Hideaki Yuki

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Objective: We compared the effect of a dual-region-of-interest (ROI) bolus-tracking technique on interpatient variability of arterial contrast enhancement with that of the conventional bolus-tracking technique in coronary computed tomographic angiography (CTA) on a 320-row scanner. Methods: This study included 100 patients who underwent coronary CTA using one of two protocols: (1) 50 patients underwent scanning using a conventional single-ROI bolus-tracking technique (P-single) with an ROI placed in the ascending aorta, and (2) 50 patients underwent scanning using a dual-ROI technique (P-dual) with two ROIs placed in the pulmonary trunk and the ascending aorta. CT attenuation in the ascending aorta and coronary arteries, and the interpatient variability were compared between the two scanning protocols. Results: The mean CT attenuation of the ascending aorta and coronary arteries tended to be higher for P-dual than for P-single, but the difference was not significant (p = 0.08–0.30). The interpatient variability of contrast enhancement (SD of the CT attenuation) was significantly smaller for P-dual than for P-single (p < 0.01). Conclusion: The dual-ROI bolus-tracking technique can reduce interpatient variability of arterial contrast enhancement in coronary CTA on a 320-row scanner. Advances in knowledge: The use of a dual-ROI bolus-tracking technique can provide sufficient and consistent arterial enhancement of coronary CTA.

Objective: Different CT scanners have different X-ray spectra and photon energies indicating that contrast enhancement vary among scanners. However, this issue has not been fully validated; therefore, we performed phantom and clinical studies to assess this difference. Methods: Two scanners were used: scanner-A and scanner-B. In the phantom study, we compared the contrast enhancement between the scanners at tube voltage peaks of 80, 100 and 120 kVp. Then, we calculated the effective energies of the two CT scanners. In the clinical study, 40 patients underwent abdominal scanning with scanner-A and another 40 patients with scanner-B, with each group using the same scanning protocol. The contrast enhancement of abdominal organs was assessed quantitatively (based on the absolute difference between the attenuation of unenhanced scans and contrast-enhanced scans) and qualitatively. A two-tailed independent Student's t-test and or the Mann–Whitney U test were used to compare the discrepancies. Results: In the phantom study, contrast enhancement for scanner-B was 36.9, 32.6 and 30.8% higher than that for scanner-A at 80, 100 and 120 kVp, respectively. The effective energies were higher for scanner-A than for scanner-B. In the quantitative analysis for the clinical study, scanner-B yielded significantly better contrast enhancement of the hepatic parenchyma, pancreas, kidney, portal vein and inferior vena cava compared with that of scanner-A. The mean visual scores for contrast enhancement were also significantly higher on images obtained by scanner-B than those by scanner-A. Conclusion: There were significant differences in contrast enhancement of the abdominal organs between the compared CT scanners from two different vendors even at the same scanning and contrast parameters. Advances in knowledge: Awareness of the impact of different X-ray energies on the resultant attenuation of contrast material is important when interpreting clinical CT images.

Key Clinical Message: Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation usually involving the upper and lower respiratory tracts and necrotizing vasculitis predominantly affecting small‐sized vessels. Although categorized as a small vessel vasculitis, GPA can cause periaortitis and pericarditis. Physicians should recognize all categories of vasculitis can affect any size arteries.

The aim of this study was to evaluate the effect of cardiac output (CO) on aortic peak enhancement using protocols with different contrast material (CM) injection durations. We used a flow phantom that simulated the human circulatory system. Contrast material was injected at a rate of 4.0 mL/s for a period of 2.5, 5, 10, 15, or 20 seconds for a CO of 2.8, 4.2, and 5.6 L/min. Single-level serial computed tomography scans of the simulated aorta were acquired after the start of CM delivery, and aortic peak enhancement was recorded under the different injection protocols. Under a long injection duration protocol (20 seconds), a decrease in CO increased aortic peak enhancement proportionally (CO of 2.8 L/min, 420 Hounsfield units [HU]; CO of 4.2 L/min, 365 HU; CO of 5.6 L/min, 291 HU). However, this effect was decreased under shorter injection duration protocols (5, 10, and 15 seconds); under the shortest (2.5-second) injection duration protocol, a decrease in CO resulted in a decrease in aortic peak enhancement (CO of 2.8 L/min, 36 HU; CO of 4.2 L/min, 51 HU; CO of 5.6 L/min, 55 HU). The magnitude of the effect of CO on aortic peak enhancement depends on the CM injection duration.

Objective:We performed 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy bodies disease (LBD) and assessed whether the early heart-to-mediastinum (H/M) ratio is diagnostic and whether visual image analysis is useful.Methods:Our study included 453 patients with clinically suspected LBD who had undergone 123I-MIBG myocardial scintigraphy. We evaluated semi-quantitative values (early and delayed H/M ratio, washout rate) and performed visual image analysis. The sensitivity, specificity, accuracy, and positive and negative predictive value (PPV, NPV) of both analyses were calculated.Results:The early H/M ratio exhibited the best diagnostic ability. Its overall sensitivity, specificity, accuracy, PPV and NPV were 72.2%, 93.1%, 84.3%, 88.5%, and 82.2%, respectively (cut-off value 2.2or less). However, there was no significant difference from the delayed H/M ratio or the results of visual assessment.Conclusions:123I-MIBG myocardial scintigraphy differentiates accurately between patients with and without...

Objectives We evaluated the effects of a low contrast material (CM) dose protocol using 80-kVp on the image quality of hepatic multiphasic CT scans acquired on a 320-row CT scanner. Methods We scanned 30 patients with renal insufficiency (eGFR < 45 mL/min/1.73 m²) using 80-kVp and a CM dose of 300mgI/kg. Another 30 patients without renal insufficiency (eGFR > 60 mL/min/1.73 m²) were scanned with the conventional 120-kVp protocol and the standard CM dose of 600mgI/kg. Quantitative image quality parameters, i.e. CT attenuation, image noise, and the contrast-to-noise ratio (CNR) were compared and the visual image quality was scored on a four-point scale. The volume CT dose index (CTDI_vol) and the size-specific dose estimate (SSDE) recorded with the 80- and the 120-kVp protocols were also compared. Results Image noise and contrast enhancement were equivalent for the two protocols. There was no significant difference in the CNR of all anatomic sites and in the visual scores for overall image quality. The CTDI_vol and SSDE were approximately 25–30 % lower under the 80-kVp protocol. Conclusion Hepatic multiphase CT using 80-kVp on a 320-row CT scanner allowed for a decrease in the CM dose and a reduction in the radiation dose without image quality degradation in patients with renal insufficiency. Key Points • The 80-kVp CT protocol enabled reduction of contrast dose by 50 % • The 80-kVp CT protocol reduced the radiation dose by 25–33 % • There was no degradation in the image quality of the 80-kVp protocol