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Road to RSNA 2011: CT Preview
By Eric Barnes, AuntMinnie.com staff writer
November 10, 2011

Wide-area detectors, dual-source scanners, fast kV switching, and new contrast protocols that leverage CT's growing spatial and temporal resolution are important sides of the CT picture that will be showcased in presentations at this year's RSNA meeting in Chicago.

But equally important if not more so in 2011 is what's happening on the other side of the photon beam -- the image reconstruction and analysis side. There, researchers are honing techniques that boost the value of data acquisition in ways ranging from iterative reconstruction to material separation, from flow mapping to kV manipulation for reduced radiation dose and contrast.

Monochromatic imaging erases artifacts and makes low-dose scans easier to read. And software is becoming more adept at planning and implementing increasingly complex acquisition protocols. It is wielding image analysis to detect subtle attenuation differences and characterize patterns that better depict disease states, eliminate artifacts, measure tumors volumetrically, compensate for increased noise, and, of course, find pathology that the radiologist might have missed.

Road to RSNA 2011: CT Preview One effect of all this innovation (besides a little transient vertigo) is a blurring of lines over which modality to choose, and when that choice is CT, deciding on the combination of techniques that will render the best result. But there can be little doubt that the picture is improving, to the point where radiologists are sometimes seeing more than they'd like to see.

One intriguing session is a presentation on stress myocardial perfusion scans that match the accuracy of SPECT and MRI (SSC01-03). We're also featuring a study that links pericolonic fat to polyps (SST04-01), and another in which fatty liver disease is never mischaracterized by CT (SSE08-01). Another presentation looks at computer-aided detection via a database in the cloud (LL-INE1216).

Researchers from Germany are getting far better pulmonary embolism (PE) scans using high-pitch DSCT (MSVE21-10), and it's a win-win because patients don't have to stop breathing, and radiologists don't have to deal with the anatomic distortions that accompany the breath-hold. Meanwhile U.S. researchers quantify perfusion defects at PE and associate the results with patient outcomes (SSE05-04).

One study measures neoangiogenesis in liver tumors, distinguishing it from normal vasculature (SSG05-05). Another pits coronary artery calcium scoring against coronary CT angiography for diagnosis (SSA02-01).

Finally, a couple of overview presentations are must-sees, including Dr. Geoffrey Rubin's keynote speech on new developments in CT (PS10), and Dr. Ronald Boucher and colleagues' talk on life, death, and radiology in wartime Afghanistan (RC124), both on Sunday.

This being the RSNA meeting, you won't be able to see half of what piques your interest, but we hope this preview will help get you started. For more information, check out the RSNA's online program.

Scientific and Educational Presentations
Mature CT angiography looks to new frontiers
Sunday, November 27 | 8:30 a.m.-10:15 a.m. | PS10 | Arie Crown Theater
As part of the RSNA president's address and opening panel on Sunday morning, Dr. Geoffrey Rubin will look at the history of CT angiography (CTA) as a prologue to its future. CTA has more work to do and more frontiers to explore, according to Rubin, who is chairman of radiology at Duke University.
CCTA outpaces calcium scoring in acute chest pain
Sunday, November 27 | 10:45 a.m.-10: 55 a.m. | SSA02-01 | Room S502AB
There is little value in coronary artery calcium scoring by itself in patients presenting with acute chest pain. In a head-to-head comparison, it's clear that only coronary CTA (CCTA) can replace angiography in diagnosing these patients, according to researchers from Italy.
Single-pass triphasic body technique improves multitrauma scanning
Sunday, November 27 | 10:45 a.m.-10:55 a.m. | SSA05-01 | Room N227
A triphasic, single-pass, whole-body scanning protocol is better than the conventional method of scanning multitrauma patients, researchers from Chaim Sheba Medical Center in Ramat Gan, Israel, will report at the RSNA 2011 meeting.
Automated kV cuts abdomen dose the easy way
Sunday, November 27 | 11:05 a.m.-11:15 a.m. | SSA08-03 | Room E450B
A study from Massachusetts General Hospital has shown that automated kV selection is feasible, providing the benefits of lower kV imaging without complicated protocols.
CT perfusion inadequate to detect basilar artery occlusion
Sunday, November 27 | 11:25 a.m.-11:35 a.m. | SSA16-05 | Room N226
CT perfusion imaging of the brain is often used in acute stroke centers to aid in diagnosing and characterizing acute stroke. But it doesn't work as well in the brainstem: A new study has found that CT perfusion alone is inadequate to detect basilar artery occlusion.
HR-pQCT helpful in osteogenesis imperfecta patients at risk of severe fracture
Sunday, November 27 | 11:45 a.m.-11:55 a.m. | SSA14-07 | Room E451B
High-resolution peripheral quantitative CT (HR-pQCT) is compared to dual-energy x-ray absorptiometry (DEXA) in patients with osteogenesis imperfecta in this presentation by Austrian researchers. They found that CT does a better job than conventional DEXA bone mineral density scans of characterizing bone structure and the risk of fracture.
Military radiologists report on experiences in Afghanistan
Sunday, November 27 | 2:00 p.m.-3:30 p.m. | RC124 | Room N229
Navy physicians Dr. Ron Boucher and Dr. Steve Ferrara recently returned from deployment to the Kandahar Air Base in southern Afghanistan armed with gripping stories and images of wartime radiology. The presentation will show the efforts of U.S. and coalition medical teams operating in the country as they care for coalition forces, as well as Afghan military personnel and many civilians.
Newer readers need contrast for acute appendix
Monday, November 28 | 9:00 a.m.-9:10 a.m. | MSVE21-02 | Room E353A
How important is contrast for diagnosing suspected appendicitis? Researchers from New York University's Langone Medical Center and department of radiology conducted a novel study that examined appendiceal visualization rates in the same patient with and without oral and IV contrast.
Perfusion quantified in normal, infarcted myocardium
Monday, November 28 | 10:50 a.m.-11:00 a.m. | SSC01-03 | Room S502AB
A new CT study from the Medical University of South Carolina found significant differences in myocardial perfusion parameters for ischemic and infarcted myocardium compared with normal myocardium.
Monochromatic images erase beam-hardening artifacts
Monday, November 28 | 11:10 a.m.-11:20 a.m. | SSC16-05 | Room S403B
Synthesized monochromatic imaging with fast kV switching at 40 keV to 70 keV may boost the magnitude and uniformity of aortic enhancement for a wide range of body sizes, say researchers at Duke University.
High-pitch, free-breathing DSCT improves pulmonary embolism assessment
Monday, November 28 | 11:20 a.m.-11:30 a.m. | MSVE21-10 | Room E353A
High-pitch CT pulmonary angiography with dual-source CT (DSCT) in freely breathing patients consistently provides diagnostic image quality, suppresses artifacts, and has the potential to further reduce contrast material usage, according to new research from Goethe University.
Liver CT shows high accuracy in steatosis assessment
Monday, November 28 | 3:00 p.m.-3:10 p.m. | SSE08-01 | Room E450B
Unenhanced CT is highly specific for detecting and characterizing steatosis or fatty liver, according to researchers from the University of Wisconsin, in cooperation with Dr. Seong Ho Park and colleagues from Asan Medical Center.
CT equivalent to MRI in evaluating ventricular size, function
Monday, November 28 | 3:10 p.m.-3:20 p.m. | SSE03-02 | Room S502AB
Ventricular size and function are important for diagnosing and managing patients with several conditions. Fortunately, dual-source CT has caught up to the reference standard, MRI, for the task, say researchers from the Medical University of South Carolina.
Extent of perfusion defects predicts PE outcomes
Monday, November 28 | 3:30 p.m.-3:40 p.m. | SSE05-04 | Room S404CD
Quantifying perfusion defects at dual-energy CT helps identify pulmonary embolism (PE) patients at risk of adverse outcomes and should be part of their risk assessment, say investigators from the University of Munich.
CT approaches IVUS in plaque detection
Monday, November 28 | 3:30 p.m.-3:40 p.m. | SSE03-04 | Room S502AB
A study comparing CT to intravascular ultrasound (IVUS) for plaque detection found that CT isn't quite ready to take on ultrasound -- but it's not far off, the authors concluded.
Dual-energy measurements aid electronic cleansing in VC
Tuesday, November 29 | 10:30 a.m.-10:40 a.m. | SSG13-01 | Room S403A
A study of dual-energy index values at the boundary between colonic mucosa and air found significant enough differences between components of the bowel lumen to develop new virtual colonoscopy computer-aided detection schemes that will be more accurate than current-generation systems that rely on CT attenuation values.
Krypton replaces xenon for patient-friendly ventilation lung scan
Tuesday, November 29 | 10:40 a.m.-10:50 a.m. | SSG03-02 | Room S504AB
Ventilation lung scans with high-resolution CT can be used to examine lung morphology and function in patients with chronic obstructive pulmonary disease. Replacing xenon with stable krypton gas might make the procedure easier for patients to complete, according to a new study.
Myocardial perfusion stress CT moves to clinical use
Tuesday, November 29 | 10:50 a.m.-11:00 a.m. | SSG02-03 | Room S503AB
Cardiac CT is ready for the comprehensive assessment of coronary artery disease in routine clinical use, say researchers from the Medical University of South Carolina. In the group's initial experience applying myocardial perfusion CT to a clinical population with acute chest pain, the technique detected myocardial perfusion defects just as well as the reference standards, MRI and SPECT.
CT perfusion quantifies neoangiogenesis in HCC tumors
Tuesday, November 29 | 11:10 a.m.-11:20 a.m. | SSG05-05 | Room E353C
Researchers in Italy believe that CT perfusion can noninvasively quantify tumor blood supply in hepatocellular carcinoma (HCC) that relates to tumor neoangiogenesis, a process that is essential for tumor growth. The knowledge will help doctors better assess the disease and strategize treatment options, they said.
2-hour prep may ease VC scheduling after optical colonoscopy
Tuesday, November 29 | 3:40 p.m.-3:50 p.m. | SSJ08-05 | Room E450B
When a conventional colonoscopy fails to reach the cecum, virtual colonoscopy is a logical choice to complete the screening. But it can be difficult to refer these patients to VC fast enough to avoid a second bowel cleaning. Fortunately, a two-hour prep might be effective enough to spare the patient an extra trip to the clinic, according to a study being presented in a Tuesday session on VC techniques.
Heavy-metal contrast cuts radiation dose
Wednesday, November 30 | 3:10 p.m.-3:20 p.m. | SSM20-02 | Room S404AB
Compared with some heavy metals, iodine and barium simply don't produce enough contrast in CT to optimize dose, according to medical physicist Tristan Nowak, from the Institute of Medical Physics at Friedrich-Alexander-University Erlangen-Nuremberg. In a study to be presented Wednesday afternoon, his group tested several heavy metals in phantoms in the search for an eventual replacement.
Pericolonic fat associated with adenomatous polyps
Friday, December 2 | 10:30 a.m.-10:40 a.m. | SST04-01 | Room E350
Patients with adenomatous colorectal polyps have higher fat volume fractions than patients without these polyps, according to a multipurpose virtual colonoscopy scan. The pairing sounds obvious enough, but researchers from Bethesda, MD, believe the results suggest that pericolonic fat itself may be the culprit behind adenoma growth.
Mobile cloud powers CAD for colon cancer screening
Educational Exhibit | LL-INE1216 | Lakeside Learning Center
A lunchtime continuing medical education session will be held this year to demonstrate a high-resolution mobile display of virtual colonoscopy powered by a cloud-based computer-aided detection (CAD) system.

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