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Bariatric CT Imaging: Challenges
and Solutions
Autores: Dzmitry M. Fursevich, MD; Gary M. LiMarzi, MD; Matthew C. O’Dell, MD, MPH; Manuel A. Hernandez, MD; William F. Sensakovic, PhD
Se analiza una serie de 6 pacientes en forma retrospectiva portadores de masas pulmonares con contacto parietal, que fueron pasibles de ser puncionados bajo método ecográfico por vía percutánea, con el objetivo de arribar a un diagnóstico anatomo-patológico.
Se enfatiza el rol de ésta técnica de imagen en pacientes seleccionados, analizando los resultados obtenidos, destacando de la misma su accesibilidad y la no utilización de radiaciones ionizantes.
El rendimiento diagnóstico obtenido fue excelente, lográndose en todos los casos arribar a una muestra de tejido suficiente para su análisis, sin un incremento de las complicaciones del procedimiento.
Palabras clave Tórax, Biopsia, Ultrasonido, Diagnóstico.
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The obesity epidemic in the adult and pediatric populations affects
all aspects of health care, including diagnostic imaging. With the
increasing prevalence of obese and morbidly obese patients, bariatric
computed tomographic (CT) imaging is becoming common
in day-to-day radiology practice, and a basic understanding of the
unique problems that bariatric patients pose to the imaging community
is crucial in any setting. Because larger patients may not fit
into conventional scanners, having a CT scanner with an adequate
table load limit, a large gantry aperture, a large scan field of view,
and a high-power generator is a prerequisite for bariatric imaging.
Iterative reconstruction methods, high tube current, and high tube
voltage can reduce the image noise that is frequently seen in bariatric
CT images. Truncation artifacts, cropping artifacts, and ring
artifacts frequently complicate the interpretation of CT images of
larger patients. If recognized, these artifacts can be easily reduced
by using the proper CT equipment, scan acquisition parameters,
and postprocessing options. Lastly, because of complex contrast
material dynamics, contrast material–enhanced studies of bariatric
patients require special attention. Understanding how the rate of injection,
the scan timing, and the total mass of iodine affect vascular
and parenchymal enhancement will help to optimize contrast-enhanced
studies in the bariatric population. This article familiarizes
the reader with the challenges that are frequently encountered at
CT imaging of bariatric patients, beginning with equipment selection
and ending with a review of the most commonly encountered
obesity-related artifacts and the technical considerations in the acquisition
of contrast-enhanced images.
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