We have a Siemens, Emotion Duo in our department. What i want to learn is, can we acquire diagnostic arteriographic images for large vessel-massive embolic processes with that system ? If it is possible, what should be the parameters such as time delay, amount of contrast agent, etc.? Especially for pulmonary and lower extremity CTA? Thank you in advance.
Personally I have only experience with 4 row detectors, but it should also be possible with your machine to image vascular structures, definitely for great vessels (pulmonary, aorta), but also for smaller vessels in the leg etc. Coronary imaging is not possible.
For protocols you should ask the manufacturer, or look up the manual on the internet. I found a link to a manual on the internet and try to post a link (don’t know if it works, if not just type “Siemens emotion duo ct scanner” in a search engine).
Link:
http://www.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@ct/documents/download/mdaw/mje3/~edisp/emotion2_6_vb10_04-00211366.pdf
It's absolutely possible . Before the arrival of mutli-detector CT, everyone used these CT .
The Siemens site referenced yet all the protocols for this type of scanner. I think you can use that. (link below)
Regarding injection procedures , it is explained in the guide that the study of the arterial phase requires maintaining a relatively long injection to have an amount of contrast in the arterial compartment but this should not be a problem.
http://www.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@ct/documents/download/mdaw/mje3/~edisp/emotion_duo_e_va30_02-00211353.pdf
Thank you very much for your precious answers, Dr. Alfke and Dr. Morel. The link that you suggested is what I absolutely need. I examined the manual and it is very useful. Thank you again and have a good day.
That is possible! Do you use automatic injector? Which kind of contrast media you used? I mean concentration of iodine 300, 350, 370? It is very important to know value of cardiac output because it changes delay time, also the age of patients. Delay time can find in standard Siemens protocols. If you are involved in interventional radiology especially trombolisis of pulmonal artery that is useful!! Smaler vessels is possible to see (BTK) but resolution is poor, especially when patients have heavy calcification.Have a nice day!
Pulmonary CTA with this scanner should be doable, but at the recommended 6 mm/rot table feed, corresponding to 7.5mm/s with a 0.8s rotation time, your scan will be 40 seconds long to scan a 30 cm long thorax. That is way too long for a breath hold in a dyspneic patient and would require a huge contrast material dose. You could try and get away with a scan of the central pulmonary arteries only, which would be 15-20 cm of coverage, but understand that you can miss peripheral emboli and the possibility for significant artifacts from respiratory misregistration will still exist.
For the lower extremities, I wouldn't try it. Notice that the referenced document from Siemens does not provide any guidance on this application and for good reason. When we first started doing 4-row lower extremity CTA in 1998, a 0.8 s rotation time resulted in scan durations of 70 seconds using 4x2.5mm acquisition. A two row scanner will not be capable if covering a 1200 mm territory in a reasonable period of time for an arterial phase of contrast opacification and the preferred resolution of a ≤1.5 mm section thickness. You might be able to get away with a scan from the knees down to look for distal emboli, but that would be a challenge.
You can find our initial report on 4-row LE CTA, which should provide useful insights here:
https://www.researchgate.net/publication/11780479_MultiDetector_Row_CT_Angiography_of_Lower_Extremity_Arterial_Inflow_and_Runoff_Initial_Experience1?ev=prf_pub
Good luck. You have a challenging task ahead.
Article Multi–Detector Row CT Angiography of Lower Extremity Arteria...
Dear Dr. Till,
Yes, i am using automatic injector and will use 350 or 370 mg contrast agent for the angiographic examinations. Thank you for your useful answer. Have a good day...
Dear Dr. Rubin,
Thank you for your valuable answer and trick points in it. I think that the manuscript that you suggested will also be very helpful for the lower extremity CTA examinations. Thank you again and have a good day. I wish all the things go well in your life.
Best regards,
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