split-bolus techniques beyond ct urography - scbtmr · 2013-12-06 · conclusions • split-bolus...
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Split-Bolus Techniques
Beyond CT Urography
Vassilios Raptopoulos, MD
Beth Israel
Deaconess
Medical Center
Harvard
Medical
School
34th Annual Course
October 2011
Washington, DC
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Radiation Reduction Strategies
1. Equipment
e.g. Scanner – Reconstruction (ASIR)
2. Techniques
e.g. Pitch – Slice thickness – mA – kVp,
3. Protocols
e.g. Tailor to indication – IV contrast Phases
4. Utilization
e.g. Alternative tests – Display # Exams
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Split Bolus Techniques
Can provide combined phase scans including
excretory-parenchymal
arterial – portal venous
vascular - parenchymal
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CT Urography Synchronous nephrographic and excretory phase
– Chow, LC et al: AJR (Stanford) 2007;189:314
Chow L C et al. AJR 2007;189:314-322
©2007 by American Roentgen Ray Society
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CT Urography
Synchronous excretory & nephrographic phase
– Chow, LC et al: AJR (Stanford) 2007;189:314
4 min
80 cc
@ 2cc/sec
for 40 sec
80 sec
40 cc
@ 2cc/sec
for 20 sec
120s 7 min
©2007 by American Roentgen Ray Society
1st bolus: Excretory
2nd bolus: Nephrographic
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4 min
80 cc @ 2/s
80s
40 cc @ 2/3
50 cc @3.5/s
for 14 sec 80 cc @3.5/s
for 23 sec
3 min 47s
70s
120s
CT Urography - 2 1st bolus: Excretory
2nd bolus: Early nephrographic &
Parenchymal/Vascular
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Split bolus CT Urography 1st bolus: Excretory
2nd bolus: Early nephrographic & Parenchymal/Vascular
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General Spit-bolus
3 min 30s
30 cc @ 2.5/s
for 12 sec
70s
100 cc @ 2.5/s
for 40 sec
1st bolus: Excretory
2nd bolus: Parenchymal & Vascular
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General Spit-bolus
3 min ~30s
30 cc @ 2.5/s
for 12 sec
~70s
100 cc @ 2.5/s
for 40 sec
Li 50HU e
Trigger scan at
Liver enhancement of 50 HU or 70s
1st bolus: Excretory
2nd bolus: Parenchymal & Vascular
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General Spit-bolus
• Gen Abd.
• Abd Pain
• Abscess
• Trauma
• Tumor
(non-liver)
•Lymphoma
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General Spit-bolus
• Gen Abd.
• Abd Pain
• Abscess
• Trauma
• Tumor
(non-liver)
•Lymphoma
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General Spit-bolus
• Gen Abd.
• Abd Pain
• Abscess
• Trauma
• Tumor
(non-liver)
•Lymphoma
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General Spit-bolus
• Gen Abd.
• Abd Pain
• Abscess
• Trauma
• Tumor
(non-liver)
•Lymphoma
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General Spit-bolus
• Gen Abd.
• Abd Pain
• Abscess
• Trauma
• Tumor
(non-liver)
•Lymphoma
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Renal Split-bolus
3 min 16
s
30 cc @ 5/s
for 6 sec
Ao 175HU + 15s
120 cc @ 5/s
for 24 sec
~40 s
1st bolus: Excretory
2nd bolus: Parenchymal & Late Arterial & Venous
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Renal Split-bolus
Renal donors – Renal CTA – Renal tumors
Vascular-excretory MDCT Angiography for renal donors
Zamboni GA et al (BIDMC/HMS): AJR 2010;194:145
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Split-bolus Vascular CTA
30s ~16s
70 cc @ 5/s
for 14 sec
50 cc @ 5/s
for 10 sec
~70s Ao 280HU
Mesenteric CTA
1st bolus: Venous & Parenchyma
2nd bolus: Arterial
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Split-bolus Vascular CTA
20s ~15s
50 cc @ 5/s
for 10 sec 50 cc @ 5/s
for 10 sec
~55s Ao 280HU
Aorta CTA
1st bolus: Venous & Late Arterial
2nd bolus: Arterial
Type B EVS Endoleak
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Aortic Dissection
1st bolus: Venous & Late Arterial
2nd bolus: Arterial
Single bolus
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Split-bolus Pancreas
15s ~30s
100 cc @ 5/s
for 20 sec
50 cc @ 5/s
for 10 sec
~75s
Ao 280HU + 15s
1st bolus: Portal venous (liver)
2nd bolus: Late arterial (pancreatic)
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Split-bolus Pancreas 1st bolus: Portal venous (liver)
2nd bolus: Late arterial (pancreatic)
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Conclusions
• Split-bolus techniques allow for combine
phase scanning that
• Provides vascular and parenchymal
information or arterial and venous
information in a single acquisition that may
• Limit multiphase scanning or
• Provide information otherwise not obtained.
• Powerful tool in radiation reduction
strategies
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Applications
• CT Urography
• General Scanning – Acute/chronic pain
• Trauma
• Lymphoma & other non-liver-affecting tumors
• Renal CT Angiography
• Mesenteric CTA
• Post EVS AAA follow-up
• Aortic dissection
• Pancreatic cancer