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Case Reports
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multislice CT
SOMATOM Plus 4
Volume Zoom
S P E C I A L
I S S U E
The drugs and doses mentioned herein are consistent with the approval
labeling for uses and/or indications of the drug. The treating physician bears
the sole responsibility for the diagnosis and treatment of patients, including
but not limited to the parameters selected during image acquisition and
postprocessing and any drugs and doses prescribed in connection with such
use.
Contents
Letter from the Editor
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Pancreatic Carcinoma
Ulrich Baum, MD
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg
Page 14
Page 16
Rectal Carcinoma
Anton Nmayr, MD
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg
Page 18
Rectourethral Fistula
Ulrich Baum, MD
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg
Page 20
Page 22
3
Technical data:
injection.
Slice Collimation
4 x 1 mm
Slice Width
1.25 mm
Recon Increment
0.5 mm
KV
140
mA (mAs/slice)
300 (75)
Pitch
1.5
Kernel
B30
Scan Range
10.5 cm
Scan Time
35 s
Rotation Time
0.5 s
Temporal Resolution
0.25 s
FOV
200 mm
Technical data:
Technical data:
ordered.
Technical data:
The CT examination was performed on SOMATOM Plus 4
Volume Zoom as a follow-up approximately two months
after the initial episode.The arterial phase of the examination
was performed using 1 mm collimation, 500 ms gantry
rotation, pitch 4.5 with slice reconstruction at 1.5 mm thickness every 1.5 mm along the Z-axis.
Results:
The scan shows a right renal artery aneurysm, bilateral
renal infarcts which decreased in size when compared to
the outside examination as well as resolution of the right
perinephric hematoma.
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11
Technical data:
12
13
Pancreatic Carcinoma
History:
Patient preparation:
Results:
Technical data:
Scan
Region
upper abdomen
Scan length
156 mm
Slice collimation
4 x 1 mm
Table feed/rotation
3.5 mm
Pitch
3.5
Scan direction
caudocranial
Rotation time
0.5 s
kV
120
mAs
165
Kernel
B30
Scan time
23 s
Comments:
One of the major advantages of multislice Spiral CT is
that you can acquire an anatomical range with thin slice
(4 x 1 mm) in a reasonable scan time. This provides you
with the possibility of excellent multiplanar reformations
that demonstrate the exact delineation of the tumor
extension in all directions. I. e. the exact determination of
the tumor extension, the differentiation from neighbouring
Contrast Injection
Volume
150 ml (non-ionic
contrast medium)
Concentration
300 mg iodine/ml
Flow rate
3 ml/s
Start delay
40 s
Image reconstruction
Reconstructed slice width
1.25 mm/4 mm
Reconstruction increment
1 mm/3 mm
Postprocessing
Multiplanar reformations
14
Fig. 3: MPR
Vascular infiltration is excluded by curved coronal
MPRs. This images shows normal calibre of the great
peripancreatic veins (portal vein, superior mesenteric
vein, splenic vein). Pay attention to the small line of
fatty tissue between the superior mesenteric vein and
the carcinoma.
Fig. 4: MPR
The MPR allows the exact assessment of anatomic
details of the upper abdomen. Please note the excellent
visualization of the vessels and the gastrointestinal
wall.
15
Image reconstruction
1.25 mm
3 mm
Reconstruction increment
0.8 mm
3 mm
had worsened over the preceding 3 days. She had undergone chemotherapy for Sigmoid carcinoma 3 years previously.
An ultrasound scan examination 4 days prior to presentation
Postprocessing
Multiplanar reformations
Technical data:
Scan
Region
upper abdomen
(Arterial phase)
upper abdomen
(Venous phase)
Scan length
200 mm
200 mm
Slice collimation
4 x 1 mm
4 x 2.5 mm
Table feed/rotation 6 mm
15 mm
Pitch
Scan direction
craniocaudal
caudocranial
Rotation time
0.5 s
0.5 s
kV
120
120
mAs
110
110
Kernel
B30
B30
Scan time
17.57 s
7.47 s
the quality of image postprocessing. Obtaining the coverage desired with the technical factors and collimation
necessary to attain excellent image quality that can only be
achieved with the multislice technology.
A helpful follow-up with careful imaging procedures was
used to evaluate the clinical situation and pathologic changes,
which might critically affect management. For this reason
imaging must be performed to determine the number
of metastases present and their segmental location and
extent, and the relationship of the lesions to the major
venous structures (Fig. 1). Compared with the axial image
(Fig. 2), the MPR image was of paramount importance in
Contrast Injection
Volume
100 ml (non-ionic
contrast medium)
Concentration
300 mg iodine/ml
Flow rate
3 ml/s
Start delay
25 s
50 s
16
Rectal Carcinoma
History:
Image reconstruction
1.25 mm/3 mm
5 mm
Reconstruction increment
1 mm/3 mm
2.5 mm
Postprocessing
Multiplanar reformations
Results:
Technical data:
Regions
(1) Pelvis
(2) Abdomen
Scan length
200 mm
450 mm
Slice collimation
4 x 1 mm
4 x 2.5 mm
10 mm
Pitch
3.5
Scan direction
craniocaudal
craniocaudal
Rotation time
0.5 s
0.5 s
kV
120
120
mAs
150
175
Kernel
B30
B30
Scan time
30 s
23 s
Contrast Injection
Volume
120 ml (non-ionic
contrast medium)
Concentration
300 mg iodine/ml
Flow rate
3 ml/s
Start delay
30 s
18
70 s
19
Rectourethral Fistula
History:
Image reconstruction
1.25 mm/3 mm
Reconstruction increment
1 mm/3 mm
Postprocessing
Multiplanar reformations
Technical data:
Results:
The examination was performed without oral, rectal or
Scan
Region
Pelvis
Scan length
200 mm
Slice collimation
4 x 1 mm
Table feed/rotation
3.5 mm
Pitch
3.5
Scan direction
craniocaudal
Rotation time
0.5 s
kV
120
mAs
150
Kernel
B30
Scan time
30 s
Contrast Injection
Volume
Concentration
300 mg iodine/ml
Flow rate
3 ml/s
Start delay
30 s
Comments:
If MRI is contra-indicated, multislice Spiral CT can be used
for diagnosis of small pelvic fistulas due to its almost
isotropic resolution. The 500 ms rotation time and 4-slice
acquisition per rotation allow thin slice scanning within a
reasonable scan time. Therefore a large anatomical section
can be covered within single breath-hold, and even very
small structures can be depicted with excellent image quality in all planes, i. e. axial and multiplanar reformations.
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21
Image reconstruction
4 mm/1.25 mm
Reconstruction increment
2 mm/1.2 mm
pathology.
Postprocessing
Multiplanar reformations
Technical data:
Results:
Scan
Region
Scan length
Slice collimation
4 x 1 mm
Table feed/rotation
6 mm
Pitch
Scan direction
craniocaudal
Rotation time
0.5 s
kV
140
mAs
130
Kernel
B30
Scan time
quiet breathing: 17 s
Valsalvas manoeuvre: 8 s
e-phonation: 8 s
Contrast Injection
Volume
Concentration
300 mg iodine/ml
Flow rate
2.5 ml/s
Start delay
80 s
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Micheal Lell, MD
U. Joseph Schoepf, MD
Mark E. Baker, MD
Division of Radiology/Hb6
9500 Euclid Avenue
Cleveland, Ohio 44195
USA
Anton Nmayr, MD
Institute of Diagnostic Radiology
University of Erlangen-Nuremberg
Maximiliansplatz 1, D-91054 Erlangen
Germany
Ulrich Baum, MD
Institute of Diagnostic Radiology
University of Erlangen-Nuremberg
Maximiliansplatz 1, D-91054 Erlangen
Germany
Impressum
Published by
International Distribution
CT Marketing
Siemens AG
Medical Engineering
Siemensstrasse 1
91301 Forchheim, Germany
Correspondence
and U.S. Distribution
Barbara Cammisa
Siemens Medical Systems, Inc.
186 Wood Avenue South
Iselin, NJ, 08830, USA
Phone +01 412 351 0803
Fax
+01 732 321 3291
eMail barbara.cammisa@
exchange.sms.siemens.com