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Computed
Tomographic Angiography
The
development of multi-detector CT
scanners has greatly improved the
practicality of CTA. Multislice
scanners (e.g., 8 channels, 16 channels),
collecting several channels of data
simultaneously, provide a speed
advantage over older single-slice
helical and incremental models.
With
the commonly available 16-channels
scanners, it is possible to scan the
entire body very rapidly (in less than
30 seconds).
With this speed, the images are
usually not degraded by motion or
breathing (it can be completed in a
single breath-hold). The major
limitation of the technique remains the
undesired (particularly in children)
radiation exposure, although the
absorbed dose using CTA has proven to be
less than that for conventional
arteriography.
Contrast
doses ranging from 1-3 ml/kg are used
for pediatric CT and CTA, with a dose of
2 ml/kg used most frequently (300 mg
iodine/ml, total dose not to exceed 5
ml/kg).
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Large
venous malformation of the chest
wall on the right in a young
male patient. These CTA images
are processed in different
window settings to see various
soft tissue components. First
image clearly demonstrates no
arterial inflow into this
malformation. There are small
phleboliths and obvious
inhomogeneous soft tissue
prominence. 2nd image
demonstrates contrast
enhancement pattern of this
low-flow vascular
malformation. |
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Image
quality is similar to or better than
conventional arteriograms. The
post-processing options that are most
beneficial with respect to evaluating
pediatric vascular anomalies are
multiplanar reformation (MPR), curved
planar reformation (CPR), volume
rendering (VR), and maximum intensity
projection (MIP).A
number of different projection angles
may be used to view the anatomy of
interest from different perspectives or
to rotate it around an axis. With
this technique, images similar those
achieved with conventional angiography
are generated. Even blood vessels
that do not lie in a single plane can be
demonstrated in their entirety.
CTA
is particularly helpful to evaluate
high-flow anomalies (e.g., Arteriovenous
malformation - AVM, arteriovenous
fistula - AVF)
including some hemangiomas. On the other
hand, the technique has a limited value
to evaluate the low-flow malformations
such as venous malformations or
lymphatic malformations.
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