https://www.ctspectral.com/spectral-cases daily 1.0 2021-06-27 https://www.ctspectral.com/spectral-cases/2021/6/27/something-new-for-adrenal-nodules monthly 0.5 2021-06-27 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1624823542564-GDNVU6NEHF0IS6654KPV/adrenal1.png Cases - Something new for adrenal nodules - Make it stand out Conventional CT: The nodule warrants workup. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1624823579876-9QPLWSPER20SVR0ZQHK3/adrenal2.png Cases - Something new for adrenal nodules - Make it stand out Virtual non-contrast: Attenuation not low enough to let go https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1624823639756-CRD7PFSHCYULWWP7JFD3/adrenal3.jpg Cases - Something new for adrenal nodules - Make it stand out Iodine density: Shows intense iodine uptake. We can calculate ratio of uptake to VNC attenuation. Here the ratio is definitely diagnostic of a benign adenoma. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1624823689925-LK25MF3B077YTVX9R5JC/adrenal4.jpg Cases - Something new for adrenal nodules - Make it stand out CT from 20 years prior: The proof is in the pudding! https://www.ctspectral.com/spectral-cases/2020/11/15/simple-and-easy monthly 0.5 2020-11-15 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1605469994545-SMHMO3JP8XM4CNQ5CBU5/adrenal12.JPG Cases - Simple and easy Conventional CT: Large left adrenal mass, about 60 HU. Typically read as “indeterminate”. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1605470004899-MQFLKDFSUHIDDFRH6HHB/image-asset.jpeg Cases - Simple and easy VNC: Mass remains hyperdense https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1605470016957-IC4TR04OZ9NEAGLFYLNG/adrenal14.JPG Cases - Simple and easy Iodine map: Absolutely NO uptake! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1605470026871-AP8A57VL1368HI1F5DXE/adrenal15.JPG Cases - Simple and easy Iodine overlay confirms. https://www.ctspectral.com/spectral-cases/2020/9/30/hiding-in-plain-sight monthly 0.5 2020-09-30 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1601477046307-6AZZMVPFA63O0MO5JHF3/Capture22.JPG Cases - Hiding in plain sight Conventional CT: Not much to talk about https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1601477095110-4L0LR0OBA6KGFEVK5NRP/Capture24.JPG Cases - Hiding in plain sight 40 keV monoE: See the enhancing nodule at the undersurface of pylorus/duodenal bulb https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1601477150609-1XGISOVKVSIZWOKEFMA1/Capture25.JPG Cases - Hiding in plain sight Iodine map shows uptake identical to the pancreas https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1601477310715-6C2R4A32IINFMKPSEZL2/Picture26.jpg Cases - Hiding in plain sight Spectral curves in the pancreas (blue) and the heterotopic pancreas (magenta) are identical! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1601477352936-27AUYSAK5A67UXHKU1YM/Capture37.JPG Cases - Hiding in plain sight Previous MRI shows the heterotopic pancreas nicely. It was hiding in plain sight! https://www.ctspectral.com/spectral-cases/2020/6/18/lung-nodule-spectral-and-volumetric monthly 0.5 2020-06-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507326001-ACP0DN063EJN11WH9517/mammo1.JPG Cases - Lung nodule: Spectral and volumetric. Screening mammogram showing breast nodule. No, there is no way I would have seen it. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507371259-EMLT4WRLB4OV0PQ1G9MN/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. Noncalcified nodule in left lower lobe. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507396127-3AWKRLQRWBU3T0JZ31ZG/mammo5.JPG Cases - Lung nodule: Spectral and volumetric. Iodine map shows no uptake in this nodule. Notice ring of iodine uptake around nodule (yellow arrows), something I see commonly in benign nodules. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507451783-1Q8MSMSRAVNXPTUYWWYF/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. Nodule is about 30 HU on conventional CT… https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507477004-73Z31ZMV8DVJD0A1NMNX/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. …and about 26 HU on virtual non-contrast. So there is no enhancement. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507511994-ZW8T6RALINQI7VK41J6V/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. And no iodine uptake on measurement. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507536424-U0LZQWHKUKXVBPSU922T/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. About 575 cubic mm on baseline scan using volumetric analysis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1592507573340-AEB24IY5X12X00WB2LGY/image-asset.jpeg Cases - Lung nodule: Spectral and volumetric. Essentially unchanged on follow up! https://www.ctspectral.com/spectral-cases/2020/2/24/past-is-prologue monthly 0.5 2020-02-24 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577386990-CMG9TN1BOPZE7OSF31T5/CXR1.jpg Cases - Past is prologue CXR with white out on L. Notice shift of mediastinum to the R, c/w a large pleural effusion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577358838-668HPVBR9QUP7J6P4YVZ/bleedlate1.JPG Cases - Past is prologue Conventional CT shows large left hemothorax https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577405839-JBTWBXIIGOEX8CIATMJR/blledlate3.JPG Cases - Past is prologue Virtual non-contrast shows clots surrounding the left lung https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577414378-8P64DKXQ0FG8YNEN498N/image-asset.jpeg Cases - Past is prologue Iodine map shows small focus of active bleed (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582579113023-TUSV51LWI7TYLRWJQ5ZV/Angio.JPG Cases - Past is prologue Angiogram confirms bleeding aneurysm. This was embolized. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577572170-ZE45FDTPUU6FL6GV57CV/PEfirst.JPG Cases - Past is prologue Going back in time: Conventional CT 9 months prior shows saddle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577433927-SVK6IJ37PBTN84LTZ8VW/CXRmay.JPG Cases - Past is prologue A couple of months later: CXR shows nice infarct. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577448837-QXNMW6E6LTBWGJJYJHU5/CTmiddle1.JPG Cases - Past is prologue CT confirms the infarct. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577474525-9ICCGA0X0TTY0X0EPHUI/image-asset.jpeg Cases - Past is prologue Iodine map shows infarct is the core of the large perfusion abnormality https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577482117-KW21HZPTW2X3BOOW2PPF/CTmiddle3.JPG Cases - Past is prologue Iodine overlay: The infarct is a lot smaller than the perfusion abnormality https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577497443-CWC177WZ9AKGIX1689A1/image-asset.png Cases - Past is prologue Recent CXR: All that is left is a bit of pleural thickening where the infarct used to be. Notice trace left pleural effusion with blunting of L costophrenic angle. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577518769-0T8RRX1Q0P9DXZD8L89S/CTaneyrsm1.JPG Cases - Past is prologue Conventional CT shows pleural thickening https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577529539-L1A1731XSHZ9SJPMNI0R/CTaneurysm2.JPG Cases - Past is prologue Iodine map shows focal nodule of uptake in the pleural thickening https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577544409-MAF5XHYS5Z368UW2J74U/image-asset.jpeg Cases - Past is prologue 40 keV monoE: Nicely depicts the aneurysm! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1582577557005-VLJTFRN3TKA216JDD7YW/image-asset.jpeg Cases - Past is prologue Iodine overlay confirms the finding. This is what bled a few days later. https://www.ctspectral.com/spectral-cases/2020/2/8/i-want-to-have-my-life-back monthly 0.5 2020-02-08 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1581198019122-4Z3QEP7I6N888X109J3W/amiodPicture1.jpg Cases - "I want to have my life back." Conventional CT: Bilateral infiltrates and effusions https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1581198033162-C1JR2A2E1KN2K7N3919N/Pictureamiod1.jpg Cases - "I want to have my life back." Iodine map: intense uptake in the “infiltrates” https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1581198125142-9CA1IBSX0MT2NDKAG3I4/image-asset.jpeg Cases - "I want to have my life back." Conventional CT: Hyperdense liver. There is no contrast in the aorta. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1581198134093-BLPMJ8EM4Y0O3DQ0XB2L/amiod4Picture1.jpg Cases - "I want to have my life back." Iodine map: Intense iodine uptake in liver. This iodine is from the amiodarone. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1581198272511-5DH4E73EIAQUXZHOA917/amid34Picture1.jpg Cases - "I want to have my life back." Quantification on a non-contrast CT: This is a fair amount of iodine. https://www.ctspectral.com/spectral-cases/2020/2/4/no-reflow-on-abdomen-ct monthly 0.5 2020-02-04 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580846972488-L6OIVVR1VQNV7UKVNL8S/CaptureEKG.JPG Cases - No-reflow on abdomen CT EKG at presentation: The ST elevations are remarkable, and can be diagnosed by a radiologist https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580847085972-NLFWLXVIDLVKK382R5SA/image-asset.jpeg Cases - No-reflow on abdomen CT Angiogram shows severe LAD stenosis with thrombosed plaque https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580847144970-A2NPHUYXQ0KJCE6COT8G/Capture24.JPG Cases - No-reflow on abdomen CT Post-stenting: Absolutely gorgeous result! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580848559536-OWU6Q8UM9CPMFHGF5HWB/image-asset.jpeg Cases - No-reflow on abdomen CT PACS screengrab: Large hypoperfusion in LAD territory best seen on iodine map (left lower image) and 40 keV (right upper image). This is routine where I work: Spectral recons are sent to PACS, and do not need a special system to review. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580849017766-FCENFBZRMY1DZI16Y7LN/image-asset.jpeg Cases - No-reflow on abdomen CT Conventional CT: short axis. You might call the perfusion defect, if you were lucky and having a good day. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580849090524-S6Q89O8ZJGS27MMKYZZ8/Captur125e.JPG Cases - No-reflow on abdomen CT 40 keV monoE: Impossible to miss https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580849101460-M7RIRLXX6D6X6JJDV8ZV/Capture126.JPG Cases - No-reflow on abdomen CT Iodine map https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580849141248-LC562CQ8Q9DHS66JLUJ8/Capture26.JPG Cases - No-reflow on abdomen CT Troponin curve: Rare to see a troponin peak this high in my limited experience. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1580849173731-A6M3FLDVG8JWAGOCBQU3/Capture25.JPG Cases - No-reflow on abdomen CT Contrast echo confirms the perfusion defect https://www.ctspectral.com/spectral-cases/2020/1/7/a-mystifying-nodule monthly 0.5 2020-01-07 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412360118-RE0ALDIF0JZ0NVQU44F4/Capture10.JPG Cases - A mystifying nodule Conventional CT many years ago shows large right kidney mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412405402-8JFTWZ1Z011KDT1JXCLB/Capture11.JPG Cases - A mystifying nodule Tumor thrombus in right renal vein (arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412431351-RPMS9UY6IYEJGDB4RLF6/Capture12.JPG Cases - A mystifying nodule CT 2 years after nephrectomy. Tint RLL lung nodule. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412439609-1AA20UFTRHEF0E3IHCQ2/Capture13.JPG Cases - A mystifying nodule Followup CT 1 year later, nodule is larger. This was oligometastasic disease. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412520021-0LNATQ9BLP3LRC6ZWHUU/image-asset.jpeg Cases - A mystifying nodule CT a couple of years later. Intensely enhancing subcarinal nodule. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412528129-FR19WV7TVWB8UGS5EMTG/image-asset.jpeg Cases - A mystifying nodule The subcarinal nodule has intense uptake on iodine map. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412535726-9ZXT8TJ7E97TKLMF9U81/image-asset.jpeg Cases - A mystifying nodule Quantitatively intense iodine uptake. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412544507-K5XOZ0XFLGK3X58PFOIQ/image-asset.jpeg Cases - A mystifying nodule Image captured from EUS FNA. They nailed it! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412553110-1R7QRI5V7280QXR16LDB/Capture18.JPG Cases - A mystifying nodule Dotatate scan: The nodule shows uptake, consistent with neuroendocrine tumor. Note physiologic uptake in the spleen, adrenals and kidneys, as well as uncinate process of pancreas. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578412566725-ATMZX1H40ZXTS1REHD7W/image-asset.jpeg Cases - A mystifying nodule Fusion image confirms uptake in the subcarinal nodule. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1578414090747-HP0R5HWQSLBI2NUG90R5/Capture21.JPG Cases - A mystifying nodule Coronal image shows the nodule is in the roof of the left atrium. https://www.ctspectral.com/spectral-cases/2019/12/10/the-case-of-the-two-infarcts monthly 0.5 2019-12-10 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575996975370-5RCGU6PSNOQQERCQET1R/Capturea.JPG Cases - The case of the two infarcts Oblique axial iodine overlay shows inflamed loop of terminal ileum (red arrow). Note upstream dilatation. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997033669-SLL5CMOJIUG1KKEV1TDI/image-asset.jpeg Cases - The case of the two infarcts Hypodensity right kidney lower pole. Could be pyelonephritis or infarct. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997043033-4AMZBKAH5MT3R7UBN7SB/image-asset.jpeg Cases - The case of the two infarcts Absent iodine uptake. Still could be pyelonephritis or infarct. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997050028-DPK396APPR10D2CH9WY5/Captured.JPG Cases - The case of the two infarcts Here is another hypodensity. UA was clean. So these are most likely infarcts. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997082494-OPOZU38CUWX9J3SKZ53K/image-asset.jpeg Cases - The case of the two infarcts CT 2 weeks later: Do you see the spleen hypodensity? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997091216-UTDFN3LCZ6KBHFLE85BB/image-asset.jpeg Cases - The case of the two infarcts Iodine overlay shows there are actually 2 infarcts present (red arrows). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997098088-DI0YZ74M9W853T5Z2FSQ/image-asset.jpeg Cases - The case of the two infarcts Odd linear filling defect in aorta https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997109706-IR9TXHN4V82CMA7BO6SU/image-asset.jpeg Cases - The case of the two infarcts The filling defect is confirmed on 40 keV image. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1575997116535-ZR9BMPJGYXKI5K0MZXU2/image-asset.jpeg Cases - The case of the two infarcts Gated CTA shows filling defect is mobile. Video on my twitter feed (@CtSpectral). https://www.ctspectral.com/spectral-cases/2019/9/28/its-all-about-confidence monthly 0.5 2019-09-29 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721144541-IG5LMW40YSFFR92D8N05/Capture1.JPG Cases - It's all about confidence Conventional CT: Do you see the MI? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721175319-ZY8SOCMWL63CNIU7S79N/Capture2.JPG Cases - It's all about confidence 40 keV image: How can anyone miss the MI? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721187974-7K6Z16K4JHR2BOPSGIAJ/Capture3.JPG Cases - It's all about confidence Iodine map: Stands out. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721200611-LKSBR808DKYGWDJLD0YD/Capture6.JPG Cases - It's all about confidence Now some numbers. Notice the attenuation difference between MI and normal perfused myocardium on conventional scan. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721209526-P96FH4W4ATBYYWDL9IMX/Capture7.JPG Cases - It's all about confidence 40 keV: Attenuation difference nearly quadrupled! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721217620-N8TIQLINEB0NZ25LH7H4/Capture8.JPG Cases - It's all about confidence Iodine map shows no uptake on measurement. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1569721225025-YY1TEVJ9T686D8DW0Q2T/Capture5.JPG Cases - It's all about confidence Spectral curves: yellow dashed line shows difference in attenuation on conventional imaging, and red dashed line shows the difference on 40 keV image. Now, why would you not want to use spectral CT? https://www.ctspectral.com/spectral-cases/2019/9/15/another-mass-another-stone monthly 0.5 2019-09-15 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561600834-SWJFEXZTNRTQWA9SPSYP/Capturemass.JPG Cases - Another mass, another stone Conventional CT: Complex cystic and solid mass in left kidney and kidney stone. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561611939-EZJJID1475JAUPQ1PDZ7/Capturemass2.JPG Cases - Another mass, another stone Solid component is about 40 HU in density on conventional https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561643679-59ZH5172CJA0K2TPZIYV/Capturemass3.JPG Cases - Another mass, another stone Virtual non-contrast: Solid component remains dense https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561658666-AUETV2M3MIGS5WBX12MB/Capturemass4.JPG Cases - Another mass, another stone Virtual non-contrast: Solid component is about 37 HU in density, proving no enhancement. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561668473-L6C3AD2BI2AR3H59C1X0/Capturemass5.JPG Cases - Another mass, another stone Iodine overlay: Absent iodine uptake proves this is not neoplastic. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568562033730-RNIPKID6ELE7UI4D3YQW/Attenuation+curve_%28Sunday-15-2019_10-40-13-4983%29.jpg Cases - Another mass, another stone Spectral curve: Blue curve on solid component remains flat. consistent with absent perfusion. Magenta curve, for comparison, is on perfused kidney parenchyma. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1568561677496-K8KAHZJI9L1P2TR2AT95/Capturemass6.JPG Cases - Another mass, another stone Uric acid removed: The stone is made of uric acid! https://www.ctspectral.com/spectral-cases/2019/7/14/satisfaction-of-search monthly 0.5 2019-07-14 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080097393-KAF7YK7CN9GT255GRP3G/ADENOMA1.jpg Cases - Satisfaction of search Severe direct hyperbilirubinemia (blue curve, magenta is total bilirubin). Bilirubin dropped to normal over several days. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080121332-63AZVTR5CFIWHSTND6Y6/ADENOMA2.jpg Cases - Satisfaction of search Conventional CT: Fatty liver. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080149441-NA3Q339BUMTU2YZ2A4F7/ADENOMA3.jpg Cases - Satisfaction of search 40 keV monoE: Heterogeneous liver, now see the cecal mass pop into view! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080179817-RGUXQZUZDY0SJHFUJFBT/image-asset.jpeg Cases - Satisfaction of search Iodine map: same as above. Notice the stalk. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080264116-FLZPKULKTVFTVSIS9YDY/ADENOMA5.jpg Cases - Satisfaction of search Iodine overlay depicts findings well. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080201839-VMDKEZ95DH0Q0PXB1D69/image-asset.jpeg Cases - Satisfaction of search Iodine uptake in cecal mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1563080213207-0UMOQRDXOPNYE9UJKO2I/ADENOMA8.jpg Cases - Satisfaction of search Colonoscopy: Cecal tubular adenoma. https://www.ctspectral.com/spectral-cases/2019/6/25/coital-cyst-rupture monthly 0.5 2019-06-25 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561491797424-F7TNZQ64DF6LF56SBDCB/Capture11.JPG Cases - Coital cyst rupture Patient 1: Conventional CT shows right adnexal "mass”. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561491850260-K89GD6HC7A62RKQ00ZJ2/Capture121JPG.JPG Cases - Coital cyst rupture Virtual non-contrast: Dense clot in the mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561491884874-1AUD7K0X87MBG2YY6WHL/Capture122.JPG Cases - Coital cyst rupture Iodine map: No uptake in the mass. Notice the thin enhancing margin. This is a blood clot inside a cyst. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561491933136-3GSTPHZWF076WE5BSA4R/image-asset.jpeg Cases - Coital cyst rupture ROI on the clot shows no enhancement, and no iodine uptake. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561491970235-E2CY3S2N669BCYDNQ5DO/image-asset.jpeg Cases - Coital cyst rupture Flat spectral curve confirms lack of perfusion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492043101-OTBR8F3QDIWTJU9V606E/Picture1.gif Cases - Coital cyst rupture Ultrasound shows absent flow in the clot. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492077405-4P2NS76MR7Z5PMHMHFBC/Picture2.gif Cases - Coital cyst rupture CASE 2: Coronal CT shows large hemoperitoneum. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492116963-SPJ34L3P3SCSG213AZHV/Capture130.JPG Cases - Coital cyst rupture Conventional CT: Just a big mess in the pelvis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492180710-XZ9A64VRO5BB44TP78LI/Capture133.JPG Cases - Coital cyst rupture Iodine map: See perfusion to the uterus, and absent perfusion posterior, c/w clot. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492148138-T2Y8060XUJVZKYNCKHI0/Capture131.JPG Cases - Coital cyst rupture VNC: Large clot posterior to the uterus is hyperdense. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492236502-3GGFIP1X9H76HLQAHPF3/image-asset.jpeg Cases - Coital cyst rupture 40 keV monoenergy image shows small right adnexal cyst. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561492263889-WWS198YPXBZVC4AQJDUN/Picture3.gif Cases - Coital cyst rupture Ultrasound confirms right adnexal ruptured corpus luteum. https://www.ctspectral.com/spectral-cases/2019/6/21/why-spectral-ct monthly 0.5 2019-06-21 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154612008-N37IHUE3L8PCAH31R1NG/Picture7.gif Cases - Why spectral CT? Non-contrast CT. Can you see the lesion? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154703970-UT58SC93ZX0CO0GOW308/image-asset.gif Cases - Why spectral CT? Electron density: Can anyone miss the lesion? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154751179-DFWXEL7OG66A1LIE7UH6/Picture10.gif Cases - Why spectral CT? Electron density overlay: Just showing off now. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154790082-2SWAP62I992SPB1KKJ9Q/Picture11.gif Cases - Why spectral CT? Arterial phase, conventional image. Scan done with 35 mL contrast. See the enhancement? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154844117-DK2MF7PCXYXTN0DSX8QW/Picture12.gif Cases - Why spectral CT? Arterial phase, 40 keV mono-E image. No comment needed. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154893796-1V39535PTVRRX49YK72I/Picture13.gif Cases - Why spectral CT? Arterial phase, iodine map. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561154934610-TZG74ZTZK5UHMQIRMJ9Y/Picture14.gif Cases - Why spectral CT? Portal venous phase, conventional phase. You cannot assess for washout, which is one of the major criteria for LiRADS. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561155006918-TEFI6P00824T96PLXR4E/Picture15.gif Cases - Why spectral CT? Portal venous phase, 40 keV mono-E. The washout is obvious! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561155060289-H9AHFAJ6NUDQWM18ZQAQ/Picture16.gif Cases - Why spectral CT? PVP, electron density weighted image. See the lesion very well. Not sure this represents washout, as EDW seems to reflect non-contrast image quite well. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561155138085-5K1LJHINT09WUUANS6DW/Picture17.gif Cases - Why spectral CT? Conventional CT, arterial phase, higher up in the liver. This is unremarkable. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561155192082-ODCG31WU1Q1LOKQWL0KZ/Picture18.gif Cases - Why spectral CT? Arterial phase, 40 keV image. See the 2 dots of enhancement? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1561155240449-G9TX0GM3ABNPUJLOOCB2/Picture19.gif Cases - Why spectral CT? Delayed phase, electron density: The lesion shows up very well. Again, not sure this qualifies as true washout. In any case there is no capsule. I gave this a LiRADS 4, suspicious for HCC. https://www.ctspectral.com/spectral-cases/2019/6/12/more-about-electron-density monthly 0.5 2019-06-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347533402-7DD4YYX2XBI9AV1WEB40/Capture12.JPG Cases - More about electron density Conventional CT: The lesion in the liver is very hard to see. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347554812-4ZY83IXRQ84OQDS9P7VL/Capture13.JPG Cases - More about electron density Liver windows make the lesion more conspicuous. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347569191-EWGNHT2C1TENGTVP4E2C/Capture21.JPG Cases - More about electron density IMR, with it’s noise reducing ability, makes the lesion impossible to miss. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347588633-6CR2PPBD85HJMRDWS3YP/Capture14.JPG Cases - More about electron density Iodine map: The lesion is not visible! Has same iodine uptake as normal liver. This is a portal venous phase image. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347597227-FBRTRR69465UHUAGF0IL/Capture15.JPG Cases - More about electron density Virtual non-contrast: Lesion pops out again. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347609009-2G0E9HKOH1UAOTF1525U/Capture16.JPG Cases - More about electron density The best contrast resolution, by far, is on electron density image! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347622524-SRU85V2YHJCL6UV24H72/Capture18.JPG Cases - More about electron density MRI with DWI showing lesion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1560347649388-QAWQG2A1MKCCN7E8BLUR/Capture20.JPG Cases - More about electron density Hypermetabolic on PET/CT. https://www.ctspectral.com/spectral-cases/2019/5/7/anatomy-of-an-old-infarct monthly 0.5 2019-05-07 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235443563-NRZYG1YLJP176KMD5MF9/Captureekgoldmi.JPG Cases - Anatomy of an old infarct EKG: Read as unchanged from a year prior. No idea what it shows. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235484898-WKPHXOBTCJ4WPLOB7F5W/Capture53.JPG Cases - Anatomy of an old infarct Conventional CT: Clear old distal anterior and apical infarct (yellow arrow). Wall is thin and hypoenhancing relative to normal myocardium. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235542048-8K73UFC0KB0EP22U2HZ2/Capture54.JPG Cases - Anatomy of an old infarct Virtual non-contrast: fat deposition in the subendocardium (yellow arrows). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235645680-YA7BHW3Y60O7H0OGDJRV/Picture59.jpg Cases - Anatomy of an old infarct ROI placed in fat (magenta) has density of -69 HU. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235590678-G8CG0M513O4RCLGA2XP9/Picture55.jpg Cases - Anatomy of an old infarct Iodine map: Absent perfusion in the distal anterior wall and apex. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235729531-YQBQ43U6JO34XXA2J4CY/image-asset.jpeg Cases - Anatomy of an old infarct Iodine measurement: Notice striking difference between iodine uptake in normal myocardium (2.5 mg/mL) and old infarct (essentially no iodine uptake). The negative iodine uptake in the fat deposition area is likely an artifact of reconstruction. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1557235813280-2CO27ROBQTSZD175EJ78/Picture60.jpg Cases - Anatomy of an old infarct Spectral curves: Magenta (subendocardial fat) has a curve that slopes down on the left. The remainder of the infarct (blue) stays flat. Normal myocardium slopes upwards on the left. https://www.ctspectral.com/spectral-cases/2019/4/23/y1c0qv6z7eopqq41ggtyp35kq0mko9 monthly 0.5 2019-04-24 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556062931918-A980NVCU4I22CWQ7KHIF/Pictureu1.jpg Cases - Roses and islet cells Ulcer in second part of duodenum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556062941932-T9MO6XM3LDLU4HFGRWGD/Pictureu2.jpg Cases - Roses and islet cells Ulcer in third part of duodenum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556062954249-J1X29W9AXSE7BW5AU58J/Pictureu3.jpg Cases - Roses and islet cells Ulcer in jejunum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556062965942-2A002ERB75FERVO9F71M/Picturess1.jpg Cases - Roses and islet cells Conventional CT: Pancreas is NORMAL https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556110343257-O0BRE7VBGT9DDIAOVP2A/Picturesss1.jpg Cases - Roses and islet cells Iodine map: Nodule in uncinate process (red arrow) with well-defined margin. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556062991983-S26G43E8406YPZC7G9KV/Picturesse1.jpg Cases - Roses and islet cells 40 keV mono-energy image shows nodule well. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556110394572-J2FKJCK226DG907QVDSY/Picture1ssr.jpg Cases - Roses and islet cells Z-effective map shows nodule shining (blue arrow)! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556110465513-KBNY8DPTGQCZ0CPK54RG/Picture1.png Cases - Roses and islet cells Ga68 Dotatate PET scan: Intense uptake in uncinate nodule. Note similarity to the Z-eff image above. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1556110555686-XN0INNBVSR4KR7NR7JSK/Picture1ssd.jpg Cases - Roses and islet cells Ga68 Dotate PET scan whole body image. The intense uptake overlying the right kidney (red arrow) is the gastrinoma. https://www.ctspectral.com/spectral-cases/2019/3/30/role-of-electron-density-weighted-images monthly 0.5 2019-03-31 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003801361-39JG5NQA5O13WTKCWZAE/Picture1.jpg Cases - Role of electron density weighted images Non-contrast CT: Super subtle liver lesion in left lobe https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003822735-KZEYHPEKHDNYVMAGJFC5/Picture2.jpg Cases - Role of electron density weighted images Electron density weighted image: The left lobe lesion pops out. In addition, there are multiple abnormal foci in the right lobe that were simply not visible on the non-contrast image. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003845064-49NCL4RNXAOP8MODDFXN/Picture3.jpg Cases - Role of electron density weighted images Color overlay with EDW image shows findings to good effect. Notice subtle areas of abnormality in the right lobe. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003856519-E8V8DX9QR6Y1UB43D0MH/Picture4.jpg Cases - Role of electron density weighted images T2W MRI shows the left lobe of liver lesion as well as multiple areas of abnormality in the right lobe https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003881629-DJ2GVBGJHF8ZITPKMQFC/Picture5.jpg Cases - Role of electron density weighted images DWI b=0 image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003892247-AFN8FPF4SS8M3PTVYUES/Picture6.jpg Cases - Role of electron density weighted images DWI b=800 image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1554003911945-X4K08UHN14M88W2JMTXV/Picture7.jpg Cases - Role of electron density weighted images ADC map. Note all abnormal areas have restricted diffusion. The left lobe lesion has a multiloculated appearance typical of abscess. https://www.ctspectral.com/spectral-cases/2019/3/12/urinary-stone-composition monthly 0.5 2019-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403385854-RX6FMSRWDDW1NPJE2GML/image-asset.jpeg Cases - Urinary stone composition Routine conventional CT shows obstructing stone in left ureter (yellow arrow). There are peripelvic cysts in kidney bilaterally. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403426999-IFJZG5193GYT76HD63VE/Capture125.JPG Cases - Urinary stone composition conventional CT (axial image). Stone in left ureter (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403742710-LQLO2YOFT6DYUQXBBFAP/Picture3.gif Cases - Urinary stone composition Spectral CT, iodine overlay: Note delayed nephrogram in left kidney. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403641755-DWMW9IDK392U8R8YRRIG/Picture1.gif Cases - Urinary stone composition Virtual non-contrast: Stone pops out. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403672531-IDP80BMA2GM5XP8E3OXS/Picture2.gif Cases - Urinary stone composition Uric acid overlay: Color coding of left ureteral stone confirms uric acid composition. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552403485892-PWOMAVNIX3EGJJ3W2MSI/Picture130.jpg Cases - Urinary stone composition Morphological analysis after extraction: the stone is made of uric acid. https://www.ctspectral.com/spectral-cases/2019/3/10/from-switzerland monthly 0.5 2019-03-10 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552246361488-7H5DPRCCNN2J1X2I9DBX/Picture11.gif Cases - From Switzerland Conventional CT, venous phase. You might pick up hypoperfusion in lateral wall of left ventricle on a good day, but then again… https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552246209443-NG7YBHADYLP9Q8GSR7IT/Picture6.jpg Cases - From Switzerland MonoE: Large perfusion defect is obvious! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552246286683-CC3K4RRAC1PCRA82V9HE/Picture7.jpg Cases - From Switzerland Iodine overlay confirms perfusion defect https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552246295754-IA6M1FKWXVL7OY3VPF8Y/Picture8.jpg Cases - From Switzerland Z-eff image is a nice way to depict finding https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1552246304312-GOKS8WFK971UM8G396DB/Picture9.jpg Cases - From Switzerland Conventional CT, arterial phase shows Stanford type A dissection involving ostium of the left main coronary artery. https://www.ctspectral.com/spectral-cases/2019/2/24/doudenal-hematoma monthly 0.5 2019-03-10 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551072954566-HXRHMQDKRADZJANL05MF/doudenal+hematom.jpg Cases - Duodenal hematoma Ultrasound shows large “collection” https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073041774-MQI0CH45VOAJMBQ72U4Z/doudenal%2Bhematoma%2B2_%2528Sunday-24-2019_23-00-32-5516%2529.jpg Cases - Duodenal hematoma Conventional CT: Acute pancreatitis. Fatty liver reveals a more than passing familiarity with ethanol. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073093667-W9PJ5MJ0IB064LQ8LYZM/doudenal%2Bhematoma%2B2_%2528Sunday-24-2019_23-00-32-5516%2529.jpg Cases - Duodenal hematoma Iodine overlay: No evidence of pancreatic necrosis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073148748-ZGQ52CPNHZZ6NBJLMOO4/doudenal%2Bhemaoma_%2528Sunday-24-2019_22-59-34-8873%2529.jpg Cases - Duodenal hematoma Conventional CT: large doudenal “mass”. This corresponds to the “collection” seen on ultrasound. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073184040-YZPZUFP3L1RMVB83HAV8/doudenal%2Bhemaoma_%2528Sunday-24-2019_22-59-34-8873%2529.jpg Cases - Duodenal hematoma Virtual non-contrast: The mass is hyperdense. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073229070-94J96TOR3WYAVPIRT8V6/doudenal%2Bhemaoma_%2528Sunday-24-2019_22-59-34-8873%2529.jpg Cases - Duodenal hematoma No uptake on iodine map confirms a doudenal hematoma. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073280873-VZRKI4GU2LMEEX2U61EW/doudenal%2Bhemaoma_%2528Sunday-24-2019_22-59-34-8873%2529.jpg Cases - Duodenal hematoma Nicely depicted on iodine overlay https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1551073575030-NDEY3WENAR09KA1Q3R9E/doudenal11.jpg Cases - Duodenal hematoma Percutaneous drainage of the doudenal hematoma. https://www.ctspectral.com/spectral-cases/2019/2/17/a-case-of-rectal-bleeding monthly 0.5 2019-02-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448244133-32RT38H7PIWUL2OXS690/Capture12.JPG Cases - A case of rectal bleeding Conventional CT: Red arrow shows “hyperdensity” in the rectal lumen. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448252433-BX1N566OXWKLG9BX7U8T/image-asset.jpeg Cases - A case of rectal bleeding Virtual non-contrast: The “hyperdensity” is gone! So you do not really need a true non-contrast exam. The yellow arrows show the anastomosis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448267090-311BB4O4JZYAXUWERWN9/Capture14.JPG Cases - A case of rectal bleeding Iodine map: Confirms bleeder arising from near the anastomosis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448274704-CD5Z02J27FXTX8BZ7VZ6/Capture15.JPG Cases - A case of rectal bleeding Iodine overlay: Nicely confirms findings https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448323941-JKJWV2Z4EBWKQ6NGACWL/Picture17.jpg Cases - A case of rectal bleeding Bleeding vessel seen on flexible sigmoidoscopy https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1550448333310-9FB38THOBT4ZGTAURMX6/image-asset.jpeg Cases - A case of rectal bleeding Clips placed successfully. https://www.ctspectral.com/spectral-cases/2019/1/31/to-or-or-not-to-or-that-is-the-question monthly 0.5 2019-01-31 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952583003-SWUQY27QEK2ULK15BLF9/ischemia%2B2_%2528Thursday-31-2019_10-14-19-1313%2529.jpg Cases - to OR or not to OR, that is the question Conventional CT: Extensive pnematosis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952626375-MXIN19QR6GCFX4QVXARR/image-asset.jpeg Cases - to OR or not to OR, that is the question Iodine map: ALL of these loops have iodine uptake! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952661103-QE1GT2CWLQFUAR5IIT0H/ischemia%2B2_%2528Thursday-31-2019_10-14-19-1313%2529.jpg Cases - to OR or not to OR, that is the question Iodine overlay: Nicely depicts perfusion to these loops. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952724294-IJLDPPFZB9ADXWR2FSJI/image-asset.jpeg Cases - to OR or not to OR, that is the question Conventional CT: Note pnematosis in the dilate loop anteriorly. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952748092-BL09TXDMYTKD5YN3TGNQ/image-asset.jpeg Cases - to OR or not to OR, that is the question Iodine map: There is perfusion! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1548952780261-K899ZUD47ON1R0IXSJDO/image-asset.jpeg Cases - to OR or not to OR, that is the question Iodine overlay: Nicely depicts perfusion to these loops. We could have treated this conservatively. https://www.ctspectral.com/spectral-cases/2019/1/16/can-you-find-the-mass monthly 0.5 2019-01-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547647930146-ED02CJZEAIV7M7OTMTX0/sigmoid%2Bca_%2528Wednesday-16-2019_07-58-00-2366%2529.jpg Cases - Can you find the mass? Conventional CT: Can you really see the mass? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547647985884-H33ERMR0VL3PHKVH5T4O/edited.jpg Cases - Can you find the mass? 40 keV monoE image: Now you cannot miss it! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547648040345-TFP5ABLIKRPCVZU2KFRQ/sigmoid+ca_%28Wednesday-16-2019_07-58-00-2366%29.jpg Cases - Can you find the mass? Iodine map: So easy! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547648189078-8S2GCM0V5J0EA3JE1279/sigmoid+ca_%28Wednesday-16-2019_07-58-00-2366%29.jpg Cases - Can you find the mass? Iodine overlay. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547648129388-PLOOX48Z2ST9P3I8D6GO/Picture3.png Cases - Can you find the mass? Mass as seen on colonoscopy. This is a moderately differentiated adenocarcinoma. https://www.ctspectral.com/spectral-cases/2018/5/19/sudden-epigastric-pain monthly 0.5 2019-01-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526778250040-I35KLB1BUR1VUKQ0KMLE/GS1.jpg Cases - Two hits on one spectral scan... Conventional CT with normal gallbladder https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526778423601-0O4M25Z2EE8SUJ0DU7C1/image-asset.jpeg Cases - Two hits on one spectral scan... Gallstones easily seen on effective atomic number overlay image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526778532771-01UH0OAD6NC2AQ0SOOKR/GS2.jpg Cases - Two hits on one spectral scan... On conventional image, attenuation of bile (magenta ROI) and gallstones (blue ROI) is nearly the same. No wonder they are invisible. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526778956939-5SSM8M939WGVMVC78PIQ/image-asset.jpeg Cases - Two hits on one spectral scan... Spectral plot is very enlightening: at 70 kev (yellow line) , attenuation curves of bile and gallstones intersect, so they cannot be seen. At 40 keV (left), stones are hypodense relative to bile, and at 200keV (right), they are hypredense. This is obvious on the respective images. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526779146180-FT7BSE13OCG15LJ69378/image-asset.jpeg Cases - Two hits on one spectral scan... Ultrasound confirms gallstones, but no sign of acute cholecystitis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526780559771-FD4D76Y7Q6BUPFJQUFA1/image-asset.jpeg Cases - Two hits on one spectral scan... Conventional coronal CT through pelvis shows right ovarian cyst, otherwise unrerkanle https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526780654885-XAQBM3OEQG35MUFYX1ZA/OT1.jpg Cases - Two hits on one spectral scan... Virtual non-contrast image shows ovarian parenchyma below cyst is somewhat hyperdense https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526780951637-OF2ZLGLF742ESYBFRPNA/Capturotte.JPG Cases - Two hits on one spectral scan... Iodine map shows no uptake in parenchyma below right ovarian cyst. Spectral curves confirm suspicion: magenta curve (ROI in left ovary) shows rise on low keV, consistent with iodine uptake. Blue curve (ROI in right ovarian parenchyma) remains flat, and actually decreases a bit on lower keV, consistent with lack of iodine. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526780736268-2HBAIWAZVJO33K7XDC9C/OT1.jpg Cases - Two hits on one spectral scan... https://www.ctspectral.com/spectral-cases/2019/1/11/its-all-about-the-cnr monthly 0.5 2019-01-11 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221109303-V8XKAG58QX1DBE7YZ854/image-asset.jpeg Cases - It's all about the CNR! Conventional CT: Enhancing nodule in the right PZ of the prostate https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221179914-H9KNC8SY161GEWI9U75L/prostate_%28Friday-11-2019_09-20-54-4152%29.jpg Cases - It's all about the CNR! Virtual non-contrast: Both sides look the same https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221141065-0DWK509D8IYH9BNKEJIZ/image-asset.jpeg Cases - It's all about the CNR! Iodine map: The right PZ nodule is a lightbulb! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221350620-66HPVIKXQ7YC95U8SHAK/prostate2.jpg Cases - It's all about the CNR! Notice the difference in HU on conventional image: enough to be easily perceptible in this case, but will it be so on all cases? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221385008-M8K7TVWNFVBGXWV5D1UW/prostate2.jpg Cases - It's all about the CNR! Iodine map: So much more of a difference! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1547221476927-N2NXDBDH2KTO9SEJZZUL/prosatte3.jpg Cases - It's all about the CNR! Spectral curves: Normal prostate (magenta) and the cancer (blue) are clearly very different. https://www.ctspectral.com/spectral-cases/2018/12/29/the-hole-and-the-hot-rim monthly 0.5 2018-12-30 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1546131046530-1C53M7CXJX8RTGESDCNE/image-asset.jpeg Cases - The hole and the hot rim Conventional CT, sagittal image. Thick gallbladder wall with adjacent fat stranding, consistent with acute cholecystitis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1546130943645-W64S9YCQELK3HR7JWW3V/Capture46.JPG Cases - The hole and the hot rim 40 keV image: Clear disruption in wall enhancement (green arrow). No negative gallstones are seen. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1546131153671-VNAQ9P3WH4FIJIZT4TX5/image-asset.jpeg Cases - The hole and the hot rim Iodine map also shows the same “hole”. Discontinuous enhancement is a very good sign of necrosis or perforation. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1546130957036-GUTTIUBW2SBBE5UU8HLK/Capture47.JPG Cases - The hole and the hot rim Iodine overlay shows the “hole” very well (green arrow). For nuclear medicine aficionados, see the enhancement in the liver adjacent to the GB fossa (yellow oval), equivalent to the “hot rim sign” so well known from HIDA scans. https://www.ctspectral.com/spectral-cases/2018/12/5/and-the-bowel-began-to-pink-up monthly 0.5 2018-12-05 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1544044084815-CQZZK710AP7S15P85ED7/sbo2.jpg Cases - And the bowel began to pink up Conventional CT, coronal plane: Distended stomach and small bowel. Note injected mesentery in right lower quadrant and small ascites. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1544044196233-ESUX8XDFM2TKJLCSRKGU/Capture.PNG Cases - And the bowel began to pink up Conventional CT, oblique axial. Note beak like transition point, consistent with adhesive small bowel obstruction. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1544044337836-LHEH55WTAAQX65VOZ9K4/DISPLAY22_%28Wednesday-05-2018_14-50-59-7608%29.jpg Cases - And the bowel began to pink up Conventional CT, oblique axial. Focus on distended bowel loop just before transition point, nothing striking about it. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1544044385507-VMEGL8T5OSA899KCXZ1G/DISPLAY22_%28Wednesday-05-2018_14-50-59-7608%29.jpg Cases - And the bowel began to pink up Corresponding iodine map, oblique axial. Clear iodine deficit! I compare loop to surrounding loops of similar size. https://www.ctspectral.com/spectral-cases/2018/11/18/let-us-solve-this-one monthly 0.5 2018-11-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542563492304-PXBZRG7NZMDL4F220RSO/Capture.JPG Cases - Let us solve this one... EKG is inconclusive https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542566306058-HVLIXZ1R90V24PH3ORVF/Capture2.JPG Cases - Let us solve this one... Troponin trend: Obviously positive! The negative echo and cath make the case interesting. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542563595094-EY8IXE29C1WYIYXMFBB9/Picture1.jpg Cases - Let us solve this one... MRI: Small focus of transmural delayed enhancement in the inferior wall (missing piece of the donut), consistent with a myocardial infarction. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542563673685-MB4JLXBR2RVZ2QJKTUZN/Picture2.jpg Cases - Let us solve this one... Conventional CT, short axis plane: Underwhelming. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542563749137-0I9J976A4VIJL07JV33S/Picture2.jpg Cases - Let us solve this one... Iodine map, short axis plane: The perfusion defect is obvious! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1542563783144-7SX20SZ4QS23NRX2NL7E/Picture2.jpg Cases - Let us solve this one... Perfusion defect shown very nicely on iodine overlay. Note how well it corresponds to the delayed enhancement on MRI. https://www.ctspectral.com/spectral-cases/2018/11/9/spectral-ct-like-dwi-with-ct monthly 0.5 2018-11-09 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786613804-JCZ4NRBC20VLHU52PQNY/image-asset.jpeg Cases - Spectral CT: Like DWI, with CT Conventional CT: Do you see the lesion in lower pole of the right kidney? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786623380-KS35L111L8DAEHFL7FZ0/image-asset.jpeg Cases - Spectral CT: Like DWI, with CT Iodine map: So easy! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786631760-BL6ARP2AA5SAPH6L1YQH/Picture6.jpg Cases - Spectral CT: Like DWI, with CT Lesion nicely depicted on iodine overlay https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786647494-BO9K9PLY1KXWSR0N8KGZ/Picture7.jpg Cases - Spectral CT: Like DWI, with CT Conventional CT: Do you see the lesion in upper pole of the right kidney? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786655550-XH88QLZPK034L9FULK28/Picture8.jpg Cases - Spectral CT: Like DWI, with CT Iodine map: The cortical defect is so easy to find! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786663491-1SUQIOT418Y2FDFSXM7R/image-asset.jpeg Cases - Spectral CT: Like DWI, with CT Nicely depicted on iodine overlay. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541786670462-CW6KVFOHTQAO46EUVU6S/Capture88.JPG Cases - Spectral CT: Like DWI, with CT MRI (DWI b800 with ADC map): lesions are larger. Spectral CT is like DWI in some ways, significantly enhances detection of lesions in body imaging. https://www.ctspectral.com/spectral-cases/2018/11/1/the-pleura-is-it-visible monthly 0.5 2018-11-01 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541085527719-EMO7WAILZOYALX43AFMU/Capture.JPG Cases - The pleura, is it visible? Conventional CT: Pleural based nodule (yellow arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541085567731-6EV3G5232679NZYOT6XV/Captur2e.JPG Cases - The pleura, is it visible? Iodine map: See the pleura lifted off the nodule (yellow arrows). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541085609922-IWH07YMC94CZXL4D5R9A/Capture33.JPG Cases - The pleura, is it visible? Z-effective map: See the pleura so well! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541085655995-1TVAROYYCM3RFJRTMI5P/image-asset.jpeg Cases - The pleura, is it visible? Oblique sagittal iodine map: enhancement is on both sides of the rib, consistent with callus https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1541085696624-K1O53UMB11L3J82FE2PO/Capture44.JPG Cases - The pleura, is it visible? See the super-subtle rib fracture! https://www.ctspectral.com/spectral-cases/2018/10/29/thank-you-dr-page monthly 0.5 2018-10-29 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1540789647078-J7SJW3N9N9B0ALAGW4C1/Capture11.JPG Cases - Thank you, Dr. Page! Conventional CT with large left perinephric collection (yellow arrows). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1540789660909-P012WOS9O29PLNH67OV1/Capture12.JPG Cases - Thank you, Dr. Page! Virtual non-contrast: Collection is very dense, consistent with hematoma https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1540789671562-498HZ6TCMQWVAW5XDH0F/Captur13.JPG Cases - Thank you, Dr. Page! Decreased iodine uptake in left kidney confirms ischemia. Thank you, Dr. Page! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1540789863798-I2OV7NMT7LQBQRNC8XUY/Picture15.jpg Cases - Thank you, Dr. Page! Dr. Page was really on the cover of TIME magazine (picture from TIME website, accessed on 10/28/2018) https://www.ctspectral.com/spectral-cases/2018/10/17/you-saw-it-here-first monthly 0.5 2018-10-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539829385409-0VIAAWUGGYKKHIXXTTVS/CRAO1.jpg Cases - Optic nerve perfusion in CRAO Conventional CT, coronal plane. The optic nerves are unremarkable. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539829423704-O32QDNJGP97VUJIU0DO0/CRAO2.JPG Cases - Optic nerve perfusion in CRAO Iodine map: Absent uptake in right optic nerve (blue arrow). The left optic nerve shows good iodine uptake (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539829483735-2E005KI6K97UBNENVAA4/CRAO3.jpg Cases - Optic nerve perfusion in CRAO Iodine overlay shows finding nicely! https://www.ctspectral.com/spectral-cases/2018/10/9/myocardial-ischemia-at-rest monthly 0.5 2018-10-09 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092651829-TBW5NRCN3L3ADJ3U3JNL/LAD1_%28Tuesday-09-2018_08-14-33-9020%29.jpg Cases - Myocardial ischemia at rest Conventional CT: The left ventricular myocardium looks not particularly interesting https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092711327-0CX2CDRZHU1KR5RBN8KR/LAD+4_%28Tuesday-09-2018_08-19-20-6147%29.jpg Cases - Myocardial ischemia at rest Conventional CT: The septum shows slightly decreased attenuation, but hard to pick up from the noise https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092746132-RNO7OM9O38KW1NE9PDBS/LAD+4_%28Tuesday-09-2018_08-19-20-6147%29.jpg Cases - Myocardial ischemia at rest Iodine map: Clear decreased iodine uptake in septum (1.4 mg/mL vs 2.7 mg/mL) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092836452-8YTUC8BJ2FQP5LJLEL8Z/LAD+4_%28Tuesday-09-2018_08-19-20-6147%29.jpg Cases - Myocardial ischemia at rest Finding of septal hypoperfusion nicely depicted on iodine overlay https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092846691-MCTPFTGU9MK3TKGNNYSK/LAD+6_%28Tuesday-09-2018_08-20-06-3522%29.jpg Cases - Myocardial ischemia at rest Spectral curves show significant difference between septum (blue) and lateral wall (yellow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1539092891478-QL8ABGIPGIDFRSRBK1UL/LAD+9.JPG Cases - Myocardial ischemia at rest Coronary angiogram: Critical stenosis of the LAD. Severe 3-vessel disease https://www.ctspectral.com/spectral-cases/2018/10/5/goblet-anyone monthly 0.5 2018-10-05 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538754008219-YW343EPCU0TL6939IX67/goblet+1_%28Friday-05-2018_10-03-56-1018%29.jpg Cases - Goblet, anyone? Conventional CT with filling defect in right ureter (yellow circle) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538753909016-GPE2FN4BY4RC2MMVYYZ1/goblet+1_%28Friday-05-2018_10-03-56-1018%29.jpg Cases - Goblet, anyone? Virtual non-contrast: Comparison to conventional CT shows obvious enhancement visually. On measurement, HU increase from 36 to 82. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538754021201-MEEJSCFJQ05MYD3F5I22/Iodine+no+Water+%5Bmgml%5D+goblet+3_%28Friday-05-2018_10-08-03-2705%29.jpg Cases - Goblet, anyone? Iodine map shows clear iodine uptake, consistent with tumor. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538754061271-LEUIUUPSOHOI5NEHJ6B2/goblet+1_%28Friday-05-2018_10-03-56-1018%29.jpg Cases - Goblet, anyone? Iodine overlay nicely depicts the finding https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538754070638-0AM7K95ZC4HEL8BXN08B/Fused+Series+goblet+2_%28Friday-05-2018_10-07-03-0755%29.jpg Cases - Goblet, anyone? Coronal oblique with iodine overlay: Note the ureteral dilatation above and below the enhancing mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1538754120372-E95R3DL13NMID6IX2BYE/gobletRU.jpg Cases - Goblet, anyone? And the Goblet sign! https://www.ctspectral.com/spectral-cases/2018/9/18/my-oh-mi monthly 0.5 2018-09-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280179013-NB726254G9AOARS7BMQU/ekg1Capture.JPG Cases - My oh MI! First EKG: Subtle ST segment changes, below the threshold of a radiologist https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280191935-2KMFBQR7A52WBBI8KAU7/ekg2Capture.JPG Cases - My oh MI! Second EKG: Dynamic ST changes. Wish I could tell you more. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280781939-CVE56UY5L28WH7530KWX/Capture55.JPG Cases - My oh MI! Conventional CT: Focal sharply defined endocardium (red arrows). This is a very good sign for an acute MI on non-gated chest CT scans. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280765737-8B3B9G6MHQC9UAICYI6P/Capture66.JPG Cases - My oh MI! Iodine map: No iodine uptake consistent with hypoperfusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280749435-2DVW0J6Y4LQP49GWF01W/MI_%28Tuesday-18-2018_08-11-08-9808%29.jpg Cases - My oh MI! Fused image with iodine overlay: Nice depiction of perfusion deficit https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280063153-TC2WAIBG5ZWL7GPAFNIG/Capture77.JPG Cases - My oh MI! Cardiac cath: Focal occlusion of OM1, likely from a coronary dissection https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1537280074641-CHVJHLNOM33TXC9NM118/Capture88.JPG Cases - My oh MI! Post angioplasty with good flow in OM1 https://www.ctspectral.com/spectral-cases/2018/9/13/endocarditis monthly 0.5 2018-09-13 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536859313045-QH6645MXGPUMOSFO2P89/image-asset.jpeg Cases - Endocarditis Conventional CT: Cavitary nodule in left lower lobe. Nothing particularly interesting in the heart. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536859362195-LBUEJCU2CTJ1KYXW2RDK/sep+emb.jpg Cases - Endocarditis Iodine density image: Hole in the center of the nodule nicely depicts the cavitation. Small tricuspid valve nodule becomes apparent! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536859404365-5N1IJS2R606HHMT4F7Q8/sep+emb.jpg Cases - Endocarditis 40 keV image also nicely depicts the tricuspid valve vegetation. https://www.ctspectral.com/spectral-cases/2018/9/4/painless-hematuria monthly 0.5 2018-09-04 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536066947453-4QXO8J26MILE4V183155/hematuria+2_%28Tuesday-04-2018_08-00-39-3037%29.jpg Cases - Painless hematuria Conventional CT: Filling defect posterior urinary bladder with linear calcification. Also note the right sided bladder diverticulum with a dependent stone. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536066986265-5QH3UEXTNJ55R1TBTY8X/hematuria+2_%28Tuesday-04-2018_08-00-39-3037%29.jpg Cases - Painless hematuria Virtual non-contrast: The filling defect is hyperdense. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536067037044-BLICBU3ON4S1QAJUVTCL/hematuria+2_%28Tuesday-04-2018_08-00-39-3037%29.jpg Cases - Painless hematuria Iodine map: No iodine uptake in filling defect. This is a clot around a bladder stone. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536067052448-A26TI9XO55XVAPYLGP7J/Attenuation+curve_%28Tuesday-04-2018_07-59-24-7312%29.jpg Cases - Painless hematuria Spectral curve: Blue line in clot in flat. Magenta line (in left femoral vein) for comparison. Iodine containing ROI will show increase in attenuation on lower energies. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1536067090289-QXYXBI10KKBHFTJ330MV/filling.jpg Cases - Painless hematuria Prone conventional CT (delayed): The clot has moved to the dependent bladder! https://www.ctspectral.com/spectral-cases/2018/8/29/what-kind-of-scan-would-you-want monthly 0.5 2018-08-29 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535569687418-75687SW0K30UZNLVO0XD/image-asset.png Cases - What kind of scan would you want? Conventional CT, coronal plane: Biliary dilatation https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570273810-8LUFLFMW14O209IZB6U5/Picture1.jpg Cases - What kind of scan would you want? Conventional CT, axial oblique. Is there a lesion in the pancreas? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570300121-0YGAJ8ANNY5JGSCAFZP0/Picture2.jpg Cases - What kind of scan would you want? 40 keV, axial oblique: Now you're talking! Obvious lesion in head/uncinate process. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570319123-V57MDMPG99DAYKIBLPU9/Picture3.jpg Cases - What kind of scan would you want? Iodine map, axial oblique: Lesion is easy to see! Hypoenhancement is characteristic of pancreatic adenocarcinomas. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570352267-G1CH1QU0ONYB4M56OCHO/image-asset.jpeg Cases - What kind of scan would you want? Iodine overlay image, axial oblique: Just showing off. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570374981-8OH530SH6FYH6WSLEZGD/Picture5.png Cases - What kind of scan would you want? EUS confirms mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1535570400771-TT6RJA5XRJ5ANN5CD4X7/image-asset.png Cases - What kind of scan would you want? ERCP shows obstruction of distal CBD. A biliary stent was placed. https://www.ctspectral.com/spectral-cases/2018/8/21/mediastinal-mass monthly 0.5 2018-08-27 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534864265477-ON1UA0Y2N1SPV40MI4NM/med1.JPG Cases - Mediastinal mass Conventional CT: Anterior mediastinal "mass". https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534864294444-ZLLW74OCXC3S860N9ORC/Picture1.png Cases - Mediastinal mass Iodine map: No uptake in the "mass". This is certainly a benign cyst. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534864410409-R7U2S8ZHXDW3S4NKBEQ9/Picture3.png Cases - Mediastinal mass Non-contrast MR (T2-weighted with fat sat): It is indeed a simple cyst! https://www.ctspectral.com/spectral-cases/2018/8/21/not-too-small-to-characterize-anymore monthly 0.5 2018-08-24 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534887612032-E520TKQ904KEER1BXXFC/Picture4.png Cases - Not "TSTC" anymore Conventional CT: Notice tiny liver lesion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534887649660-JVFOCYGUPFOWGULGHYI7/Picture5.jpg Cases - Not "TSTC" anymore Conventional CT: At 28.5 HU, this lesion is "too small to characterize". https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534887674390-8Q5E81M8H5R61A92NN2K/Picture6.jpg Cases - Not "TSTC" anymore Iodine map: No uptake on visual analysis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534887704208-KJLL451ZI3N0TT3FMQRJ/Picture7.jpg Cases - Not "TSTC" anymore Measured iodine uptake in the lesion (blue ROI) is zero! For comparison measured iodine uptake in background liver (red ROI) is about 1.1 mg/mL. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534887776095-QUGQ7BIU9HS6TPX6TLWD/image-asset.jpeg Cases - Not "TSTC" anymore Spectral curves: Blue curve in lesion is downsloping on lower energy, consistent with no iodine uptake. Normal background liver (magenta curve) shows increased density on lower energy. https://www.ctspectral.com/spectral-cases/2018/8/18/intramural-hematoma monthly 0.5 2018-08-21 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534631708128-90M1POCSBPLBUNDBKB34/Picture4.png Cases - Intramural hematoma Conventional CT: thickened wall of the descending aorta https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534631738121-A1A8TRRIRULP6MCX7W37/Picture5.png Cases - Intramural hematoma Virtual non-contrast: The wall thickening has increased attenuation, diagnostic of an intramural hematoma. https://www.ctspectral.com/spectral-cases/2018/8/15/kuz9kprldryfle9nk7kmnyayz3sahb monthly 0.5 2018-08-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534363439276-5O2U97HK8L4G3CVE83FC/Capture1.JPG Cases - Can you Dota-tate that? Conventional CT: Large mass (red arrows) in the porta hepatis. Note gastric bypass, biliary dilatation is chronic. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534363472264-P5S38IO7UFYUO3YCRLZM/Capture3.JPG Cases - Can you Dota-tate that? Conventional CT (axial plane): Mass in porta hepatis (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534363533113-ZW7LOGG6SLMP3RHHLNI5/Capture4.JPG Cases - Can you Dota-tate that? Conventional CT (axial plane): Do you see the gastric antral submucosal nodule? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534363564793-YE0PTF6RNOJ45GRE36N3/Capture5.JPG Cases - Can you Dota-tate that? 40 keV mono-energy image (axial plane): Intensely enhancing gastric antral submucosal nodule, consistent with carcinoid. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534363813775-2K96BGQPHP56ZXHVB2XJ/Picture55.png Cases - Can you Dota-tate that? Oblique axial iodine map: Note intense uptake in the gastric submucosal nodule and the porta hepatis mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534364055371-QIUCOATJRKV34A9ZH9DJ/Capture8.JPG Cases - Can you Dota-tate that? Transhepatic biopsy! Gastric bypass precludes endoscopic approach. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1534364075252-Y6M2CEDS14FZHFNDSLO6/image-asset.png Cases - Can you Dota-tate that? Gallium Dotatate PET scan: uptake in gastric submucosal nodule and the porta hepatis mass confirms neuroendocrine nature. Physiologic uptake in pituitary, spleen and liver. https://www.ctspectral.com/spectral-cases/2018/8/11/does-this-appendix-come-out monthly 0.5 2018-08-11 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533994778176-6WRKDQQMLFE0KJAE97JB/DISPLAY+appy+3_%28Saturday-11-2018_08-19-50-7366%29.jpg Cases - Does this appendix come out? Conventional CT: Note obviously inflammed mid-appendix with small lith. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533994819694-DLO8XHPUXFZ3QAP83MS3/DISPLAY+appy+3_%28Saturday-11-2018_08-19-50-7366%29.jpg Cases - Does this appendix come out? Iodine map: The wall of the middle of the appendix is missing! You can again make out the wall in the distal appendix. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533994933647-ZFRE9VG318YL30UTS1QZ/DISPLAY+appy+3_%28Saturday-11-2018_08-19-50-7366%29.jpg Cases - Does this appendix come out? 40 keV mono-energy image shows finding very well https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533995002591-XU3ICUSWM7GXYQO0BE0Y/DISPLAY+appy+3_%28Saturday-11-2018_08-19-50-7366%29.jpg Cases - Does this appendix come out? Conventional CT with iodine overlay: Now I am just showing off, but the perfortaion is obvious! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533995115350-AI55A6EBL7GKVU4GTPUI/abscess.jpg Cases - Does this appendix come out? 10 days post-op: Large RLQ abscess. This was managed with a drain, that stayed in for a month. https://www.ctspectral.com/spectral-cases/2018/6/1/lets-make-it-easy monthly 0.5 2018-08-01 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527977528016-J9MGKXFZXQT4CWXXY7W4/colonca.jpg Cases - Let's make it easy.. Conventional CT: Can you see the subtle lesion in the cecum? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527977565350-4JMD8RMPBO04YPI1N6ZP/colonca.jpg Cases - Let's make it easy.. 40 keV mono-energy image: So obvious! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527977609788-FFO32I3OXEDUBGK9YBP1/cecal+ca_%28Friday-01-2018_21-39-01-8264%29.jpg Cases - Let's make it easy.. Iodine map: Uptake confirms this is no stool-ball.. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1533161338223-I9GMKAWD25MYG6XMUKC3/Picture1.png Cases - Let's make it easy.. Cecal mass as seen on colonoscopy. https://www.ctspectral.com/spectral-cases/2018/7/30/hyperdense-ascites monthly 0.5 2018-07-30 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532957061942-OMZW06HTD42QTQV8XAI2/DISPLAY+ascites_%28Monday-30-2018_08-04-24-5841%29.jpg Cases - Hyperdense ascites Conventional CT: coronal plane. Persistent nephrogram 28 hours after contrast admin. There is hyperdense ascites in left pericolonic gutter (33 HU). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532957104831-JLAUAXP0JBINVDUYVP3R/DISPLAY+ascites_%28Monday-30-2018_08-04-24-5841%29.jpg Cases - Hyperdense ascites Virtual non-contrast: The ascitic fluid is low density (0.9 HU). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532957148351-4OU0B1TWAVQMWHJHNGPV/DISPLAY+ascites_%28Monday-30-2018_08-04-24-5841%29.jpg Cases - Hyperdense ascites Iodine map: Clear iodine uptake in ascitic fluid. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532957226276-ENCV8AXDB3E10Q0GPR44/DISPLAY+ascites+4_%28Monday-30-2018_08-06-39-7879%29.jpg Cases - Hyperdense ascites Fused axial image with iodine overlay shows iodine uptake in perisplenic fluid, and excretion in the gallbladder. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532957265804-MD3SFMBQ8YGSBPAIZDMO/DISPLAY+ascites+5_%28Monday-30-2018_08-07-55-7832%29.jpg Cases - Hyperdense ascites Fused axial image with iodine overlay shows iodine uptake in pericolonic fluid, as well as iodine excretion in the colon (this may be from biliary excretion or direct GI excretion of contrast). https://www.ctspectral.com/spectral-cases/2018/7/27/mvc-and-a-leaking-heart monthly 0.5 2018-07-28 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734804207-GNJ9LKKJDK362BW8UNZ4/CaptureEKG.JPG Cases - Matters of the heart EKG: Very important for radiologists to appreciate the inferolateral MI (just kidding). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734586996-XSCVPYHUTTDB7XR7W2ZQ/DISPLAYfirst_%28Friday-27-2018_18-31-47-0147%29.jpg Cases - Matters of the heart Conventional trauma CT: Note hemopericardium and filling defect in the LV apex. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734625953-YJ9KRY4OKGISA2XV9VJZ/DISPLAYfirst_%28Friday-27-2018_18-31-47-0147%29.jpg Cases - Matters of the heart Iodine map: LV apical clot without iodine uptake. Can you appreciate the hypoperfusion in the inferolateral wall? If not, delayed images below make it much more obvious. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734665365-669HPQUL3YYHQIX382VC/DISPLAYfirst_%28Friday-27-2018_18-31-47-0147%29.jpg Cases - Matters of the heart Fused iodine map, early scan: LV apical clot and inferolateral hypoperfusion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734698769-OTCT05JB44B7GISLT9PC/DISPLAY_%28Friday-27-2018_17-58-08-2122%29.jpg Cases - Matters of the heart Conventional delayed scan. This is key in making the diagnosis. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532741746894-ZDD2YMXPZUD6MMLGMG38/MonoE+40keV%5BHU%5D+Image_%28Friday-27-2018_20-34-39-4824%29.jpg Cases - Matters of the heart Delayed image, 40 keV image. Iodine is a lot brighter, so the clot and MI are both much more obvious. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734745566-0M4CFX7Q7WNO5I9VCQY2/DISPLAY_%28Friday-27-2018_17-58-08-2122%29.jpg Cases - Matters of the heart Delayed scan, iodine map: Uptake in inferolateral wall nearly zero. Uptake in septum approximately 1.9 mg/mL for comparison. Notice the very subtle increased uptake in LV apex, likely from a previous MI and scarring. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734915034-MS4ZQE5YZHY8WBLN3VKU/image-asset.jpeg Cases - Matters of the heart Spectral plots on delayed image: Magenta curve from an ROI on the MI is flat, consistent with lack of iodine. The ROI in the interventricular septum shows significant increase on lower keV, consistent with iodine uptake. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532734794229-KBGTHA4QKT310R55KJKF/DISPLAY_%28Friday-27-2018_17-58-08-2122%29.jpg Cases - Matters of the heart Fused image with iodine overlay: white arrows show the LV apical clot. Red arrows highlight the acute inferolateral MI. https://www.ctspectral.com/spectral-cases/2018/7/22/filling-defects-and-iodine-maps monthly 0.5 2018-07-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297271132-7OWYMNP9QE74NMOX2DCZ/image-asset.jpeg Cases - Filling defects and iodine maps Case 1: Conventional CT with thickening of bronchus intermedius and a filling defect (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297299268-38S1YOLL0Y3X92PI22GV/bronchial2.JPG Cases - Filling defects and iodine maps Case 1: iodine map with clear uptake in lesion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297328001-NAG30JKJHSNHMRV69YNW/bronchial3.png Cases - Filling defects and iodine maps Virtual bronchosopy shows lesion now growing in the right mainstem bronchus (yellow arrow, remember this image is oriented like an optical bronchoscopy). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297362210-H0P28F5X2Y1EGKCNVFGG/bronchial4.JPG Cases - Filling defects and iodine maps Case 1: PET scan with intense uptake in the bronchial lesion. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297395305-V0BSSV4FD8Q4VPQ06FJC/bronchial5.png Cases - Filling defects and iodine maps Case 1: Optical bronchoscopy confirms mass, Biopsy was also obtained. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532298452989-9K1O988CAAOHOJLQ09C4/Picture2.png Cases - Filling defects and iodine maps Case 2: CXR with classic left upper lobe atelectasis. This one is for residents! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532298515791-SBR8J5DZ3EPHP7VU4DCX/Picture3.png Cases - Filling defects and iodine maps Case 2: lateral view confirms LUL atelectasis. Needs a CT right away! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297534975-Q7OMLVWGRGQZQU4PTBK7/PE1.JPG Cases - Filling defects and iodine maps Case 2: Filling defects in left lower lobe pulmonary artery branches (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297564511-X1ODZEXA1R7D933O8RHE/PE2.JPG Cases - Filling defects and iodine maps Case 2: Filling defect with clear iodine uptake (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532297594806-06RCLISKPBBQAE1SGE79/PE3.JPG Cases - Filling defects and iodine maps Case 2: Intense uptake on PET scan (blue arrow) https://www.ctspectral.com/spectral-cases/2018/7/19/million-dollar-wound monthly 0.5 2018-07-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532031334721-ID8C5P0WJLDY6JTEADBJ/million1.JPG Cases - Million dollar wound Conventional CT: Bullet (red arrow) in left hip. Entry (blue arrow) in the left gluteal fold. Notice small hyperdensity along the tract. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532031373791-5FPAC9MVAULNM7S7ZX3I/image-asset.jpeg Cases - Million dollar wound Virtual non-contrast: the hyperdensity is not visualized. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532031418696-UGKWQ9636MQUUPTI1QN1/Cmillion2apture.JPG Cases - Million dollar wound Focal iodine uptake (red arrow) on iodine map. This is consistent with active extravasation, this is not a bullet fragment. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532031500500-QQ5IZBNWXASZY284LSZ3/Picture1.png Cases - Million dollar wound 40 keV monoE significantly accentuates the active extravasation. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1532031462326-I1XHV92JFF3H1A610Q2V/million1.JPG Cases - Million dollar wound Iodine overlay shows ative extravasation very well (red arrow). https://www.ctspectral.com/spectral-cases/2018/7/16/transient-bowel-ischemia monthly 0.5 2018-07-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754079626-PMUVREC6V1WN7EEMQJ4Y/Picture2.png Cases - Transient bowel ischemia Chest CT shows severe COPD https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754141160-HX2MWALEHMCLOL51L15K/Picture1.png Cases - Transient bowel ischemia Conventional CT shows mesenteric venous air (red arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754234289-LI88JS0HM6Y2TOTIX0UL/Picture11.png Cases - Transient bowel ischemia Conventional CT with multiple foci of pnematosis (red arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754287034-7RSQ4IC520OQPUNMSSAV/Picture3.png Cases - Transient bowel ischemia Iodine map: Cluster of loops in anterior abdomen without iodine uptake (blue oval) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754407899-390369P6EQAJEH0Y0SS4/Picture6.png Cases - Transient bowel ischemia Iodine map: A second loop in left upper quadrant without perfusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754457487-3N7E9CJ4MF146YVLZOJE/image-asset.png Cases - Transient bowel ischemia First EKG: Note extensive ST depressions (most marked in V2-V6) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531754518670-U1XIHQYDAMVGGB77H606/image-asset.png Cases - Transient bowel ischemia Second EKG (40 minutes later): The ST depressions have normalized! https://www.ctspectral.com/spectral-cases/2018/7/12/an-adrenal-nodule monthly 0.5 2018-07-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531406036576-RY1J7PW5S4YZIFK3T0OM/adrenal1.jpg Cases - An adrenal nodule Conventional CT shows right adrenal nodule. Note normal left adrenal gland. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531406105016-GMDUETF5L95IX550TI58/adrenal2.jpg Cases - An adrenal nodule Conventional axial image, right adrenal nodule with attenuation of 46 HU. Notice small amount of fluid/hemorrhage adjacent to the nodule. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531406150656-GGNO8Q4NH9UVUBDWL8NF/adrenal2.jpg Cases - An adrenal nodule Virtual non-contrast: Attenuation in the adrenal nodule remains the same https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531406194848-029ZPKRKOGQSMBJXAK1D/adrenal2.jpg Cases - An adrenal nodule Iodine map: Absolutely no iodine uptake in the adrenal nodule, consistent with a hematoma https://www.ctspectral.com/spectral-cases/2018/7/9/a-marginal-ulcer monthly 0.5 2018-07-09 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531141810749-WBBL6VPB74H7QV3J8D9N/Capture11.JPG Cases - A marginal ulcer Conventional CT. Staple line indicates the gastric bypass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531141610120-EIOZZB9NEFT8BDM07F6I/marg2e.JPG Cases - A marginal ulcer Iodine map: The wall discontinuity from the marginal ulcer (orange arrow) is obvious. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531141866698-FH4U2P1DZP7K69UUCO6G/Capture44.JPG Cases - A marginal ulcer Iodine overlay shows finding well https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531141933634-GIOVF2BDKYRLG5PTUBLR/Capture55.JPG Cases - A marginal ulcer Image from endoscopy shows large ulcer at the GJ anastomosis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1531141942700-B5LU7PSSHJRMNO93QJPY/Capture66.JPG Cases - A marginal ulcer Normal mucosa distal to the GJ anastomosis https://www.ctspectral.com/spectral-cases/2018/6/29/renal-lesions-made-easy monthly 0.5 2018-06-29 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530301211146-BOZRMHHGUGZZYIWI2JXS/rcc34.jpg Cases - Renal lesions made easy! Conventional CT: Subtle right kidney lesion. Note dilated loops of small bowel. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530301252038-4LS90OVGA6983PD9UBLK/Capturercc.JPG Cases - Renal lesions made easy! Screenshot from PACS (clockwise from top left): Conventional CT, iodine map, 40 keV mono-energy image and virtual non-contrast. The lesion is a renal cell carcinoma, and all you need is one glance at the spectral recons! At Hennepin, all these recons are automatically generated by scanner and exported to PACS. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530301432742-8Q4R6QFHHD4N83ITFMPO/rcc.jpg Cases - Renal lesions made easy! More sophisticated measurements like iodine uptake can be done on dedicated thin-client workstation. Note that the iodine uptake in this lesion in 4.12 mg/mL, which is quite high, and suggests a clear cell RCC https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530302097488-T3G1PUTO8KU2Z5CJHA1V/mrcc.jpg Cases - Renal lesions made easy! MRI with contrast confirms what we already know. Notice how similar MRI looks to the iodine map. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530301730615-J1X7LRG5YSV4M3XT81JD/image-asset.png Cases - Renal lesions made easy! Another PACS screenshot (different patient, clockwise from top left): Conventional CT with 82 HU indeterminate left kidney lesion, 40 keV mono-E image, iodine map with no iodine uptake at all, and virtual non-contrast with attenuation of 77 HU. This is a hemorrhagic cyst! You just saved the system an MR scan, and more importantly, saved this human being the anxiety and pain of an additional exam. https://www.ctspectral.com/spectral-cases/2018/6/26 monthly 0.5 2018-06-27 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530026674799-3CZNZ5VY3SRSIBDQ2XJH/image-asset.jpeg Cases - Imaging 3.0: How spectral CT can help Conventional CT, oblique coronal plane: Closed loop in right abdomen (note the radial arrangement) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530026699491-J0H00QJBTTT12Z6U4XYV/Picture3.jpg Cases - Imaging 3.0: How spectral CT can help MIP image (50 keV mono-energy reconstruction) shows excellent opacification of the aorta on CTA with 30 mL contrast https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530026729329-AD9OB3PE8572XBBVUBD6/Picture2.jpg Cases - Imaging 3.0: How spectral CT can help Sagittal MIP image (50 keV) shows patent celiac artery and SMA https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530037653745-786EQGG0ZXISDP5Z9UAA/Picture4.png Cases - Imaging 3.0: How spectral CT can help Conventional axial image with closed loop in right lower quadrant https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530037723268-4445EQBGZ2T7XN62LDRR/Picture4.png Cases - Imaging 3.0: How spectral CT can help Virtual non-contrast: wall of closed loop remains hyperdense consistent with hemorrhage https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530037770643-HN97TU9GK4YMHXBD4N92/Picture4.png Cases - Imaging 3.0: How spectral CT can help Iodine density image: closed loop in right lower quadrant without perfusion. Note loops in left lower quadrant with intact perfusion. The iodine map has poor signal becuase of the low contrast dose technique used. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530037807659-FR4EAD4QI9SQ7YGX9GSB/Picture4.png Cases - Imaging 3.0: How spectral CT can help Iodine overlay image confirms ischemic loop https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530114029520-Q43T1QDLJ2FCQ0TU5UVK/Picture1.jpg Cases - Imaging 3.0: How spectral CT can help Gross path (courtesy of Dr. Cameron, HCMC): resected loop is "black and blue" https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530114090148-AGBIOU4E89JOEMHZSS8P/Capturemuc.JPG Cases - Imaging 3.0: How spectral CT can help Histopath (courtesy of Dr. Cameron, HCMC): Transmural hemorrhage (all that red stuff) from the mucosal side (green arrow) to the serosa. The loop is completely necrotic. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1530114161633-4ZE8719CIT3K1DZHK44J/image-asset.jpeg Cases - Imaging 3.0: How spectral CT can help Histopath (courtesy of Dr. Cameron, HCMC): Viable bowel at the margin. Note the healthy mucosa, and a small amount of serosal hemorrhage https://www.ctspectral.com/spectral-cases/2018/6/25/get-on-the-train monthly 0.5 2018-06-25 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529931301026-567H0P7YPXGM9NBC7F2J/image-asset.jpeg Cases - Get on the train! Volume rendered CTA conventional image: pretty limited https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529931331978-5O3K55E6PXTOTD6Q79ZK/MonoE+50keV%5BHU%5D+16+ml+50+kev_%28Monday-25-2018_07-37-42-9891%29.jpg Cases - Get on the train! Same image 50 keV reconstruction: looks good! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529931365446-01F6SD5TBNSTOYY5Q22A/16+ml+50+kev+sag_%28Monday-25-2018_07-41-23-8972%29.jpg Cases - Get on the train! Selected sagittal MIP image, 50 keV: diagnostic quality https://www.ctspectral.com/spectral-cases/2018/6/18/of-course-we-can-do-gout monthly 0.5 2018-06-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529376639157-2ZSNVBQS8QZ7SMDM571Y/image-asset.png Cases - Of course, we can do gout Volume rendered CT image: Large ulcer over the first MTP joint https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529376699374-FB970HSVGSDRD0C7RGL0/Capture22.JPG Cases - Of course, we can do gout CT with uric acid overlay: Large urate tophus over the first MTP joint (blue arrow). Note suble erosion between 1st and 2nd cuneiform with uric acid (red arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529376789722-NACBOIL3QTSQ7HJHD6XR/Capture33.JPG Cases - Of course, we can do gout CT with uric acid overlay: Anterior and posterior tendons with urate deposition (blue arrows). Note urate deposition in subtalar joint (red arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1529376880670-A8M1YW4TAD5CZBL3TLZT/Capture44.JPG Cases - Of course, we can do gout CT with uric acid overlay: Large tophus eroding into the talus (red arrow) https://www.ctspectral.com/spectral-cases/2018/6/14/find-the-hole monthly 0.5 2018-06-14 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986367118-R180Z08EA8SFACK01NSZ/Capture.PNG Cases - Find the hole! Non-perfused left kidney with transected bowel at ligament of Trietz (red arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986416897-J23K29TPH0V2HQQ44GE6/Picture2.jpg Cases - Find the hole! Iodine overlay image nicely depicts left kidney injury and bowel injury https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986736398-XQ1TZZ33JJRXMWVJFR7J/Capture22.PNG Cases - Find the hole! Bullet lodged in subcutaneous tissues https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986828610-CR28HTEHHFSTDL5XDHTF/Capture66.PNG Cases - Find the hole! Conventional CT: Is the stomach wall okay? https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986917301-J0H782AKCJXEOM8WBKOI/Capture77.PNG Cases - Find the hole! Iodine map: See the hole in the stomach! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528986762609-22S0LJQ84NTLS0WRCH84/Capture55.PNG Cases - Find the hole! Stomach hole in nicely seen on iodine overlay (yellow circle) https://www.ctspectral.com/spectral-cases/2018/6/5/euler-liljestrand-mechanism monthly 0.5 2018-06-06 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528238410220-FLC1AB8XLFJW3BXZM6P2/Capture22.JPG Cases - Euler-Liljestrand mechanism Iodine map shows perfusion deficit in left lower lobe (blue oval) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528238464095-3OG7CQGPGGH0KM4W9AAD/Capture66.JPG Cases - Euler-Liljestrand mechanism Iodine overlay in oblique axial plane nicely shows the perfusion defect https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528238516511-5SLWWHLZA33GVB1ZS8HJ/Capture44.JPG Cases - Euler-Liljestrand mechanism Axial image in lung windows shows filling defect in left lower lobe segmental bronchi https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528238583463-VAC12JK5PSO8RH3KZ4TM/Capture55.JPG Cases - Euler-Liljestrand mechanism Oblique axial image shows decreased contrast in left inferior pulmonary vein branch (blue arrow). This is secondary to reflex vasoconstriction in this vascular territory from bronchospasm. https://www.ctspectral.com/spectral-cases/2018/6/4/the-case-of-the-wandering-woman monthly 0.5 2018-06-04 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528116421494-M4M91IH67LZSLVU2ZLZ9/Capturest.PNG Cases - The case of the wandering woman Non-contrast head CT shows large left MCA territory infarct. Note the dense MCA sign. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528116572585-S6905ZKMZ23EJ1RWSNKA/CapturePE.PNG Cases - The case of the wandering woman Trauma CT shows subtle right lower lobe PE. This should be easy to pick up on conventional CT. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528116840149-N5ADNVAB9N24D0FTU0WP/Fused+Series+PE1_%28Monday-04-2018_07-33-57-4635%29.jpg Cases - The case of the wandering woman This lingular PE should be relatively easy too.. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528116874738-XGZUOMCSXSQ2ET7A3H8M/Fused+Series+PE2_%28Monday-04-2018_07-34-39-1276%29.jpg Cases - The case of the wandering woman ....notice how well the perfusion defect on iodine overlay stands out in the corresponding vascular territory https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528117001909-BIWE9V1IE7XY17UHSM5H/Fused+Series+PE3_%28Monday-04-2018_07-35-44-0001%29.jpg Cases - The case of the wandering woman There is a PE in the left lower lobe lateral segment, but no matter how good a day you are having, you are not going to see it https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528117116887-N4UBH32V9PW51XT7P7R7/Fused+Series+PE3a_%28Monday-04-2018_07-36-16-9484%29.jpg Cases - The case of the wandering woman Impossible to miss it on iodine overlay! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528117193697-11XHHIJEWP99ZY944NG6/Fused+Series+PE4_%28Monday-04-2018_07-40-32-4570%29.jpg Cases - The case of the wandering woman Another tiny PE in the right lower lobe on an oblique axial image... https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1528117261639-WX3XU9LVCU3P67WJNFPK/Fused+Series+PE4a_%28Monday-04-2018_07-41-01-8699%29.jpg Cases - The case of the wandering woman And the iodine overlay again makes it impossible to miss! https://www.ctspectral.com/spectral-cases/2018/6/1/hypoxemia-in-osler-weber-rendu monthly 0.5 2018-06-02 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527896879671-Q0O1K6SWTGP7PDQA395O/CapturAVMe.JPG Cases - Hypoxemia in Osler-Weber-Rendu Volume rendered image shows large right lower lobe pulmonary AVM. Note supplying artery (blue arrow) and draining vein (red arrow). https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527896931299-3JZY2MIL1FH66L1L3X2M/AVM5.jpg Cases - Hypoxemia in Osler-Weber-Rendu Pulmonary AVM seen on axial image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527896974776-KSU9FKQHNCF7C1UDAWWF/AVM5.jpg Cases - Hypoxemia in Osler-Weber-Rendu Iodine map shows perfusion deficit seen around the AVM https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527897013120-0FH7YSVRUDHZ6DBGDEL4/image-asset.jpeg Cases - Hypoxemia in Osler-Weber-Rendu Iodine map in the coronal plane nicely illustrates the pulmonary AVM and adjacent perfusion defect. This is because of blood (and iodine) shunting into the low pressure system, and results clinically in hypoxemia, that then sets off compensatory mechanisms resulting in polycythemia. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527897443998-TSGK75LC15QSHWSV3X6G/AVMlogo.jpg Cases - Hypoxemia in Osler-Weber-Rendu Iodine overlay image illustrates same finding. https://www.ctspectral.com/spectral-cases/2018/5/31/renal-pelvis-urothelial-cancer-or-not monthly 0.5 2018-06-02 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527802937713-UAT608CK93ENQ984ORDC/renal+pelvis.jpg Cases - Renal pelvis: urothelial cancer or not? Conventional CT: Is that a mass in the left renal pelvis? Note the nephrostomy tube. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527802991389-EDZJY6QY5UFMPHQ8L12M/renal+pelvis.jpg Cases - Renal pelvis: urothelial cancer or not? Virtual non-contrast: The filling defect is hyperdense https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527803081291-M2HEHDP91K0UQ1N4NJ49/image-asset.jpeg Cases - Renal pelvis: urothelial cancer or not? No iodine uptake, so this is clot. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527803132655-4S1MP1I9BFBTYFYNWTZB/renal+pelvis.jpg Cases - Renal pelvis: urothelial cancer or not? Iodine overlay image without perfusion in the left renal pelvis "filling defect" consistent with clot https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527803195068-5CKDBT30ZE233UX912E2/UB.jpg Cases - Renal pelvis: urothelial cancer or not? Notice large tumor in the urinary bladder https://www.ctspectral.com/spectral-cases/2018/5/28/v79652s96fwifiuqnb50zx2ggn99rf monthly 0.5 2018-05-29 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527558566190-7VWCXWPMQBG4V47HQUMK/spleen+main.jpg Cases - The spleen is gone....believe me! Conventional CT shows cirrhosis with varices. The spleen does not stand out as particularly abnormal. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527558608441-XKH7Q0XT0KLLCJ2RGCED/spleen+main.jpg Cases - The spleen is gone....believe me! Iodine map: The spleen is gone! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527559207200-NS8MK7IPQSKW1YFKMDZC/spleen+main.jpg Cases - The spleen is gone....believe me! Iodine overlay: Oh so easy! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527558808124-DG7F8VJDHVPBDPNIUWOV/CaptureSV.JPG Cases - The spleen is gone....believe me! 40 keV image: Splenic artery is patent to the hilum (red arrow). The splenic vein appears thrombosed (blue arrow). Note the spleen is very hypodense on the low keV image, consistent with absent iodine uptake. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527558977549-GI63E9YZDDQHBFGMCBJM/Capturesv2.JPG Cases - The spleen is gone....believe me! Spectral curves: Blue curve (ROI in spleen) is nearly flat. Contrast with magenta curve (ROI in liver) which goes up on lower keV consistent with iodine uptake. https://www.ctspectral.com/spectral-cases/2018/5/27/bladder-tumor monthly 0.5 2018-05-28 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527473166188-VJPK0RHMHR2HCLVSSC5G/bladder.jpg Cases - Bladder tumor Conventional CT shows a urinary bladder "filling defect" https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527473228966-CSO4QWUOEW31CO4ZSBAY/bladder.jpg Cases - Bladder tumor Iodine map with intense uptake in the urinary bladder "filling defect", consistent with tumor https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527473284912-5WIQRCTAATKWD5WT7VIU/bladder.jpg Cases - Bladder tumor Perfusion nicely depicted on iodine overlay https://www.ctspectral.com/spectral-cases/2018/5/26/the-hot-appendix-part-2 monthly 0.5 2018-05-27 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527375419207-8DCAD3T1WHYF826KQKWP/Captureappy.JPG Cases - The hot appendix: part 2 Conventional coronal CT with peritoneal thickening (red arrows), consistent with peritonitis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527375440296-QDNFY8XTR8V3XZVCBKOU/image-asset.jpeg Cases - The hot appendix: part 2 Axial conventional CT shows dilated appendix (yellow arrow). Adjacent fluid and inflammation, with red arrow showing the thick peritoneal lining. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527375466191-X9LAHMZGIUIFXY7HXNHB/Capture55.JPG Cases - The hot appendix: part 2 Iodine density image. Note focal discontinuity in appendix enhancement (red arrow). This is consistent with perforation. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527375329452-V6QY98BAK1L246I5LMNE/Capture56.JPG Cases - The hot appendix: part 2 Iodine density overlay. Note focal discontinuity in appendix enhancement (white arrow). https://www.ctspectral.com/spectral-cases/2018/5/25/do-we-really-need-a-true-non-contrast-scan-for-aortic-imaging monthly 0.5 2018-05-25 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527281009723-G8BR7REEZY80VULZBT1V/aorta2.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? Conventional CT through ascending aorta. Note dissection flap on the left side of the aorta, and the saphenous venous graft anteriorly. The low-density crescent on the right side of the aorta is why we do non-contrast scans: it can be hard to tell intramural hematoma/thrombosed lumen versus plaque once you have given contrast https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527281164977-W5V1T5CEMYDV0RPACA4Q/aorta2.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? Virtual non-contrast image nicely depicts increased density to the right of the ascending aorta, in this case, a thrombosed false lumen https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527281250250-59CQ1ZL9H16IO26ZJEJY/aorta2.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? 40 keV mono-energy image nicely depicts small amount of flow centrally https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527280937147-ZBUTJA640XMEW2YP45EY/aorta3.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? Conventional CT just above aortic valve. Note the type A dissection, with some contrast in the false lumen. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527281308471-MMFZ70GIFPRCJ019UJYF/aorta1.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? Mural irregularity at the level of the IMA in the abdominal aorta, this could be plaque or intramural hematoma. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1527281394474-1N6WUIBTOP6CCG0EG9R1/aorta1.jpg Cases - Do we really need a true non-contrast scan for aortic imaging? Low density on virtual non-contrast confirms plaque. This does not require intervention. https://www.ctspectral.com/spectral-cases/2018/5/21/tree-in-bud-can-mean-tumor-in-blood monthly 0.5 2018-05-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526958991048-QDDSK722R4L6PZVN0RRE/Fused+Series+tree+in+bud_%28Monday-21-2018_21-30-41-0467%29.jpg Cases - "Tree-in-bud" can mean tumor in bronchi too... Maximum Intensity projection shows "tree-in-bud" in the both the lungs https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526959031258-D6QKG27Z434WXMBUPM8D/Fused+Series+tree+in+bud2_%28Monday-21-2018_21-32-00-4942%29.jpg Cases - "Tree-in-bud" can mean tumor in bronchi too... Iodine map shows uptake in the "tree-in-bud". Not convinced? Look at magnified views below. The large paraesophageal lymph node is great for biopsy... https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526959199588-U55CZ85R1BVXRUZ1SGB5/image-asset.jpeg Cases - "Tree-in-bud" can mean tumor in bronchi too... Detail view shows "tree-in-bud" opacity https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526959232373-GEX9YVT4YW4DUI5HJK4N/image-asset.jpeg Cases - "Tree-in-bud" can mean tumor in bronchi too... Iodine uptake in the "tree-in-bud" https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526959470992-NALCYSVAF2IKF3KF4DTU/pelvis+s.jpg Cases - "Tree-in-bud" can mean tumor in bronchi too... Large mass in left pelvis. Note extension into the left external iliac vein. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526959512209-GPPMJFK78NEV860W9OZC/Fused+Series+pelvis+tumor_%28Monday-21-2018_21-48-35-7831%29.jpg Cases - "Tree-in-bud" can mean tumor in bronchi too... Oblique sagittal with iodine overlay nicely demonstrates the intravenous extension. https://www.ctspectral.com/spectral-cases/2018/5/20/open-your-eyes-and-you-will-see monthly 0.5 2018-05-20 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526834144951-JUOX1QNM6WS9JN7ZK3MS/pyeloGS.jpg Cases - Open your eyes, and you will see Conventional CT shows subtle hypoperfusion in the right kidney medially. Note the gallbladder looks normal. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526834822248-DGZD90JQU1XF8N8UHQKH/gsiodine.jpg Cases - Open your eyes, and you will see Iodine map accentuates the renal hypoperfusion, consistent with pyelonephritis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526834201078-SWUJZK4B6CU5SFJ5RDA1/pyeloGS.jpg Cases - Open your eyes, and you will see Overlay Z-effective image shows the renal cortical defect very well, but note a gallstone now pops into view! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526834342859-24USNDIPPC3H18I6XL02/Capturegf.JPG Cases - Open your eyes, and you will see Attenuation of the gallstone and bile is nearly identical on conventional images https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526834540138-ZMIB13FSUJE77BF8Z1T8/Capturegsww.JPG Cases - Open your eyes, and you will see Behavior of gallstone and bile on spectral analysis is quite different. The curves intersect at about 70 keV, which is typical energy of conventional CT scan. Gallstones (blue curve) are strikingly hypodense on low energy relative to bile (magenta curve, also image on left) and high density on higher energy (image on right). https://www.ctspectral.com/spectral-cases/2018/5/18/a-case-of-neck-pain monthly 0.5 2018-05-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696398089-Q56GIH8FVZZK7DWSZX0T/panc1.jpg Cases - A case of neck pain Cervical spine CT shows pathological fracture of C7 and T1 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696949372-ABJDNFE52BPYD4GOLNOU/panc2.jpg Cases - A case of neck pain MRI confirms pathological fractures https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696491111-4U8G07NT5PTQYG0SHYT7/pancconv.jpg Cases - A case of neck pain Conventional CT shows very subtle lesion in pancreas, not prospectively call-able https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696523340-HG6XBUSLQMO9MAPW8Q10/panc40.jpg Cases - A case of neck pain 40 keV mono-energy image shows clear lesion in pancreatic tail with upstream ductal dilatation https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696835422-AVXVS4YVFSAUCY8JPSGZ/image-asset.jpeg Cases - A case of neck pain MRCP with focal ductal dilatation in the pancreatic tail shown very nicely https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696709743-628137HC0A9P7CNF920S/image-asset.jpeg Cases - A case of neck pain Contrast enhanced MR shows hypoenhancing pancreatic lesion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696752330-UCY9FJLQ6USWYYINWIIJ/MRpanc+tail.jpg Cases - A case of neck pain Diffusion wieghted MR (b=400) shows resricted difffusion in lesion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526696580496-YIZO4UPMRC70E38ENIQN/Picture1.png Cases - A case of neck pain Mass biopsied on endocspoic ultrasound https://www.ctspectral.com/spectral-cases/2018/5/16/the-hot-appendix monthly 0.5 2018-05-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526488880961-FT4JXR762OXZHL1N7BHR/appy3.jpg Cases - The hot appendix Conventional CT with inflamed appendix https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526488937973-A0G5804W3XHBM9NKSIN7/appy3.jpg Cases - The hot appendix Iodine map shows intense uptake in the appendix https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526488984896-C6RBKENC906R7OEZMI4R/appy3.jpg Cases - The hot appendix Iodine overlay shows "hot" appendix https://www.ctspectral.com/spectral-cases/2018/5/14/lung-laceration-spectral-insight monthly 0.5 2018-05-14 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526311156102-XDGP6SS4TGFXXE7J7M0L/lunglac1.jpg Cases - Lung laceration: spectral insight Conventional CT with typical "cavitary" lung laceration, and surrounding ground glass infiltrate consistent with lung contusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526311311634-HIOITSW3OFROXNHMOBKE/lunglac2.jpg Cases - Lung laceration: spectral insight https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526311239980-4CBMAR3BFTXMAABZN1SW/lunglac1.jpg Cases - Lung laceration: spectral insight https://www.ctspectral.com/spectral-cases/2018/5/13/lightbulb-sign monthly 0.5 2018-05-14 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526304181734-9AA8L9KVES7W8HCR778Q/islet1.jpg Cases - Lightbulb sign... Conventional CT shows mass in cecum. Note incidental AAA. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526304232155-AFH4VZBD872GHWWRWO9D/isletconv.jpg Cases - Lightbulb sign... Axial image shows very subtle lesion in neck of the pancreas https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526304282822-U55C6VC7HOBPO2BD7XLD/islet490.jpg Cases - Lightbulb sign... 40 keV mono-energy image shows nodule in pancreas much more clearly. Lightbulb! https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526304345276-4KI9B3RABNIA8QTYWSRC/isletiodine.jpg Cases - Lightbulb sign... Iodine map with uptake in nodule https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1526304399560-9W3V0KLBRZMGDV7XH7WK/isletVNC.jpg Cases - Lightbulb sign... No calcification seen on virtual non-contrast image. https://www.ctspectral.com/spectral-cases/2018/5/9/what-about-the-pancreas monthly 0.5 2018-05-10 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525909470000-BAXHE35UL741UH1LULVL/panc+necrosis_%28Wednesday-09-2018_18-14-47-0340%29.jpg Cases - What about the pancreas? Conventional CT: changes of pancreatitis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525910034628-1O4LV7CH7M7L9FBA5KUW/panc+necrosis_%28Wednesday-09-2018_18-14-47-0340%29.jpg Cases - What about the pancreas? Iodine map shows complete absence of uptake in pancreatic body and tail. Even in this early phase of enhancement, there should be some uptake in the pancreas. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525910431428-U2FJ5VYYINFA6ZM8O7KT/Fused+Series+panc+necrosis+3_%28Wednesday-09-2018_18-17-34-6036%29.jpg Cases - What about the pancreas? Oblique axial image with iodine overlay shows some iodine uptake in the head of pancreas, but none in the body and tail consistent with necrosis. https://www.ctspectral.com/spectral-cases/2018/5/8/liver-abscess monthly 0.5 2018-05-08 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525788967946-3J8O4O332DKIFUYH4B5Y/liver+US.jpg Cases - Liver abscess Ultrasound shows large hypoechoic liver lesion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525789038193-LJ0SAOSDK59EGH29B00F/liver+abscess+1_%28Tuesday-08-2018_07-26-55-9459%29.jpg Cases - Liver abscess COnventional CT shows large ill-defined liver mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525789117976-M29ZT9XPIC76D4F5F034/liver+abscess+1_%28Tuesday-08-2018_07-26-55-9459%29.jpg Cases - Liver abscess Iodine map shows liver lesion is a "black hole" except for a shaggy margin which shows low iodine uptake, this appearance is very suggestive of an abscess https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525789237743-PZK1LLNDGVBLAGH1DLA1/liver+abscess+1_%28Tuesday-08-2018_07-26-55-9459%29.jpg Cases - Liver abscess 40 keV monoenergy image shows internal character of abscess very well https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1525789415661-C75ENQQ0T1XLBQOJZPDQ/image-asset.jpeg Cases - Liver abscess Post-contrast MRI reflects the findings on iodine map https://www.ctspectral.com/spectral-cases/2018/4/26/gunshot-chest-spectral-insights monthly 0.5 2018-05-08 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524760458527-P7U0LPTUQ81NM1FPG0AD/Picture1.jpg Cases - Gunshot chest: spectral insights Volume rendered image from CT shows bullet injury site (yellow arrow). Note right chest tube. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524760848653-2C9BVKZHKMNVC17GECAR/tract.jpg Cases - Gunshot chest: spectral insights Bullet tract form left to the right in the anterior chest, somehow missing central vascular structures. Note punctate bullet fragments. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524760972017-WMU5GTG0ZJF3Y7TURMCC/Fused+Series+gunshot+2_%28Thursday-26-2018_10-24-03-8758%29.jpg Cases - Gunshot chest: spectral insights Oblique axial shows the injury tract https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524761022245-F9OGQHW5IMH52C4YPBBD/Fused+Series+gunshot+4_%28Thursday-26-2018_10-26-59-7864%29.jpg Cases - Gunshot chest: spectral insights Iodine overlay (same section as above) shows increased perfusion in the periphery of the tract https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524761130420-DE59QFAWE8GWNOHGLWJI/Fused+Series+gunshot+5+sag_%28Thursday-26-2018_10-28-34-1649%29.jpg Cases - Gunshot chest: spectral insights Sagittal iodine overlay image beautifully shows increased perfusion at the periphery of the tract. Note the hemothorax posteriorly, and small anterior pneumothorax. https://www.ctspectral.com/spectral-cases/2018/4/24/this-will-blow-your-mind monthly 0.5 2018-05-08 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524586499600-7O865KYZGW1Y4GP63IDE/image-asset.jpeg Cases - This will blow your mind.... Conventional CT (oblique sagittal) shows normal appearing right lower lobe pulmonary artery https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524586573611-EPZ5SRZ5389TAXLZQ3XN/PE+on+aorta+1_%28Tuesday-24-2018_08-37-23-1161%29.jpg Cases - This will blow your mind.... Same slice as above, 40 keV mono-energy image sgows right lower lobe pulmonary artery filling defect consistent with pulmonary embolism https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524587135559-NSZ7TNG40DQ5WXJGYTMJ/222.jpg Cases - This will blow your mind.... CT chest PE protocol confirms pulmonary embolism in right lower lobe https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524586711304-JPYYLIWV56UG92ZMAEYL/image-asset.jpeg Cases - This will blow your mind.... Oblique sagittal image lung windows shows infiltrate in the costophrenic angle with surrounding ground-glass opacity https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524586922972-U218FFXAWVQ52QEBWIQ8/image-asset.jpeg Cases - This will blow your mind.... Iodine overlay image on CT PE study shows large perfusion defect in right lower lobe (outlined in yellow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524587345844-M8Z83K2IWLAPJUXXT22I/Fused+Series+PE+aorta+infarct_%28Tuesday-24-2018_08-45-38-7926%29.jpg Cases - This will blow your mind.... Iodine overlay image on CT Aorta shows the central core of decreased perfusion (outlined in yellow), and a peripheral zone of increased perfusion (outlined in blue). I beleive this is the penumbra. https://www.ctspectral.com/spectral-cases/2018/4/21/time-to-retire-the-sestamibi-scan monthly 0.5 2018-04-21 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524326832366-0X6LV0AX66DNJAS91F5J/Capturesesss.JPG Cases - Time to retire the sestamibi scan? Early and delayed sestamibi scan images are unremarkable. Uptake in left lower neck is in the submandibular gland. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524326942474-Y8V0QWULMOWZFO8WOIXT/parath2_%28Saturday-21-2018_10-51-14-8817%29.jpg Cases - Time to retire the sestamibi scan? Conventional CT image. Note left internal jugular vein (blue circle) and left common carotid artery (the big red). Yellow arrow points to parathyroid adenoma, and green arrow to an adjacent lymph node; both look nearly identical https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524327927505-NY77NDI4FQDR9TIRJO9U/Iodine+no+Water+%5Bmgml%5D+Image333_%28Saturday-21-2018_11-24-33-4951%29.jpg Cases - Time to retire the sestamibi scan? On iodine map, the adenoma shows more uptake than the lymph node (2.1 mg/mL vs 1.2 mg/mL) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1524328008826-BMGEYNIIAQPNUR89M86L/image-asset.jpeg Cases - Time to retire the sestamibi scan? Attenuation curve of adenoma (magenta) and lymph node (blue) are quite different https://www.ctspectral.com/spectral-cases/2018/4/16/pulmonary-septic-emboli monthly 0.5 2018-04-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523881953613-3QACK07COPZ2NMA06LEZ/image-asset.jpeg Cases - Pulmonary septic emboli Conventional CT shows right upper lobe nodule with subtle cavitation https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523881983040-479QU99OOWT6XGJ29P40/septic+infactr1.jpg Cases - Pulmonary septic emboli Iodine map shows markedly decreased iodine uptake in the nodule https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523882056483-9T4ZJ3V2U6KF9UFWE9E0/sepinfarct+2.jpg Cases - Pulmonary septic emboli Iodine uptake in nodule is about 0.13 mg/mL (vs 1.58 mg/mL in normal lung) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523882103079-6AUUQE0RFNE475ZZA9OG/sep+infarct+3.jpg Cases - Pulmonary septic emboli Large embolus in right lower lobe https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523882137338-4A2U3FPQXGSHWDJ29QFM/image-asset.jpeg Cases - Pulmonary septic emboli Note subtle vegetation adjacent to the tricuspid valve https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523920328205-9BFAI00BTXGCSEEXPJT0/VegCapture.JPG Cases - Pulmonary septic emboli Image from transthoracic echocardiogram confirms vegetation on tricuspid valve (yellow arrow) https://www.ctspectral.com/spectral-cases/2018/4/16/lung-laceration-spectral-analysis monthly 0.5 2018-04-16 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523906805857-7UC4U9YCWU9CR5JAI3GS/lung+lac_%28Monday-16-2018_14-20-09-9819%29.jpg Cases - Lung injury: spectral insights Conventional CT shows mutiple right lung lacerations. Note the right hemo-pneumothorax. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523906851115-2X670RGO0MYUIJYSKHFR/lung+lac_%28Monday-16-2018_14-20-09-9819%29.jpg Cases - Lung injury: spectral insights Iodine map shows increased perfusion surrounding the lung lacerations. There is also increased perfusion in the area of lung contusion compared to contralateral lung. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523906913894-SM0J7L28WQLHA1IQG2EX/image-asset.jpeg Cases - Lung injury: spectral insights Fusion image nicely demonstrates the perfusion alterations. https://www.ctspectral.com/spectral-cases/2018/4/12/can-it-be-this-easy monthly 0.5 2018-04-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523551610661-6ZOFBBY8PE0D60BDAC4I/closed+loop11.png Cases - Can it be any easier? Oblique coronal image from conventional CT shows radial closed loop with mesenteric edema. Note the central "whirl". https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523567042911-88W3UICHFRQD4ILGTFBN/Iodine+no+Water+%5Bmgml%5D+closed+loop+56_%28Thursday-12-2018_16-02-08-6582%29.jpg Cases - Can it be any easier? Iodine map shows clearly diminished perfusion in the abnormal loop https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523567071922-DJVJ89V481H5Q6FDGBZG/Fused+Series+closed+loop+34_%28Thursday-12-2018_16-00-30-2563%29.jpg Cases - Can it be any easier? Fused image with iodine map shows absent iodine uptake in wall of dilated loop consistent with ischemia https://www.ctspectral.com/spectral-cases/2018/4/9/myocardial-ischemia-effect-of-scan-timing monthly 0.5 2018-04-09 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523279465777-ISJFOII4HSDA8R8VGUWK/Picture22.jpg Cases - Myocardial ischemia: Effect of scan timing CT Chest PE shows normal appearing myocardial perfusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523279480593-CTL1DQCDI8HFH1UGFGLY/Picture33.jpg Cases - Myocardial ischemia: Effect of scan timing Fusion image on CT chest PE shows normal appearing myocardial perfusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523280130580-N66G0SOS8Y64YHCYKMV0/Picture66.jpg Cases - Myocardial ischemia: Effect of scan timing CT Abdomen performed 3 weeks prior (conventional image) shows subtle LV anteroseptal hypoperfusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523280140876-M3VJMQEI6OWKJFD56VKR/Picture77.jpg Cases - Myocardial ischemia: Effect of scan timing Iodine map shows perusion defect much more clearly https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523280182946-OPSB76PXCD7CT77WNL2N/Picture551.jpg Cases - Myocardial ischemia: Effect of scan timing Iodine overlay enhances perfusion defect https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1523280701263-RZF097TX6VX1FVR8VNFU/Captureekg.JPG Cases - Myocardial ischemia: Effect of scan timing EKG shows Q waves consistent with old anteroseptal MI https://www.ctspectral.com/spectral-cases/2018/4/5/a-case-of-focal-infiltrate monthly 0.5 2018-04-05 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522956716566-2IB9JUIPEV0NC18IVNHD/histo_%28Thursday-05-2018_13-58-06-9002%29.jpg Cases - A case of focal infiltrate Conventional CT with pleural based opacity in right lung. Astute obervers will notice small cavitation. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522956759341-RERJW9E55SKRQN12V05S/histo_%28Thursday-05-2018_13-58-06-9002%29.jpg Cases - A case of focal infiltrate Notice focal hypoperfusion in the lung opacity and adjacent air-trapping. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522956789752-ZJNU8ZWZSOAJ9ZHU0V9C/histo+3_%28Thursday-05-2018_13-59-36-5202%29.jpg Cases - A case of focal infiltrate Large subcarinal lymph node with decreased perfusion, suggesting necrosis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522956682406-2IDDQC10LO51FEZJNGNJ/image-asset.jpeg Cases - A case of focal infiltrate intense FDG uptake in mediastinal lymph nodes and lung opacity. https://www.ctspectral.com/spectral-cases/2018/4/5/a-case-of-a-lung-infiltrates monthly 0.5 2018-04-05 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522942695163-IAFYO3LFYMSX07S8BNLD/image-asset.jpeg Cases - A case of a lung infiltrates CXR with diffuse infiltrates https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522942756662-8K9D5X9JTL8E2R30MSTA/kaposi+2_%28Thursday-05-2018_10-08-32-8428%29.jpg Cases - A case of a lung infiltrates Conventional CT (lung windows) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522942818347-HPTKWKXU1MUGNZ8PMFR1/image-asset.jpeg Cases - A case of a lung infiltrates Infiltrates in left lung have "flame shaped" appearance https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522942861478-9XK28JWLE1FN85CP1HZ4/kaposi+3_%28Thursday-05-2018_10-10-00-9316%29.jpg Cases - A case of a lung infiltrates INcreased iodine uptake in the nodules https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522943769018-XPME8YOA8OTKXOXQ3LVY/Iodine+Density+%5Bmgml%5D+kaposi+5_%28Thursday-05-2018_10-11-21-0917%29.jpg Cases - A case of a lung infiltrates Iodine density is more than double of normal lung (2 mg/mL in lesion vs 1 mg/mL in normal lung) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522943955417-WE3G4QK96N12EAJAQ13H/Capture222.JPG Cases - A case of a lung infiltrates https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522943968921-MZBS3LGM9NQYH6QFMGE9/Capture333.JPG Cases - A case of a lung infiltrates Bronchoscopy shows plaques of Kaposi sarcoma https://www.ctspectral.com/spectral-cases/2018/4/3/see-the-invisible monthly 0.5 2018-04-04 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522762049426-38BWO20YKLQGTNHH7CN7/GS1.jpg Cases - See the invisible! Conventional CT shows inflammatory changes around the gallbladder, but NO gallstone https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522762194187-2HCPM0TDOWRT3XWEUQPC/image-asset.jpeg Cases - See the invisible! ROI placed over expected location of gallstone (blue) and bile (magenta) on convantional CT show nearly identical density (8.1 vs 6.7 HU) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522776462041-GKI3NWBH3GIT9F7A7ILU/23.jpg Cases - See the invisible! Spectral curves show the density of gallstone and bile is nearly identical at 70 keV (yellow line), but diverges at higher and lower keV https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522776237325-9N9LNEY13Z08H7NX8GRB/MonoE+40keV%5BHU%5D+gs+40+kev_%28Tuesday-03-2018_08-33-54-2421%29.jpg Cases - See the invisible! Gallstone seen as negative density on 40 keV image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522776269714-FK3A07KJ1C80W55ONVNU/MonoE+200keV%5BHU%5D+gs+200+kev_%28Tuesday-03-2018_08-34-34-7701%29.jpg Cases - See the invisible! Gallstone seen as positive density on 200 keV image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522776487880-AV5BRPQW4IM3IHKISPHI/34.jpg Cases - See the invisible! Spectral curves show clearly different Z-effective of the gallstones (blue) and bile (magenta) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522776522198-MV1D2XT3X3W9DXE9L33M/gs.jpg Cases - See the invisible! Ultrasound confirms stone lodged in neck of gallbladder. Note wallthickening and edema. https://www.ctspectral.com/spectral-cases/2018/3/30/lv-aneurysm-with-thrombus monthly 0.5 2018-03-30 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522414392800-5KDQD9GTTU6JIHFIQW5O/LV+PSA_%28Thursday-29-2018_09-50-07-1549%29.jpg Cases - LV aneurysm with thrombus Conventional CT shows large left ventricle lateral wall aneurysm (yellow arrows) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522414473678-M355VE6ZBSB2NU59R71H/LV+PSA_%28Thursday-29-2018_09-50-07-1549%29.jpg Cases - LV aneurysm with thrombus Iodine map shows large thrombus in the aneurysm with absent iodine uptake (red curve) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522414543913-KBKG3K0A7VHZJ6UX0LEQ/LV+PSA_%28Thursday-29-2018_09-50-07-1549%29.jpg Cases - LV aneurysm with thrombus Iodine overlay image. Note normal LV wall perfusion (white arrow), color is absent in the aneurysm. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522416140118-P0Y99S8SSCAY1WKLB1FM/Capture.PNG Cases - LV aneurysm with thrombus Echocardiogram (HLA view) shows obvious lateral wall aneurysm (yellow arrows) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522416216478-3P0Q11G6K4NOFV9UZNJK/Capture2.PNG Cases - LV aneurysm with thrombus Large echolucent area (blue arrows) after contrast confirms thrombus https://www.ctspectral.com/spectral-cases/2018/3/29/stab-wound-with-active-extravasation monthly 0.5 2018-03-30 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522374209007-A4FX79P6OJQHEAIXGCFJ/stab.jpg Cases - Stab wound with active extravasation Conventional CT with subtle hyperdensity inferior to the right scapula in the back https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522374279640-ZCIIS6FGG138UM6WW0RE/stab.jpg Cases - Stab wound with active extravasation 40 keV image makes finding very easy to appreciate (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522374340355-8EYGPLUP9C2R9598VNCH/stab.jpg Cases - Stab wound with active extravasation Absence of density on virtual non-contrast confirms contrast extravasation https://www.ctspectral.com/spectral-cases/2018/3/27/low-contrast-dose-neck-cta monthly 0.5 2018-03-28 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522175639248-ILZ2YN8D0QG5DRFKMLDN/image-asset.jpeg Cases - Low contrast dose neck CTA Conventional CT with poor enhancement https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522175679607-2LPJ0RFW9V94M77N9MWR/neck+2.jpg Cases - Low contrast dose neck CTA 40 keV image shows excellent enhancement and visualization of the neck arteries https://www.ctspectral.com/spectral-cases/2018/3/27/gi-bleed monthly 0.5 2018-03-27 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522170413818-0LSE3E3S8AB9LMKGFOZ2/fist.jpg Cases - GI bleed Conventional CT (coronal image) shows fistula (F) between the stomach (St), spleen (Sp) and colon (C) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522170520628-NWJEJ5MZB0CF5WW4HJSC/anemia.jpg Cases - GI bleed Virtual non-contrast image shows increased contrast between LV myocardium (48 HU) and blood pool (27 HU), consistent with anemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522170797839-A6FRTUJN3FPCZ2BATDFN/image-asset.jpeg Cases - GI bleed Conventional CT (axial plane) shows ill-defined density (red arrow) in the posterior aspect of fistula https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522170866228-5E1O5XJS2V342DEL8NBL/GI+bleed_%28Tuesday-27-2018_12-10-59-7670%29.jpg Cases - GI bleed Iodine uptake (yellow arrows) confirms GI bleed https://www.ctspectral.com/spectral-cases/2018/3/24/spontaneous-renal-artery-dissection monthly 0.5 2018-03-25 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521946365861-TQJFL138LSRVPO011FSJ/renal+art+dissec_%28Saturday-24-2018_21-43-16-1566%29.jpg Cases - Spontaneous renal artery dissection Conventional image shows hypodensity in letf kidney https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521946428263-WBNSLY49EVP7BFDHQERW/renal+art+dissec_%28Saturday-24-2018_21-43-16-1566%29.jpg Cases - Spontaneous renal artery dissection Complete lack of iodine confirms a renal infarct https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521946485786-PGKRWJR0BS60J9P6RN17/renal+art+dissec_%28Saturday-24-2018_21-43-16-1566%29.jpg Cases - Spontaneous renal artery dissection Fusion image nicely demsntrates lack of iodine uptake https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521946549769-J0XX2RNDZZ826R2K2HOI/renal+art+dissec_%28Saturday-24-2018_21-43-16-1566%29.jpg Cases - Spontaneous renal artery dissection 40 keV image clearly shows the renal artery flap consistent with dissection (yellow arrow). Low Kev reconstructions can be used as virtual CT angiograms. https://www.ctspectral.com/spectral-cases/2018/3/18/pleural-effusion monthly 0.5 2018-03-23 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521426177768-U0WIV5GN61WR8D651XGO/pleural+eff+conv_%28Sunday-18-2018_21-11-27-1904%29.jpg Cases - Pleural effusion Conventioanl CT shows large pleural effusion on the right. Note the central mass. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521426215128-TAX0XEOZHUY1PF4PW2D4/image-asset.jpeg Cases - Pleural effusion 40 keV image clearly depicts the pleural tumor deposit. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521426380648-L8NE7WDCFROZM6Q2JEWT/colon+ca.jpg Cases - Pleural effusion Susequent CT shows large sigmoid colon mass (circled). https://www.ctspectral.com/spectral-cases/2018/3/21/pancreatic-cancer monthly 0.5 2018-03-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521687878099-RE1G56B9MI4Z33L4SWX3/image-asset.png Cases - Pancreatic cancer Coronal oblique conventioanl CT image shows biliary dilatation. Note hyperdense nodule (yellow arrow) obstructing the CBD. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521687988486-LL4KYCSHF1YH91OH4CXO/pan+ca+all_%28Wednesday-21-2018_18-31-14-7111%29.jpg Cases - Pancreatic cancer Axial conventional image shows subtle nodule in pancreatic head https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521688069746-LZG1DG6THS3VFJXXVBFU/pan+ca+all_%28Wednesday-21-2018_18-31-14-7111%29.jpg Cases - Pancreatic cancer Nodule is much easier to see on 40 keV image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521688126145-F219USG73O2OA9N9VDH4/pan+ca+all_%28Wednesday-21-2018_18-31-14-7111%29.jpg Cases - Pancreatic cancer Fusion image shows clear iodine uptake in the nodule, consistent with tumor https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521688161936-BV95XS36YPJ6YE7LHI7S/eusCapture.JPG Cases - Pancreatic cancer Image from endosopic ultrasound shows hypoechoic mass obstructing common bile duct https://www.ctspectral.com/spectral-cases/2018/3/22/urothelial-mass monthly 0.5 2018-03-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521759071764-5FZ4Q726H68QH57WJV7Z/image-asset.jpeg Cases - Urothelial mass Conventional image with filling defect in left renal pelvis (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521759103509-CDPDT49EEGTVO4YXZ0L2/image-asset.jpeg Cases - Urothelial mass Iodine overlay with uptake confirms neoplasm https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521759256668-PZNARO55LKO20DN9FQHS/urothel+6_%28Thursday-22-2018_17-39-14-4348%29.jpg Cases - Urothelial mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521759283978-LKGZI6ZQIBXHYI32X5VL/Attenuation+curve+7_%28Thursday-22-2018_17-39-30-1233%29.jpg Cases - Urothelial mass Region of interest placed on lesion shows spectral curve rising on lower keV, an elegant way to confirm iodine uptake and perfusion https://www.ctspectral.com/spectral-cases/2018/3/21/appendage-clot monthly 0.5 2018-03-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521690375217-AC2OCEX5D8IE4UCTQ6MA/image-asset.png Cases - Left atrial appendage clot Volume rendered image from CTA showing bilateral popliteal artery occlusion https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521690478272-IVB56SBNK1WY7S4KIYR4/pop+art+2.jpg Cases - Left atrial appendage clot Conventional CT with filling defect in left atrial appendage, clot vs mixing artifact https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521690537138-Z67NNQZK6GVGS3593SKJ/pop+art+2.jpg Cases - Left atrial appendage clot Iodine map shows no iodine uptake in filling defect, consistent with clot https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521690588601-3Y37EVORYCK9HY80OEZ0/image-asset.jpeg Cases - Left atrial appendage clot Fusion image nicely demonstrates lack of iodine uptake in clot https://www.ctspectral.com/spectral-cases/2018/3/18/intrahepatic-biliary-calculi monthly 0.5 2018-03-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521424442807-VCKB6N800MSYJS6SGTJZ/image-asset.jpeg Cases - Intrahepatic biliary calculi Coronal conventional CT with central liver "lesions" (yellow arrows). Note pneumobilia. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521424618111-5E76J255251QL0G7C52N/image-asset.jpeg Cases - Intrahepatic biliary calculi Iodine map shows no iodine uptake in these "lesions" https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521424520585-FB4MRFB076918D6R3R12/VNC+%5BHU%5D+rpc+vncc_%28Sunday-18-2018_20-46-47-9728%29.jpg Cases - Intrahepatic biliary calculi Virtual non-contrast shows high density consistent with stones. https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521424681379-7RWQYVVZE3BLU8E957X6/rpcmri.jpg Cases - Intrahepatic biliary calculi T2W coronal MRI confirms calculi, which are without signal (black) https://www.ctspectral.com/spectral-cases/2018/3/15/low-contrast-dose-ct-pe monthly 0.5 2018-03-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521134981195-3K6IVA1HALX2SGKXY9MG/MonoE+45keV%5BHU%5D+CT+PE+32.5+ml_%28Thursday-15-2018_12-23-37-3202%29.jpg Cases - Low-contrast dose CT PE https://www.ctspectral.com/spectral-cases/2018/3/13/myocardial-infarction monthly 0.5 2018-03-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520966520960-5JPKR1X2XURUOXSO1KDZ/beshtmi.jpg Cases - Myocardial infarction https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520966550024-ZBL6AMIEPYSVAQ362XA2/beshtmi.jpg Cases - Myocardial infarction https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520966485146-IF9TXW74Y3AVLI17PB5W/bemi2.jpg Cases - Myocardial infarction https://www.ctspectral.com/spectral-cases/2018/3/14/adrenal-incidentaloma monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521410772639-II106ED4D4K7TLP5N1JT/adrenal%2Baden1ANNOT.jpg Cases - Adrenal "incidentaloma" Conventional CT with indeterminate nodule in left adrenal gland (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521065051473-T0UIBPXL10TR6VTXBVT4/adrenal+aden+2.jpg Cases - Adrenal "incidentaloma" Virtual non-contrast with attenuation of -7 HU, diagnostic of a benign adenoma https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521065108566-E0QIDTXCGH2B07YSNZDC/adrenal+aden+true+noncon+-10.jpg Cases - Adrenal "incidentaloma" Follow-up true non-contrast CT shows nearly identical attenuation https://www.ctspectral.com/spectral-cases/2018/3/13/cecal-volvulus monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520951411242-I45EEY6ILVPMTCWAAZPF/cecal+volv+2_%28Tuesday-13-2018_09-08-17-6028%29.jpg Cases - Internal hernia with necrotic colon Conventional CT with dilated malpositioned cecum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520951454370-B58Y1D57MAVLWIKAJB0R/cecal+volv+2_%28Tuesday-13-2018_09-08-17-6028%29.jpg Cases - Internal hernia with necrotic colon Iodine map with no perfusion in wall of cecum and terminal ileum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520951491475-MRB80CI91FG047KIA6DU/cecal+volv+2_%28Tuesday-13-2018_09-08-17-6028%29.jpg Cases - Internal hernia with necrotic colon Iodine density overlay with no perfusion in wall of cecum and terminal ileum https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520951538699-EAGCESLKXPZDTAWVINUF/cecal+volv+3_%28Tuesday-13-2018_09-09-24-1045%29.jpg Cases - Internal hernia with necrotic colon Dilated segment of colon extends into pelvis, note absent perfusion in the wall on overlay image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521065355214-PBG8F1A79JOJZL91ATYF/Picture1.jpg Cases - Internal hernia with necrotic colon Intraop image courtesy Dr Ryan Fey; dilated necrotic colon confirmed https://www.ctspectral.com/spectral-cases/2018/3/13/spleen-injury monthly 0.5 2018-03-13 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520950679047-TPKJID2RWG9I66R3A7EQ/spleen+injury_%28Tuesday-13-2018_08-37-43-4034%29.jpg Cases - Spleen injury https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520950754926-Z8HFF6W6OGIVVZQLA7FT/spleen+injury_%28Tuesday-13-2018_08-37-43-4034%29.jpg Cases - Spleen injury https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520956289917-DYKL8WLVACEHSXCIU9QH/spleen+inj+2_%28Tuesday-13-2018_08-38-55-6416%29.jpg Cases - Spleen injury Early image with intrasplenic focal enhancement https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520956354111-H0QHBPNS0S1JRBZIVI9L/spleen+delay+1_%28Tuesday-13-2018_08-46-05-2306%29.jpg Cases - Spleen injury Delayed image conventional https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520956397090-E2AO4KDO038F2Z6WYS92/spleen+delay+1_%28Tuesday-13-2018_08-46-05-2306%29.jpg Cases - Spleen injury Delayed image 40 keV https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520956480394-9FHB86W0ACRZKLF60OL0/splen+psa.jpg Cases - Spleen injury Angiogram confirms splenic pseudoaneurysm https://www.ctspectral.com/spectral-cases/2018/3/12/necrotic-fibroid monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520874382997-H7IXLOULNRRY6CXS4UFZ/fibroidSBO11.jpg Cases - Necrotic fibroid https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520874412570-QCQLIJCASCO1XMSNYRVF/fibroidSBO22.jpg Cases - Necrotic fibroid https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520874447690-VNC0KKA23FIH528RF1QB/Fused+Series+necFIROIDSBO_%28Monday-12-2018_11-55-47-4342%29.jpg Cases - Necrotic fibroid https://www.ctspectral.com/spectral-cases/2018/3/12/jejunal-hyperdensity monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520872986890-2CUOQ1XDKLOMA4VA2GOR/ingested1.jpg Cases - Jejunal hyperdensity https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520872949353-MDE4ILGPOR6JTT3XAMNV/ingested2.jpg Cases - Jejunal hyperdensity https://www.ctspectral.com/spectral-cases/2018/3/12/8bndsh1hx52zqx203ym8nphrkgrdgg monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411205490-BHGJD4J399CGI6RYDVHQ/tumor%2Band%2Bclot1+%281%29.jpg Cases - Tumor thrombus Conventional CT with filling defect in portal vein (yellow arrow) https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411255187-WCI4PE1V54JNYMRTPTU9/tumor%2Band%2Bclot%2B3.jpg Cases - Tumor thrombus Iodine map shows perfusion in portal vein clot, consistent with tumor thrombus https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411304911-OFS0VMM6P08D9STPQDNB/tumor%2Band%2Bclot%2B2.jpg Cases - Tumor thrombus Virtual non-contrast shows bleed adjacent to the left lobe https://www.ctspectral.com/spectral-cases/2018/3/12/complex-kidney-cyst monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411596923-9EJS86DQ51AK3BYSDGIY/image-asset.jpeg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411671761-XK71LZU9CE5281GFAP06/DISPLAY%2Bhem%2Bcyst_%28Monday-05-2018_07-43-27-4916%29+%281%29.jpg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411720840-5ZPVTKDZVREJ3722HQW6/DISPLAY%2Bhem%2Bcyst_%28Monday-05-2018_07-43-27-4916%29+%282%29.jpg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520866201793-WRS4310BXYMYOIG09JT3/DISPLAY%2Bhem%2Bcyst_%28Monday-05-2018_07-43-27-4916%29+%283%29.jpg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520866228803-92F0QMW8FTTVQS1C54VF/hemcystmrt2.jpg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520866238387-BKBLTAI3E1RJL0DF734H/hemcystmrt1.jpg Cases - Complex kidney cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520866243318-5EST0E9KRRQ1R0RQ5LA5/hemcystsub.jpg Cases - Complex kidney cyst https://www.ctspectral.com/spectral-cases/2018/3/12/endoleak monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521411903126-NW87QSDO6D59I78GHSGU/image-asset.jpeg Cases - Endoleak Conventional CT with focal hyperdensity adjacent to endograft https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865995044-9AMR4LF9JLOJNIUWIBLT/endoleak+%281%29.jpg Cases - Endoleak Virtual non-contrast https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521412013141-N2HMLCGSZITA2BQEEMKL/endoleak%2B%282%29.jpg Cases - Endoleak Fusion image nicely depicts the endoleak https://www.ctspectral.com/spectral-cases/2018/3/12/pancreatitis monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865852579-VOLS6PXQKLW0AVMBVOW1/panc1.jpg Cases - Pancreatitis Conventional CT shows pancreatitis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521412310948-1NI6PSFH7LVV61G6T5IB/panc1%2B%281%29.jpg Cases - Pancreatitis Iodine map shows absent perfusion (outlined in yellow), consistent with necrosis in body and tail https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865877877-6VLS24J817WLR1YACCU9/panc1+%282%29.jpg Cases - Pancreatitis Fusion image https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521412476624-W7FLHXIBML9NHHB2OOML/panc2.jpg Cases - Pancreatitis CT few weeks later shows large necrotic collection (outlined) https://www.ctspectral.com/spectral-cases/2018/3/12/spleen-infarct monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865744578-770J04SHUAHMUEGZQEU1/spleen1.jpg Cases - Splenic infarct Conventional CT https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865753771-FI5P66IURUMK67NQXFGH/spleen2.jpg Cases - Splenic infarct Iodine map https://www.ctspectral.com/spectral-cases/2018/3/12/bowel-ischemia monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865632162-7LE3F4C7ZWWAO4YO4NK6/sma1.jpg Cases - Bowel ischemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865642704-CHBUNRBMMFUYNKT00E6N/sma2.jpg Cases - Bowel ischemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865658323-UGXC2AAZ1F0Q3Z2GFO75/sma3.jpg Cases - Bowel ischemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865674503-AXSUF1FGG3MRWI55XMHG/sma4.jpg Cases - Bowel ischemia https://www.ctspectral.com/spectral-cases/2018/3/12/pyelonephritis monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865499490-0KGTARCDCKT06Z19CAGD/pyelo1.jpg Cases - Pyelonephritis Conventional CT https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865510124-BHH0NQ1265OCDK7ZSSVY/image-asset.jpeg Cases - Pyelonephritis Iodine map https://www.ctspectral.com/spectral-cases/2018/3/12/evwdmfthkiy2shfhosq02uyhcuaa39 monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865386798-YF65E83EJNQX4GR7ZR6E/panc%2Bca%2B1_%28Tuesday-06-2018_13-07-59-4243%29.jpg Cases - Pancreatic cancer Conventional CT, oblique axial https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865396801-VYRENZT5ADFQTE5J0GSB/MonoE%2B45keV%5BHU%5D%2Bpanc%2Bca%2B2_%28Tuesday-06-2018_13-09-47-6681%29.jpg Cases - Pancreatic cancer 45 keV, oblique axial https://www.ctspectral.com/spectral-cases/2018/3/12/perineal-nodule monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865290156-JTW7TSNCYOM14DQOLH2U/vagnod1.jpg Cases - Perineal nodule https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865312442-OZBRWH6Q6BXFY1WF77EB/vag%2Bnodule%2B2.jpg Cases - Perineal nodule https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865321981-5Q7J6U1UMRPFH54LDWG9/vagnodule%2B3.jpg Cases - Perineal nodule https://www.ctspectral.com/spectral-cases/2018/3/12/pelvic-mass monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865149145-GPITQBQVFN625OTQXDKK/pelvic%2Bhematoma_%28Wednesday-07-2018_11-32-25-2077%29.jpg Cases - Pelvic mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865163685-ZBIDNSSZY49D23B0HA08/pelvic%2Bhematoma_%28Wednesday-07-2018_11-32-25-2077%29+%281%29.jpg Cases - Pelvic mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865181011-YTY5VN6YNL3U20OD2XAY/pelvic%2Bhematoma_%28Wednesday-07-2018_11-32-25-2077%29+%282%29.jpg Cases - Pelvic mass https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865199929-T8HR208S0GS21ZI5HJIE/pelvichematoma.jpg Cases - Pelvic mass https://www.ctspectral.com/spectral-cases/2018/3/12/hemorrhagic-cyst monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865016892-CXXFELSX6VWZG509E9SQ/hem%2Bcyst%2B1.jpg Cases - Hemorrhagic cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865028407-F254U86SEEFACISL48NY/hem%2Bcyst%2B2.jpg Cases - Hemorrhagic cyst https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520865043791-WE6LD91YU42AJ8WTFTLT/hem%2Bcyst%2B3.jpg Cases - Hemorrhagic cyst https://www.ctspectral.com/spectral-cases/2018/3/12/gi-bleed monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864392208-SLJ5TG176423D7G4HDOA/picGI.png Cases - GI bleed https://www.ctspectral.com/spectral-cases/2018/3/12/rectus-sheath-hematoma monthly 0.5 2018-03-18 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864519459-3IS8NJL5B3TJAHRHL07L/rectussheath1.jpg Cases - Rectus sheath hematoma Conventional CT https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1521412816282-BBLFYZOHJPEXUFFFY4ST/rectussheathVNC.jpg Cases - Rectus sheath hematoma Virtual non-contrast shows rectus sheath hematoma much better (outlined) https://www.ctspectral.com/spectral-cases/2018/3/12/crohn-disease monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864610213-5BI0M9Z0BF99H2H3YO2L/Fused%2BSeries%2Bcrohn%2B1_%28Tuesday-06-2018_13-29-38-6342%29.jpg Cases - Crohn disease https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864625116-A3I6EXIZSPG9EQLG18AX/Fused%2BSeries%2Bcrohn%2B2_%28Tuesday-06-2018_13-30-17-5401%29.jpg Cases - Crohn disease https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864636452-NW2YVJUTX3HKL9HHKXVJ/Fused%2BSeries%2Bcrohn%2B3_%28Tuesday-06-2018_13-30-48-9852%29.jpg Cases - Crohn disease https://www.ctspectral.com/spectral-cases/2018/3/12/appendicitis monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864719193-WWPV6PTFHJCVWHSNY5NN/appy1.jpg Cases - Appendicitis https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520864730364-3G1XN66X8BP91YJNV850/appy2.jpg Cases - Appendicitis https://www.ctspectral.com/spectral-cases/2018/3/12/perinephric-hematoma monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861714450-0QN2B9BI7PC2I2UMTDQR/perinephrichem.jpg Cases - Perinephric hematoma https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861724312-884MLGASY1C0MGY7JQES/perinephrichem+%281%29.jpg Cases - Perinephric hematoma https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861737758-ABA2UASZNDRQGIX5Q8AM/perinephrichem+%282%29.jpg Cases - Perinephric hematoma https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861813061-O4G6PH5IYJ68HORSYB2K/perinephrichem+%283%29.jpg Cases - Perinephric hematoma https://www.ctspectral.com/spectral-cases/2018/3/12/c5tecqtnqxknunnh3zsa4kawu38v8i monthly 0.5 2018-03-22 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861518892-CPA6A1UUMCBE8UX3BDR1/Fused%2BSeries%2Bsb%2Binjury1_%28Tuesday-06-2018_11-26-38-3322%29.jpg Cases - Small Bowel injury https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861537092-928S4ROLSMQIWMC0J914/Fused%2BSeries%2Bsb%2Binjnj%2B2_%28Tuesday-06-2018_11-27-28-6083%29.jpg Cases - Small Bowel injury https://www.ctspectral.com/spectral-cases/2018/3/12/detection-of-myocardial-ischemia monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862684468-C6N2ULEN8V1NH0VZ4CJS/mi1.jpg Cases - Detection of myocardial ischemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862696240-KXMSAVO616HM5SJEIRUO/mi2.jpg Cases - Detection of myocardial ischemia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862709271-EMKR96F28ZE2SUJER6MY/mi3.jpg Cases - Detection of myocardial ischemia https://www.ctspectral.com/spectral-cases/2018/3/12/salvage-bad-ct-pe-scans monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862012600-GY9FGHI5U0B1NTPSDNGB/Picture2.png Cases - Salvage bad CT PE scans https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862023812-MO1IJCIXSWGAZA0TGKSM/Picture3.png Cases - Salvage bad CT PE scans https://www.ctspectral.com/spectral-cases/2018/3/12/more-subtle-pe monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862494327-1PTIMS0IILCYUL8OBT6C/subtlePE1.jpg Cases - More subtle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862507740-U0H7VK03KXIEYP7ZJN3X/subtlePE2.jpg Cases - More subtle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862525291-DLWJ3S2Y1BL03WUBPF9B/subtlepe3.jpg Cases - More subtle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862536075-XHANHLSOS2IZAL4RGENH/subtlepe4.jpg Cases - More subtle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862552341-H28O65CQQXU7FFPKJSK4/subtlepe5.jpg Cases - More subtle PE https://www.ctspectral.com/spectral-cases/2018/3/12/subtle-pe monthly 0.5 2018-03-19 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862197532-HWUCS7B0Q4UZXGQMYTI9/subtlePE.jpg Cases - Subtle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862210969-ZYN0G22LVYX5G43A4WW4/subtlePE+%281%29.jpg Cases - Subtle PE https://www.ctspectral.com/spectral-cases/2018/3/12/saddle-pe monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861927551-SC4OPPX9ISX99QGQ56XZ/saddle11_%28Friday-09-2018_10-28-03-2157%29.jpg Cases - Saddle PE https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520861939018-TXEGJSGOSP2NCZVSO56J/Fused%2BSeries%2Bsaddle22_%28Friday-09-2018_10-27-42-5066%29.jpg Cases - Saddle PE https://www.ctspectral.com/spectral-cases/2018/3/12/pneumonia monthly 0.5 2018-03-12 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862351250-3NGO46FVU0NUHMLLCJTG/pneumonia_%28Monday-05-2018_20-52-47-7204%29.jpg Cases - Pneumonia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862364533-FU3NCX9WO9M6M7XSMM4N/pneumonia_%28Monday-05-2018_20-52-47-7204%29+%281%29.jpg Cases - Pneumonia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862384300-GI3Z5NB6F2Y5R1F4FLC2/pneumonia_%28Monday-05-2018_20-52-47-7204%29+%282%29.jpg Cases - Pneumonia https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520862404921-BA7JL2KTV8RBX2E0UVPW/pneumonia2.jpg Cases - Pneumonia https://www.ctspectral.com/about-hcmc daily 0.75 2020-11-15 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520286872436-FBJ76RSJZW4HNTPCASLW/IMG_0136.JPG About blogger and HCMC https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1520305477383-97D91VZDT7WLH5VJK9EC/IMG_0136.JPG About blogger and HCMC - Hi! Welcome to CT spectral! I am Gopal Punjabi, body imager privileged to work at Hennepin County Medical Center as Chief of Radiology. HCMC is the premier level 1 trauma center in Minneapolis, MN. We have been working with spectral CT (Philips IQon) since Nov 2016. It was love at first scan! All opinions in this blog are mine and mine alone, and do NOT reflect on my employer. No patient identifiers on any image/case, and specific details (age, history etc) may be changed. Cases may or may not be from my workplace. https://www.ctspectral.com/new-page daily 0.75 2018-06-04 https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522071116725-YW073A4DKINXZFOC4LUC/Fused+Series+Image_%28Monday-26-2018_08-31-47-5056%29.jpg About spectral CT https://images.squarespace-cdn.com/content/v1/5a9c1cc25b409ba79feb2450/1522077823726-PNTIFY89XNW9A9LT4BEN/Picture1.png About spectral CT https://www.ctspectral.com/new-page-1 daily 0.75 2019-05-01