Learning objectives
Spectral or dual energy computed tomography (CT) is an emerging diagnostic technique.
At present in our district general hospitals many radiologists are unfamiliar with it's application and underutilise it's availability.
We review the application of Philips IQon detector-based spectral CT,
and demonstrate it's ability to aid the diagnosis of pathology and the characterisation of lesions. We will focus on renal and adrenal lesions to demonstrate the utility of this technique.
We demonstrate that the benefits of spectral CT could improve the clinical radiologist’s confidence in...
Background
Spectral CT scanning has the ability to improve the radiologist's performance beyond that of conventional CT. Conventional CT can present us with lots of unanswerable questions when incidental renal and adrenal nodules are identified. Many of these require supplementary imaging for definitive characterisation.
On review of such further imaging,
we feel,
with the benefit of hindsight,
that many of these studies could have been avoided with appropriate use of the spectral application during theinitialCT study.
A key finding for renal lesioncharacterisation in the differentiation ofbenign...
Findings and procedure details
Case 1: Adrenal adenoma.
(Figs.
1 & 2)
Incidental adrenal nodule identified on routine investigation for alternative pathology. The patient underwent follow up magnetic resonance imaging (MRI) study confirming benign pathology. The retrospective review of the virtual non-contrast (VNC) of the initial CT study demonstrates a lesional Hounsfield unit (HU) of less than 10 (-8.5),
consistent with benign lipid rich adrenal adenoma.
We feel the follow up MRI study would have been superfluous with appropriate review of lesion using the spectral application.
Case 2: Adrenal...
Conclusion
Philips IQon detector-based spectral scanning has more applications than conventional CT and can improve radiologist's confidence in diagnostic accuracy,
lesion characterisation and prevention of further unnecessary imaging. We feel at present this emerging technique is underutilised by the general radiologist.
Through these adrenal and renal cases we hope to have demonstratedthe imaging adjunct and therefore clinical utility Spectral CT imaging can offer.
As application of this new technology becomes more widespread we feel it can improve efficiency in the imaging department resulting in moretimely diagnosis...
Personal information
C.McConville,
FRCR.
Radiology Department,
Ulster Hospital,
Southeastern Health and Social Care Trust - Northern Ireland.
Address:
Ulster Hospital,
Upper Newtownards Rd.,
Dundonald,
Belfast. BT16 1RH
Telephone: +4428 9048 4511
e-mail:
[email protected]
Secondary information:
Declan Neeson -
[email protected]
Peter Blair -
[email protected]
References
Silvia AC et al.
Dual energy (Spectral) CT.
Applications in abdominal imaging.
Radiographics 2001;31:1031-46.
Graser et al.Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images?Radiology 2009;252(2):433-40.
Patel BN et al.
Characterization of Small (<4cm) Focal Renal Lesions: Diagnostic Accuracy of Spectral Analysis Using Single-Phase Contrast-Enhanced Dual-Energy CT.Am J Roentgenol2017;209(4):815-25.
Ho LM et al.
Characterization of adrenal nodules with dual-energy CT: Can virtual unenhanced attenuation values replace true unenhanced attenuation values?AJR Am J Roentgenol.2012;198:840–5.
Graser A et al....