EP1942805A2 - Systeme radiographique destine a la creation de representations radiographiques par application d'agents de contraste - Google Patents

Systeme radiographique destine a la creation de representations radiographiques par application d'agents de contraste

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Publication number
EP1942805A2
EP1942805A2 EP06807524A EP06807524A EP1942805A2 EP 1942805 A2 EP1942805 A2 EP 1942805A2 EP 06807524 A EP06807524 A EP 06807524A EP 06807524 A EP06807524 A EP 06807524A EP 1942805 A2 EP1942805 A2 EP 1942805A2
Authority
EP
European Patent Office
Prior art keywords
contrast
ray
radiation
patient
ray system
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP06807524A
Other languages
German (de)
English (en)
Inventor
Hubertus Pietsch
Hanns-Joachim Weinmann
Michael Grasruck
Karl Stierstorfer
Thomas Flohr
Christoph SÜSS
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Bayer Pharma AG
Original Assignee
Siemens AG
Bayer Schering Pharma AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Siemens AG, Bayer Schering Pharma AG filed Critical Siemens AG
Publication of EP1942805A2 publication Critical patent/EP1942805A2/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K49/00—Preparations for testing in vivo
    • A61K49/04—X-ray contrast preparations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/481—Diagnostic techniques involving the use of contrast agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/482—Diagnostic techniques involving multiple energy imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/488—Diagnostic techniques involving pre-scan acquisition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/504—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of blood vessels, e.g. by angiography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/542—Control of apparatus or devices for radiation diagnosis involving control of exposure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/545—Control of apparatus or devices for radiation diagnosis involving automatic set-up of acquisition parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1075—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/06—Diaphragms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/40—Arrangements for generating radiation specially adapted for radiation diagnosis
    • A61B6/4007—Arrangements for generating radiation specially adapted for radiation diagnosis characterised by using a plurality of source units
    • A61B6/4014—Arrangements for generating radiation specially adapted for radiation diagnosis characterised by using a plurality of source units arranged in multiple source-detector units
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/40—Arrangements for generating radiation specially adapted for radiation diagnosis
    • A61B6/4035—Arrangements for generating radiation specially adapted for radiation diagnosis the source being combined with a filter or grating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/42—Arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4208—Arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
    • A61B6/4241—Arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector using energy resolving detectors, e.g. photon counting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/42—Arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4266—Arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a plurality of detector units
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A61B6/4435—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure
    • A61B6/4441—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure the rigid structure being a C-arm or U-arm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/582—Calibration
    • A61B6/583—Calibration using calibration phantoms

Definitions

  • the invention relates to an X-ray system for generating diagnostic X-ray images of a patient with an X-ray tube, a detector, a Kontraststoffapplikati ⁇ onshim and a control and processing unit, wherein the X-ray system has a possibility for selecting different operating parameters at least with respect to the energy spectrum of the X-ray radiation used.
  • the invention also relates to a method for optimizing to-mographischer representations of a patient by X-rays with an energy spectrum to be selected and measurement of the attenuation of the X-ray radiation when passing through the patient in different solid angles with additional administration of contrast agent for contrast enhancement in the tomographic presentation.
  • the invention relates to the use of a lanthanide-containing complex for producing a contrast agent for diagnostic support in an X-ray examination.
  • contrast media are often applied to produce a high-contrast representation, which either attaches to specific body structures, eg carcinomas, or enriches certain bodily fluids, eg, blood.
  • Such contrast agents usually contain elements which are distinguished by high absorption coefficients and thus provide a good contrast to the surrounding tissue with a relatively low absorption coefficient.
  • iodine-containing contrast agents Because of any existing incompatibilities of the examined patient with iodine, gadolinium-containing contrast agents are also used. In this context, are generally lanthanide-containing
  • Contrast agents proposed. It is in this regard, for example ⁇ , to the headings "Arterial angiography in high kilovol- day technique with gadolinium as the contrast agent: first clinical experience", F. Fobbe et al, Eur Radiol 6, 224- 229 (1996)... , Springer-Verlag; "Evaluation of Gadobutrol in a Rabbit Model as a New Lanthanide Contrast Agent for Computer Tomography", Stephan A. Schmitz et al. , Investigative Radiolgy, Vol.
  • the inventors have recognized that it is not enough for it ⁇ submission of an optimum contrast-to-noise ratio easy to select a contrast agent is busy with the highest possible atomic number which ment with a EIe-. Rather, it has been found that, depending on the particular area of the patient examined, an optimal combination of contrast agent and the energy spectrum of the X-ray radiation used for the examination is necessary.
  • the ge coherences between absorption and energy spectrum of the radiation, taking into account an optimum contrast-to-noise ratio at the respective predetermined Letsbe ⁇ rich in patient are relatively complex and can not in simple rules or formulas reflect.
  • these parameters can also be considered in the examined tissue environment.
  • Different tissue environments Exercises such as bone, heart, liver or brain also cause differences in the selection of the optimal contrast agent / energy spectrum combination due to the different absorption behavior of the respective tissue.
  • the choice can not relate only to the difference ⁇ contrast-generating elements or different contrast agents, but it can also be differences regarding the optimal chemical structure of the contrast medium necessary.
  • a contrast medium ⁇ which only accumulate in the blood stream and is intended to degrade later
  • another molecule be used as a contrast agent in which a marker is to be attached to structures in the form carcinogenic. It is also possible for combinations of both variants to be selected for optimal recognition in an X-ray representation.
  • the concentration of the contrast medium can be gen as an indication or the compatibility of the respective contrast agent herangezo ⁇ their application concentration.
  • different contrast agents and for selecting the optimum contrast agent / radiation combination can then be used in accordance with normalized contrast mediums telkonzentrationen.
  • a spectrum-dependent radiation damage factor can also be incorporated here, since in principle it can be assumed that higher-energy X-ray radiation is less damaging than low-energy radiation.
  • the optimization ⁇ refers tion always expressed the contrast-to-noise ratio in the same dose of radiation or otherwise, it is the optimum choice of a contrast agent, which is the best contrast-to-noise ratio obtained by setting a BE ⁇ agreed contrast to noise ratio in the image mini ⁇ tion of the dose used so the radiation exposure of the examined patient reached.
  • Contrast-to-noise ratio on by increasing the concentra ⁇ a contrast agent can be achieved, on the other hand the patient for reasons of compatibility should not be burdened with too ho ⁇ hen contrast agent doses.
  • the combination of contrast agent and X-ray radiation is found, which is normalized to the radiation dose used or better normalized to its damaging effect and standardized to the concentration of the contrast agent or better its compatibility the best contrast-to-noise ratio. are, then taking place on the basis of these determined contrast mediums / radiation combination, the CT examination under a minimized dose and contrast agent concentration, so that a sufficiently high contrast for the clinical evaluation image can be reconstructed.
  • an X-ray system for generating diagnostic X-ray images of a patient, preferably an X-ray system with at least one X-ray tube for generating a beam of X-rays with an energy ⁇ spectrum for scanning the patient, a detector for measuring the attenuation of X-rays during passage through the patient, an application unit for the administration of contrast agent for contrast enhancement in the tomographic view of the patient, a control and processing unit for controlling the X-ray system andVaccinel ⁇ the X-ray images and lung of the patient with the aid of stored and executed computer programs, wherein the X-ray system has a possibility of selecting different operating parameters at least with regard to the energy spectrum of the X-ray radiation used, this X-ray system having a selecting means wel ⁇ ches by the direct or indirect indication of the parameter examination volume on the one hand and investigated Gewe- be Modell the other hand, at least one combination of contrast and energy spectrum of the X-ray radiation predetermines for the
  • the selection means itself will generally be realized by computer programs in conjunction with an input keyboard and a display unit. Basically, it is also within the scope of the invention, when specific keys are optionally associated with specially ⁇ len ads, provided at the X-ray system. It is essential for the invention that the surgeon appropriate means is provided, whereby he can pass on the necessary specifications to the system.
  • This selection means now makes it possible for the surgeon to find the optimum combination of contrast agent to be used and energy spectrum by simply specifying a body region to be examined or the tissue structure to be examined.
  • the selection means having a look-up table in which, depending on the body region to be examined or the tissue structure to be examined, optimum combinations of contrast agent and energy spectrum of the X-ray radiation to be used are stored.
  • the selecting means may be additionally connected to the control of the X-ray system, so that by the selection of Ope ⁇ rateurs if this results in a clear choice of optimum Kon medium and energy spectrum, automatically results in a corresponding adjustment of the X-ray system with respect to the tube voltage used and / or a filter to use for the radiation. If several equivalent solutions are available, these can be offered to the surgeon for further selection.
  • the detector in differing ⁇ chen modes of operation, as an integral detector to operate event-counting detector or energy-specific detector, the optimal choice may be dictated by the teldatemit-. Because even by different modes of operation of the detector, the optimal choice of contrast agent / energy spectrum combination can be influenced.
  • both integrating and event counting can be detected in these energy ranges, wherein the at least one limit value between the detected energy ranges is variable is.
  • the selection means may be connected to a controller that limit it and this limit entspre ⁇ accordingly optimal with respect to the best set ratio contrast-to-noise ratio.
  • the inventors also suggest that an indirect input possibility for the examination volume by specifying the body region is provided in the X-ray system ,
  • the indication of the examination regions of the head, thorax or abdomen already provides a largely good approximation for these values.
  • the proposed X-ray system can be both a system for producing transmission images and an X-ray system for producing tomographic representations, ie a CT or a C-arm device with means for the reconstruction of tomographic images, wherein the preferred application in the tomographic systems.
  • an X-ray system for generating tomographic representations the X-ray tube (s) and possibly the one or more detectors rotatably mounted around the patient, so that a plurality of projections from different projection directions can be recorded.
  • CT images are provided, said means usually consist of egg ⁇ ner combination of computing unit and corresponding computer programs.
  • the contrast to be able to optimize contrast agents are made available ⁇ noise ratio, comprising at least one contrast agent complex, and as a contrast material include a selection of at least two contrast-producing elements from the list below: I, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu, Bi; preferably Dy, Ho, Er, Tm, Yb or Lu.
  • the inventors propose a method for optimizing tomographic representations of a patient by X-rays with an energy spectrum to be selected and measuring the attenuation of the X-ray radiation when passing through the patient at different solid angles with additional administration of contrast agent to improve the contrast in the tomographic display prior to the examination for the CT system, determining the contrast-to-noise ratio of different energy spectra of the X-ray and different contrast agents relative to tissue-like material or tissue and before examining a patient on the basis of the X-ray system an optimized selection of at least one contrast agent / X-ray spectrum combination is made available to a given examination region of the patient, which provides an optimal contrast-to-noise ratio in the examination b area allows.
  • According to the invention can be to select a look-up table USAGE ⁇ det, in the function of the predetermined sec ⁇ monitoring region of the patient at least one optimal combination nation of contrast medium is stored to the energy spectrum of the X-ray radiation to be used.
  • the Letsbe- can even after a prescan rich, optionally ren with different Energyspekt ⁇ , on the basis of the actual present absorption values in the examination zone by means of simulation with different available contrast agents and energy spectra, optionally also detectors relational as detector modes, the optimal combination of Contrast means and used for scanning energy ⁇ spectrum of the X-ray radiation can be determined.
  • the tube voltage can also be set automatically after the selection of the contrast agent initiated by the surgeon and / or the energy spectrum of the X-ray radiation used can be automatically adjusted by filtering according to previously stored or calculated information.
  • an energy-specific detection of at least two energy ranges may, however, depending on the energy integ ⁇ be detected rierend separated, wherein the at least one limit switch ⁇ value variable between the detected energy ranges adjustable and the control of this limit value entspre ⁇ accordingly the selection made by the operator and existing Defaults depending on the contrast agent used and the energy spectrum of the X-radiation takes place.
  • At least two energy ranges can separates ge ⁇ and detected event counting, said ranging min ⁇ least a limit value between the detected Energybe ⁇ is variably adjustable and the control of this Limit value corresponding to the choice made by the surgeon and existing specifications depending on the contrast agent used and the energy spectrum of the X-ray radiation.
  • a measure for the patient volume, ie for the cross section of the patient to be examined, to be penetrated by the radiation can be entered directly or indirectly for selecting the optimal combination of contrast agent and energy spectrum.
  • a look-up table can be used which, from other information, includes the actual patient volume or the cross section to be penetrated.
  • the patient volume can be determined and, preferably automatically, transferred to the X-ray system. Accordingly, the patient volume can also be optically determined.
  • the weight preferably by a weighing device in the patient table, so that there is a, usually additional parameter for estimating the cross section of the patient in the examination area.
  • a pre-scan can be used, and it is thus possible simultaneously to make approximate absorption provisions without contrast to using this information and Simulati ⁇ onsticianen with contrast even better the optimal combination of einbydem contrast medium and energy spectrum predetermine and, if appropriate, to automatically take over the X-ray system and to configure it accordingly.
  • the inventive method may be similar to the previously signed ⁇ X-ray system for both the production and presentation Position of transmission recordings are used as for the representation of tomographic images by corresponding and per se known reconstruction steps.
  • contrast agents made available to be provided according to the invention at least two contrast media with un ⁇ teretzlichen contrast-producing elements for selection, wherein the elements from the following list I, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho , Er, Tm, Yb, Lu, Bi, preferably selected from the list Dy, Ho, Er, Tm, Yb, Lu.
  • An example of this would be a set of contrast agents with the contrast generating elements I, Sm and Er. In principle, however, it should be noted that a higher number of different contrast agents also permits a more optimized selection.
  • the contrast media available for selection can also be mixed, so that different contrast agent mixtures with different complexes are used.
  • the list of elements used remains the same.
  • contrast agents which have different contrast-forming elements in chemical bonding.
  • a contrast agent can have a complex with one La and one Gd atom or two complexes with one La and one Gd atom each. It thereby becomes the mixing ratio fixed, so that a change in the mixing ratio can not arise due to application problems.
  • Example ⁇ example can also by 3 chemically bound contrast-forming elements fixed mixing ratios of 1: 2 at different two elements, or 1: 1: be achieved at three different elements.
  • a lanthanide com- plex for the preparation of a contrast agent for diagnostic assistance in a CT examination to use, wherein depending on the cross section and the weave structure of the examination ⁇ range, such a combination of a lanthanide for the contrast agent and an energy spectrum of the X-radiation used is selected which produces a maximum contrast-to-noise ratio in a CT representation.
  • the fol ⁇ constricting reference numerals are used: 1: CT system; 2: first X-ray tube; 3: first detector; 4: second X-ray tube; 5: second detector; 6: gantry housing; 7: patient; 8: patient couch; 9: system axis; 10: control and computing unit; 11: memory; 12: contrast agent applicator; 13: temporal contrast course; 14: aorta abdominalis; Prg x : computer programs.
  • FIG. 1 CT system with contrast agent injector
  • FIG. 3 Simulation values of contrast-to-noise
  • FIG 6 Simulation values from FIG 5 as applied to the same dose normalized with respect mass equivalents contrast-to-noise ratio of the contrast agent; 7 shows simulation values of the contrast-to-noise ratio
  • FIG 8 shows simulation values of FIG 7 as a contrast-to-noise applied to the same dose normalized with respect mass equivalents ratio of the contrast agent
  • FIG 9 shows simulation values of Figure 3 with a cylindrical phantom of 20 cm diameter
  • FIG 10 shows simulation values of Figure 3 with a cylindrical phantom of 30 cm diameter
  • 11 shows simulation values of Figure 3 with a cylindrical phantom of 40 cm diameter
  • FIG. 12 Simulation values of the contrast-to-noise ratio
  • FIG. 14 Time course of the ⁇ HU values in the aorta from FIG. 13;
  • FIG 15 To same dose normalized mass equivalents contrast-to-noise ratio of voltage against tubes ⁇ , celiac in aorta.
  • the inventive CT system can be in its basic structure, for example, a conventional CT system having a single focus / detector system to act, wherein the X-ray tube used influencing at least the possibility of Be ⁇ has the energy spectrum of X-ray radiation used. This can be done for example by controlling the acceleration voltage or the insertion of filters in the beam path.
  • Such systems are well known.
  • the selection means described in more detail later are additionally integrated as an additional component.
  • a dual or multiple focus / detector system As shown in FIG.
  • a CT system 1 has a first X-ray tube 2 with an opposite detector 3 and a second X-ray tube 4 with a further, opposite detector 5.
  • Both focus / detector systems 2, 3 and 4, 5 are in a gantry housing 6 one to a system axis 9 rotating and not shown here, gantry ordered ⁇ .
  • the patient 7 is situated at an lekssver ⁇ slidable patient table 8 which is pushed to scan the patient 7 during the rotation of the focus / detector systems kontinuier ⁇ Lich or stepwise through an opening in the gantry. 6 As a result, the patient 7 is scanned spirally or repeatedly in a circle.
  • a contrast agent is applied to the patient 7 to improve the contrast of a CT image reconstructed from the detector output data.
  • This can be done, for example, by a contrast agent injector 12, which injects the selected contrast agent into the patient 7 with a predetermined flow, possibly also with time-dependent variation.
  • the contrast agent may be designed for a cardio examination so that after the injection it remains exclusively in the bloodstream before it is degraded.
  • a very good representation of the bloodstreams and corresponding clinical reviews are possible.
  • this tumor is strongly highlighted in CT examination and thus easily diagnosed or determined in its location and extent.
  • combinations of both previously described variants possible in which case preferably different contrast-forming elements used who ⁇ can, which can be displayed separately due to their energy-specific difference ⁇ absorption behavior.
  • control and processing unit 10 has a memory 11, in which in addition to the measured detector output data and computer programs Prgi-prg n are stored, which are executed ⁇ out in operation and essentially take over the control of the system and the evaluation of the data.
  • ⁇ selection means in this preferred embodiment of a CT 's present in the form of a computer program Prg x in the control and computing unit 10th The necessary inputs to the selection means, such as patient diameter or examination area, can be made via the keyboard.
  • the outputs of the selection means to the surgeon in the form of the optimal to be selected contrast agent / radiation combination can be done on the screen. Alternatively, this combination can also be passed on to the computer and fed directly into the controller.
  • System offers various advantages over a conventional CT system. For example, different two or more detectors with different lent operating modes are used, if not detectors are available, which are switchable with the same structure in different operating modes. Detector system, a prescan or also the actual scan are carried out, each with a different energy spectrum gleichzei ⁇ tig with each focus /. Likewise, a simple simultaneous on ⁇ 's takeover of several tomograms to determine the patient's dimensions possible, which later optimum selection of the right contrast agent / facilitate radiation combination.
  • the contrast-generating elements are plotted in this figure 2 from left to right with increasing atomic number.
  • the results show that, first with increasing ordinal number ⁇ an improvement therefore increase the contrast-to-noise ratio can be observed. It will be a small plateau reaches the contrast-to-noise ratio in the contrast ⁇ form the elements Er and Tm, followed by a unsteti ⁇ gen drop of the contrast-to-noise ratio to Bi.
  • the elements provide Tb to Bi at 10OkV accelerating voltage a maximum value for the contrast-to-noise ratio, currency ⁇ rend the minimum value at Tb to Ho through 140 kV radiation in He to Lu through 80 kV radiation and Bi by 100kV Radiation is generated.
  • this simulation values of Figure 3 are still ⁇ times than the same dose normalized mass equivalents con- contrast-to-noise ratio plotted against the elements. Basically, it is a re-normalization of the curves of FIG. 3. These curves illustrate that, for example, in the range of I to Sm, the use of lower acceleration voltages and higher order contrasting elements leads to a reduction in the necessary contrast agent concentration for the same contrast-to Noise ratio leads. However, this statement is no longer transferable for further increasing atomic number.
  • FIG. 5 shows the simulation values of the contrast-to-noise ratio of various contrast agents with different elements against water, using the two acceleration voltages 8OkV and 12OkV, respectively with and without beam hardening by copper filters.
  • the influence of the filtering is greater in the 80kV radiation than in the 120kV radiation. Since the same filter thickness was used for both radiations, the effect of beam hardening was also relatively stronger with the 80 kV radiation than with the 120 kV radiation.
  • Contrast-to-noise ratio of various contrast agents applied Another effect which influences the behavior of the contrast-to-noise ratios of different contrast agents zueinan ⁇ at different radiation is the operating mode of the detector used. 7 shows the simulation values of the contrast-to-noise ratio diver ⁇ ser contrast agents with different contrast-forming elements against water with a X-ray radiation for four different detectors with different Radiomo ⁇ mode. Results are compared with a simple energy-integrating detector, an event-counting detector, an energy-specific event-counting detector with two energy ranges and an energy-specific event-counting detector with energy ranges in the 5keV range.
  • FIG. 9 the simulation values according to FIG. 3 with a cylindrical phantom with diameters of 20 cm are shown in FIGS. 9 to 11. 30cm and 40cm, where centrally in the phantom a small contrast medium-filled cylinder is arranged.
  • FIGS. 9 to 10 the simulation results for each of four different X-ray radiations with 80, 100, 120 and 140 kV acceleration voltage are shown.
  • FIG. 11 corresponds identically to FIG. 3.
  • results of Si ⁇ mulations are, but which can be equally replaced by direct measurements.
  • results shown were all determined against a water environment. If a further improved selection and coordination of the contrast agents and their combination with radiation variants and / or detector variants is to be determined, it is better to record these measured values compared to actual tissue structures, since further differentiations are also possible due to different environments for the contrast agent.
  • experimental studies have been conducted in animals to compare the contrast agent gadolinium component using the contrast agent Gadovist® and Kontraststoffponen ⁇ te iodine using the contrast agent Ultravist.
  • G2 Gadovist lmol Gd / kg KM (157 mg Gd / kg KM)
  • G3 Gadovist 2 mol Gd / kg KM (314 mg Gd / kg KM)
  • G4 Gadovist estimate how much is necessary to achieve the same ⁇ HU in the vessels, here the aorta.
  • the measurement protocol should allow angiography of the large abdominal vessels (aorta, cava, v. Portae) and a kidney ⁇ presentation to generate (human protocol: abdomen standard). Over 8 minutes, the animals are scanned closely.
  • ⁇ HU values HU values minus baseline value in the abdominal vessels and the kidneys were determined at different tube voltages. For the established protocol, an extrapolation of the administered radiation dose was made. At- closing was estimated that dose reduction may allow the on ⁇ rate of gadolinium significant picture quality.
  • a sample recording of a scan is in the figure 13 Darge ⁇ .
  • gadolinium has been shown in vivo that nen for clinically relevant tube voltages lanthanides ei ⁇ higher CT contrast reach as iodine.
  • a CT system with a selection agent for the best combination of Kon medium and energy spectrum of X-rays used to scan to optimize is the noise-to-contrast-comparison holds isses, a method for generating CT images with so by this invention Assistance of contrast agents taking into account an optimal combination of contrast medium and energy spectrum of an X-radiation used for the scan and the use of The use of a lanthanide-containing complex for producing a contrast agent for optimizing the combination of contrast agent and radiation to achieve a maximum contrast-to-noise ratio in a CT display suggested.

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Abstract

L'invention concerne un système radiographique comportant un élément de sélection destiné à sélectionner la meilleure combinaison entre agent de contraste et spectre énergétique d'un rayonnement X employé pour le balayage, de manière à optimiser le rapport bruit sur contraste. L'invention concerne également un procédé de création de représentations radiographiques à l'aide d'agents de contraste faisant intervenir une combinaison optimale entre agent de contraste et spectre énergétique d'un rayonnement X employé pour le balayage, ainsi que l'utilisation d'un complexe contenant des lanthanides pour la fabrication d'un agent de contraste de manière à optimiser la combinaison entre agent de contraste et rayonnement afin d'obtenir un rapport contraste sur bruit maximal dans une représentation radiographique.
EP06807524A 2005-10-31 2006-10-25 Systeme radiographique destine a la creation de representations radiographiques par application d'agents de contraste Withdrawn EP1942805A2 (fr)

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DE102005052368.4A DE102005052368B4 (de) 2005-10-31 2005-10-31 Röntgensystem zur Erstellung diagnostischer Röntgendarstellungen unter Applikation von Kontrastmitteln
PCT/EP2006/067741 WO2007051739A2 (fr) 2005-10-31 2006-10-25 Systeme radiographique destine a la creation de representations radiographiques par application d'agents de contraste

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US20080310582A1 (en) 2008-12-18
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WO2007051739A3 (fr) 2007-06-21
DE102005052368A1 (de) 2007-05-16
DE102005052368B4 (de) 2015-07-30

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