Kettering Network Radiologists, Inc.

KNRI is the premier radiology practice in Southwestern Ohio, offering board certified, fellowship trained physician expertise partnered with state-of-the-art Hospital Networks and Imaging Facilities. Our radiologists provide the highest quality patient care and referring physician consultations with excellent results delivery.

CT Angiography Redefining Vascular Imaging

May 14, 2015

Multidetector CT angiography has redefined vascular imaging. There is a shift from axial to more volumetric imaging and Multidetector CT scanning is leading this shift. Multidetector CT scanning allows larger volumes to be scanned in less time due to software improvements. Not only is the vascular anatomy being seen well enough to eliminate the need for a catheter based angiography for initial diagnostic evaluation, it also allows different vascular phases to be evaluated with respect to the arterial, capillary and/or parenchymal phase and the venous phases with one contrast bolus.

Multidetector CT Scanners:

  • Utilize a single x-ray source,
  • A fan shaped x-ray beam, and
  • Multiple detectors in the CT scanner gantry.

Multidetector CT Scans result in isotropic voxel acquisition, which produce a significant volume data set. This data can then be manipulated by software to yield high quality multiplanar reconstructions. (Isotropic data allow reformatting of images in any plane with spatial resolution identical to the original scanning plane.)

The diagnostic benefit of Multidetector CT Scans is the post scan image processing which manipulates the 500 to 1,000 axial images. These images (isotropic data) can be processed in multiplanar reconstruction algorithm, which allows one to display the volume in coronal and sagittal planes as well as transaxial planes. Three dimensional images and maximum intensity projections can produce multiplanar images for further evaluation. Being able to rapidly review the images on robust viewing software (PACS) is critical.

Clinical applications:

Multidetector CT scanning of the abdomen allows for evaluation for endovascular therapies, oncologic treatment, transplant surgery and multisystem trauma. If vascular evaluation is warranted the aorta and its branch vessels can be easily demonstrated in the acute and nonacute settings to evaluate pathological etiologies such as embolic phenomenon and aneurysmal disease.

Vascular imaging requires a reliable venous access that has contrast boluses of 3 to 5 ml/s with a saline chaser bolus. Timing of the scan with respect to contrast bolus is crucial and bolus detection technology allows imaging in the appropriate vascular phase.

Venous abnormalities and arterial anomalies can also be evaluated non-evasively. Carotid, vertebral basilar as well as aortic arch and branch vessel anomalies are easily evaluated with CT angiography. Vascular stenosis and aneurysmal disease are demonstrated as seen in catheter-based studies, however also due to three dimensional multiplanar capabilities the vessels can be viewed as never before. The integrity of the plaque is to also be more carefully evaluated and this would be applicable also to determine if plaque is at risk for more acute rupture.

Arterial imaging is now moving into the forefront. Non-evasive evaluation of the coronary arteries is replacing catheter based diagnostic studies in many cases. Once again, coronary plaque characterization to determine those patients at risk for acute coronary syndrome as well to follow patients on lipid therapy to evaluate for plaque remodeling has become an important component in the battle against vascular disease.

Peripheral vascular disease patients can now undergo CT angiography in lieu of catheter-based angiography. A map of the vascular disease can be thoroughly evaluated with an intravenous injection rather than a more invasive procedure and based on the pathologies identified; a plan can be developed for therapeutic options prior to intervention. Intervention can then be tailored to target the lesion in question and limit the amount of time the patient has catheter-based intervention. In summary, Multidetector CT angiography has revolutionized cardiovascular imaging and will continue to improve the evaluation of patients prospectively to allow physicians to intervene and prevent vascular complications. Technology Upgrade, April 2007: The Imaging Centers proudly announce the availability of Multidetector CT Scanning Special Thanks to Tom Kracus, Imaging Specialist/Consultant For assistance with the Imaging shown in this report.