0:00

This next case is an example of calcium blooming

0:03

artifact which is another commonly encountered problem

0:06

in coronary CT. In this case. We're starting up

0:09

at the level they ordered and heading down to the left mean and

0:12

we're going to focus on this lesion here in

0:15

the LED and let me zoom in here and show

0:18

you what we're dealing with. We see it's not a

0:21

huge vessel. So that's already given us

0:24

some trouble and then we see this big hunk of

0:27

calcium here and then this dark area next

0:30

to it. And so the question is is this non-calify

0:33

black. Where is this blooming artifact

0:37

and I should correct my terminology really

0:40

it's not just blooming artifact but also beam

0:43

hardening artifacts because of this dense

0:46

calcification. It's really combination of the two factors contributing here.

0:49

And so the question is the true Lumen this

0:52

little thin area of lumen here or is it

0:55

This whole area here with just a mild calcified plaque next

0:58

to it.

0:59

So how do we tease that out? Well, if we only

1:02

have one phase we're kind of stuck but again multifay is

1:05

oftentimes is a big help in this case. So here on

1:08

the right hand side where I'm going to show you is a stack of

1:11

multiple phases throughout the cardiac cycle that we acquired in

1:14

this patient.

1:15

And as you scroll through the different phases, I

1:18

want it to focus on this area in the

1:21

LED and look at how it changes. And so

1:24

one thing about blooming artifacts and the beam hardening artifacts

1:27

is they often will change throughout the

1:30

cardiac cycle. And so if it's a real stenosis and

1:33

real non-calside plackets always there unchanging but

1:36

if it's sort of modifying throughout the cardiac

1:39

cycle, then that will lend support to the

1:42

fact that it's an artifact. So here on this particular phase it

1:45

looks huge. It looks like a big stenosis, right?

1:49

now if we fast forward

1:51

on this axial stack

1:54

to the next phase. It's quite a bit smaller.

1:58

And move on to the next phase. Well now it's just a big bluragram. So

2:01

that doesn't really help us.

2:03

Then the next phase again blurry not super

2:06

helpful.

2:10

on this phase

2:12

Still blurry but maybe parts of it

2:15

look like they have less low attenuation than that

2:18

original set of images.

2:21

Also blurry not super helpful.

2:26

more blurry images

2:29

And then here I think we're starting to get

2:32

into the area where we see that that Lumen is maybe larger than we thought

2:35

on those original images here. You can see there's Lumen there's a

2:38

little bit of lumen here and a little bit limit here. Let's keep going.

2:43

And this I think is our original set of images. We've got

2:46

Lumen Lumen and Lumen and the

2:49

questions. They're non-calside black there. So let's check the last set of

2:52

images.

2:54

And sure enough on this last set we are finally saved

2:57

by the last set of images you can see.

3:00

Nearly, all that calcified black blooming related artifact is gone.

3:03

We have a nice.

3:05

Stable set of images with no motion related artifacts

3:08

through this calcium and you can see that the Lumen

3:11

is actually fine. There's no significance stenosis.

3:14

And this is all really just an artifact related to

3:17

be hardening in a patient who has a

3:20

study that's no marginal in terms of quality because of

3:23

emotionally artifacts. I'll say I'll tell you that this case

3:26

is actually done on one of our slightly slower scanners.

3:30

So when you're dealing with a slower scanner these types of

3:33

artifacts become more important because there's just a tendency

3:36

to blur some of the images and that blurring can

3:39

result in more of those beam hardening effects. So

3:42

Again with calcium blooming if you see that appearance that

3:46

looks like there might be some non calcified black attached the calcium want to make

3:49

sure on other phases that it actually is a

3:52

persistent outer Melody and not an artifact.