Dual Energy Carotid Angiography for Rapid Visualization of Paraganglioma

SOMATOM Definition Flash Scanning

By João Carlos Costa, MD*; J. Oliveira, MD*; Dinis T., MD*; R. Duarte, MD*; O. Borlido; RT;* M. Gonçalves; RT;* D. Martins, RT;* S. Silva, RT;* D. Teixeira, RT;* A. Chaves, ** and Andreas Blaha**
 |  11.01.2011

*Radiology Department, Hospital Particular de Viana do Castelo, Viana do Castelo, Portugal
**Siemens Healthcare



A 30-year-old female patient with a one-year history of progressive growth of a right cervical mass was referred to the CT department. There were no associated local symptoms. The patient did not complain of pain but reported physical weakness. An eco-doppler study revealed a well defined solid mass between the internal and external right carotid arteries with intense arterial irrigation being suggestive of a paraganglioma.


A Dual Energy CT angiography examination confirmed a solid mass with the size of 2.5 cm in diameter, located in the right carotid bulb which could lead to carotid paraganglioma. The arterial enhancement of the carotid arteries did not show any signs of stenoses or occlusions. There is no vascular abnormity present in the Circle of Willis. Due to exact contrast timing, venous contamination could be avoided.
A typical sharp delineation of the lesion in the right carotid artery confirmed the suspicion of paraganglioma. The patient was referred to surgery where the initial diagnosis could be confirmed.
A complete isolation and resection of the paraganglioma could be achieved.
Convalescence of the patient was short and no complications arose.


The SOMATOM Definition Flash allows the acquisition of Dual Energy examination at a low-dose level of 0.84 mSv. Using syngo DE Direct Angio, the cervical spine could be immediately hidden and the vascular status was immediately visible. Vascular examinations are acquired in Dual Energy technique allowing fast diagnosis and the additional benefit from second contrast for tissue characterization or virtual non-contrast (VNC) that eliminates the need for an additional non-contrast scan.

Examination Protocol

Scanner SOMATOM Definition Flash
Scan mode Dual Energy Direct Angio
Scan area Carotid CTA
Scan length 185 mm
Scan direction Cranio -Caudal
Scan time 5 s
Tube voltage A/B 140 kV / 100 kV
Tube current A/B 139 / 139 eff. mAs
Rotation time 0.28 s
Slice collimation 64 x 0.6 mm
Slice width 1 mm
Reconstruction increment 0.5 mm
Spatial Resolution 0.33 mm
Reconstruction kernel D26f
CTDIvol 3.29 mGy
DLP 68 mGy/cm
Effective Dose 0.84 mSv
Volume 70 ml contrast
Flow rate 5 ml/s
Start delay 6 sec

The information presented in this case study is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard.

The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.