Imaging of noncalcified coronary plaques using helical CT with retrospective ECG gating.
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Biomedical subjects
Publications and source records attributed to B Ohnesorge.
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In this review the technical principles and applications of multi-slice CT are discussed. Multi-slice CT systems allow simultaneous acquisition of up to 4 slices by using multi-row detector systems. Intuitive geometrical arguments are used to establish the limitation to a maximum of 4 slices which is kept by all currently existing multi-slice CT systems. Two different construction principles of the detector are discussed, the "Fixed Array" detector and the "Adaptive Array" detector. The extension of conventional 360 LI and 180 LI spiral interpolation techniques to multi-slice spiral CT is explained as well as a new generalized multi-slice spiral weighting concept, the so-called "Adaptive Axial Interpolation". Several techniques to improve multi-slice spiral image quality are discussed. Finally, some examples for clinical applications are given, and the principle of ECG triggered and ECG gated cardiac examinations with optimized temporal resolution is presented. Multi-slice CT systems are a milestone with respect to increased volume coverage, shorter scan times, improved axial (longitudinal) resolution and better use of the X-ray tube output. Additionally, new clinical applications are possible such as Cardiac CT.
X-ray photons which are scattered inside the object slice and reach the detector array increase the detected signal and produce image artifacts as "cupping" effects in large objects and dark bands between regions of high attenuation. The artifact amplitudes increase with scanned volume or slice width. Object scatter can be reduced in third generation computed tomography (CT) geometry by collimating the detector elements. However, a correction can still improve image quality. For fourth generation CT geometry, only poor anti-scatter collimation is possible and a numeric correction is necessary. This paper presents a correction algorithm which can be parameterized for third and fourth generation CT geometry. The method requires low computational effort and allows flexible application to different body regions by simple parameter adjustments. The object scatter intensity which is subtracted from the measured signal is calculated with convolution of the weighted and windowed projection data with a spatially invariant "scatter convolution function". The scatter convolution function is approximated for the desired scanner geometry from pencil beam simulations and measurements using coherent and incoherent differential scatter cross section data. Several examples of phantom and medical objects scanned with third and fourth generation CT systems are discussed. In third generation scanners, scatter artifacts are effectively corrected. For fourth generation geometry with poor anti-scatter collimation, object scatter artifacts are strongly reduced.
The recent advent of multislice-scanning is the first real quantum leap in computed tomography since the introduction of spiral CT in the early 90s. We discuss basic theoretical considerations important for the design of multislice scanners. Then, specific issues, like the design of the detector and spiral interpolation schemes are addressed briefly for the SOMATOM PLUS 4 Volume Zoom. The theoretical concepts are validated with phantom measurements. We finally show the large potential of the new technology for clinical applications. The concurrent acquisition of multiple slices results in a dramatic reduction of scan time for a given scan technique. This allows scanning volumes previously inaccessible. Similarly, given volumes can be scanned at narrower collimation, i.e. higher axial resolution in a given time. From data acquired at narrow collimation, both high-resolution studies and standard images can be reconstructed in the so-called Combi-Mode. This on the one hand reduces dose exposure to the patient because repeated scanning of a patient is no longer required. On the other hand, standard reconstructions benefit from narrow collimation as Partial Volume Artifacts are drastically suppressed. The rotational speed of 0.5 s of the SOMATOM PLUS 4 Volume Zoom furthermore opens up a whole range of new applications in cardiac CT. For the first time, virtually motion-free images can be acquired even for large volumes in a single breathhold by the combination of fast rotation and ECG triggering, respectively gating. We explain the underlying concepts and present initial results. The paper concludes with a brief discussion of the impact of the new technique on image display and postprocessing.
From 1995 to 1997 11 racehorses, one Hanoverian and one Pony were presented to the clinic with a sudden appearing, very loudly gurgling expiratory respiratory noise. Considering the preliminary report and the clinical and endoscopical findings, as exercise induced dorsal displacement of the soft palate (DDSP) was found to be the cause of the respiratory noise. The 13 horses were treated in general anaesthesia by transendoscopic coagulation of the caudal margin of the soft palate with a Neodym-YAG-Laser. This surgical intervention had to be repeated on four horses with unchanged signs. Eight of 13 horses (62%) did not show any respiratory noises after the operation. These horses were again successfully raced and ridden. Only an improvement was observed in two horses (15%), while in three patients (23%) the respiratory noise was unchanged after surgery. The laser chirurgic approach to the exercise induced DDSP offers, compared to previous therapies important advantages, like shorter recoveries, combined with similar success rates.
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Laryngoscopic examination during sedation was performed on 24 stallions and on their offspring (240 foals and 474 adult horses). Additionally the dams (n = 308) of 35 foals and 216 horses were examined. With the bilateral comparison of the arytaenoid movements the function of the abductory and adductory laryngeal muscles were evaluated and the left abductory dysfunction (idiopathic laryngeal hemiplegia, ILH) was divided into six degrees. The incidence and degree of ILH depended on age and the occurrence of the same dysfunction in the parents. Foals suffered in significantly lower number (24.7 per cent) than adult horses (49.7 per cent). The progeny of unaffected parents suffered significantly less from ILH (8.9 per cent of the foals, 39.6 per cent of the adult offspring) than did comparable progeny of affected parents (41 per cent of the foals, 60.9 per cent of the adult offspring). There was no correlation between the occurrence of ILH and sex. 120 horses were examined laryngoscopically and during work to get an information about the correlation between a visible ILH and the appearance of a typical inspiratory noise. 54.3 per cent of the horses with ILH had a typical inspiratory noise. 80.9 per cent of the horse with a typical inspiratory noise showed ILH.
During a five year experiment on the causes of forest disease, symptoms of visible injury and pest infestations in trees treated with various air pollutants in open-top chambers were observed. Though the long-term experiment was originally not intended to include such investigations, insect infestation and some discoloration of the trees (Beech, Fagus sylvatica; Fir, Abies alba; Spruce, Picea abies) could not be avoided. Abundance and size of some of the insects were measured after two years and at the end of the experiment. Because it was unknown when the first infestation in the chambers occurred, quantitative investigations of the population size provided little information. Visible injury on leaves and needles was infrequent in general. When it occurred, it appeared to be caused by at least three stress factors. However, three different types of symptoms on beech and fir could be attributed mainly to air pollutants. These symptoms consisted of two types of foliar necrosis and browning in beech and needle tip chlorosis in fir. These symptoms have been observed under certain conditions in the German forests. The spruce clone used, however, developed no injuries which could be connected definitely to treatment effects.
The objective of the present study was to analyze the mode of inheritance of guttural pouch tympany (GPT) using pedigrees of Arabian horses. Complex segregation analyses were employed to test for the significance of nongenetic transmission and for monogenic, polygenic, and mixed monogenic-polygenic modes of inheritance. Horses affected by GPT comprised 27 Arabian purebred foals. Of these 27 animals, 22 were patients at the Clinic for Horses, School of Veterinary Medicine Hannover, Hannover, Germany, between 1994 and 2001 and 5 Arabian foals were from stud farms. Information on the pedigrees of these patients allowed us to classify the affected foals into four families with a total of 276 animals. The regressive logistic model analysis took into account the nonrandomness of the pedigrees through multiple single ascertainment correction. The complex segregation analysis showed that, among all other models employed, a polygenic and a mixed monogenic-polygenic model best explained the segregation of Arabian foals with GPT. Models including only nongenetic distributions and monogenic inheritance could be significantly rejected. This is the first report in which a genetic component could be shown to be responsible for GPT in horses.
PURPOSE: Clinical studies indicate that coronary plaque morphology might be differentiated noninvasively using multislice CT by determining tissue density within the lesions. The aim of the present experimental study was to evaluate factors that influence density measurements within small vessels. METHOD: A coronary phantom model was developed, consisting of silicon tubes (lumen diameter 4 mm) with two plaques of known density inside, simulating soft and intermediate lesions (Plaque 1: -39 HU; Plaque 2: 72 HU). Density measurement were conducted in three different contrast medium concentrations (1:30, 1:40, 1:50) and two different slice widths (4 x 2.5 mm, 4 x 1 mm). All scans were performed on a Somatom Volume Zoom (Siemens, Forchheim, Germany). Experimental results were compared with calculated data based on computer simulation. RESULTS: The two plaques could be clearly differentiated from each other on both collimations (4 x 2.5 mm: Plaque 1, 85 +/- 61 HU vs. Plaque 2, 119 +/- 26 HU, p < 0.0001; 4 x 1 mm: Plaque 1, 50 +/- 54 HU vs. Plaque 2, 91 +/- 17 HU, p < 0.0001). Significantly lower and more accurate results were achieved with 1.0 mm collimation (p < 0.0001). Contrast medium concentration contributed significantly to the measurements (p < 0.001). The experimental findings were confirmed by computer simulation, which revealed even more accurate results when using a 0.5 mm collimation (Plaque 1, 0.5 mm: -9 HU vs. 4 x 1 mm: 14 HU, Plaque 2, 4 x 0.5 mm: 83 HU vs. 4 x 1 mm: 93 HU). CONCLUSION: Density measurements were found to be highly dependent on slice width and surrounding contrast enhancement. Our results indicate that standardization of methodology is required before the noninvasive differentiation of human plaque morphology by multislice CT can be applied in the clinical setting as a screening test for coronary soft plaques.
PURPOSE: We introduce a reconstruction method for electrocardiogram (ECG)-gated multislice spiral computed tomography (CT) examinations of the heart [adaptive cardio volume (ACV) reconstruction]. It is evaluated for a four-slice CT system (Siemens Somatom VolumeZoom). METHOD: State-of-the-art reconstruction techniques for ECG-gated multislice spiral CT use scan data from N consecutive heart cycles for image reconstruction. With increased N, the temporal resolution improves up to t rot /(2 N ) ( t rot is the 360 degrees rotation time of the scanner) but at the expense of insufficient volume coverage or loss of longitudinal resolution, especially at low heart rates. With the ACV technique, the number N of consecutive heart cycles used for image reconstruction is automatically adapted to the momentary heart rate of the patient, ranging from N = 1 at very low heart rates up to N = 3 at high heart rates, to maintain both high z resolution (reconstructed slice width close to the collimated slice width) and adequate temporal resolution. We evaluated slice sensitivity profiles and investigated 10 patients with different heart rates ranging from 55 to 110 beats/min for CT angiography (CTA) studies of the coronary arteries and compared the results with those from a reconstruction with fixed N ( N = 1 and N = 2). Axial images as well as multiplanar reformations were used for an evaluation of image quality. RESULTS: With the ACV approach, the complete heart may be scanned at 1 mm slice width within 25-35 s. A narrow slice sensitivity profile (full width at half-maximum of approximately 1.3 mm) is maintained for all heart rates. Diagnostic results can be obtained for heart rates up to about 95 beats/min by individual patient optimization of the ECG gating parameters. Improved temporal resolution at the expense of reduced longitudinal resolution may degrade the image quality of CTA studies at low heart rates by blurring plaques and stenoses. CONCLUSION: The results indicate the potential of the ACV reconstruction technique for high-resolution coronary CTA in a wide range of heart rates.
OBJECTIVES: The authors compared multislice CT angiography and selective angiography for the assessment of coronary artery disease. METHODS: In 28 patients, the presence and degree of coronary artery stenoses were determined in coronary segments prepared with beta-blocker for good image quality with multislice CT. RESULTS: In 187 coronary artery segments, sensitivity, specificity, and negative predictive value for the detection of stenoses >50% with multislice CT angiography were 81%, 90%, and 97%, respectively. The agreement for determining the degree of stenoses with multislice CT angiography and selective coronary angiography was only moderate (kappa = 0.58). CONCLUSIONS: Because of the limited spatial resolution, it is not possible with multislice CT angiography to determine the degree the coronary artery stenoses precisely. However, the high negative predictive value indicates that multislice CT may be a suitable tool to reliably rule out coronary artery disease.