Why settle for less when you can have more with spectral CT?

Why settle for less when you can have more with spectral CT?

November 14, 2018
CT X-Ray
The biggest benefit for patients with spectral CT is that we can make more confident diagnoses using low-contrast tools to get the same information, or even better information, at a low radiation dose. Additionally, radiologists can sometimes miss something on an image due to patient movement or the patient’s circulation being too fast or too slow during the exam. With spectral CT, the radiologists can go back retrospectively to the low energy images (e.g., 40keV) without having to rescan the patient. This also leads to less harmful effects from an additional dose of potentially nephrotoxic intravenous contrast and, ultimately, a faster turnaround on diagnosis, so we can improve patient care.

For example, one important application of dual-energy technology is the amplification of contrast enhancement. In our hospital, if a patient with a diseased heart valve is undergoing a Transcatheter Aortic Valve Implantation (TAVI), a planning CT scan is required. Instead of injecting 150 or 200 mL of contrast with standard CT, we can use our Philips IQon Spectral CT to do a scan of the chest, abdomen and pelvis in 50 mL, because the 40keV spectral images enable us to improve contrast and create the 3D volume-rendered reconstruction of the vessels. The automatic vessel segmentation of IQon Spectral CT software works better than any routine raw data you would get from a standard CT scanner. Using the algorithms that we have specifically in Philips IQon Spectral CT and the 40keV image, we get the contrast boost but not at the expense of increased image noise. The biggest application of spectral CT is in 40keV images because it gives you high image quality without a noise penalty.

How can I best use spectral?

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When talking with my peers about spectral CT, some are hesitant because of the cost or the sheer volume of images produced with spectral versus standard CT. It may seem overwhelming to figure out where to start with the immense amount of data spectral provides. However, it can be broken down in a pragmatic way. When using spectral CT, I recommend to my colleagues that they only need to look at four images: a conventional CT image, a virtual non-contrast image, a 40keV image, and an iodine density image. I have found that the clinical relevance of these four images is routine in approximately 95 percent of patient cases. Each of these images provides different information:
• Conventional CT image – is similar to the image as that from a standard CT scanner, which radiologists are comfortable with and have been trained to use. This can serve as starting point for image interpretation.

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