Patrone S

Utility of low mA 1.5 pitch helical versus conventional high mA abdominal ct

The objective of this study was to evaluate the utility of a low mA 1.5 pitch helical versus conventional high mA conventional technique in abdominal computed tomography (CT). Twenty-five patients who had both a conventional high mA (> 300) and a 1.5 pitch low mA (80-125) helical CT within 3 months were selected for inclusion in the study. Patients were excluded who had a significant change in pathology between the two studies. The other parameters (injection rate, contrast type and volume, and filming window/level) were constant. The studies were randomized and blinded to five separate experienced readers who graded the studies by a variety of normal anatomical structures and pathological criteria. Overview questions also assessed noise, resolution, contrast, and overall quality. The abdominal wall/retroperitoneum and hiatal hernias were statistically better visualized on the conventional high mA studies. However, for all other normal anatomical and pathological sites, there was equivalent or better visualization on the helical versus the conventional CT examinations. The resolution of the helical studies was graded statistically better than the high mA conventional CT scans as was the amount of noise present on the images. While there was some advantage for conventional high mA CT with respect to contrast enhancement and low contrast sensitivity, these differences were not statistically significant. It appears from the data of this study that a low mA technique in evaluating the abdomen may be a useful option in performing routine abdominal CT. The radiation dose savings to the patient is significant and there appears to be little degradation of image quality using a low mA 1.5 helical versus mA conventional CT technique.

Multiplanar image reconstruction and 3D imaging using a musculoskeletal phantom: conventional versus helical CT.

PURPOSE Our goal was to perform a detailed comparison of the relative performances of helical CT (pitches 1.0, 1.5, and 2.0) and conventional (overlapped and nonoverlapped) CT in detailed 3D and MPR musculoskeletal imaging. METHOD A specially designed bone fragment phantom was imaged with multiple slice thicknesses using conventional (overlapped and nonoverlapped) and helical (varying pitch and slice index) CT. Studies were randomized, blinded, and graded using predetermined criteria by 10 radiologists. Statistical analysis included an assessment of raw image scores, a separate testing using duplicate copies of the conventional images as gold standards, and a multivariate model based upon the results of both scoring systems. RESULTS When assessing raw scores of the images, conventional scans were consistently scored more favorably than helical studies. Decreasing the slice index improved conventional CT studies and helical studies with a pitch of 1.0, but showed no effect on helical studies with a pitch of > 1.0. When using the conventional studies as gold standards, the helical studies were consistently graded as poorer than conventional overlapped and nonoverlapped studies. CONCLUSION For detailed musculoskeletal 3D and MPR work, helical CT may not adequately compare with conventional CT and offers no discernible advantage, particularly for pitches of > 1.0.

Comparison of 1.0-, 1.5-, and 2.0-pitch abdominal helical computed tomography in evaluation of normal structures and pathologic lesions.

RATIONALE AND OBJECTIVES The authors performed a comprehensive prospective clinical trial comparing 1.0-, 1.5-, and 2.0-pitch abdominal helical computed tomography (CT) in the evaluation of normal and pathologic structures/lesions. METHODS Seventy-five consecutive patients were randomized by computer into one of three equal groups: helical CT pitch 1.0, 1.5, and 2.0. The imaging parameters and contrast enhancement of all 75 patients were kept constant. The 75 studies were masked, placed into a randomized order, and evaluated by five separate experienced radiologists who rated visualization of 25 normal structures and up to five pathologic findings per patient using a scale of 1 (not seen) to 5 (very well seen/very sharp margins). RESULTS There were no statistical differences in 1.0- and 1.5-pitch abdominal CT scans when assessing the display of normal and pathologic lesions. In addition, helical pitch 1.0 and 1.5 studies were equivalent for both normal and pathologic structures/lesions, whereas equivalency was not demonstrated for helical pitch 2.0 studies. Overall study assessment questions again found equivalency between helical 1.0- and 1.5-pitch studies. CONCLUSIONS Abdominal CT performed with pitches of 1.0 and 1.5 are equivalent. Because of its advantages, we advocate the routine use of an extended pitch (1.5) in routine abdominal CT. Further studies are required to evaluate the usefulness of the helical 2.0-pitch technique.

Live Monochorionic Adnexal Twin Ectopic Pregnancy

CLINICAL HISTORY A pregnant 30-year-old woman presented with abdominal pain and nausea ongoing for 3 weeks. Her medical history was significant for smoking, an elective abortion in 2004, and biopsy-confirmed endometriosis in 2009. Pertinent surgical history included a left salpingo-oophorectomy due to complicated ovarian dermoid in 2002. She had regular menstrual cycles and no history of abnormal Papanicolaou smear or sexually transmitted disease. The reported first day of her last menstrual period was 3 weeks prior to presentation. She was not on contraceptives. On arrival, she was in mild abdominal discomfort with normal vital signs. Her clinical examination was normal. Quantitative human chorionic gonadotropin (hCG) measured 19,236 IU/L, and a pelvic ultrasound was performed (Figs.AYF). The patient was subsequently treated via uncomplicated laparoscopic removal of the right fallopian tube and associated adnexal mass. A twin ectopic gestation was confirmed within the fimbriated end of the fallopian tube on pathology.