Thursday, June 19, 2008

Chest


CT is excellent for detecting both acute and chronic changes in the lung parenchyma. (parenchyma means internals, in this case, of the lungs. It is relevant here because normal two dimensional x-rays do not show up defects in the internals of the lungs). A variety of different techniques are used depending on the suspected abnormality. For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used - often scans are performed both in inspiration and expiration. This special technique is called High resolution CT (HRCT). HRCT is normally done with thin section with skipped areas between the thin sections. Therefore it produces a sampling of the lung and not continuous images. Continuous images are provided in a standard CT of the chest.
For detection of airspace disease (such as pneumonia) or cancer, relatively thick sections and general purpose image reconstruction techniques may be adequate. IV contrast may also be used as it clarifies the anatomy and boundaries of the great vessels and improves assessment of the mediastinum and hilar regions for lymphadenopathy; this is particularly important for accurate assessment of cancer.
CT angiography of the chest is also becoming the primary method for detecting pulmonary embolism (PE) and aortic dissection, and requires accurately timed rapid injections of contrast (Bolus Tracking) and high-speed helical scanners. CT is the standard method of evaluating abnormalities seen on chest X-ray and of following findings of uncertain acute significance.

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