Dual Energy Locates Progressive Wrist Arthritis

SOMATOM Definition Dual Energy Scanning

Philipp Weisser, MD, Ralf W. Bauer, MD, J. Matthias Kerl, MD and Thomas J. Vogl, MD
Goethe University Clinic, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
 |  2010-09-21

History

Swelling and pain in the right hand symptoms started 3 months ago, initially there were no pathologic findings in conventional radiography. As an earlier radiography showed massive erosive changes in the wrist, but unclear changes in the MCP (metacarpophalangeal joint) and PIP (proximal interphalangeal joint), we performed a CT Dual Energy examination to search for further erosions and synovitis.
 

Diagnosis

Rapid progressive wrist arthritis in the right hand. The CT scan revealed massive erosive destruction of the right wrist, accompanied by synovitis and joint effusion. Within the phalanges we found subcortical osteolytic changes (which were not visible in the left hand), with intact cortical structures. With Dual Energy technique, we could easily visualize the synovitic tissue. Unfortunately, even histopathologic examination was unspecific.

 

Comments

In rheumatic imaging, when the verification of erosive changes is the most important question in CT, synovitic tissue can still be easily detected in Dual Energy technique. As the 80/140 kV separation is quite high after iodine contrast application, it is very easy to visualize this tissue.

Examination Protocol (Dual Energy Lung PBV)

Scanner SOMATOM Definition
Scan area Dual Energy Wrist
Scan length 282 mm
Scan direction Cranio-Caudal
Scan time 21 s
Tube voltage 140 kV / 80 kV
Tube current 68 / 292 effmAs
Dose modulation Care Dose
CTDIvol 12,97 mGy
Dose 0,32 mSv
Rotation time 1 s
Slice collimation 64x0.6 mm
Slice width 2 mm
Spatial Resolution 0.33 mm
Reconstructed increment 1 mm
Contrast  
Volume 90 ml
Flow Rate 4 ml/sec
Start delay 360 sec

The information presented in this case study is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard.


The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.