Dual-Energy CT for the Musculoskeletal System

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:

Computed Tomography: 3.50
Image Production: 3.50
Image Formation: 3.50

Outline

1. Introduction
2. Basic Principles of Dual-Energy CT
   1. Physics
   2. Hardware Design
   3. Postprocessing Tools
   4. Dose Considerations
   5. Time Considerations
3. Clinical Applications
   1. Metal Artifact Reduction Techniques
   2. Gout Imaging-Urate Detection and Analysis
   3. Bone Marrow Edema Detection
   4. Collagen Analysis: Ligaments, Tendons, and Intervertebral Disks
   5. Bone Mineral Density Analysis
   6. Dual-Energy CT for Detection of Metastases
   7. Iodine Application in CT Arthrography
4. Conclusion

Objectives

Upon completion of this course, students will:

1. know the advantages of dual-energy CT over conventional CT
2. be familiar with the term DEI
3. know what the k-edge is
4. understand the drawbacks of sequential scanning
5. be familiar with sequential dual-energy CT scanning
6. be familiar with double-layer detector dual-energy CT scanning
7. be familiar with dual-source dual-energy CT scanning
8. be familiar with rapid photon switching dual-energy CT scanning
9. understand the material-specific display technique
10. understand the energy-specific display technique
11. be familiar with the dose of dual-energy CT scans compared to the dose of conventional CT scans
12. describe the presentation of particle disease In patients with metallic prostheses
13. describe the presentation of aseptic loosening In patients with metallic prostheses
14. describe the presentation of periprosthetic fractures in patients with metallic prostheses
15. know which imaging modality is considered the definitive test for suspected infection in patients with metallic prostheses
16. understand how to reduce the appearance of metal artifacts on conventional polychromatic CT images
17. know what the “sweet spot” is for implant images
18. understand what the optimal extrapolated energy level depends on
19. know what is currently considered the reference standard for the diagnosis of gout
20. be familiar with the role of plain radiography for assessing patients with gout
21. be familiar with the role of dual-energy CT for assessing patients with gout
22. be familiar with the role of MR imaging for assessing patients with gout
23. know the artifacts radiologists should recognize when using dual-energy CT gout protocols
24. recall how bone marrow edema secondary to trauma has historically been diagnosed
25. understand why conventional CT often provides suboptimal visualization of the bone marrow cavity
26. be familiar with the limitations of dual-energy CT VNCa imaging of bone marrow lesions
27. know what the visualization of collagenous structures with dual-energy CT is dependent on
28. understand how conventional CT compares with dual-energy CT imaging of the hand
29. understand the use of dual-energy CT images reconstructed in an oblique sagittal plane in patients with traumatic ACL disruption
30. know which imaging modality is the reference standard for characterizing the collagen of intervertebral spinal disks
31. know which imaging modality the WHO considers the reference standard for osteoporosis assessment and diagnosis
32. be familiar with the limitations of DXA
33. understand the changes in tissue composition that occur during the process of metastatic seeding and infiltration
34. be familiar with the tissue composition of vertebral body metastases
35. be familiar with the tissue composition of Schmorl nodes
36. understand the enhancement patterns of sclerotic components of bone lesions when using contrast-enhanced CT imaging
37. understand the enhancement patterns of lytic soft tissue components filled with tumor tissue when using contrast-enhanced CT imaging
38. be familiar with the advantages of CT arthrography when compared with MR imaging
39. understand the mechanisms by which dual-energy CT may enhance arthrographic images beyond those of conventional CT
40. know what clinical outcomes may result as dual-energy CT technology advances