Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT / Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico.(AU)

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.(AU)

Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging.

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly. DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values.. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages. A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.

Análisis de las fortalezas, oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello / Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging

El desarrollo tecnológico de la tomografía computarizada de energía dual (TCED) en el área de la cabeza y el cuello ha supuesto un avance importante, ya que se han desarrollado múltiples aplicaciones para optimizar las imágenes y reducir los artefactos metálicos, así como para diferenciar los materiales, permitiendo una mejor delineación del tumor primario, del cartílago tiroideo y la invasión ósea. Además, los algoritmos de cuantificación permiten medir la concentración de yodo, lo que refleja el flujo de sangre que llega a una lesión de forma indirecta. Permite adquirir imágenes con menores dosis de radiación y menor cantidad de contraste yodado para obtener los mismos valores de TC. Sin embargo, utiliza radiaciones ionizantes y el posprocesamiento de las imágenes consume tiempo, y los artefactos en los mapas de yodo pueden suponer una fuente potencial de pseudolesiones. Además, los escáneres de TC con tecnología de recuento de fotones son una técnica prometedora que puede desplazar algunas de las ventajas de la TCED.Esta revisión hace un análisis de la TCED aplicada a las imágenes de cabeza y cuello desde el ámbito del análisis de las fortalezas, oportunidades, debilidades y amenazas para facilitar una visión realista, basada en datos, de esta técnica.(AU)

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly.DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages.A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.(AU)

Ultralow-dose CT of the petrous bone using iterative reconstruction technique, tin filter and high resolution detectors allows an adequate assessment of the petrous bone structures.

OBJECTIVES: To assess image quality and radiation dose in computed tomography (CT) studies of the petrous bone done with a scanner using a tin filter, high-resolution detectors, and iterative reconstruction, and to compare versus in studies done with another scanner without a tin filter using filtered back projection reconstruction. MATERIAL AND METHODS: Thirty two patients (group 1) were acquired with an ultra-low dose CT (32-MDCT, 130kV, tin filter and iterative reconstruction). Images and radiation doses were compared to 36 patients (group 2) acquired in a 16-MDCT (120kV and filtered back-projection). Muscle density, bone density, and background noise were measured. Signal-to-noise ratio (SNR) was calculated. To assess image quality, two independent radiologists subjectively evaluated the visualization of the different structures of the middle and inner ear (0=not visualized, 3=perfectly identified and delimited). Interobserver agreement was calculated. Effective dose at different anatomical levels with the dose-length product was recorded. RESULTS: In the quantitative analysis, there were no significant differences in image noise between the two groups. In the qualitative analysis, a similar or slightly lower subjective score was obtained in the delimitation of different structures of the ossicular chain and cochlea in the 32-MDCT, compared to 16-MDCT, with statistically significant differences. Mean effective dose (±standard deviation) was 0.16±0.04mSv for the 32-MDCT and 1.25±0.30mSv for the 16-MDCT. CONCLUSIONS: The use of scanners with tin filters, high-resolution detectors, and iterative reconstruction allows to obtain images with adequate quality for the evaluation of the petrous bone structures with ultralow doses of radiation (0.16±0.04mSv).

Ultralow-dose CT of the petrous bone using iterative reconstruction technique, tin filter and high resolution detectors allows an adequate assessment of the petrous bone structures. / La tomografía computarizada de peñascos con dosis ultrabaja, utilizando filtro de estaño, detectores de alta resolución y reconstrucción iterativa, permite una adecuada valoración de las estructuras del peñasco.

OBJECTIVES: To assess image quality and radiation dose in computed tomography (CT) studies of the petrous bone done with a scanner using a tin filter, high-resolution detectors, and iterative reconstruction, and to compare versus in studies done with another scanner without a tin filter using filtered back projection reconstruction. MATERIAL AND METHODS: Thirty two patients (group 1) were acquired with an ultra-low dose CT (32-MDCT, 130 kV, tin filter and iterative reconstruction). Images and radiation doses were compared to 36 patients (group 2) acquired in a 16-MDCT (120 kV and filtered back-projection). Muscle density, bone density, and background noise were measured. Signal-to-noise ratio (SNR) was calculated. To assess image quality, two independent radiologists subjectively evaluated the visualization of the different structures of the middle and inner ear (0 = not visualized, 3 = perfectly identified and delimited). Interobserver agreement was calculated. Effective dose at different anatomical levels with the dose-length product was recorded. RESULTS: In the quantitative analysis, there were no significant differences in image noise between the two groups. In the qualitative analysis, a similar or slightly lower subjective score was obtained in the delimitation of different structures of the ossicular chain and cochlea in the 32-MDCT, compared to 16-MDCT, with statistically significant differences. Mean effective dose (± standard deviation) was 0.16 ± 0.04 mSv for the 32-MDCT and 1.25 ± 0.30 mSv for the 16-MDCT. CONCLUSIONS: The use of scanners with tin filters, high-resolution detectors, and iterative reconstruction allows to obtain images with adequate quality for the evaluation of the petrous bone structures with ultralow doses of radiation (0.16±0.04 mSv).

Nódulo pulmonar incidental: caracterización y manejo / Incidental pulmonary nodules: characterization and management

En esta actualización se aborda el manejo de los nódulos pulmonares, solitarios o múltiples, detectados incidentalmente en estudios radiológicos que se realizan por otros motivos. Se describe la técnica de tomografía computarizada más adecuada para su evaluación, y cómo se clasifican y se miden los diferentes tipos de nódulos. También se revisan los criterios que permiten establecer el riesgo de malignidad, tanto asociados al paciente como a las características del nódulo, y, por último, las recomendaciones de manejo y seguimiento para cada tipo de nódulo en función del tamaño y el riesgo de malignidad, siguiendo fundamentalmente las guías recientemente publicadas por la Sociedad Fleischner

This update covers the management of solitary or multiple pulmonary nodules detected incidentally in imaging studies done for other reasons. It describes the most appropriate computed tomography technique for the evaluation of these nodules, how they are classified, and how the different types of nodules are measured. It also reviews the patient-related and nodule-related criteria for determining the risk of malignancy. It discusses the recommendations in the guidelines recently published by the Fleischner Society for the management and follow-up of each type of nodules according to its size and risk of malignancy

Seudocavitación en las neoplasias de pulmón. ¿Permite predecir el diagnóstico de adenocarcinoma con crecimiento lepídico? / Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth?

OBJETIVO: Evaluar la prevalencia de seudocavitación en las neoplasias de pulmón y si permite predecir el diagnóstico del adenocarcinoma con crecimiento lepídico. MATERIAL Y MÉTODOS: Revisión retrospectiva de las tomografías computarizadas (TC) de tórax de 212 neoplasias de pulmón consecutivas incluidas en una base de datos de perfusión por TC y de 351 adenocarcinomas consecutivos diagnosticados entre julio de 2007 y septiembre de 2017. Dos radiólogos recogieron la presencia o ausencia de quistes aéreos en el tumor sin conocer los resultados de anatomía patológica, excluyendo las lesiones con necrosis, rodeadas de bullas o enfisema. Se analizó si la presencia de seudocavitación tenía relación con el tipo histológico, el tamaño de la lesión y la positividad para el receptor del factor de crecimiento epidérmico (EGFR) del tumor, la edad y el sexo del paciente. También se valoró la relación con el subtipo histológico del adenocarcinoma en aquellos pacientes sometidos a cirugía. Se utilizó la prueba de la χ2 para variables cualitativas y el modelo de regresión logística para variables cuantitativas. RESULTADOS: El 15% de las neoplasias presentaron seudocavitación, que fue significativamente más frecuente en los adenocarcinomas (24,1%), p = 0,003, si bien también se observó en el 9,8% de los carcinomas epidermoides y en el 3% de los carcinomas microcíticos. Presentó una especificidad del 92,4% para predecir el diagnóstico del adenocarcinoma, con una sensibilidad del 24%, un valor predictivo positivo (VPP) del 73,3%, un valor predictivo negativo del 58,4% y una precisión del 37,6%. En los adenocarcinomas resecados, el 65% de los tumores con seudocavitación presentaron crecimiento lepídico con una prevalencia del 40,6% en lepídicos, 31,5% en acinares y 33% en papilares. Fue significativamente más frecuente en mujeres (29%) y no se encontraron diferencias en función de la edad, tamaño y positividad para EGFR. CONCLUSIONES: La seudocavitación es más frecuente en los adenocarcinomas con crecimiento lepídico y en mujeres

OBJECTIVE: To determine the prevalence of pseudocavitation in lung tumors and whether its presence makes it possible to predict the diagnosis of adenocarcinoma with lepidic growth. MATERIAL AND METHODS: We retrospectively reviewed chest CT studies for 212 consecutive lung tumors included in a CT perfusion database and for 351 consecutive adenocarcinomas diagnosed between July 2007 and September 2017. Two radiologists blinded to the pathology report determined whether air cysts were present in the tumors, excluding lesions with necrosis and those surrounded by bullae or emphysema. We analyzed whether the presence of pseudocavitation was associated with the histologic type, size, or EGFR positivity of the tumor as well as with the age or sex of the patient. We also evaluated the relationship with the histologic subtype of the tumor in patients who underwent surgery. We used the chi-square test for categorical variables and logistic regression for continuous variables. RESULTS: Pseudocavitation was present in 15% of the tumors and was significantly more common in adenocarcinomas (24.1%), p = 0.003, although it was also observed in 9.8% of the epidermoid carcinomas and in 3% of the microcytic carcinomas. For the diagnosis of adenocarcinoma, the presence of pseudocavitation yielded 92.4% specificity, 24% sensitivity, 73.3% PPV, 58.4% NPV, and 37.6% accuracy. In the resected adenocarcinomas, 65% of the tumors with pseudocavitation had lepidic growth; the prevalence of pseudocavitation was 40.6% in tumors with lepidic growth, 31.5% in those with acinar growth, and 33% in those with papillary growth. Pseudocavitation was significantly more common in women (29%); no differences were found with respect to age, size, or EGFR positivity. CONCLUSIONS: Pseudocavitation is more common in adenocarcinomas with lepidic growth and in women

Incidental pulmonary nodules: characterization and management. / Nódulo pulmonar incidental: caracterización y manejo.

This update covers the management of solitary or multiple pulmonary nodules detected incidentally in imaging studies done for other reasons. It describes the most appropriate computed tomography technique for the evaluation of these nodules, how they are classified, and how the different types of nodules are measured. It also reviews the patient-related and nodule-related criteria for determining the risk of malignancy. It discusses the recommendations in the guidelines recently published by the Fleischner Society for the management and follow-up of each type of nodules according to its size and risk of malignancy.

Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth? / Seudocavitación en las neoplasias de pulmón. ¿Permite predecir el diagnóstico de adenocarcinoma con crecimiento lepídico?

OBJECTIVE: To determine the prevalence of pseudocavitation in lung tumors and whether its presence makes it possible to predict the diagnosis of adenocarcinoma with lepidic growth. MATERIAL AND METHODS: We retrospectively reviewed chest CT studies for 212 consecutive lung tumors included in a CT perfusion database and for 351 consecutive adenocarcinomas diagnosed between July 2007 and September 2017. Two radiologists blinded to the pathology report determined whether air cysts were present in the tumors, excluding lesions with necrosis and those surrounded by bullae or emphysema. We analyzed whether the presence of pseudocavitation was associated with the histologic type, size, or EGFR positivity of the tumor as well as with the age or sex of the patient. We also evaluated the relationship with the histologic subtype of the tumor in patients who underwent surgery. We used the chi-square test for categorical variables and logistic regression for continuous variables. RESULTS: Pseudocavitation was present in 15% of the tumors and was significantly more common in adenocarcinomas (24.1%), p=0.003, although it was also observed in 9.8% of the epidermoid carcinomas and in 3% of the microcytic carcinomas. For the diagnosis of adenocarcinoma, the presence of pseudocavitation yielded 92.4% specificity, 24% sensitivity, 73.3% PPV, 58.4% NPV, and 37.6% accuracy. In the resected adenocarcinomas, 65% of the tumors with pseudocavitation had lepidic growth; the prevalence of pseudocavitation was 40.6% in tumors with lepidic growth, 31.5% in those with acinar growth, and 33% in those with papillary growth. Pseudocavitation was significantly more common in women (29%); no differences were found with respect to age, size, or EGFR positivity. CONCLUSIONS: Pseudocavitation is more common in adenocarcinomas with lepidic growth and in women.

Tomografía computarizada de pitch alto en estudios de triple descarte: dosis de radiación y calidad de la imagen comparada con la de la tomografía computarizada multidetector / High pitch CT in triple rule-out studies: radiation dose and image quality compared to multidetector CT

Objetivo. Comparar la calidad de imagen y dosis de radiación de la TC de doble fuente (128-TCDF) con pitch alto y la adquisición retrospectiva con TC de 64 filas de detectores (64-TCMD) en estudios de triple descarte. Material y métodos. Estudiamos retrospectivamente 60 pacientes con dolor torácico agudo: 30 con una adquisición ECG-retrospectiva con 64-TCMD y 30 con 128-TCDF y pitch alto. Analizamos cuantitativamente la calidad de la imagen calculando la densidad vascular (DV), densidad muscular (DM), ruido y cocientes densidad vascular/ruido (CDVR) y contraste/ruido (CCR). Valoramos cualitativamente los artefactos en la vena cava, aorta y coronarias. Calculamos la dosis de radiación efectiva estimada (DRE) con el producto dosis-longitud. Resultados. No hubo diferencias significativas en la DV. Con 128-TCDF los CDVR y CCR fueron mayores en la aorta (CDVR: 28,9 ± 11,7 y 20 ± 5,5; CCR: 24,4 ± 10,9 y 16,8 ± 5,4; p < 0,01), arterias pulmonares (CDVR: 25,5 ± 10 y 20,6 ± 6,5; CCR: 24,5 ± 5,4 y 17,4 ± 6,4; p < 0,01) y coronarias (CDVR: 25,9 ± 8,2 y 18,9 ± 4,9; CCR: 24,9 ± 8,2 y 15,6 ± 4,6; p < 0,01). Los artefactos coronarios (3 y 34 segmentos no diagnósticos p < 0,001) y la DRE (13,77 ± 4 y 2,77 ± 0,6 mSv; p < 0,001) fueron menores con 128-TCDF. Conclusión. El pitch alto en el triple descarte disminuye la dosis de radiación y mejora la calidad de la imagen con respecto a la adquisición retrospectiva con 64-TCMD (AU)

Objective. To compare the image quality and radiation dose from high pitch dual source CT (128-DSCT) versus those from retrospective acquisition with 64-row multidetector CT (64-MDCT) in triple rule-out studies. Material and methods. We retrospectively studied 60 patients with acute chest pain: 30 with a retrospective EKG acquisition with 64-MDCT and 30 with high pitch 128-DSCT. We quantitatively analyzed the image quality by calculating the vascular density, muscular density (DM), noise, vascular density/noise ratio (VDNR), and contrast/noise ratio (CNR). We qualitatively evaluated the artifacts in the vena cava, aorta, and coronary arteries. We estimated the effective dose (ED) of radiation by means of the dose-length product. Results. There were no significant differences between 128-DSCT and 64-MDCT in the vascular density. The VDNR and CNR were higher on 128-DSCT than on 64-MDCT in the aorta (VDNR: 28.9 ± 11.7 vs. 20 ± 5.5; CNR: 24.4 ± 10.9 vs. 16.8 ± 5.4; P < .01), in the pulmonary arteries (VDNR: 25.5 ± 10 vs. 20.6 ± 6.5; CNR: 24.5 ± 5.4 vs. 17.4 ± 6.4; P < .01), and in the coronary arteries (VDNR: 25.9 ± 8.2 vs. 18.9 ± 4.9; CNR: 24.9 ± 8.2 vs. 15.6 ± 4.6; P < .01). There were fewer artifacts in the coronary arteries on 128-DSCT than on 64-MDCT (3 vs. 34 nondiagnostic segments; P < .001), and the ED in 128-DSCT was lower than in 64-MDCT (13.77 ± 4 vs. 2.77 ± 0.6 mSv; P < .001). Conclusion. In triple rule-out studies, high pitch 128-DSCT delivers a lower dose of radiation and provides better image quality than retrospective acquisition with 64-MDCT (AU)

High pitch CT in triple rule-out studies: Radiation dose and image quality compared to multidetector CT.

OBJECTIVE: To compare the image quality and radiation dose from high pitch dual source CT (128-DSCT) versus those from retrospective acquisition with 64-row multidetector CT (64-MDCT) in triple rule-out studies. MATERIAL AND METHODS: We retrospectively studied 60 patients with acute chest pain: 30 with a retrospective EKG acquisition with 64-MDCT and 30 with high pitch 128-DSCT. We quantitatively analyzed the image quality by calculating the vascular density, muscular density (DM), noise, vascular density/noise ratio (VDNR), and contrast/noise ratio (CNR). We qualitatively evaluated the artifacts in the vena cava, aorta, and coronary arteries. We estimated the effective dose (ED) of radiation by means of the dose-length product. RESULTS: There were no significant differences between 128-DSCT and 64-MDCT in the vascular density. The VDNR and CNR were higher on 128-DSCT than on 64-MDCT in the aorta (VDNR: 28.9 ± 11.7 vs. 20 ± 5.5; CNR: 24.4 ± 10.9 vs. 16.8 ± 5.4; P<.01), in the pulmonary arteries (VDNR: 25.5 ± 10 vs. 20.6 ± 6.5; CNR: 24.5 ± 5.4 vs. 17.4 ± 6.4; P<.01), and in the coronary arteries (VDNR: 25.9 ± 8.2 vs. 18.9 ± 4.9; CNR: 24.9 ± 8.2 vs. 15.6 ± 4.6; P<.01). There were fewer artifacts in the coronary arteries on 128-DSCT than on 64-MDCT (3 vs. 34 nondiagnostic segments; P<.001), and the ED in 128-DSCT was lower than in 64-MDCT (13.77 ± 4 vs. 2.77 ± 0.6 mSv; P<.001). CONCLUSION: In triple rule-out studies, high pitch 128-DSCT delivers a lower dose of radiation and provides better image quality than retrospective acquisition with 64-MDCT.

Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100 kV / Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80 kV versus 100 kV

Objetivo. Comparar la calidad de imagen y la dosis de radiación en 2 grupos de pacientes a los que se realiza angio-TC de extremidades inferiores con 80 y 100 kV. Material y métodos. Se realizó angio-TC de miembros inferiores a 60 pacientes con sospecha de enfermedad arterial periférica aleatorizados en 2 grupos, en uno la TC se realizó con 80 kV y en el otro con 100 kV. Los demás parámetros de adquisición se mantuvieron constantes. Se analizaron las imágenes cuantificando la densidad vascular (DV) y el ruido (R), y se calcularon los cocientes densidad vascular/ruido (CDVR) y contraste/ruido (CCR). Dos radiólogos evaluaron independientemente la calidad subjetiva de las imágenes. Se calculó la dosis efectiva estimada (DEE) basada en el producto dosis-longitud (DLP). Resultados. El grupo de 80 kV presentó valores significativamente más elevados de la DV (462,5 UH ± 95,6 vs. 372 UH ± 100,9; p < 0,001) y del CDVR (241,9 ± 48,1 vs. 194,3 ± 49,6; p < 0,001) y diferencias no significativas del R (21,3 UH ± 13 vs. 16,3 UH ± 3,5; p = 0,098) y el CCR (21,4 ± 12,1 vs. 22,9 ± 9,1; p = 0,15). No hubo diferencias significativas en la calidad subjetiva de la imagen y la dosis efectiva fue significativamente menor en el grupo de 80 kV (4,73 mSv ± 1,1 vs. 9,6 mSv ± 2,2; p < 0,001). Conclusión. La utilización de 80 kV en el estudio de angio-TC de miembros inferiores disminuye la dosis de radiación sin afectar a la eficacia diagnóstica del estudio respecto a la utilización de 100 kV (AU)

Objective. To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV. Material and methods. We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80 kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). Results. In the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P <. 001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P < .001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P = .098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P = .15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P <. 001). Conclusion. Using 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study (AU)

Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV / Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV

Objetivo: Estudiar las diferencias en la calidad de imagen vascular, la capacidad de eliminar el hueso y la dosis de radiación de la angio-TC de troncos supraaórticos con la técnica de energía dual utilizando dos diferentes potenciales del tubo. Material y métodos: Se revisaron retrospectivamente los estudios de angio-TC de troncos supraaórticos realizados a 46 pacientes con un equipo de TC de doble fuente de 128 cortes, tilizando 2 protocolos de voltaje diferente (80/140 kV y 100/140 kV). El posproceso se hizo con la herramienta «head bone removal». Las arterias se dividieron en 15 segmentos. En ellos se evaluó la calidad de los vasos y la capacidad de eliminar el hueso en imágenes multiplanares (MPR) y de proyección de máxima intensidad (MIP) con cada protocolo, analizando de forma separada los huesos trabecular y cortical. También se evaluó la dosis de radiación recibida. Resultados: Se realizaron 13 estudios con 80/140 kV y 33 con 100/140 kV, sin diferencias significativas entre los grupos en edad y sexo. Las diferencias fueron significativas en la calidad de los vasos en 4 segmentos, mayor en el grupo de 100/140 kV. También en este grupo fue mejor la eliminación automática de hueso cortical en MPR y MIP, y del trabecular en las imágenes MIP. La dosis de radiación (1,16 mSv con 80/140 kV y 1,59 mSv con 100/140 kV) fue significativamente mayor en el grupo de 100/140 kV. Conclusión: El potencial 100/140 kV incrementa la dosis de radiación, pero también mejora la calidad del estudio por segmentos arteriales y la eliminación de hueso (AU)

Objective: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. Material and methods: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The ‘‘head bone removal’’ tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately.We also evaluated the dose of radiation received. Results: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). Conclusion: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction (AU)

Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80 kV versus 100 kV.

OBJECTIVE: To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV. MATERIAL AND METHODS: We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). RESULTS: In the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P<.001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P<.001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P=.098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P=.15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P<.001). CONCLUSION: Using 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study.

[Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV]. / Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV.

OBJECTIVE: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. MATERIAL AND METHODS: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The "head bone removal" tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received. RESULTS: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). CONCLUSION: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.

La tomografía computarizada de doble energía: ¿para qué la quiero? / Dual-energy computed tomography: what is it useful for?

La tomografía computarizada con energía dual (TCED) es uno de los campos más novedosos y atractivos en la radiología actual. La posibilidad que tienen los equipos de última generación de adquirir estudios con distintos espectros de rayos X facilita la caracterización de determinados elementos químicos y, se adentra en el campo del análisis funcional al permitir detectar alteraciones funcionales en ausencia de anomalías morfológicas o densitométricas. La capacidad de caracterizar estos elementos está permitiendo generar nuevas aplicaciones en la práctica clínica y modificar nuestra forma de trabajar. El objetivo de este artículo es explicar en qué consisten los estudios de TCED, qué tipos de técnicas existen para realizarlos, cuáles son sus ventajas e inconvenientes y qué se espera de ellos en un futuro (AU)

Dual-energy CT is one of the newest and most attractive fields in radiology today. New generation scanners can acquire datasets with different X-ray spectra, which facilitates the characterization of certain chemical elements, making it possible to detect functional alterations in the absence of morphologic or densitometric anomalies. The capability of characterizing these elements is enabling new applications to be developed for clinical practice and changing the way we work. The aim of this article is to explain what dual-energy CT studies are, the techniques available for performing them, the advantages and disadvantages of these studies, and what we might expect from this field in the future (AU)

[Dual-energy computed tomography: what is it useful for?]. / La tomografía computarizada de doble energía: ¿para qué la quiero?

Dual-energy CT is one of the newest and most attractive fields in radiology today. New generation scanners can acquire datasets with different X-ray spectra, which facilitates the characterization of certain chemical elements, making it possible to detect functional alterations in the absence of morphologic or densitometric anomalies. The capability of characterizing these elements is enabling new applications to be developed for clinical practice and changing the way we work. The aim of this article is to explain what dual-energy CT studies are, the techniques available for performing them, the advantages and disadvantages of these studies, and what we might expect from this field in the future.

¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado / Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial

Objetivos. Estudiar si existen diferencias en los tiempos empleados en la atención al paciente, según se utilice la vía oral o intravenosa en la administración de betabloqueantes a pacientes ambulatorios sometidos a coronariografía mediante tomografía computarizada (TC). Material y métodos. Estudio prospectivo, analítico, aleatorizado y controlado. Se distribuye a 40 pacientes con frecuencia mayor de 65 latidos por minuto en 2 grupos. En el grupo 1 se administra el betabloqueante por vía oral y en el grupo 2 por vía intravenosa. Se mide el tiempo global transcurrido desde la entrada del paciente en Radiología hasta su marcha y el tiempo parcial de ocupación de sala desde que entra hasta que sale de la sala de TC. Variables secundarias: frecuencia cardíaca, tensión arterial y número de estudios concluyentes. Resultados. La mediana (rango intercuartílico) del tiempo global fue de 120 minutos (100-150) en los 19 pacientes betabloqueados por vía oral y de 35 minutos (27,5-67,5) en los 21 pacientes con medicación intravenosa (p<0,001). El tiempo parcial de ocupación de sala fue 10 minutos (6-15) en el grupo 1 y 10 minutos (9-20) en el grupo 2 (p=0,57). El descenso de la tensión arterial media es 10 mmHg con los betabloqueantes por vía intravenosa frente a 3,3 mmHg por la vía oral (p=0,01). No se hallaron diferencias significativas en la calidad diagnóstica de las exploraciones. Conclusiones. El tiempo de atención al paciente es significativamente menor con la administración intravenosa de betabloqueantes. No se demostraron diferencias en el tiempo de ocupación de sala ni en la calidad diagnóstica (AU)

Objectives. To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methods. This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. Results. The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p<0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p=0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p=0.01). No significant differences were found in the diagnostic quality of the examinations. Conclusions. The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations (AU)

[Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial]. / ¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado.

OBJECTIVES: To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. MATERIAL AND METHODS: This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. RESULTS: The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p<0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p = 0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p = 0.01). No significant differences were found in the diagnostic quality of the examinations. CONCLUSIONS: The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.