Role of Multi Detector (MDCT)
Role of Multi Detector (MDCT)
Role of Multi Detector (MDCT)
(MDCT)
Dr. Peter Johnson
Consultant Radiologist
University Hospital of the
West Indies
• What does MDCT mean ?
CT-Principle
Advantages of MDCT over
SDCT
• Improved spatial resolution
• Improved temporal resolution
MDCT & Spatial Resolution
• 16 Slice scanners : Isotrophic
• No appreciable improvement in
quality (spatial resolution) with > 16
detectors
Multiplanar Reconstructions
(MPR)
Multiplanar Reconstructions
(MPR)
Multiplanar Reconstructions
(MPR)
Multiplanar Reconstructions
(MPR)
Volume Rendering
Surface Rendering
MDCT & Temporal
Resolution
• > number of detectors, greater
volume covered per unit time
• > number of detectors, faster
scanning
• Better for CTA and Cardiac (esp)
• Advantage of 64 slice over 16 slice
etc.
Temporal Resolution
• Useful for:
– Vascular work eg. CTA, CTV
– Phased scanning eg. Liver, Kidneys
– Functional work eg. CT Perfusion,
Cardiac CT
• Reduces scan time hence great for:
– Uncooperative patients
• SOB
• Confused (eg. Head injury etc)
• Paediatric
Reduced Frequency of Sedation of
Young
Children with Multisection Helical
CT
Pappas John N., Donnelly Lane F., Frush Donald P.
Johnson CD, Dachman AH. CT colonography: the next colon screening examination. Radiology
2000;216:331–341
Macari M, Bini EJ, Milano A, et al. Clinical significance of missed polyps at CT colonography. AJR
Am J Roentgenol
2004;183:127–134.
Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for
colorectal neoplasia in
asymptomatic adults. N Engl J Med 2003;349:2191–2200
Virtual Colonoscopy:
Patient Tolerance
“Patients undergoing colorectal cancer screening prefer CT colonography to both
colonoscopy and DCBE. The
majority of patients experience discomfort and inconvenience with cathartic bowel
preparation.”
Thomas M. Gluecker, MD, C. Daniel Johnson, MD, William S. Harmsen, MS, Kenneth P. Offord, MS, Ann M.
Harris, BA, Lynn A.
Wilson, RN and David A. Ahlquist, MD
Radiology 2003;227:378-384
“CT colonography was considered less painful and less difficult overall than
colonoscopy and was the
preferred examination”
Maria H. Svensson, MD, Elisabeth Svensson, PhD, Anders Lasson, MD and Mikael Hellström, MD, PhD
Radiology 2002;222:337-345
“In this study, the improved spatial resolution obtained with a 16–
detector row CT
scanner is reflected in the total sensitivity and specificity (96% and
97%, respectively,
for both readers) in the detection of hemodynamically significant
arterial stenosis of
aortoiliac and lower extremity arteries. In particular, excellent
sensitivities (ie, 96% and
97% for readers 1 and 2, respectively) and specificities (ie, 95% and
96% for readers 1
and 2, respectively) for grading small popliteocrural arteries were
obtained in this
Peripheral CTA
Whole Body CT
Cost-effectiveness of Whole-Body CT
Screening
Radiation Effects
Radiation Dose
“On the basis of such risk estimates and data on CT use from
1991 through
1996, it has been estimated that about 0.4% of all cancers in
the United States
may be attributable to the radiation from CT studies. By
adjusting this
estimate for current CT use, this estimate might now be in the
range of 1.5 to
2.0%”
Huda W, Vance A
AJR 2007; 188:540-546
However……..
• To date, no example of cancer
definitely attributable to exposure to
diagnostic x-ray doses has been
reported.
• Data represent extrapolated risk
estimates related to known cancer
incidences from exposure at
Hiroshima and “therapeutic Xray
treatments” in the early 20th century.
Radiation
• Care and good judgement should be
excersised….esp. paediatric
population.
• Risk/Benefit
• Indications
• Contraindications (including no
indication !)
And so…….
• MDCT has revolutionized diagnostic
imaging
• Tremendous potential
• High radiation dose
• Not indicated for everything !
• Not a replacement for other
modalities
Thank you