Dual Source CT Dual Energy Head and Neck CTA
Case history
A 72-year-old female patient arrives to CMIV at the University Hospital in Linköping, Sweden. She has been having two episodes of amarosis fugax two times last month and a severe holocephal headache for the last six hours. A CTA of the head and neck were performed at CMIV.
Diagnosis/ Differential diagnosis
An occlusion of the right internal carotid artery (ICA) and a 95 % stenosis of proximal part of the external carotid artery (ECA) 95 % is noted. With the DE technique it was possible to visualize the region of the carotid bifurcation with the different plaque components. The ECA stenosis was first overlooked on the conventional single energy CTA images. The direct subtraction of bone without user interaction gives virtual real time display of the whole cerebral vasculature and allows immediate rule out of aneurysms and embolism. Figure 4, same image with and without i.v. contrast. The patient was referred for stent angioplasty.
Comment
In the dual energy mode two x-ray sources can be operated simultaneously at different kV levels. One of the results is that the plaque composition can be better determined and calcified plaques can be separated from intra luminal contrast.
 [1, 2] Total occlusion in ICA on the right side. Stenosis in ECA. |
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 [3, 4] Calcified tissue and plaques rendered in blue. |
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See corresponding protocol: Dual Energy Head and Neck CTA
can the DSCT identify the fibrous cap and distinct the various components in the plaque?
Dear Anders Persson !
Then, in the furture, Can we be scan CTA without i.v.contrast (for clinical diagnostic) ?( it’s only in my mind ), I think that we could reformat on the VRT, something like this ( similar to your figure 4) but How is it on the MPR or 2D ?
By the way, please give a answer about DSA (for neuro)
all of the vendors (GE, Phillip, Siemens, Toshiba…) have had the DSA software also.
Thank you and best regards
Minh Truong