Comparison of noise-optimized linearly blended images and noise-optimized virtual monoenergetic images evaluated by dual-source, dual-energy CT in cardiac vein assessment

Cardiac Computed Tomography Identification of the Septal Vein-A Small Retrospective Study

BACKGROUND

The advancement of medical interventions towards minimally invasive procedures highlights the crucial role of precise pre-procedural evaluation, particularly in catheter-based treatments for heart and cardiovascular conditions. This study investigates innovative techniques such as mitral loop cerclage (MLC) and transcatheter intramyocardial radiofrequency ablation (TIRA), emphasizing the importance of preprocedural cardiac CT scans for accurate anatomical guidance in these emerging therapies.

PURPOSE

The objective of this study was to assess the cardiac cycle through examination of the proximal septal vein (ps) for mitral loop cerclage and the distal septal vein (ds) for transcatheter intramyocardial radiofrequency ablation.

MATERIALS AND METHODS

Forty patients (mean age 59.4 ± 14.7 years) undergoing third-generation dual-source computed tomography (DSCT) for chest pain evaluation were enrolled. CT scans, utilizing dual-energy CT (DECT) with iopamidol and saline, encompassed the carina to the heart base. A noise-optimized linear blended image was reconstructed at 10% intervals throughout the cardiac cycle, and the presence of ps and ds in each phase was noted by two radiologists.

RESULTS

This study identified ps in 62.5% and ds in 72.5% of patients, with both present in 45% of cases. The observation of septal veins occurred more frequently in the sequence of 70, 60, 40, 80, 30, 20, and 10% for ps, and 60, 70, 40, 80, 30, 90, 20, and 10% for ds, respectively.

CONCLUSIONS

DECT in cardiac imaging is instrumental in assessing septal vein frequency. The 70% phase is optimal for MLC, while the 60% phase is preferred for TIRA.

Value of dual-source CT dual-energy parameters combined with serum detection of VEGF and CEA in the diagnosis of early lung cancer

To discuss the value of dual-source CT dual-energy parameters combined with serum detection of vascular endothelial growth factor (VEGF) and carcinoembryonic antigen (CEA) in the diagnosis of early lung cancer (LC). In total, 100 patients with lung lesions in our hospital from January 2020 to January 2022 were selected for retrospective study, and were divided into the lung cancer group (group A) and benign lung disease group (group B) according to the final results of pathological diagnosis, using dual-source CT dual-energy scanning combined with serum detection of VEGF and CEA to analyze the diagnostic values of single detection and combined detection. Among the 100 patients with lung lesions, there were 58 patients with LC and 42 patients with benign lung diseases after pathological examination, with no statistical difference in normalized iodine concentration (NIC) and the increased value of iodine at arterial phase between the two groups (P > 0.05). The NIC value of group A was higher than group B at venous phase (P < 0.05). The serum levels of VEGF and CEA in group A were higher than group B (P < 0.05). The area under the curve, specificity, sensitivity, Youden index and 95% CI of combined diagnosis were higher than single detection of NIC, VEGF and CEA at venous phase. The combined application of dual-source CT dual-energy parameters and serum detection of VEGF and CEA has higher diagnostic value in patients with early LC, which can provide effective reference for clinical diagnosis and treatment, with higher application value in clinic.

Noise-optimized virtual monoenergetic imaging technology of the third-generation dual-source computed tomography and its clinical applications

The third-generation dual-source computed tomography (DSCT) is among the most advanced imaging methods. It employs noise-optimized virtual monoenergetic imaging (VMI+) technology. It uses the frequency-split method to extract high-contrast image information from low-energy images and low-noise information from images reconstructed at an optimal energy level, combining them to obtain the final image with improved quality. This review is the first to summarize the results of clinical studies that primarily and recently evaluated the VMI+ technique based on tumor, blood vessel, and other lesion classification. We aim to assist radiologists in quickly selecting the appropriate energy level when performing image reconstruction for superior image quality in clinical work and providing several ideas for future scientific research of the VMI+ technique. Presently, VMI+ reconstruction is mostly used for images of various tumors or blood vessels, including coronary plaques, coronary stents, deep vein thromboses, pulmonary embolisms (PEs), active arterial hemorrhages, and endoleaks after endovascular aneurysm repair. In addition, VMI+ has been used for imaging children's heads, liver lesions, pancreatic lacerations, and reducing metal artifacts. Regarding the reconstruction at the optimal energy level, the VMI+ technique yielded a higher image quality than the pre-optimized virtual monoenergetic imaging (VMI) technique and single-energy CT. Moreover, either low concentrations of contrast medium or low iodine injection rates can be applied before VMI+ reconstruction at a low-energy level to reduce contrast agent-related kidney injury risk. After reconstructing an image at the optimal energy level, both the image's window width and level can also be adjusted to improve the image effect's reach and diagnosis suitability. To improve image quality and lesion-imaging clarity and reduce the use of contrast agents, VMI+ reconstruction technology has been applied clinically, in which the selection of energy level is the key to the whole reconstruction process. Our review summarizes these optimal levels for radiologists' reference and suggests new ideas for the direction of future VMI+ research.