Technical Innovation
Multislice Helical CT to Facilitate Combined CT of
the Neck, Chest, Abdomen, and Pelvis in Children
Lane F. Donnelly 1,2, Donald P. Frush1, Rendon C. Nelson1
P erforming CT of the neck, chest,
abdomen, and pelvis in children
who have lymphoma or other
nodal or nonnodal neck masses may be nec-
essary for staging or follow-up [1–3]. These
regions should be scanned concurrently to
simplify imaging, and optimal CT in chil-
dren usually requires administration of IV
contrast material.
Because of the large anatomic area of inter-
est, performing optimal contrast-enhanced
studies of the neck, chest, abdomen, and pelvis
poses a technical challenge. The table speed of
most standard helical CT scanners makes it
impossible to cover all of these areas in larger
children during a single IV contrast material
bolus without risking suboptimal enhancement
within the anatomic region imaged later. Mul-
tiple tactics have been used to obtain optimal
contrast-enhanced scans over this extensive
area of interest. Some investigators have sug-
gested splitting the IV contrast material bolus
into two doses, giving one dose for evaluation
of the neck and chest and one dose for evalua-
tion of the abdomen and pelvis [1].
This “split bolus” approach has several dis-
advantages. First, the patient has to undergo,
and is subject to potential complications of,
two separate IV injections. Second, because
two separate IV contrast injections and CT ac-
quisitions must be performed, the length of
the examination is increased. Finally, because
Received July 28, 1999; accepted after revision November 10, 1999.
1
Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710.
2
Present address: Department of Radiology, Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 54229-3039. Address correspondence to L. F. Donnelly.
AJR 2000;174:1620–1622 0361–803X/00/1746–1620 © American Roentgen Ray Society
1620
only a portion of the total contrast material
dose is given for each separate examination,
the degree of contrast enhancement can be
suboptimal. Some investigators have sug-
gested administering two thirds of the contrast
material bolus for evaluation of the abdomen
and one third of the contrast material bolus for
evaluation of the chest and neck [1]. Another
strategy is to increase the total amount of con-
trast material administered to exceed the stan-
dard of 2 ml/kg to help alleviate the problem
of inadequate contrast administration for the
two (split) boluses.
Multislice Helical CT Technology
CT scanners are now available that are
equipped with multidetector technology,
which allows for multisection data collec-
tion from each complete gantry rotation [4,
5]. With the multislice helical CT scanner
used at our institution (LightSpeed QX/i;
General Electric Medical Systems, Milwau-
kee, WI), four interleaving helices of data
are collected from a 16-element ceramic
mosaic detector array. Each of the 16 detec-
tor elements has a z-axis dimension of 1.25
mm, for a total z-axis length of 20 mm (16 ×
1.25 mm). A volumetric data set is acquired
with each gantry rotation (0.8 sec). This
multidetector technology results in rapid ta-
ble speeds and the opportunity to greatly in-
crease the speed of data acquisition [4, 5]. It
has been shown that multislice CT can ob-
tain a greater range of anatomic coverage
during the same or even less total acquisi-
tion time compared with single-section heli-
cal CT (Killius JS and Nelson RC, presented
at the Radiological Society of North Amer-
ica meeting, December 1998). Faster scan-
ning has facilitated our ability to accomplish
high-quality, contrast-enhanced CT scans of
the neck, chest, abdomen, and pelvis in eval-
uating children with lymphoma.
Pediatric Multislice Helical CT Technique
Imaging is performed using a multislice heli-
cal CT scanner. Two milliliters per kilogram of
nonionic iodinated IV contrast material (Isovue
300; Bracco Diagnostics, Princeton, NJ) is ad-
ministered using a mechanical power injector
(MedRad, Pittsburgh, PA) at a rate of 2 ml/sec or
by rapid hand injection. Diagnostic imaging is
commenced 10 sec after contrast administration
is completed. The detector configuration is such
that four 3.75-mm sections are generated per
gantry rotation. The pitch used is 6:1 (table
speed = 22.50 mm/0.8 sec gantry rotation or
28.125 mm/sec). From this data set, images
can be reconstructed with a thickness of either
5.0 or 7.5 mm at any interval, either prospec-
tively or retrospectively. We have chosen to re-
construct 5-mm-thick sections in the neck and
AJR:174, June 2000
 Helical CT to Facilitate Combined CT in Children

A B

C D

Fig. 1.—10-year-old boy with history of widespread (stage 4) lymphoma imaged to

exclude recurrent lymphoma. CT scans obtained of neck, chest, abdomen, and pel-
vis covered 35 cm in 12.4 sec.
A, CT scan at level of neck shows optimal enhancement of common carotid arteries
(short arrows) and internal jugular veins (long arrows).
B, CT scan at level of chest shows optimal enhancement of aorta (A), pulmonary ar-
teries (P), and superior vena cava. Note catheter in superior vena cava.
C, CT scan at level of liver shows optimal enhancement of portal vein (P), hepatic
vein (arrows), and arterial structures.
D, CT scan at level of pelvis shows optimal enhancement of iliac arteries (arrows)
and veins.
E, CT scan through lungs shows high-quality spatial resolution within lungs.
E

7.5-mm sections in the chest, abdomen, and pel-
vis. The field of view can be adjusted to the size
of the particular body part, either prospectively
or retrospectively. Therefore, scans of the neck
can be obtained with a smaller field of view than
that used when obtaining scans of the chest, ab-
domen, and pelvis. Breath-holding is performed
in cooperative patients.
In a child whose anatomic region of interest
is approximately 35 cm from skull base to pu-
bic symphysis, CT scans can be obtained us-
ing this technique in 12.4 sec (Fig. 1). In
contrast, if the same images were generated
on a single-section helical CT scanner (CT/i;
General Electric Medical Systems) (with 7 cm
of the neck imaged with 5-mm slice thickness
and 28 cm of the chest, abdomen, and pelvis
imaged at 7.5-mm slice thickness, 0.8-sec
gantry rotation), imaging time would be a
minimum of 64 sec with a pitch of 1:1 and 36
sec with a pitch of 1.5:1. The use of multislice
CT can reduce imaging time by approxi-
mately three to five times compared with sin-
gle-section helical CT. This has facilitated
optimal contrast enhancement during CT of
the neck, chest, abdomen, and pelvis using a
single IV contrast material bolus of the stan-
dard pediatric dose of contrast material.
Concerning our experience with quality of
images obtained on multislice helical CT as

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compared with single-slice helical CT, in a re-
view of the first 467 CT studies of the chest,
abdomen, or pelvis, performed on children at
our institution, the interpreting pediatric radi-
ologists noticed no decrease in quality from
conventional helical technique [5]. All multi-
slice helical CT scans were of diagnostic qual-
ity. The number of motion-related artifacts did
not increase. Subjectively, the pediatric radiol-
ogists thought that motion-related problems
were actually decreased, perhaps related to the
faster speed of scanning. In addition, the num-
ber of children requiring sedation was signifi-
cantly decreased [5]. Concerning combined
CT examinations of the neck, chest, abdomen,
and pelvis, although the number of scans that
we have obtained does not allow statistical
comparison with such examinations per-
formed on single-slice CT, we have been im-
pressed with the quality of the images (Fig. 1).
Certainly, enhancement caused by IV contrast
material has been greatly optimized compared
with examinations performed with a split bo-
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Donnelly et al.
lus and single-slice CT. Note the distinctness
of the pulmonary vessels in Fig. 1E.
There has been some concern about the radia-
tion dosage to a pediatric patient when using
multislice instead of single-slice helical CT. Con-
cerning radiation dose with multislice helical CT,
because of the phenomenon referred to as focal
spot wobble, the collimators must be opened
more than would be typically required to irradiate
the designated detectors used to yield four slices.
For example, when acquiring four 1.25-mm
slices, one would expect a total collimation
width of 5 mm (4 × 1.25 mm). Because the
focal spot moves back and forth, the actual
collimation width may be twice that ex-
pected. As a result, the radiation exposure per
gantry rotation is higher than that for a single-
slice helical scanner. However, this is partially
offset by the much shorter exposure times re-
quired for a given anatomic region of interest.
Furthermore, most of the manufacturers now use
a tracking mechanism that causes the collimator
to wobble with the focal spot, thereby signifi-
cantly decreasing the required collimation width
and reducing unnecessary radiation exposure.
In conclusion, multislice helical CT has fa-
cilitated optimal contrast enhancement during
CT examinations of the neck, chest, abdomen,
and pelvis and allowed scanning using a single
IV contrast bolus.
References
1. Zeman RK, Baron RL, Jeffrey RB Jr, Klein J, Sie-
gel MJ, Silverman PM. Helical body CT: evolution
of scanning protocols. AJR 1998;170:1427–1438
2. Ng YY, Healy JC, Vincent JM, et al. The radiol-
ogy of non-Hodgkins lymphoma in childhood: a
review of 80 cases. Clin Radiol 1994;49:594–600
3. Chisin R, Weber AL. Imaging of lymphoma man-
ifestations in the extracranial head and neck re-
gion. Leuk Lymphoma 1994;12:177–189
4. Hu H, He H, Fox S, et al. Imaging characteristics
and tradeoff selections of four-slice CT: theoreti-
cal and experimental results (abstr). Radiology
1998;209(P):283
5. Pappas JN, Donnelly LF, Frush DP. Reduced fre-
quency of sedation of young children using new
multi-slice helical CT (abstr). Radiology 1999;
213(P):418
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