[Relative Error between Organ Doses and Size-specific Dose Estimates for a Specific Location When the Mean CTDIvol Value Is Used for Calculation].

Size-specific dose estimates (SSDEs) are dose indices that account for differences in body shape in computed tomography (CT) scans, allowing the evaluation of approximate absorbed doses in any cross section that could not be obtained with the volume CT dose index (CTDIvol). When using automatic exposure control (AEC), CTDIvol is modulated in the body axis direction, but the value displayed after the examination is the mean CTDIvol for the entire scan, and it is expected that the SSDE value will change depending on which value is used in the calculation. In this study, using a human body phantom, we examined the influence of whether the mean CTDIvol or the modulation value for each slice is used to calculate the SSDE on local organ dose evaluation. A program to calculate water equivalent diameter according to the procedure in the American Association of Physicists in Medicine Report No. 220 was developed and compared. As a result, SSDE calculated using the mean CTDIvol (local-SSDEmean) overestimated organ doses in the lung region by 18%-56% compared with those calculated by a web system for evaluating CT exposure doses (WAZA-ARIv2, Japan). In contrast, local-SSDEmodulated, which was calculated using the modulated value of the CTDIvol, was able to estimate the organ dose with a relative error of 10%-13%. The average local-SSDE over the entire body axis direction was not significantly different between the two methods, regardless of which method was used for CTDIvol. If the mean CTDIvol is stored in the Digital Imaging and Communications in Medicine (DICOM) header tag (0018, 9345) of the CT image and the modulated CTDIvol value is not available for each slice, the calculated local SSDE will contain many errors and will not correctly reflect the organ doses at the scan region. In such cases, it is available to use the method of evaluating local organ doses by multiplying the SSDE, which is the average of the SSDE for the entire scan, by a factor for each organ.

Visualization of the lenticulostriate arteries, long insular arteries, and long medullary arteries on intra-arterial computed tomography angiography with ultrahigh resolution in patients with glioma.

PURPOSE: The anatomical association between the lesion and the perforating arteries supplying the pyramidal tract in insulo-opercular glioma resection should be evaluated. This study reported a novel method combining the intra-arterial administration of contrast medium and ultrahigh-resolution computed tomography angiography (UHR-IA-CTA) for visualizing the lenticulostriate arteries (LSAs), long insular arteries (LIAs), and long medullary arteries (LMAs) that supply the pyramidal tract in two patients with insulo-opercular glioma. METHODS: This method was performed by introducing a catheter to the cervical segment of the internal carotid artery. The infusion rate was set at 3 mL/s for 3 s, and the delay time from injection to scanning was determined based on the time-to-peak on angiography. On 2- and 20-mm-thick UHR-IA-CTA slab images and fusion with magnetic resonance images, the anatomical associations between the perforating arteries and the tumor and pyramidal tract were evaluated. RESULTS: This novel method clearly showed the relationship between the perforators that supply the pyramidal tract and tumor. It showed that LIAs and LMAs were far from the lesion but that the proximal LSAs were involved in both cases. Based on these results, subtotal resection was achieved without complications caused by injury of perforators. CONCLUSION: UHR-IA-CTA can be used to visualize the LSAs, LIAs, and LMAs clearly and provide useful preoperative information for insulo-opercular glioma resection.

Simulation of the occipital transtentorial approach incorporating visualization of the cerebellar tentorium using three-dimensional computed tomography angiography and gadolinium-enhanced T1-weighted magnetic resonance imaging: technical note.

The occipital transtentorial approach (OTA) is one of the useful approaches to the lesions of the pineal region, dorsal brainstem, and supracerebellar region. However, a wide operative field is sometimes difficult to obtain due to the tentorial sinus and bridging veins. This study evaluated the usefulness of preoperative simulation of OTA, specifically including the cerebellar tentorium in 9 patients. All patients underwent computed tomography angiography and venography and gadolinium-enhanced three-dimensional T1-weighted magnetic resonance images (Gd-3D-T1WI). The images were fused, and the cerebellar tentorium, vessels, and tumor were manually extracted from Gd-3D-T1WI to obtain the simulation images. Visualization of the cerebellar tentorium could discriminate between bridging veins from the occipital lobe and cerebellum, and recognize the site of bridging to the tentorial sinus and variants which may interfere with the tentorial incision. Simulation of the tentorial incision was also possible based on the relationships between the tumor, tentorial sinus, bridging vein, and cerebellar tentorium. The simulation suggested that safe tentorial incision was difficult in two sides because of the crossed tentorial sinus draining the left basal vein and draining veins from the glioblastoma. The OTA was performed in eight cases, and no difficulty was experienced in the tentorial incision in all cases. The simulation findings of the bridging vein and tentorial sinus were consistent with the intraoperative findings. Preoperative simulation including the cerebellar tentorium is useful for determining the optimum and safe side and required extent of the tentorial incision necessary for tumor resection with the OTA.

Erratum to "Carotid computed tomography angiography after cobalt-based alloy carotid artery stenting using ultra-high-resolution computed tomography with model-based iterative reconstruction" [Radiol Case Rep 2021;16:3721-8].

[This corrects the article DOI: 10.1016/j.radcr.2021.09.003.].

[Relationship between Image Quality and Reconstruction FOV in Deep Learning Reconstructed Images of CT].

In this study, we compared the image quality of deep learning reconstruction (DLR) with that of conventional image reconstruction methods under the same conditions of reconstruction FOV and acquisition dose assuming abdomen computed tomography (CT) in children. Standard deviation (SD) of the CT value, noise power spectrum (NPS), and task-based modulation transfer function (TTF) were evaluated. DLR reduced image noise while maintaining sharpness, and the noise reduction effect showed a different characteristic depending on the size of reconstruction FOV from the conventional image reconstruction methods. The SD of CT value increased gradually in the range from 320 mm to 240 mm, but there was almost no change from 240 mm to 200 mm. The NPS showed completely different characteristics. The low-frequency component increased, and the high-frequency component decreased at 240 mm. However, the frequency component below 0.5 cycle/mm decreased at 200 mm and the peak frequency moved to the lower side at 320 mm. DLR showed the highest TTF value compared to the conventional reconstruction methods.

Accuracy of virtual non-contrast images with different algorithms in dual-energy computed tomography.

We investigated the accuracy of the computed tomography (CT) numbers of virtual non-contrast (VNC) images for two different material decomposition algorithms using the same image data for different diluted contrast agent concentrations. A container filled with contrast agents was inserted into a cylindrical phantom and scanned with dual-energy protocols (80/Sn140 kV, 100/Sn140 kV) using a dual-source CT. VNC images were generated by the 2-material decomposition (MD) algorithm using the energy of each tube voltage and the linear attenuation coefficient, calculated from the theoretical spectral curve of the agent and the CT number of the image, respectively. Furthermore, VNC images using 3-material decomposition (3-MD) algorithm were produced by applying LiverVNC, an analysis parameter implemented in the scanner. The robustness of both the algorithms was verified by investigating the CT numbers of the agents in the VNC. The closer the CT number is to 0 HU, the more robust the algorithm. Without beam-hardening correction, the CT numbers increased with an increase in concentration in both the algorithms, maximal at 50 mg/ml concentration, with CT numbers of 38 HU for 2-MD, 86 HU for 3-MD. With correction, CT numbers were ± 10 HU or less for both the algorithms up to 30 mg/ml concentration, whereas, for concentrations above 40 mg/ml, the maximal averaged CT number was 12 HU for 2-MD, 22 HU for 3-MD. For both the algorithms, the accuracy of the CT numbers was maintained in the low-concentration range; parameter adjustment was necessary to maintain the accuracy at concentrations higher than clinically expected.

[A Review of Current Knowledge for X-ray Energy in CT: Practical Guide for CT Technologist].

In computed tomography (CT) systems, the optimal X-ray energy in imaging depends on the material composition and the subject size. Among the parameters related to the X-ray energy, we can arbitrarily change only the tube voltage. For years, the tube voltage has often been set at 120 kVp. However, since about 2000, there has been an increasing interest in reducing radiation dose, and it has led to the publication of various reports on low tube voltage. Furthermore, with the spread of dual-energy CT, virtual monochromatic X-ray images are widely used since the contrast can be adjusted by selecting the optional energy. Therefore, because of the renewed interest in X-ray energy in CT imaging, the issue of energy and imaging needs to be summarized. In this article, we describe the basics of physical characteristics of X-ray attenuation with materials and its influence on the process of CT imaging. Moreover, the relationship between X-ray energy and CT imaging is discussed for clinical applications.

Efficacy of ultra-high-resolution computed tomographic angiography for postoperative evaluation of intracranial aneurysm after clipping surgery: A case report.

Background: Following clipping surgery for intracranial aneurysm, computed tomography angiography (CTA) is often used to confirm complete aneurysm obliteration. However, artifacts from the titanium clips usually degrade the images around them. The ultra-high-resolution computed tomography (UHR-CT) system recently became available in clinical practice. Here, we report a case in which CTA using the UHR-CT system successfully pointed out a small aneurysmal remnant after the clipping surgery, which was validated by digital subtraction angiography. Case Description: A patient underwent clipping surgery for an unruptured aneurysm using two titanium alloy clips. CTA using the UHR-CT system demonstrated a small remnant aneurysm. Digital subtraction angiography confirmed the minor remnant. The UHR-CTA images were comparable to three-dimensional reconstructed images from the rotational angiography. Conclusion: We propose that UHR-CTA is a reliable postoperative assessment method for intracranial clipping surgeries.

Accuracy of virtual monochromatic images generated by the decomposition of photoelectric absorption and Compton scatter in dual-energy computed tomography.

The decomposition of the linear attenuation coefficient into photoelectric absorption and Compton scattering provides virtual monochromatic images (VMIs). The accuracy of the computed tomography (CT) number of VMI, which is obtained by decomposing the linear attenuation coefficient into photoelectric absorption and Compton scattering, was verified in the energy range of 40-200 keV. The possibility of improving the accuracy of CT numbers by using pre-energy-calibrated images as input was also investigated. The VMIs were generated in two groups of images: (i) dual-energy scanned images and (ii) high- and low-energy images generated by two-material decomposition (i.e., pre-energy-calibrated images). The object for analysis was solid iodine rods inserted in the center of the multi-energy CT phantom. The VMIs were generated from the dual-energy scanned images and pre-energy-calibrated images, and the theoretical and measured CT numbers of solid iodine rods were compared. Furthermore, the absolute error (AE) and relative error (RE) were calculated. With both images, the accuracy of the CT numbers was extremely high for regions close to the high- and low-tube-voltage X-ray energy or the high and low energy of the input images. By using the pre-energy-calibrated images, the maximum AE was reduced from 133 to 96 HU at an energy of 40 keV. Similarly, the maximum RE was reduced from 325 to 50% at an energy of 200 keV. The pre-energy-calibrated images reduced the overall error of the CT numbers and controlled the energy region where accurate CT numbers could be obtained.

Comparison between ultra-high-resolution computed tomographic angiography and conventional computed tomographic angiography in the visualization of the subcallosal artery.

BACKGROUND: The subcallosal artery (ScA) is a single dominant artery arising from the anterior communicating artery. Its injury causes amnesia and cognitive disturbance. The conventional computed tomographic angiography (C-CTA) is a common evaluation method of the intracranial artery. However, to image tinny perforating arteries such as the ScA is technically demanding for C-CTA. The purpose of this study is to investigate whether the ultra-high-resolution CTA (UHR-CTA) could image the ScA better than C-CTA. UHR-CTA became available in clinical practice in 2017. Its novel features are the improvement of the detector system and a small X-ray focus. METHODS: Between April 2019 and May 2020, 77 and 49 patients who underwent intracranial UHR-CTA and C-CTA, respectively, were enrolled in this study. Two board-certified neurosurgeons participated as observers to identify the ScA based on UHR-CTA and C-CTA images. RESULTS: UHR-CTA and C-CTA detected the ScA in 56-58% and 30-40% of the patients, respectively. In visualization of the ScA, UHR-CTA was better than C-CTA (P < 0.05, Fisher's exact test). Between the two observers, the Cohen's kappa coefficient was 0.77 for UHR-CTA and 0.78 for C-CTA. CONCLUSIONS: UHR-CTA is a simple and accessible method to evaluate intracranial vasculature. Visualization of the ScA with UHR-CTA was better than that with C-CTA. The high quality of UHR-CTA could provide useful information in the neurosurgery field.

Carotid computed tomography angiography after cobalt-based alloy carotid artery stenting using ultra-high-resolution computed tomography with model-based iterative reconstruction.

In conventional carotid computed tomographic angiography, the artifacts of the stent vary depending on the structure and characteristics of the alloy type. Cobalt-based alloy stents have been reported to exhibit high artifacts, and accurate evaluation of the internal lumen can be difficult. Recently, ultra-high-resolution computed tomography scanner systems have become available for clinical practice. The primary features of this computed tomography scanner are a 0.25-mm detector row width and a 1024 × 1024 matrix. We report a case-series of carotid artery stenting using a cobalt-based alloy stent scanned by an ultra-high-resolution computed tomography scanner system and model-based iterative reconstruction. We also report that the combination of the ultra-high-resolution computed tomography scanner system with model-based iterative reconstruction would be useful to evaluate vessel patency after placement of a cobalt-based alloy stent.

Accuracy of spectral curves at different phantom sizes and iodine concentrations using dual-source dual-energy computed tomography.

To validate the accuracy of spectral curves obtained by an image-data-based algorithm and clarify the error factors that reduce accuracy. Iodine rods of known composition and different concentrations were inserted into a cylinder or elliptic-cylinder phantom and scanned according to the dual-energy protocol. Spectral curves were obtained by (i) theoretical calculation, (ii) image-data-based 2-material decomposition, and (iii) using a dedicated workstation. Accuracy was verified by comparing the spectral curve obtained by theoretical calculations with those obtained by the image-data-based algorithms or the dedicated workstations. For a quantitative evaluation, the error and relative error (RE) were calculated. In the image-data-based calculation, the errors with respect to the theoretical CT number ranged from - 8.3 to 71.1 HU. For all 192 combinations, 80.7% of the errors were under ± 15 HU, and 97.9% of the REs were under 10%. In the dedicated workstation, the errors ranged from - 94.7 to 26.8 HU. For all combinations, 68.8% of the errors were under ± 15 HU, and 68.2% of the REs were under 10%. By appropriately setting the effective energy corresponding to the CT number of the basis materials, an accurate spectral curve can be obtained. The beam-hardening effect is canceled by the 2-material decomposition process even without beam-hardening correction. Accuracy is primarily reduced by scattered radiation rather than the beam-hardening effect.

Method to calculate frequency characteristics of reconstruction filter kernel in X-ray computed tomography.

A computed tomography (CT) image is generally reconstructed by a filtered back projection (FBP) algorithm. In an FBP algorithm, the image quality primarily depends on a reconstruction filter kernel. Although the details of the filter kernel are not disclosed to users, the frequency response of the filter kernel can theoretically be calculated using the relational formula of the filter kernel and the modulation transfer function (MTF) of the reconstruction algorithm (MTFA). In this study, we proposed a method to determine the frequency response of a filter kernel and verify its validity. Two clinical CT scanners were used to derive the filter kernel. The MTF was obtained and subsequently separated to the MTF of the scanner system and MTFA. Using the relational formula of the filter kernel and MTFA, we calculated the frequency response of the filter kernel. To verify the calculated result, we measured the noise power spectrum (NPS). Additionally, the filter kernel was calculated using the relational formula of the filter kernel and NPS. In both CT scanners, the filter kernels calculated by the two methods showed good agreement, and we confirmed the validity of the results and the effectiveness of the proposed method. Furthermore, the inherent image quality performance of the CT scanner could be clarified by the reconstruction filter kernel.

Association of the incidence of venous air embolism on coronary computed tomography angiography with the intravenous access route preparation process.

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.

A case of iatrogenic air bubbles in the left ventricle by coronary computed tomographic angiography.

We report a case of asymptomatic iatrogenic air bubbles in the left ventricle observed by coronary computed tomographic angiography. Air bubbles are rarely found in the left ventricle and could prove fatal should they migrate to the brain or coronary arteries. We believe that the cause is micro air bubbles in the tubing system between the intravenous catheter and power injector.

[Relationship between Quantitativeness of Iodine and Accuracy of Virtual Non-contrast Image in Dual-energy Computed Tomography].

Dual-energy computed tomography (DE-CT) is the promising technology, such as enabling material decomposition, generation of the virtual monochromatic image, and measurement of effective atomic numbers. There are reports that utilization of the virtual non-contrast (VNC) image, the iodine map image, and the virtual monochromatic image can contribute to the improvement of lesion detection and its characterization, compared with conventional contrast CT by single-energy computed tomography (SE-CT). In addition, acquisition of the VNC images makes it possible to skip scanning of true non-contrast CT, which is also expected to reduce exposure. However, a reliable evaluation of the accuracy of the VNC image has not been established, and only a few reports have verified their accuracy. In this study, we evaluated the relationship between the quantitativeness of iodine and the CT value of VNC image. As a result of our study, when the iodine volume was overestimated, the CT value of the VNC image was lower than the reference value, and when the iodine volume was underestimated, the CT value was upper than the reference value. Moreover, we clarified that the CT value of the VNC image greatly diverges as the iodine volume increases.

[Fundamental study of the energy subtraction process using a monochromatic image for computed tomography angiography after coil embolization of a cerebral aneurysm].

Coil-embolized cerebral aneurysms are difficult to evaluate using computed tomography (CT) angiography (CTA) due to artifacts caused by the coil devices. This study was conducted to assess the practicality of energy subtraction processing using monochromatic images obtained using CTA after coil embolization of a cerebral aneurysm. In this study, the changes in the CT value of the contrast agent and the coil were analyzed not only at varying monochromatic energy levels but also by energy subtraction processing. Our analyses revealed an exponential change in the CT value of the contrast agent at any desired energy. We also found that the CT value of the coil was unchanged at the upper threshold of the grayscale limit. Based on these results, we were able to create images of changes in material-specific CT values and thus eliminate the material. Energy subtraction processing enabled us to distinguish between the contrast agent, the coil, and the artifacts from coil devices. We suggest that energy subtraction processing using monochromatic images can resolve the limitations of CTA after coil embolization of cerebral aneurysms.