general and in critically ill patients. MATERIALS AND METHODS: We retrospectively analyzed brain CT and MRI scans of 34 hospitalized COVID-19 patients at our level I COVID-19 center between March 15 and April 24 with regard to pathological neuroimaging findings. In addition, clinical parameters such as neurological symptoms, comorbidities, and type of ventilation therapy were also documented. A descriptive statistical analysis was performed. RESULTS: Pathological findings were detected in 38.2 % of patients in the study cohort. Based on the weekly institutional SARS-CoV-2 report of all positively tested patients in our clinic at the time of data collection, neuroimaging findings could be found in 6 % of all patients (34/565). The most common findings were microbleeds (20.6 %) and signs of hypoxic brain injury (11.8 %). Furthermore, cortical subarachnoid hemorrhage, typical and atypical cerebral hematomas, ischemic strokes, and generalized brain edema were documented. All neuroimaging findings occurred in patients who were either intubated or treated by ECMO. CONCLUSION: Based on the analysis of this large cohort of SARS-CoV-2-positive patients, pathological neuroimaging findings seem to be relatively rare in general but do occur in a substantial proportion of patients with severe COVID-19 disease needing intubation or ECMO. KEY POINTS: · Neuroimaging findings appear to be relatively rare in SARS-CoV-2 positive patients.. · Pathological findings occur mainly in critically ill COVID-19 patients.. · Frequent findings include hemorrhagic, ischemic and hypoxic changes.. · Critically ill COVID-19 patients should receive neuroimaging with a low threshold.. CITATION FORMAT: · Büttner L, Bauknecht HC, Fleckenstein FN et al. Neuroimaging Findings in Conjunction with Severe COVID-19. Fortschr Röntgenstr 2021; 193: 822 - 829.

Direct puncture of the carotid artery as a bailout vascular access technique for mechanical thrombectomy in acute ischemic stroke-the revival of an old technique in a modern setting.

PURPOSE: To describe our single-center experience of mechanical thrombectomy (MTE) via a direct carotid puncture (DCP) with regard to indication, time metrics, procedural details, as well as safety and efficacy aspects. METHODS: DCP thrombectomy cases performed at our center were retrospectively identified from a prospectively maintained institutional MTE database. Various patient (age, sex, stroke cause, comorbidities), clinical (NIHSS, mRS), imaging (occlusion site, ASPECT score), procedural (indication for DCP, time from DCP to reperfusion, materials used, technical nuances), and outcome data (NIHSS, mRS) were tabulated. RESULTS: Among 715 anterior circulation MTEs, 12 DCP-MTEs were identified and analyzed. Nine were left-sided M1 occlusions, one right-sided M1 occlusion, and two right-sided M2 occlusions. DCP was successfully carried out in 91.7%; TICI 2b/3-recanalization was achieved in 83.3% via direct lesional aspiration and/or stent-retrieval techniques. Median time from DCP to reperfusion was 23 min. Indications included futile transfemoral catheterization attempts of the cervical target vessels as well as iliac occlusive disease. Neck hematoma occurred in 2 patients, none of which required further therapy. CONCLUSION: MTE via DCP in these highly selected patients was reasonably safe, fast, and efficient. It thus represents a valuable technical extension of MTE, especially in patients with difficult access.

Effect of MRI-based semiautomatic size-assessment in cerebral metastases on the RANO-BM classification.

AIM: Evaluation of a semiautomatic software algorithm for magnetic resonance imaging (MRI)-based assessment of cerebral metastases in cancer patients. MATERIAL AND METHODS: Brain metastases (n = 131) in 38 patients, assessed by contrast-enhanced MRI, were retrospectively evaluated at two timepoints (baseline, follow-up) by two experienced neuroradiologists in a blinded manner. The response assessment in neuro-oncology (RANO) criteria for brain metastases (RANO-BM) were applied by means of a software (autoRANO-BM) as well as manually (manRANO-BM) at an interval of 3 weeks. RESULTS: The average diameter of metastases was 12.03 mm (SD ± 6.66 mm) for manRANO-BM and 13.97 mm (SD ± 7.76 mm) for autoRANO-BM. Diameter figures were higher when using semiautomatic measurements (median = 11.8 mm) as compared to the manual ones (median = 10.2 mm; p = 0.000). Correlation coefficients for intra-observer variability were 0.993 (autoRANO-BM) and 0.979 (manRANO-BM). The interobserver variability (R1/R2) was 0.936/0.965 for manRANO-BM and 0.989/0.998 for autoRANO-BM. A total of 19 lesions (15%) were classified differently when using semiautomatic measurements. In 14 cases with suspected disease progression by manRANO-BM a stable course was found according to autoRANO-BM. CONCLUSION: Computerized measuring techniques can aid in the assessment of cerebral metastases by reducing examiner-dependent effects and may consequently result in a different classification according to RANO-BM criteria.

A hidden giant: Wallenberg syndrome and aortal wall thickening as an atypical presentation of a giant cell arteritis.

We report a case of a 73-year-old woman with a brainstem stroke presenting as Wallenberg syndrome. By transoesophageal echocardiography and combined 18F-fluordeoxyglucose positron emission and CT (18F-FDG PET/CT), the diagnosis of large artery vasculitis owing to giant cell arteritis was confirmed. In the absence of classical clinical signs, the examination of the large extracranial vessels by ultrasound and 18F-FDG PET/CT played the key role in detecting a widespread vasculitis.

Measurement of cerebral circulation times using dynamic whole-brain CT-angiography: feasibility and initial experience.

The objective of the study was to use 320-detector row 4D CT angiography (CTA) for measuring cerebral circulation times (CCT) and to assess early venous drainage (EVD) and shortening of CCT in arteriovenous malformations (AVM) and to compare with DSA. CCT of 12 physiological patients and five AVM patients were acquired using a 4D CTA protocol by recording cerebrovascular bolus passage time. In the AVM patients EVD time (EVDT) was measured. Identical measurements were performed on DSA for the AVM patients. It was found that the physiological CCTs were 5.8 ± 1.4 s (M ± SD). EVD was seen in all AVMs and resulted in a shortened CCT of 3.4 ± 1.1 s (p = 0.01). There was no significant difference for CCT and EVDT values derived from DSA and 4D CTA. Thus, the CCTs can be measured non-invasively using clinical 4D CTA. Early venous drainage with shortened CCTs was observed by 4D CTA in all five patients with AVMs.

Neuroimaging by 320-row CT: is there a diagnostic benefit or is it just another scanner? A retrospective evaluation of 60 consecutive acute neurological patients.

320-row CT enables dynamic CT angiography (4D CTA) of the entire intracranial circulation and whole-brain perfusion imaging (CTP). Sixty acute patients with neurological symptoms underwent various 320-row CT-specific protocols, including combined 4D CTA and CTP. Clinical and neuroradiological records were assessed for presumptive diagnoses, final diagnoses, supplementary and follow-up imaging studies. Additional diagnostic benefits delivered by 320-row CT were noted. Out of 60 procedures, 59 were accomplished successfully. Ischemia (n = 19), intracerebral hemorrhage (n = 7) and transient ischemic attacks (n = 10) were the major final diagnoses. Except one small cortical and two small subcortical infarctions all ischemias were diagnosed. All hemorrhages were diagnosed together with their underlying vascular pathology in five atypical cases. In conclusion, 320-row CT is a technically robust procedure being suitable for comprehensive neuroimaging of acute patients. It can provide dynamic angiographic and perfusion data of the whole brain and can deliver additional diagnostic information not available by standard CT.

Intra- and interobserver variability of linear and volumetric measurements of brain metastases using contrast-enhanced magnetic resonance imaging.

OBJECTIVES: To compare the intra- and interobserver variability of diameter and semiautomated volume measurements of brain metastases on contrast-enhanced magnetic resonance imaging (CE-MRI) data. MATERIALS AND METHODS: About 75 MRI staging examinations of patients with metastasized renal cell carcinoma, thyroid cancer, or malignant melanoma (mean age, 56 years; range, 40-75 years) were included. Patients had been examined with a routine MRI protocol, including a CE 3D T1-weighted MP-RAGE sequence (1-mm slice thickness). MRI data were retrospectively analyzed using the OncoTREAT segmentation system (MeVis, Bremen, Germany, version 1.6). Volume of 355 enhancing brain metastases included in the analysis as well as the largest diameter according to Response Evaluation Criteria for Solid Tumors were measured by 2 radiologists. Intra- and interobserver variability was calculated. RESULTS: Metastases (n = 355) had a mean diameter of 12.2 mm (range, 3.4-44.3 mm) and a mean volume of 1.4 cm(3) (range, 12-25.1 cm(3)). With respect to interobserver variability analysis revealed broader limits of agreement for response evaluation criteria for solid tumor measurements of all lesions (range, +/-27.8%-+/-33.0%; unsigned mean: 0.2%-2.5%) than for volume measurements (range, +/-21.4%-+/-23.3%; unsigned mean, 0.1%-0.3%) with statistically significant differences between diameter and volume measurements (P

Impact of image noise levels, scout scan dose and lens shield on image quality and radiation exposure in z-axis dose-modulated neck MSCT on 16- and 64-slice Toshiba Aquilion scanners.

OBJECTIVE: Assessing the impact of image noise (IN) levels, scout scan dose and lens shield use on image quality and radiation exposure in neck multislice CT (MSCT) when using z-axis dose modulation (DM). METHODS: Neck MSCT phantom studies with/without z-axis DM were performed by using different IN levels (S.D. 7.5-30HU) and scout scan tube currents (7.5-50mA) on Toshiba Aquilion scanners (16-/64-slice). Image quality indices were evaluated by two radiologists and radiation exposure parameters calculated. Cadaveric phantom measurements elucidated lens shield interactions with DM efficacy. The lowest dose scan protocol with diagnostic image quality was introduced into the clinical imaging routine and retrospectively evaluated in 20 age-matched patients undergoing neck MSCT with/without DM. RESULTS: The highest image noise level in DM neck studies with comparable image quality to standard neck CT amounted to 20HU, resulting in a mean tube current of 50mAs (CTDI(w) 6.3mGy). DM reduced effective dose by 35% and organ dose figures (lens, thyroid) by 33%. Scout scan dose lowering to 20mA resulted in an effective dose (ED) decrease of 0.06mSv (5%). Avoiding lens shield placement during scout scan effected an organ dose decrease of 20%. Overall contour sharpness and image contrast did not differ significantly (DM/without DM) whereas image noise was rated higher in DM neck CT studies (p<0.05). CONCLUSIONS: z-Axis dose modulation, as assessed on 16- and 64-slice Toshiba Aquilion scanners, is effective and mandatory in neck MSCT. DM efficacy can be enhanced by optimising scout scan doses and lens shield use.