Computed Tomographic Angiography

  • M. S. van Leeuwen
  • L. J. Polman
  • J. Noordzij
  • B. Velthuis
  • P. F. G. M. van Waes
Conference paper

Abstract

Computed tomographic angiography (CTA) is a vascular imaging technique based on the rapid acquisition of volumetric CT data during the bolus phase of intravenously administered contrast [1–3]. CTA is a recent diagnostic technique and is still under development. Only preliminary studies on its diagnostic value have been performed. In this chapter the technique is described and the clinical experience of various research groups with a number of specific CTA applications is discussed. The latest generation of CT scanners are equiped with slip-ring current and data transfer. This makes it possible to rotate the assembly of X-ray tube and X-ray detectors continuously. During this continuous rotation the patient can be moved at a constant speed through the plane of the X-ray tube and detectors. The simultaneous linear movement of the patient and continuous rotation of the X-ray tube creates a helical path of the X-ray beam relative to the patient’s longitudinal axis. From the continuous, helical data acquisition, axial CT slices can be reconstructed at any desired location along the longitudinal axis of the examined volume. Overlapping slices can be reconstructed with no additional radiation to the patient, improving anatomic resolution in the longitudinal direction and enabling image reconstructions to be performed in any desired plane [4, 5]. The quality of these reconstructions is markedly improved from conventional CT due to the continuous helical data acquisition. In conventional CT, data acquisition and subsequent table transport takes 6–12 s for each slice. With helical CT a full rotation usually takes 1 s and, depending on the capacity of the X-ray tube, up to 50 rotations can be acquired in one scan. Therefore, the time needed to image a large number of overlapping slices is dramatically reduced. Vascular detail is optimized because the entire volume of interest is scanned at peak vascular enhancement during a single breath-hold.

Keywords

Catheter Attenuation Heparin Respiration Iodide 

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References

  1. 1.
    Napel S, Marks MP, Rubin GD, Dake MD et al. (1992) CT Angiography with spiral CT and maximum intensity projection. Radiology 185: 607–610PubMedGoogle Scholar
  2. 2.
    Rubin GD, Dake MD, Napel SA, McDonnel CH, Jeffrey RB Jr (1993) Three-dimensional spiral CT angiography of the abdomen: initial clinical experience. Radiology 186: 147–152PubMedGoogle Scholar
  3. 3.
    Dillon EH, van Leeuwen MS, Fernandez MA, Mali WPTM (1993) Spiral CT angiography. AJR 160: 1273–1278PubMedGoogle Scholar
  4. 4.
    Kalender WA, Seissler W, Klotz E, Vock P (1990) Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology 176: 181–183PubMedGoogle Scholar
  5. 5.
    Crawford CR, King KF (1990) Computed tomography scanning with simultaneous patient translation. Med Phys 17: 967–982PubMedCrossRefGoogle Scholar
  6. 6.
    Barnes JE (1992) Characteristics and control of contrast in CT. RadioGraphics 12: 825–837PubMedGoogle Scholar
  7. 7.
    Polacin A, Kalender WA, Marchai G (1992) Evaluation of section sensitivity profiles and image noise in spiral CT. Radiology 185: 29–35PubMedGoogle Scholar
  8. 8.
    Vahlensieck M, Lang Ph, Chan WP, Grampp S, Genant HK (1992) Three-dimensional reconstruction, part I: applications and techniques. Eur Radiol 2: 503–507CrossRefGoogle Scholar
  9. 9.
    NASCET Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445–453Google Scholar
  10. 10.
    ECST Collaborators (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337: 1235–1243Google Scholar
  11. 11.
    Grzyska U, Freitag J, Zeumer H (1990) Selective cerebral intraarterial DSA. Neuroradiology 32:296–299Google Scholar
  12. 12.
    Davies KN, Humphrey PR (1993) Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound. J Neurol Neurosurg Psychiatry 56: 967–972PubMedCrossRefGoogle Scholar
  13. 13.
    Masaryk TJ, Obuchowsky N (1993) Noninvasive carotid imaging: caveat emptor. Radiology 186:325‱328Google Scholar
  14. 14.
    Schuler JJ, Flanigan DP, Lim LT, Keifer T et al. (1982) The effect of carotid siphon stenosis on stroke rate, death, and relief of symptoms following elective carotid endarterectomy. Surgery 92: 1058–1067PubMedGoogle Scholar
  15. 15.
    Schwartz RB, Jones KM, Chernoff DM, Mukherji SK et al. (1992) Common carotid bifurcation: evaluation with spiral CT. Radiology 185: 513–519PubMedGoogle Scholar
  16. 16.
    Dillon EH, van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WPTM (1993) CT angiography: application to the evaluation of carotid artery stenosis. Radiology 189: 211–219PubMedGoogle Scholar
  17. 17.
    Marks MP, Napel S, Jordan JE, Enzmann DR (1993) Diagnosis of carotid artery disease: preliminary experience with maximum-intensity-projection spiral CT angiography. AJR 160: 1267–1271PubMedGoogle Scholar
  18. 18.
    Castillo M (1993) Diagnosis of disease of the common carotid artery bifurcation: CT angiography vs catheter angiography. AJR 161: 395–398PubMedGoogle Scholar
  19. 19.
    Inagawa T, Kamiya K, Ogasawara H, Yano T (1987) Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28: 93–99PubMedCrossRefGoogle Scholar
  20. 20.
    Van Gijn J (1992) Subarachnoid haemorrhage. Lancet 339: 653–655PubMedCrossRefGoogle Scholar
  21. 21.
    Kassel NF, Torner JC, Haley EC Jr, Jane JA et al. (1990) The International Cooperative Study on the Timing of Aneurysm Surgery, part 1: overall management results. J Neurosurg 73: 18–36CrossRefGoogle Scholar
  22. 22.
    Hijdra A, Braakman R, Van Gijn J, Vermeulen M, Van Crevel H (1987) Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population. Stroke 18: 1061–1067PubMedCrossRefGoogle Scholar
  23. 23.
    Kassel NF, Torner JC, Jane JA, Haley EC Jr, Adams HP (1990) The international co-operative study on the timing of aneurysm surgery, part 2: surgical results. J Neurosurg 73: 37–47CrossRefGoogle Scholar
  24. 24.
    Öhman J, Heiskanen 0 (1989) Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg 70: 55–60PubMedCrossRefGoogle Scholar
  25. 25.
    Schmid UD, Steiger HJ, Huber P (1987) Accuracy of high resolution computed tomography in direct diagnosis of cerebral aneurysms. Neuroradiology 29: 152–159PubMedCrossRefGoogle Scholar
  26. 26.
    Aoki S, Sasaki Y, Machida T, Ohkubo T et al. (1992) Cerebral aneurysms: detection and delineation using 3-D-CT angiography. AJNR 13: 1115–1120PubMedGoogle Scholar
  27. 27.
    Dalen JE, Alpert JS (1975) Natural history of pulmonary embolism. Prog Cardiovasc Dis 17: 259–270PubMedCrossRefGoogle Scholar
  28. 28.
    Mant MJ, Thong KL, Birtwhistle RV, O’Brien BD et al. (1977) Haemorrhagic complications of heparin therapy. Lancet 1: 1133–1135PubMedCrossRefGoogle Scholar
  29. 29.
    PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263: 2753–2759CrossRefGoogle Scholar
  30. 30.
    Mills SR, Jackson DC, Older RA, Heaston DK, Moore AV (1980) The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology 136: 295–299PubMedGoogle Scholar
  31. 31.
    Remy-Jardin M, Remy J, Wattinne L, Giraud F (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath technique: comparison with pulmonary angiography. Radiology 185: 381–387PubMedGoogle Scholar
  32. 32.
    Sinner WN (1987) Computed tomography patterns of pulmonary thromboembolism and infarction. J Comput Assist Tomogr 2:395‱399Google Scholar
  33. 33.
    Godwin JD, Webb WR, Gamsu G, Ovenfors C-O (1980) Computed tomography of pulmonary embolism. AJR 135: 691–695PubMedGoogle Scholar
  34. 34.
    DCarlo LA Jr, Schiller NB, Herfkens RL, Brundage BH, Lipton MJ (1982) Noninvasive detection of proximal pulmonary artery thrombosis by two-dimensional echocardiography and computerized tomography. Am Heart J 104: 879–881CrossRefGoogle Scholar
  35. 35.
    Breatnach E, Stanley RJ (1984) CT diagnosis of segmental pulmonary artery embolus. J Comput Assist Tomogr 8:762‱764Google Scholar
  36. 36.
    Chintapalli K, Thorsen K, Olson DL, Goodman LR, Gurney J (1988) Computed tomography of pulmonary thromboembolism and infarction. J Comput Assist Tomogr 12: 533–559CrossRefGoogle Scholar
  37. 37.
    Kalebo P, Wallin J (1989) Computed tomography in massive pulmonary embolism. Acta Radiol [Diag] (Stockh) 30: 105–107CrossRefGoogle Scholar
  38. 38.
    Ren H, Kuhlman JE, Hruban RH, Fishman EK et al. (1990) CT of inflation-fixed lungs: wedge-shaped density and vascular sign in the diagnosis of infarction. J Comput Assist Tomogr 14: 82–86PubMedCrossRefGoogle Scholar
  39. 39.
    Erol C, Candan I (1993) Non-invasive methods in the diagnosis of chronic major-vessel thromboembolic pulmonary hypertension. Eur Heart J 14: 1004–1005PubMedCrossRefGoogle Scholar
  40. 40.
    Verschakelen JA, Vanwijck E, Bogaert J, Baert AL (1993) Detection of unsuspected central pulmonary embolism with conventional contrast-enhanced CT. Radiology 188: 847–850PubMedGoogle Scholar
  41. 41.
    Tardivon AA, Musset D, Maitre S, Brenot F et al. (1993) Role of CT in chronic pulmonary embolism: comparison with pulmonary angiography. J Comput Assist Tomogr 17: 345–351PubMedCrossRefGoogle Scholar
  42. 42.
    Teigen CL, Maus TP, Sheedy PFII, Johnson CM, Stanson AW, Welch TJ (1993) Pulmonary embolism: diagnosis with electron-beam CT. Radiology 188: 839–845PubMedGoogle Scholar
  43. 43.
    Costello P, Gaa J (1993) Spiral CT angiography of the abdominal aorta and its branches. Eur Radiol 3: 359–365CrossRefGoogle Scholar
  44. 44.
    Costello P, Dupuy DE, Ecker CP, Tello R (1992) Spiral CT of the thorax with reduced volume of contrast material: a comparative Study. Radiology 183: 663–666PubMedGoogle Scholar
  45. 45.
    Balm R, Eikelboom BC, van Leeuwen MS, Noordzij J Spiral (1994) CT-Angiography of the Aorta Eur J Vase Surg 8: 544–551CrossRefGoogle Scholar
  46. 46.
    Galanski M, Prokop M, Chavan A, Schaefer CM et al. (1993) Renal arterial stenoses: spiral CT angiography. Radiology 189: 185–192PubMedGoogle Scholar
  47. 47.
    Rubin GD, Dake MD, Napel S, Jeffrey RB Jr et al. (1994) Spiral CT of renal artery stenosis: comparison of three-dimensional rendering of techniques. Radiology 190: 181–189PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • M. S. van Leeuwen
    • 1
  • L. J. Polman
    • 1
  • J. Noordzij
    • 1
  • B. Velthuis
    • 1
  • P. F. G. M. van Waes
    • 1
  1. 1.Department of Radiotherapy and Nuclear MedicineUniversity Hospital UtrechtUtrechtThe Netherlands

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