Savvas Nicolaou, M.D.

Associate professor – Expert in trauma, emergency, thoracic imaging and musculoskeletal radiology

Curriculum vitae

All posts of Savvas Nicolaou, M.D.

Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure

posted by Savvas Nicolaou, M.D. | Jun 4, 2015
Savvas Nicolaou, M.D.

CCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion. Read more

Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide

posted by Savvas Nicolaou, M.D. | Mar 10, 2015
Savvas Nicolaou, M.D.

The objective of our study was to discover the types and incidence of artifacts in dual-energy CT (DECT) using datasets of 50 consecutive patients who underwent a four-limb DECT protocol for the evaluation of suspected gout. Read more

Half-dose non-contrast CT in the investigation of urolithiasis: image quality improvement with third-generation integrated circuit CT detectors

posted by Savvas Nicolaou, M.D. | Mar 2, 2015
Savvas Nicolaou, M.D.

Third-generation IC detectors result in lower objective image noise at full- and half-radiation dose levels as compared with traditional DC detectors. Read more

Dual-energy CT increases reader confidence in the detection and diagnosis of hypoattenuating pancreatic lesions

posted by Savvas Nicolaou, M.D. | Feb 17, 2015
Savvas Nicolaou, M.D.

To prospectively compare detection and reader confidence of pancreatic lesions using a standard MDCT imaging protocol to a DECT imaging protocol with additional virtual non-contrast series. Read more

Dual-energy CT virtual noncalcium algorithm for detection of bone marrow edema in acute fractures: early experiences

posted by Savvas Nicolaou, M.D. | Feb 10, 2015
Savvas Nicolaou, M.D.

Dual-energy CT may provide a convenient modality for further characterizing acute bony injury when MRI is not readily available. Read more

High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

posted by Savvas Nicolaou, M.D. | Jan 27, 2015
Savvas Nicolaou, M.D.

Increased use of CT Pulmonary angiography in suspected pulmonary embolism (PE) has driven research to minimize radiation dose while maintaining image quality and diagnostic accuracy. Read more

A pilot study on dual-energy CT for detection of urate deposits in renal transplant patients with asymptomatic hyperuricemia

posted by Savvas Nicolaou, M.D. | Jan 5, 2015
Savvas Nicolaou, M.D.

The objective of this study was to assess the prevalence of joint and renal monosodium urate deposits by DECT in asymptomatic hyperuricemia. Read more

Detection of occult, undisplaced hip fractures with a dual-energy CT algorithm targeted to detection of bone marrow edema

posted by Savvas Nicolaou, M.D. | Dec 6, 2014
Savvas Nicolaou, M.D.

The value of DECT-VNC primarily lies in its ability to help detect fractures which may be subtle or undetectable on bone reconstruction CT images. Read more

The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases

posted by Savvas Nicolaou, M.D. | Aug 18, 2014
Savvas Nicolaou, M.D.

In this observational study, we provide for the first time a detailed analysis of extremity urate distribution in gout, which both supports and augments to the current understanding based on clinical and microscopic findings. Read more

Peering through the glare: using dual-energy CT to overcome the problem of metal artefacts in bone radiology

posted by Savvas Nicolaou, M.D. | Jun 27, 2014
Savvas Nicolaou, M.D.

This article reviews the theory of dual-energy CT (DECT) and its ability to reduce metal artefact, thus enhancing the diagnostic value of musculoskeletal imaging. Read more

Dual-Energy CT Tendon Algorithm in Acute Trauma: Initial Experiences

posted by Savvas Nicolaou, M.D. | Jun 13, 2014
Savvas Nicolaou, M.D.

CT has become increasingly popular in the assessment of limbs in the acute trauma setting. We report our initial experiences of 4 cases with imaging and clinical correlation. Read more

50% Dose CT in acute cervical spine injury: Improved Signal and Reduced Artifact at the Cervicothoracic Junction using Fully Integrated Circuit CT detectors

posted by Savvas Nicolaou, M.D. | May 21, 2014
Savvas Nicolaou, M.D.

In this study we compare subjective and objective image quality between 100% dose and 50% dose dual source cervical spine CT datasets obtained using both traditional discrete (DC) and novel fully integrated (IC) detectors. Read more

Imaging Acute Left Lower Quadrant Pain

posted by Savvas Nicolaou, M.D. | May 6, 2014
Savvas Nicolaou, M.D.

1. Review the variety of pathophysiology causing patients to present with acute left lower quadrant (LLQ) pain 2. Discuss the imaging modalities and imaging characteristics used in diagnosis of LLQ pain Read more

Clinical Utility of Fully Integrated Chip CT detector in Suspected Pulmonary Embolism Imaging

posted by Savvas Nicolaou, M.D. | Apr 29, 2014
Savvas Nicolaou, M.D.

We compare both quantitative and qualitative image quality, between the traditional DC detector and a novel IC detector in diagnosis of pulmonary embolism in the acute setting. Read more

Updates and New concepts on Multi-detector CT (MDCT) imaging of Blunt Hepato-Biliary and Splenic Trauma

posted by Savvas Nicolaou, M.D. | Apr 23, 2014
Savvas Nicolaou, M.D.

Major teaching points were • imaging findings and spectrum of injury on MDCT, and implications on conservative vs operative management • new dose reduction strategies using MDCT • Role of follow up imaging and provide an imaging algorithm initial assessment and follow up Read more

Presentation: Detection of occult hip fractures utilizing a dual energy CT algorithm targeted to detection of bone marrow edema: early clinical experience

posted by Savvas Nicolaou, M.D. | Apr 9, 2014
Savvas Nicolaou, M.D.

DECT with virtual non-calcium subtraction imaging is highly sensitive in the detection of bone marrow edema in radiographically occult hip fractures. In our limited series it was a very useful adjunct to confirm equivocal CT findings of subtle cortical irregularities. Read more

Iterative reconstructed ultra high pitch CT pulmonary angiography with cardiac bowtie-shaped filter in the acute setting: Effect on dose and image quality

posted by Savvas Nicolaou, M.D. | Sep 23, 2013
Savvas Nicolaou, M.D.

To evaluate the effect of a cardiac bowtie-shaped filter in an ultra high pitch CTPA protocol at 100kV on image quality and radiation dose. Read more

Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: Are we one step closer towards a non-gated triple rule out?

posted by Savvas Nicolaou, M.D. | Aug 7, 2013
Savvas Nicolaou, M.D.

Aim of this study was to retrospectively compare the image quality and the radiation dose of an ultra high pitch CT scan for the evaluation of PE and visualization of cardiac structures in comparison to our institution’s standard PE protocol. Read more

Diagnostic Performance of Reducing the Dose with 100kVp Scan in Assessment of Acute Pulmonary Embolism Utilizing Ultra-High Pitch Imaging

posted by Savvas Nicolaou, M.D. | Mar 28, 2013
Savvas Nicolaou, M.D.

Significant dose reduction of greater than 50% in the assessment of acute pulmonary embolism can be achieved without compromising diagnostic image quality by decreasing the kVp from 120 to 100kVp utilizing ultra-high-pitch imaging. Read more

Dual-Energy CT: A Promising New Technique for Assessment of the Musculoskeletal System

posted by Savvas Nicolaou, M.D. | Jan 30, 2013
Savvas Nicolaou, M.D.

The most validated application of DECT is undoubtedly its noninvasive and highly specific ability for confirming the presence of monosodium urate deposits in the assessment of gout. Read more

Presentation: Clinical Utility of Dose Reduction in Suspected Pulmonary Embolism Imaging utilizing SAFIRE

posted by Savvas Nicolaou, M.D. | Jan 10, 2013
Savvas Nicolaou, M.D.

The presentation assesses the utility of SAFIRE (sinogram affirmed iterative reconstruction) to allow a dose reduction in assessment of PE with ultra-high pitch imaging by decreasing the voltage, yet still maintaining diagnostic image quality. Read more

Dual energy CT in gout: a prospective validation study

posted by Savvas Nicolaou, M.D. | Nov 8, 2012
Savvas Nicolaou, M.D.

The authors prospectively determined: (1) the specificity and sensitivity of dual energy CT for gout; and (2) the interobserver and intraobserver reproducibility for DECT urate volume measurements. Read more

Organ-based CT radiation dose reduction to the lenses: impact on image quality for CT of the head.

posted by Savvas Nicolaou, M.D. | Oct 1, 2012
Savvas Nicolaou, M.D.

The purpose of this pilot project was to evaluate image quality and dose distribution in the acquired data with the new specific organ dose adaption and reduction protocol. Read more

Case: Diagnosis of Sub-acute Pulmonary Emboli using Flash Mode, SAFIRE and 100 kV

posted by Savvas Nicolaou, M.D. | Sep 21, 2012
Savvas Nicolaou, M.D.
  • Protocol
  • Pulmonary-Embolism_Image-1a
  • Pulmonary-Embolism_Image-1b
  • Pulmonary-Embolism_Image-1c

A 44-year-old male patient presented himself to the hospital due to worsening shortness of breath on exertion for the past 6 months. A CT scan with contrast was requested to rule out pulmonary emboli (PE). Read more

Case: RIPIT to the Rescue – Fast CT Examination for Trauma Patients

posted by Savvas Nicolaou, M.D. | Oct 31, 2011
Savvas Nicolaou, M.D.
  • Table Case - RIPIT to the Rescue
  • 1, 2. Volume Rendered (VRT) view showing vascular status of this trauma patient.
  • 3, 4. Fast pitch of 1.8 allows long range scanning from head to pelvis. The sagittal view (Fig. 4) shows artifact free aortic angiogram.
  • 5. Subarachnoid hemorrhage delineated with a fused MPR (Multi Planar Reformation) and VRT visualization technique (arrow). <br>6. Coronal MPR of the brain (calculated out of the full body scan) shows the extension of the bleeding (arrow).

In the trauma setting, the “golden hour” is critical. The FLASH RIPIT scan can provide critical, life-saving information in a matter of seconds. Read more

Ultra High pitch imaging in pulmonary embolism in the ER – are we nearer to a complete triple rule out

posted by Savvas Nicolaou, M.D. | Oct 15, 2010
Savvas Nicolaou, M.D.

The abstract was presented at the ASER meeting in Seattle August 2010 and awarded the prize for the best resident scientific presentation. Read more

Dual-Energy CT as a Potential New Diagnostic Tool in the Management of Gout in the Acute Setting

posted by Savvas Nicolaou, M.D. | Aug 31, 2010
Savvas Nicolaou, M.D.

Dual-energy CT is a promising new imaging technique offering potential new applications in a number of clinical areas. Read more

Which scanner: GE CT750 or the Siemens Flash?

posted by Savvas Nicolaou, M.D. | Jul 7, 2010
Savvas Nicolaou, M.D.

The following question has been sent by John Phillips: Which scanner: Which is the more advanced and best all around scanner….the GE CT750 or the Siemens Flash? If you could only buy one as your only scanner which would you buy? Are there any “must have” options? Savvas Nicolaou,  MD, Vancouver General … Read more

Short review: DSCT beats other methods for noninvasive gout diagnosis

posted by Savvas Nicolaou, M.D. | Apr 27, 2010
Savvas Nicolaou, M.D.

DSCT is an accurate a noninvasive method to diagnose gout in its preclinical stages. This may lead to an early treatment and help to avoid associated diseases. Read more

Case: Trauma – AOD

posted by Savvas Nicolaou, M.D. | Apr 12, 2010
Savvas Nicolaou, M.D.

Case history: 20 year old female involved in a MVC had CT scan in the acute setting. Diagnosis: The CT scan revealed marked atlanto occipital dissociation (ie seperation of the skull from the neck), with the presence of a traumatic arterio venous fistula at the base of the neck. Read more

Case: Dual energy Gout – Foot

posted by Savvas Nicolaou, M.D. | Mar 22, 2010
Savvas Nicolaou, M.D.
  • Case: Dual energy Gout – Foot
  • Case: Dual energy Gout – Foot

Case history: 60 year old male with a history of gout . However patient was not tolerating uric acid lowering medication and thus DECT scan was performed to identify whether the patient was compliant with medications and for the presence of tophi (i.e. disease burden and associated joint destruction). Read more

Case: Dual Energy Gout – Knee

posted by Savvas Nicolaou, M.D. | Mar 5, 2010
Savvas Nicolaou, M.D.
  • Case: Dual Energy Gout  – Knee
  • Case: Dual Energy Gout  – Knee
  • Case: Dual Energy Gout  – Knee

Case history: DECT images of patients with known gout. Images of the right knee reveals uric acid (UA) deposits along the collateral & cruciate ligaments and in the prepatellar region. It is evident that with the material decomposition algorithm, UA can be clearly depicted in red thereby confirming the diagnosis … Read more

Dual Energy CT – Renal Stone Composition

posted by Savvas Nicolaou, M.D. | Sep 26, 2008
Savvas Nicolaou, M.D.

The following question has been sent by Dr. Ravi Mahal, Radiologist, Boca Radiology Group, USA: We have been using the DECT for Urinary stone composition for the past 6 months.  Recently I had a case where a patient had 2 stones of different compositions; a right uric acid stone and a … Read more

Utilization of Dual Energy CT to Characterize Renal Stones and Effects on Patient Management

posted by Savvas Nicolaou, M.D. | Sep 15, 2008
Savvas Nicolaou, M.D.

The following study was presented at the UBC Radiology Scientific Day, June 2008 & Stanford Radiology’s 10 th Annual International Symposium on Multidetector CT In May 2008. Purpose: To investigate whether DECT can accurately determine composition of renal calculi at acceptable dose. To observe how this information changes patient management in the … Read more

Utilization of the Dual Source CT for Musculoskeletal Applications: Confirming the Pattern of Distribution of Gout

posted by Savvas Nicolaou, M.D. | Jul 17, 2008
Savvas Nicolaou, M.D.

The following abstract summarizes a talk held during the 10th Annual International Symposium Multidetector Row CT, Stanford Department of Radiology, Las Vegas, Tuesday, May 13th 2008 (Session V: Trauma/ Musculoskeletal) BACKGROUND The dual energy application designed to identify uric acid deposition within kidneys (kidney stones) has been proven both in vitro and … Read more

Fellowship at Vancouver General Hospital

posted by Savvas Nicolaou, M.D. | Apr 1, 2008

There is a unique opportunity that has arisen and we are offering variable 3-6 months, up to a one year period Trauma / ER imaging fellowship which can begin as early as May 2008. The individual will be exposed to all aspects of DSCT imaging in acute and trauma … Read more

Resolution of Definition Axial Datasets

posted by Savvas Nicolaou, M.D. | Apr 1, 2008
Savvas Nicolaou, M.D.

The following question has been sent by Judy Oltmann, CTA Technologist, USA: My question may have appeared vaque before. My radiology group has had a consistent complaint concerning the mottle or graininess, both terms applied, to the axial datasets acquired during our coronary scans with the Definition scanner. We have applied … Read more

Grainy axial datasets

posted by Savvas Nicolaou, M.D. | Mar 3, 2008
Savvas Nicolaou, M.D.

The following question has been sent by Judy Oltmann, CTA Technologist, USA: Grainy axial datasets: In trial patients using the Definition, the clarity of the axial datasets has been a constant complaint. Using an ROI to measure the pixel density, the 64 slice has a marked improvement … Read more

Case: Dual energy provides new insight in the distribution of disease of gout

posted by Savvas Nicolaou, M.D. | Feb 10, 2008
Savvas Nicolaou, M.D.
  • gout-disease-1.jpg
  • gout-disease-2.jpg
  • gout-disease-3.jpg
  • gout-disease-4.jpg

History A 53 year old patient presented to the rheumatologist with right knee pain that was associated with a locking knee while walking. This patient had a past history of aspiration-proven gout affecting his first metatarsophalangeal joint. No active inflammation and subcutaneous nodules that would be suggestive of tophus. Mild … Read more




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