Imaging Pearls ❯ Dual Energy ❯ Head and Neck
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- Carotid CT Angiography: Challenges
- Acquisition timing
- Venous contamination
- Difficulty in segmenting vascular structures from the skull base
- Artifacts generated by bone removal algorithms - “ The use of CT arteriography for the evaluation of carotid atherosclerosis is justified as an accurate and cost effective alternative to DSA and MR angiography.”
Dual-Energy CT: Vascular Applications
Vlahos I et al.
AJR 2012; 199:S87-S97 - Bone removal techniques for Carotid CTA
- Threshold based bone subtraction
- Unenhanced mask bone subtraction
- Dual energy CT - “ Dual energy bone subtraction for cervical CT arteriography compares very favorably to threshold-based bone subtraction. Early studies confirmed that dual energy bone subtraction was faster and more accurate versus threshold based bone subtraction without user modification (88% vs 7% technically adequate).”
Dual-Energy CT: Vascular Applications
Vlahos I et al.
AJR 2012; 199:S87-S97 - “ In comparison with DSA, dual energy bone subtraction including plaque removal shows good intertechnique correlation (r>0.9), although possible mild overestimation of stenosis with dual energy bone subtraction is possible, particularly in distinguishing severely stenotic and completely occluded vessels.”
Dual-Energy CT: Vascular Applications
Vlahos I et al.
AJR 2012; 199:S87-S97