CT Dynamics: The Shift from Morphology to Function
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ADVANCES IN CT IMAGING (NJ PELC, SECTION EDITOR)
CT Dynamics: The Shift from Morphology to Function Rich Mather
Published online: 12 January 2013 Springer Science+Business Media New York 2013
Abstract CT has historically been a static imaging modality, but the human body is in constant motion. The need to visualize the underlying physiology has driven CT to capture functional information as well. CT dynamics can be acquired using several different acquisition techniques on both conventional and high-end scanners. Dynamic joints, dynamic CTA, perfusion, and dynamic lungs are all emerging applications of CT dynamics. The use of dynamic CT can yield key diagnostic information not available from static scans. Keywords Computed tomography Dynamic volume CT Dual source CT 320-row CT Dynamic imaging
Introduction Since its beginnings as solely a neurological imaging device, the number of applications of CT imaging has expanded tremendously. Currently, CT has applications for every anatomical region and nearly every physiological process. CT technology has seen both gradual improvements and breakthrough advances driven by accuracy and sensitivity as well as in speed and economic efficiency. The use of CT has steadily increased by more than threefold since 1993 to over 70 million scans per year [1]. By and large, however, CT has traditionally been used as a
R. Mather (&) Toshiba Medical Research Institute, 706 N Deerpath Dr, Vernon Hills, IL, USA e-mail: [email protected]
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modality that produces static images of morphology with high spatial resolution and good soft tissue contrast. Static anatomic information has always been used to infer the underlying physiology and function. One good example of this is in coronary angiography where the physiologic significance of a lesion is determined wholly by its degree of stenosis: a morphologic metric. However, landmark clinical trials such as COURAGE [2] and the FAME I [3] and FAME II [4••] trials have shown that such metrics are inadequate. COURAGE showed that the outcome of patients receiving percutaneous coronary intervention (PCI) driven solely by anatomical measures was no better than for patients who received no surgical intervention but were treated with optimal medical therapy (OMT). Subsequently, the FAME trials showed that using fractional flow reserve (FFR), a functional metric, to drive PCI led to a significant reduction in hospitalization and urgent revascularization compared to the OMT group. In order to realize this kind of higher precision imaging, earlier diagnosis, and direct impacts on patient therapy, there is currently a shift in the nature of CT applications from morphology to function. This shift in CT clinical applications towards the imaging of function has opened up a new paradigm in clinical imaging: CT dynamics. The human body is an inherently dynamic machine. Whether examining the flow of blood through the vessels and perfusing into tissue, the expansion and contraction of the lungs, the movement of the vocal cords, or the flexion and
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