Christian Kloeters

University Hospital Essen, Essen, North Rhine-Westphalia, Germany

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Publications (32)71.53 Total impact

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    ABSTRACT: Background: More recently, autoimmune pancreatitis (AIP) in association with IgG4-positive cholangitis (IAC) has been recognised as a new and challenging entity. Currently, initiation of high dose steroids (e. g., prednisolone 0.5 - 1 mg/kg/day) followed by a steroid dose taper in combination with purine antagonists (e. g., azathioprine or 6-mercaptopurine) after resolution has been recommended as standard therapy. Case Report: A 68-year-old male patient was referred to our institution in February 2012 for therapy evaluation of a steroid-dependent course of autoimmune pancreatitis type 1 with IgG4-associated cholangitis. Since the first diagnosis in March 2011, the patient was treated with high-dose steroids with good response. Whenever steroids were tapered down to a daily dose < 20 mg, cholestatic liver enzymes increased dramatically despite concurrent immunosuppressive therapy primarily with azathioprine and 6-MP thereafter. Therefore, we restarted steroid therapy (1 mg/kg/day) in combination with tacrolimus achieving a target level of 5 - 7 ng/mL. During the down-tapering phase, follow-up examinations presented a patient in good general condition without jaundice. Moreover, liver and pancreatic enzymes and also immunoglobulins returned to normal values without any evidence of relapse up today (66 weeks). Conclusion: In this case, the combination of steroids with tacrolimus seems to be a reasonable alternative in a patient with steroid-dependent and thiopurine-refractory autoimmune pancreatitis with IgG4-associated cholangitis. To date, this is the first description of such a therapeutic approach for this entity.
    Zeitschrift für Gastroenterologie 06/2014; 52(6):564-568. DOI:10.1055/s-0034-1366331 · 1.67 Impact Factor
  • S Kinner · C Kloeters · N Sippel · L Umutlu · TC Lauenstein
    RöFo - Fortschritte auf dem Gebiet der R 04/2013; 185(S 01). DOI:10.1055/s-0033-1346402 · 1.96 Impact Factor
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    ABSTRACT: RATIONALE AND OBJECTIVES: Workflow efficiency and workload of radiological technologists (RTs) were compared in head examinations performed with two 1.5 T magnetic resonance (MR) scanners equipped with or without an automated user interface called "day optimizing throughput" (Dot) workflow engine. MATERIALS AND METHODS: Thirty-four patients with known intracranial pathology were examined with a 1.5 T MR scanner with Dot workflow engine (Siemens MAGNETOM Aera) and with a 1.5 T MR scanner with conventional user interface (Siemens MAGNETOM Avanto) using four standardized examination protocols. The elapsed time for all necessary work steps, which were performed by 11 RTs within the total examination time, was compared for each examination at both MR scanners. The RTs evaluated the user-friendliness of both scanners by a questionnaire. Normality of distribution was checked for all continuous variables by use of the Shapiro-Wilk test. Normally distributed variables were analyzed by Student's paired t-test, otherwise Wilcoxon signed-rank test was used to compare means. RESULTS: Total examination time of MR examinations performed with Dot engine was reduced from 24:53 to 20:01 minutes (P < .001) and the necessary RT intervention decreased by 61% (P < .001). The Dot engine's automated choice of MR protocols was significantly better assessed by the RTs than the conventional user interface (P = .001). CONCLUSIONS: According to this preliminary study, the Dot workflow engine is a time-saving user assistance software, which decreases the RTs' effort significantly and may help to automate neuroradiological examinations for a higher workflow efficiency.
    Academic radiology 03/2013; DOI:10.1016/j.acra.2013.01.004 · 2.08 Impact Factor
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    ABSTRACT: PURPOSE Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis resulting in stenoses of leg arteries. PAD can be diagnosed by magnetic resonance angiography (MRA). This technique requires high amounts of gadolinium and can be often limited due to venous overlay. A new time-resolved MRA technique (TWIST) combines parallel imaging with a 3D view sharing implementation. Hence, 3D datasets can be collected with only little intravenous gadolinium, but high temporal resolution. Aim of this study was to assess whether PAD can be diagnosed with TWIST MRA. METHOD AND MATERIALS 120 consecutive patients with suspected PAD were studied. Examinations were performed on a 1.5-T system (MAGNETOM Avanto; Siemens). A dedicated peripheral vascular coil was used for signal reception. Following the i.v. administration of 3cc gadobutrol (Gadovist, Bayer) at a flow-rate of 3 cc/s, 20 consecutive coronal T1-weighted 3D datasets of the lower legs were acquired using a TWIST protocol (TR/TE/flip = 2.5ms/0.9ms/25°; matrix: 384x202; 60slices; temporal resolution: 3.0s). TWIST images were compared to high resolution 3D T1w MRA data sets (TR/TE/flip = 3.1ms/1.1ms/25°; matrix: 448x358; 88slices) using a bolus chase technique after the i.v. administration of gadobutrol (0.1 cc/kg body weight). Image quality was assessed using a five-point scale (5=high image quality, 1=low image quality). Furthermore, it was evaluated if TWIST MRA led to a change of diagnosis. RESULTS Mean image quality of TWIST MRA amounted to 3.9 (high resolution MRA: 3.3; p<.05). High resolution MRA were severely hampered by venous overlay in 24 patients. TWIST MRA resulted in a change of diagnosis in 22 patients compared to the mere evaluation of high resolution MRA. CONCLUSION TWIST MRA is a fast and robust technique to display PAD of the lower legs. It provides additional information and increases diagnostic confidence as conventional high resolution MRA often is hampered by venous overlay CLINICAL RELEVANCE/APPLICATION TWIST MRA should be part of a conclusive MRI protocol in patients with suspected PAD.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE A precise evaluation of tumour response after Yttrium 90 (Y90) therapy is essential for adequate clinical management. However, evaluation of cross sectional imaging may be hampered as Y90 itself can lead to reactive changes of liver parenchyma with similar appearance to tumour progress. We aimed to compare a liver specific contrast agent (Gd-EOB-DTPA) to gadobutrol MRI concerning therapy response evaluation. METHOD AND MATERIALS 20 patients with histologically proven HCC were included. They underwent contrast enhanced CT as well as MRI with gadobutrol on the day before and liver MRI with Gd-EOB-DTPA directly before Y90 therapy. Follow up images were performed 30, 90 and 180 days after therapy on two consecutive days. Two radiologists reviewed gadobutrol and Gd-EOB-DTPA MRI in consensus using a 4-point-scale: 1 = definitely response, 2 = probably response, 3 = probably no response, 4 = definitely no response. CT in combination with laboratory parameters served as reference standard. RESULTS CT and laboratory parameters revealed progressive disease in 5 patients after 30, in 3 patients after 90 and in 7 patients after 180 days. With Gd-EOB-DTPA MRI radiologists were more determinate compared to gadobutrol MRI (mean values day 30 for responders with Gd-EOB-DTPA = 1.4; gadobutrol = 1.9). In one patient on day 90 and one patient on day 180 radiologists rated gadobutrol MR as probable response while with Gd-EOB-DTPA MRI revealed definite progress which was confirmed by AFP values. One of these patient presented with a negative CT. CONCLUSION Gd-EOB-DTPA enhanced MRI allows a more precise assessment of tumor response in patients after Y90 therapy. The liver specific contrast enabled earlier diagnosis of tumor progress compared to gadobutrol MR and also to CT and can differentiate between therapy induced changes and real tumor progress. CLINICAL RELEVANCE/APPLICATION Follow-up of HCC patients after Y90 therapy should be performed using Gd-EOB-DTPA MRI as the liver specific agent allows a more accurate diagnosis of tumor response and earlier diagnosis of progress.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: BACKGROUND: Neoadjuvant treatment is thought to improve resection with margin-negative surgery in locally advanced soft-tissue sarcomas (STS). Treatment-induced alterations of the tumor peripheryhave not yet been microscopically evaluated. OBJECTIVE: This histopathological study compared limb STS with primary resection and those that had undergone neoadjuvant treatment, emphasizing microscopic changes of the fibrous capsule (FC) and reactive zone (RZ) after neoadjuvant treatment. PATIENTS AND METHODS: Patients with primary high-grade limb sarcomas (N = 76) which have not previously been treated were included. Of those, 37 were primarily resected and 39 were treated with one of the following neoadjuvant treatment modalities: 7x chemotherapy (CTX), 3x radiotherapy (RT), 15x isolated limb perfusion (ILP), 8x CTX + RT, and 6x CTX + ILP. Sizes of the FC and RZ were microscopically measured, and FC-integrity was documented. Histopathologic regression was expressed as a percent. RESULTS: Only 35.1% of untreated sarcomas showed an intact FC. We observed significantly higher capsular integrity after treatment (76.9%). Additionally, the average width of the FC (0.21 mm vs. 0.61 mm) and RZ (0.67 mm vs. 1.48 mm) increased significantly. The extent of histopathologic regression showed a correlation with capsular integrity and width. The combination of two treatment modalities (CTX + RT or ILP) showed strongest effects at the tumor periphery. CONCLUSIONS: Neoadjuvant treatment stabilizes the tumor periphery in STS (e.g., the capsule). Concerning local treatment strategies, these novel histopathologic insights might significantly influence the decision as to whether primary resection is advisable in advanced local soft-tissue sarcoma.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 10/2012; 39(1). DOI:10.1016/j.ejso.2012.10.009 · 2.89 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) has evolved as a powerful tool for the assessment of the small bowel. Strengths of MRI include the superb soft-tissue contrast, lack of radiation exposure, and the implementation of fast scanning techniques. Clinically relevant findings such as inflammation and tumor disease can be well-depicted. We describe in this article current techniques of small bowel MRI including its implementation and clinical outcome in comparison to other radiological and endoscopic procedures.
    Academic radiology 07/2012; 19(11):1424-33. DOI:10.1016/j.acra.2012.05.019 · 2.08 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 05/2012; 184(S 01). DOI:10.1055/s-0032-1311354 · 1.96 Impact Factor
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    ABSTRACT: A 68-year-old male patient was referred to our institution in May 2011 for a suspected tumor in the pancreatic head with consecutive jaundice. Using magnetic resonance imaging, further differentiation between chronic inflammation and a malignant process was not possible with certainty. Apart from cholestasis, laboratory studies showed increased values for CA 19-9 to 532 U/ml (normal <37 U/ml) and hypergammaglobulinemia (immunoglobulin G, IgG) of 19.3% (normal 8.0-15.8%) with an elevation of the IgG4 subtype to 2,350 mg/l (normal 52-1,250 mg/l). Endoscopic retrograde cholangiopancreatography revealed a prominent stenosis of the distal ductus hepaticus communis caused by pancreatic head swelling and also a bihilar stenosis of the main hepatic bile ducts. Cytology demonstrated inflammatory cells without evidence of malignancy. Under suspicion of autoimmune pancreatitis with IgG4-associated cholangitis, immunosuppressive therapy with steroids and azathioprine was started. Follow-up endoscopic retrograde cholangiopancreatography after 3 months displayed regressive development of the diverse stenoses. Jaundice had disappeared and blood values had returned to normal ranges. Moreover, no tumor of the pancreatic head was present in the magnetic resonance control images. Due to clinical and radiological similarities but a consecutive completely different prognosis and therapy, it is of fundamental importance to differentiate between pancreatic cancer and autoimmune pancreatitis. Especially, determination of serum IgG4 levels and associated bile duct lesions induced by inflammation should clarify the diagnosis of autoimmune pancreatitis and legitimate immunosuppressive therapy.
    Case Reports in Gastroenterology 04/2012; 6(1):211-6. DOI:10.1159/000338649
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    ABSTRACT: We examine volumetric CT perfusion in soft tissues of the entire foot with an en bloc technique to provide a meaningful measure of differentiation between mild and major vascular impairment. With Institutional Review Board approval, 22 healthy male subjects between the ages of 21 and 50 (mean 37) were enrolled. Volumetric computed tomography using an en bloc technique was conducted on 14 subjects for validation while unilateral vascular obstruction was simulated in the calves of the remaining 8 subjects. Perfusion estimates were made using in-house software and differences in perfusion estimates between feet were evaluated with Student's t-test at 95% confidence. Subjects with simulated major vascular obstruction (calf blood pressure cuff inflated to 200 mmHg) showed significantly higher ratios of perfusion estimates between the unobstructed and obstructed foot compared to subjects with simulated mild vascular obstruction (cuff inflated to 120 mmHg), mean 4.6, SD 2.6 vs. mean 1.3, SD 0.2; P = 0.05. CT perfusion using an en bloc technique shows promise for the future evaluation of patients with critical limb ischemia and particularly for re-characterization post medical, surgical or endovascular intervention.
    The international journal of cardiovascular imaging 01/2012; 28(8). DOI:10.1007/s10554-011-9978-z · 2.32 Impact Factor
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    ABSTRACT: PURPOSE The throracic outlet syndrome (TOS) is defined as a positional compression of the subclavian and vertebral artery. TOS can be diagnosed by magnetic resonance angiography (MRA) performed in association with postural maneuvers. However, this technique requires high amounts of gadolinium and exact timing of contrast delays. A new time-resolved MRA technique (TWIST) combines parallel imaging with a 3D view sharing implementation. Thus, 3D datasets can be collected with high temporal resolution and only little intravenous gadolinium. We aimed to assess whether TOS can be diagnosed with TWIST MRA. METHOD AND MATERIALS 21 patients with suspected TOS were included. Examinations were performed on a 1.5-T system (MAGNETOM Avanto; Siemens). A Body Matrix RF surface coil was used for signal reception of the upper thorax. Following the i.v. administration of 3cc gadobutrol (Gadovist, Bayer) at a flow-rate of 3 cc/s, 20 consecutive coronal T1-weighted 3D datasets were acquired using a TWIST protocol (TR/TE/flip = 2.5ms/0.9ms/25°; matrix: 384x202; 60slices; temporal resolution: 3.0s). The acquisition was performed twice: with the arms alongside the body and after elevation. Images were analyzed with regards to stenotic changes of the subclavian arteries. Results of subsequent B-mode and color duplex ultrasonography were used as the standard of reference. RESULTS 6 patients did not reveal a stenosis of the right or left subclavian artery. In 15 patients a compression of the subclavian artery was observed after arm elevation (unilateral n=9, bilateral n=6). Findings were confirmed by the standard of reference. CONCLUSION TWIST MRA is a fast and robust technique to identify patients with TOS. CLINICAL RELEVANCE/APPLICATION MRA should be applied using the TWIST technique to diagnose TOS as only a small amount of gadolinium is applied. In addition, high temporal resolution overcomes the need for exact contrast timing.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: Objectives To apply the economic terminology of lean manufacturing and the Toyota Production System to the procurement of vascular stents in interventional radiology. Methods The economic- and process-driven terminology of lean manufacturing and the Toyota Production System is first presented, including information and product flow as well as value stream mapping (VSM), and then applied to an interdisciplinary setting of physicians, nurses and technicians from different medical departments to identify wastes in the process of endovascular stent procurement in interventional radiology. Results Using the so-called seven wastes approach of the Toyota Production System (waste of overproducing, waiting, transport, processing, inventory, motion and waste of defects and spoilage) as well as further waste characteristics (gross waste, process and method waste, and micro waste), wastes in the process of endovascular stent procurement in interventional radiology were identified and eliminated to create an overall smoother process from the procurement as well as from the medical perspective. Conclusion Economic terminology of lean manufacturing and the Toyota Production System, especially VSM, can be used to visualise and better understand processes in the procurement of vascular stents in interventional radiology from an economic point of view.
    Insights into Imaging 08/2011; 2(4):415-423. DOI:10.1007/s13244-011-0097-0
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    ABSTRACT: To compare tube current adaptation based on 3 body mass index (BMI) categories versus anterior-posterior chest diameter (APD) for radiation dose optimisation in patients undergoing dynamic volume cardiac CT. Two cardiac imaging centres participated in the study. 20 patients underwent a prospectively triggered 320-slice single beat cardiac CT using the X-ray tube current [mA] manually adjusted to the patient's BMI (group I). In 20 subsequent patients, the tube current was adapted according to the patient's APD (group II). All other parameters were kept constant. Image noise was defined as the standard deviation of attenuation values and measured using a ROI in the descending aorta. Variation in image noise was statistically compared between both patient groups. Average and standard deviation of pixel noise were 29.1 HU and 14.8 HU in group I and 28.0 HU and 4.2 HU in group II. Inter-individual variation of pixel noise was significantly lower in group II compared to group I (p < 0.0001). Tube current adaptation based on APD is superior to stepwise adaptation based on BMI for optimising radiation dose in dynamic volume cardiac CT and therefore limits unnecessary radiation dose while ensuring diagnostic image quality in patients with diverse body habitus.
    The international journal of cardiovascular imaging 12/2010; 26(8):933-40. DOI:10.1007/s10554-010-9630-3 · 2.32 Impact Factor
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    ABSTRACT: PURPOSE Critical limb ischemia is a significant cause of morbidity and mortality in the diabetic population. The goal of this study was to examine the potential of volumetric CT perfusion of the feet for demonstration of vascular compromise. METHOD AND MATERIALS With informed consent, 16 healthy male subjects, aged 25-50 underwent dynamic 4D CT perfusion of their feet on a 320 detector CT scanner with 70cc's of IV contrast. 8 patients were scanned with a blood pressure cuff inflated around the left calf (4 subjects at 120 mmHg, 4 at 200mmHg) to simulate large vessel obstruction. After defining a posterior tibial arterial input function (AIF), a time-enhancement curve for the soft tissues of the entire foot was created. The perfusion index (PI) was obtained by dividing the maximum slope of the tissue enhancement curve by the peak of the AIF. Ratios of PIs and maximum slopes were defined as greater/lesser value in the unobstructed group and right/left foot in subjects with left-sided obstruction. RESULTS Normal subjects demonstrated an average PI ratio of 1.3 +/- 0.3 and maximum slope ratio of 1.3 +/- 0.2. Patients with 120mmHg circumferential pressure applied to the left calf demonstrated an average PI ratio of 0.7 +/- 0.1 and slope ratio of 1.3 +/- 0.2. Patients with 200mmHg of pressure applied to the left calf did not show appropriate AIFs for calculation of perfusion index. The ratio of maximum slopes at 200mmHg was 4.6 +/- 2.6. Difference in slope was statistically significant (p=0.05) between the 200mmHg and 120mmHg groups and the 200mmHg and unobstructed groups. CONCLUSION The PI ratio in patients with 120mmHg of vascular obstruction was paradoxically decreased due to the decrease in peak density of the AIF with relative preservation of tissue enhancement, resulting in an overall decrease of the PI on the “obstructed” side. Maximum slope of tissue enhancement was, however, successfully used as a surrogate measure of decreased perfusion in all subjects. This approach is not dependent upon the presence of visible or uncalcified large blood vessels and discriminates between normal, mild and severe vascular compromise, making it feasible for use in the diabetic population. CLINICAL RELEVANCE/APPLICATION CT perfusion may potentially be applied to the ischemic lower limb of diabetic patients, both to gauge severity of disease and evaluate response to medical, endovascular or surgical treatment.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010
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    ABSTRACT: L19-IL2, a tumour-targeting immunocytokine composed of the recombinant human antibody fragment L19 (specific to the alternatively-spliced EDB domain of fibronectin, a well characterised marker of tumour neo-vasculature) and of human IL2, has demonstrated strong therapeutic activity in animal cancer models. This phase I/II trial was performed to evaluate safety, tolerability, recommended phase II dose (RD) and early signs of activity of L19-IL2. Five cohorts of patients with progressive solid tumours (n=21) received an intravenous infusion of L19-IL2 (from 5 to 30 Mio IU IL2 equivalent dose) on days 1, 3 and 5 every 3 weeks. This treatment cycle was repeated up to six times. In the following expansion phase, patients with metastatic renal cell carcinoma (RCC) (n=12) were treated at the RD of L19-IL2. Clinical data and laboratory findings were analysed for safety, tolerability and activity. Preclinical studies in rats and monkeys did not raise any safety concerns. The RD was defined to be 22.5 Mio IU IL2 equivalent. Pharmacokinetics of L19-IL2 was dose proportional over the tested range, with a terminal half-life of 2-3h. Toxicities were manageable and reversible with no treatment-related deaths. We observed stable disease in 17/33 patients (51%) and 15/18 with mRCC (83%) after two cycles. Median progression-free survival of RCC patients in the expansion phase of the study was 8 months (1.5-30.5). L19-IL2 can be safely and repeatedly administered at the RD of 22.5 Mio IU IL2 equivalent in advanced solid tumours. Preliminary evaluation suggests clinical activity of L19-IL2 in patients with mRCC.
    European journal of cancer (Oxford, England: 1990) 11/2010; 46(16):2926-35. DOI:10.1016/j.ejca.2010.07.033 · 4.82 Impact Factor
  • P Rogalla · C Kloeters · S Kandel · H Meyer · A Lembcke · P Hein
    RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252887 · 1.96 Impact Factor
  • S Kandel · H Meyer · C Kloeters · P Rogalla
    RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252856 · 1.96 Impact Factor
  • S Kandel · C Kloeters · P Hein · H Meyer · P Rogalla
    RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252889 · 1.96 Impact Factor
  • S Kandel · H Meyer · C Kloeters · P Hein · P Rogalla
    RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252720 · 1.96 Impact Factor
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    ABSTRACT: PURPOSE To determine the radiation dose and to evaluate the image quality of 320-slice dynamic volume CT in children. METHOD AND MATERIALS 39 patients (1 day–14 years, mean: 2.1 years, median: 0.8 years) underwent a dynamic volume CT (Toshiba Aquilion One). The scan parameters wer as follows: 80 kV for scans follwing intravenous contrast material injection, 120 kV in non-contrast scans, 10-50 mA, 0.35 to 0.5s gantry rotation time, 1-3 rotation acquisition. The formula (body weight in [kg]+5) x f was used for mAs calculation with f=1 for chest and 1.5 for abdominal scans at 120 kV. For 80 kV scans, the mAs-value was multiplied by a factor of 2.5. In non-cooperative patients and patients not able to hold their breath, 3 rotations at 0.35 s were acquired to shift the reconstruction within the acquisition window for motion artifact reduction. All scans were evaluated in respect to image quality on a scale of 1-3 (1= poor, 3=good), the resulting radiation dose was calculated based on the DLP displayed on the patient dose report and veryfied using commercially available software for dose calculation in CT (CT-Expo). RESULTS 16 cm detector coverage sufficed for scanning of the target area with exception of four patients (two chest, two abdominal scans). None of the scans was rated poor, one patient moved despite manual fixation so that a repeat scan was deemed necessary. Despite continuous respiratory motion in 10 patients, axial slices were rated as good, in one patient, motion blur was rated relevant but did not hinder diagnosis. Radiation exposure (calculated by both methods) ranged from 0.2 to 2.3 mSv, depending on the scanning area and parameters used. CONCLUSION Although no intraindividual comparison to helical CT was performed, 320-slice dynamic volume CT carries the potential for dose reduction in the pediatric patient population without the penalty of poor image quality. Motion artifacts rarely occur. CLINICAL RELEVANCE/APPLICATION 320-slice non-helical CT represents a further advancement to reduce radiation dose in pediatric CT scanning.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009

Publication Stats

268 Citations
71.53 Total Impact Points

Institutions

  • 2012–2014
    • University Hospital Essen
      • Institute of Diagnostic and Interventional Radiology and Neuroradiology
      Essen, North Rhine-Westphalia, Germany
    • Mount Sinai Hospital, Toronto
      • Department of Medical Imaging
      Toronto, Ontario, Canada
    • University of Duisburg-Essen
      • Faculty of Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2006–2011
    • Charité Universitätsmedizin Berlin
      • Department of Urology
      Berlín, Berlin, Germany
  • 2010
    • University of Toronto
      • Department of Medical Imaging
      Toronto, Ontario, Canada
  • 2004
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany