Type:
Educational Exhibit
Keywords:
Abdomen, Liver, CT, Contrast agent-intravenous, Acute, Ischaemia / Infarction
Authors:
K. Singh, S. Singh, C. Rushton
DOI:
10.26044/ranzcr2022/R-0060
Background
BACKGROUND
Recent tertiary centre implantation of Spectral data analysis performed on the IQon Philips Spectral CT has the potential to revolutionize daily radiologist practice in the detection of acute thromboembolic pathology and the resultant end-organ parenchymal sequalae without the need for multiphase conventional CT. In doing so, there will be reduction in the acquisition times and radiation dose to the patient, potentiating improved turn over times and reducing patient risk whilst ensuring critical diagnoses are met without diagnostic uncertainty. The simultaneous analysis of Iodine density, monoenergetic, virtual non contrast and Iodine no water as well as Z effective maps has allowed for rapid diagnosis and the interpretation of diagnoses usually requiring multiphase assessment. We present a post surgical case of polypectomy complicated by portal venous thrombosis and resultant perfusion ischemic changes involving the hepatic parenchyma.
PATIENT PRESENTATION:
A 45 year old patient underwent a colonoscopy for a positive fecal occult blood test result which revealed an irregular sessile polyp measuring 2 cm at the sigmoid colon which was subsequently resected. A week post operative, the patient presented to the emergency department with complaints of right upper quadrant pain. In the emergency department the patient displayed local peritonism in the right upper quadrant. The White blood cells were mildly elevated to 11,000 however the remainder of the serum biochemical analysis and Full blood count were within normal limits. CT and US was performed and review by the general surgical registrar on call. By spectral data iQon analysis and image modulation on Magic Glass PACs app we are able to employ post processing methods to aquire higher contrast resolution than conventional CT.
METHOD:
Monoenergetic low kV are able to be utiliised to markedly improve contrast resolution in both the parenchyma of the liver and also the arterial and venous structures. The examples below demonstrates how improved contrast resolution within the hepatic parenchyma and arterial and venous structures can lead to simpler detection of thrombus. The Iodine suppressed maps are able to negate iodine contrast in post processing, and therefore the diagnosis of thrombus can be ascertained within a vessel. In contrast iodine overlay image maps may increase the detection of normal flow within the vessel to be interrogated. Perfusional ischemic detection of hepatic parenchyma is also enhanced with Z-colour maps. Please see the related images for detailed description.