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C
omputed tomography (CT) isan imaging technique thatuses x-ray energy and com-puter processing to create cross-sec-tional (transverse) slices of internalstructures (e.g., within the head, tor-so).
1,2
One of the main advantages of CT over conventional radiography isthe abilityto eliminate superimposi-tion; CT images are not only clearerbut can isolate a specific internal re-gion. A disadvantage of CT is thattransverse sectional anatomy is oftenunfamiliar and, therefore, difficult tointerpret. New computer processing(reformatting) techniques are now available that can create three-dimen-sional (3-D) CT images. Because theimages that are created more closely resemble the way anatomic structureslook during physical examination orsurgery, the information gleaned from3-D CT images is often easier to in-terpret than that from transverse CTimages.
Background 
Each CT slice is formed from mul-tiple x-ray exposures captured as thescan completes a 360˚ rotation. Trans-mitted x-ray energy is recorded by detectors positioned opposite the pa-tient. The x-ray energy is convertedto an electric signal and sent to theCT computer for processing. TheCT computer translates the electricsignal to numeric (digital) informa-tion, which in turn is used to display images on a computer monitor. Toperform 3-D CT reformatting, thecomputer first combines all digital in-formation from a set of transverseCT images.
3–6
The outside picture el-ements (pixels) of each transverse sliceare selected to create a surface display of the volume image. Although the images are actually shown in two dimensions, depth isperceived through the use of surfaceshading. The volume image appearsto be illuminated by a single sourceof light, with objects closest to theobserver displayed in white and thosefarthest away in black. The operatorcan select which tissue densities are tobe shown and which viewing angle isto be used. By selecting sequential 3-D viewing angles, a videotape anima-tion in which the image appears to berotating in space can be created. Theoperator can also remove unwantedoverlying structures from the image,select only certain structures to bedisplayed, assign colors to selectedstructures, and measure the volumeof a specific region.One limitation of 3-D CT is theappearance of reconstruction arti-facts.
2,7–10
 Artificial bone defects (pseu-doforamina) may occur in areas withlow tissue density. Reconstruction arti-facts can be minimized by reducing thethreshold for the range of displayedbone densities. Comparisons with the
Small Animal/Exotics
Compendium 
June 2000
opposite side may help differentiatepseudoforamina from true lytic lesions. Another limitation is the “stair-step”pattern (raster effect) that can occur onthe surface of 3-D images. This prob-lem is primarily caused by inaccuratecomputer interpolation at the junc-tions between adjacent transverse slices.This effect can be minimized by usingthinner slices, increasing slice overlap-ping, or using oblique slice planes.
Uses
The most common uses for 3-D CTare clarifying spatial relationships forsurgical planning, determining volumeand extent of involvement for tumorstaging, and facilitating client commu-nication.
11–14
Some of the more ad-vanced 3-D CT computer programsalso perform virtual endoscopy,
12,15–17
surgical simulations,
18–23
and radiationtherapy planning.
12,24–26
Virtual endoscopy is a noninvasivemethod for evaluating the interior of hollow organs. A movie that sequen-tially displays color 3-D CT images al-lows viewers to “fly through” suchstructures as the trachea, bronchi,stomach, and bowel. Surgical simula-tion is a technique in which color 3-DCT images are used to “rehearse” oper-ations. The surgeon can compare dif-ferent approaches by rotating the com-puter-generated images and usingelectronic cursors to selectively removeor replace tissue. Some promising new applications for 3-D CT in veterinary medicine include evaluation of the ab-domen (Figure 1), spine, thorax, pelvis(Figure 2), skull, and brain (Figure 3;Table I).
27–31
Three-Dimensional ComputedTomography: User-Friendly Images
Jeryl C. Jones, DVM, PhDDiplomate, ACVRDepartment of Small AnimalClinical SciencesVirginia-Maryland Regional Collegeof Veterinary MedicineBlacksburg, Virginia
EMERGING TECHNOLOGY
V
 
 Access and Cost Considerations
In practices anticipating client de-mand for fewer than 10 scans per week, access to 3-D CT may best beachieved by using tertiary veterinary referral centers or local medical imag-
Compendium 
June 2000Small Animal/Exotics
ing facilities. Costs per scan may range from $200 to $1200, depend-ing on geographic location and indi-vidual imaging center policies. Inpractices anticipating client demandfor 10 or more scans per week, pur-chasing the equipment may be a vi-able option (Table II). Many manu-facturers provide installment plans. Yearly maintenance contracts arehighly recommended and may be ob-tained at a cost of approximately 
Figure 1A Figure 1B
Figure 1—(
 A 
) Transverse, postcontrast CT image of a dog with a left adrenal mass
(M) 
. Surgical landmarks are the right kidney 
(RK) 
,left kidney 
(LK) 
, aorta
(A) 
, caudal vena cava
(C) 
, and portal vein
(P) 
. (
B
) Three-dimensional CT image of the same dog demonstratesthe adrenal mass and landmarks in color, without superimposed structures. The kidneys and ureters are in
 yellow 
, adrenal glands in
dark pink 
, and blood vessels in
blue 
.
Figure 2AFigure 2B
Figure 2—(
 A 
) Color 3-D CT image of a dog with a right gluteal sarcoma. Overlying soft tissue structures have been removed topermit visualization of the mass
(blue) 
relative to the pelvis. The mass and pelvis appear to have multiple “stair steps” because of areconstruction artifact caused by computer misinterpretation of the margins between two adjacent slices. (
B
) The pelvis has beenremoved to permit 3-D volume measurement for tumor staging. The calculated volume of the mass is displayed at the top of theimage in
 green text 
(82.97 ml).
 
Small Animal/Exotics
Compendium 
June 2000
10% of the equipment purchaseprice. Most of the newer CT scan-ners can produce basic 3-D images.Single-slice (third- or fourth-genera-tion) CT scanners acquire one trans-verse slice at a time. The costs rangefrom $200,000 to $400,000. Multi-slice (spiral) scanners acquire datafrom the entire volume of tissue atone time and then retrospectively create the transverse slices. This capa-bility permits rapid examinations, of-ten in less than 1 minute.
6
The costof multislice scanners ranges from$500,000 to $1,200,000. Advanced 3-D image manipula-tion (e.g., color enhancement, virtualendoscopy) requires a reformattingcomputer workstation that performsmore complex image manipulations(interactive creation and viewing of images).
27,29,31,32
 Workstations canalso be used to convert CT imagesinto formats that can be transferredover the Internet and viewed at any personal computer. Reformatting workstations may be added to a con-ventional or spiral CT scanner sys-tem for $80,000 to $120,000. Ob-taining a workstation made by thesame company as the CT scannerminimizes the risk of software in-compatibilities and associated down-time. Most manufacturers includethe cost of applications training for
TABLE I
Some Disease Indications for Three-Dimensional Computed Tomography 
DiseaseUses 
 Adrenal massesDetermine relationship of mass to adjacent blood vessels for treatment planning andprognosisLateral disk herniationPlan approach for removal of disk fragmentVertebral osteomyelitisDetermine extent of involvement for treatment planning and prognosisVertebral traumaDetermine locations and origins of fracture fragments and demonstrate subluxation/luxationsRib massesDetermine extent of involvement and margins for surgical excisionMediastinal massesDetermine relationship of mass to adjacent vital structures for surgical planning andprognosisPelvic massesDetermine extent of involvement and margins for surgical excisionCraniofacial massesDetermine extent of involvement and margins for surgical excisionCraniofacial trauma Determine extent of involvement for treatment planning and prognosisNasal massesDetermine tumor volume and extent of involvement for staging and radiation therapy planningBrain massesDetermine tumor volume and extent of involvement for staging and radiation therapy planning; plan surgical approach for removing mass
Figure 3—Color CT images of a dog with a rostral cerebral meningioma. On theright are transverse, sagittal, and dorsal planar views of the brain mass
(purple) 
. Onthe left is a 3-D view of the head, with a cube-shaped tissue section removed to per-mit visualization of the mass relative to such surgical landmarks as the eye
(E) 
, cribri-form plate
(C) 
, and frontal sinus
(F) 
.
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