Dual Energy Computertomographie

Der Hintergrund der beiden vorliegenden Studien war eine objektive Betrachtung neuentwickelter Methoden der modernen bildgebenden Diagnostik hinsichtlich der Strahlenbelastung für den menschlichen Organismus. Mit der Einführung der Dual Source Computertomographen eröffnete sich ein weites Spektrum an neuen diagnostischen Möglichkeiten. Durch den simultanen Betrieb der um 90° versetzt angeordneten Röntgenquellen lassen sich bewegungsartefaktfreie Schichtauf-nahmen mit hoher zeitlicher und räumlicher Auflösung erzeugen, welche der schnellen Ursachendiagnostik im Bereich der Akutmedizin bei Thoraxschmerz-Patienten zu Gute kommt. Der Dual Energy Modus, in welchem die Röntgenquellen mit unterschiedlichen Energien betrieben werden, erlaubt eine Materialdifferenzierung, was eine Unterscheidung von beispielsweise Knochen, Jod oder anderen organischen Materialien ermöglicht. [6-17] Dass diese technischen Neuerungen einen weiteren wertvollen Beitrag zur klinischen Diagnostik leisten können, steht angesichts der vielfältigen Einsatzmöglichkeiten außer Frage. Es galt jedoch nachzuweisen, dass diese neuen Verfahren nicht zu einer zusätzlichen Strahlenbelastung im Vergleich zu den bisher verwendeten Methoden zu Lasten der untersuchten Patienten führen. Durch die Verwendung eines anthropomorphen Phantoms und geeigneter Detektoren konnten die resultierenden Strahlenbelastungen der unterschiedlichen Untersuchungsprotokolle auf den menschlichen Organismus quantifiziert werden. Für die Durchführung der Dual Energy Protokolle konnte im Vergleich zu den standardmäßigen Computertomographie-Untersuchungen eine Dosisneutralität bei vergleichbarer Bildqualität und deutlich verbessertem Kontrast-zu-Rausch Verhältnis nachgewiesen werden. Das Dual Energy Protokoll kommt heute unter anderem routinemäßig bei Patienten mit klinischem Verdacht auf eine Pulmonalarterien-Embolie zur Anwendung. Ein wichtiger Erfolg in Bezug auf die Dosiseinsparung konnte durch die Einführung des Triple-Rule-Out Protokolls erreicht werden. Hierbei lassen sich nun unterschiedliche Fragestellungen aus der Akutmedizin bei Patienten mit akutem Thoraxschmerz wie Myokardinfarkt, Lungenarterienembolie oder Aortendissekation, in einer einzigen Untersuchung mit hoher Präzision und einem Bruchteil der bisher benötigten Strahlendosis beantworten

CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR

Objectives: To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease. Design: Prospective, non-randomised, diagnostic study. Setting: Academic hospital-based study. Patients: 65 patients (42 men age 70.4 +/- 9) with typical or atypical chest pain. Interventions: CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis. Main outcome measures: We tried to correlate haemodynamically relevant stenosis (FFR <0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis. Results: Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone. Conclusions: Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function

Polymer transport in random flow

The dynamics of polymers in a random smooth flow is investigated in the framework of the Hookean dumbbell model. The analytical expression of the time-dependent probability density function of polymer elongation is derived explicitly for a Gaussian, rapidly changing flow. When polymers are in the coiled state the pdf reaches a stationary state characterized by power-law tails both for small and large arguments compared to the equilibrium length. The characteristic relaxation time is computed as a function of the Weissenberg number. In the stretched state the pdf is unstationary and exhibits multiscaling. Numerical simulations for the two-dimensional Navier-Stokes flow confirm the relevance of theoretical results obtained for the delta-correlated model.Comment: 28 pages, 6 figure

CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR

Objectives: To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease. Design: Prospective, non-randomised, diagnostic study. Setting: Academic hospital-based study. Patients: 65 patients (42 men age 70.4 +/- 9) with typical or atypical chest pain. Interventions: CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis. Main outcome measures: We tried to correlate haemodynamically relevant stenosis (FFR <0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis. Results: Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone. Conclusions: Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function

Increased Pericardial Adipose Tissue in Smokers

Background: Pericardial adipose tissue (PAT), a visceral fat depot directly located to the heart, is associated with atherosclerotic and inflammatory processes. The extent of PAT is related to the prevalence of coronary heart disease and might be used for cardiovascular risk prediction. This study aimed to determine the effect of smoking on the extent of PAT. Methods: We retrospectively examined 1217 asymptomatic patients (490 females, age 58.3 ± 8.3 years, smoker n = 573, non-smoker n = 644) with a multislice CT scanner and determined the PAT volume. Coronary risk factors were determined at inclusion, and a multivariate analysis was performed to evaluate the influence of smoking on PAT independent from accompanying risk factors. Results: The mean PAT volume was 215 ± 107 mL in all patients. The PAT volume in smokers was significantly higher compared to PAT volume in non-smokers (231 ± 104 mL vs. 201 ± 99 mL, p = 0.03). Patients without cardiovascular risk factors showed a significantly lower PAT volume (153 ± 155 mL, p &lt; 0.05) compared to patients with more than 1 risk factor. Odds ratio was 2.92 [2.31, 3.61; p &lt; 0.001] for elevated PAT in smokers. Conclusion: PAT as an individual marker of atherosclerotic activity and inflammatory burden was elevated in smokers. The finding was independent from metabolic risk factors and might therefore illustrate the increased inflammatory activity in smokers in comparison to non-smokers