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CT-Guided Intervention with Low Radiation Dose: Feasibility and Experience

¹ Department of Radiology, Division of Body Imaging, Boston University Medical Center, 88 E Newton St., Atrium 2, Boston, MA 02118.
² Present address: Department of Radiology, Boston Veterans Administration Healthcare System, West Roxbury, MA.
³ Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —42-year-old man with HIV infection. Preprocedural CT scan obtained at 20 mAs shows two small low-attenuation masses (arrows) within liver. Multiple similar masses were present throughout liver, but none was clearly identifiable with sonography. More posterior lesion was selected for biopsy.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —42-year-old man with HIV infection. CT scan obtained at 30 mAs shows that although lesion is less conspicuous, coaxial needle is directed at target mass (arrow). Multiple cores were obtained. Lesion proved to be lymphoma.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —63-year-old man with history of colon cancer. Diagnostic contrast-enhanced CT scan obtained at 250 mAs shows low-attenuation mass (arrow) in right lobe of liver that likely represents metastatic disease.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —63-year-old man with history of colon cancer. Preprocedural unenhanced CT scan obtained at 250 mAs faintly shows poorly delineated target lesion (arrow).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —63-year-old man with history of colon cancer. CT scan obtained at 220 mAs after administration of 100 mL of 300 mg I/mL contrast material shows needle within target lesion (arrow). Lesion was not identified at lower radiation dose. Lesion proved to be metastatic adenocarcinoma from primary colon cancer.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —51-year-old man with cirrhosis. Arterial phase contrast-enhanced CT scan obtained at 220 mAs shows early enhancing lesion (arrow) in left lobe of liver.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —51-year-old man with cirrhosis. CT scan after IV administration of 100 mL of 300 mg I/mL contrast material obtained at 65 mAs shows mass that proved to be hepatocellular carcinoma.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —21-year-old man with acute appendicitis. CT scan obtained at 180 mAs shows abscess (arrows) not identified on sonography.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —21-year-old man with acute appendicitis. CT scan obtained at 30 mAs shows needle within abscess (arrow).

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —21-year-old man with acute appendicitis. CT scan obtained at 30 mAs shows catheter coiled within abscess (arrows). Aspiration yielded 50 mL of pus.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —58-year-old woman with history of resection of rectal cancer. CT scan obtained by angling CT gantry 20° and using 220 mAs shows soft-tissue mass (arrows) with faintly identifiable low-attenuation center (arrowheads).

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —58-year-old woman with history of resection of rectal cancer. CT scan obtained at 30 mAs after administration of 100 mL of 300 mg I/mL IV contrast material. Needle is directed toward low-attenuation center (arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —58-year-old woman with history of resection of rectal cancer. CT scan obtained at 30 mAs shows catheter deployed within collection (arrow). Aspiration yielded 80 mL of pus.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —43-year-old woman with history of malignant melanoma. CT scan obtained at 220 mAs clearly shows enlarged lymph node (arrow) anterior in relation to iliacus muscle on left.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —43-year-old woman with history of malignant melanoma. CT scan obtained at 30 mAs shows needle in target node (arrow). Surrounding fat helps to outline node, making identification easy on low-dose image. Lesion proved to be metastatic melanoma.

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