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Laroia ST, Bhadoria AS, Venigalla Y, Chibber GK, Bihari C, Rastogi A, Sarin SK. Role of dual energy spectral computed tomography in characterization of hepatocellular carcinoma: Initial experience from a tertiary liver care institute. Eur J Radiol Open 2016; 3:162-71. [PMID: 27504474 DOI: 10.1016/j.ejro.2016.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate dual-energy spectral CT in characterization of hepatocellular Carcinoma (HCC) in patients with chronic liver disease. METHODS Dynamic computed tomography (CT) was performed in 3600 patients (2879 males; 721 females, mean age 50.9 ± 11.9 years) with working clinical diagnosis of liver cirrhosis for hepatocellular carcinoma screening and other clinical indications. The study was conducted over a period of 3 years. During dynamic CT scanning, spectral (monochromatic) and routine (polychromatic) CT acquisitions were obtained on a single tube, dual energy, 64 slice multi-detector CT scanner. Imaging findings were studied on routine CT. On the basis of routine CT findings, indeterminate lesions (lesions not showing characteristic hypervascularity followed by washout on dynamic routine CT scan) that were referred for biopsy or surgery were segregated. A retrospective blinded review of the lesions, acquired by the spectral CT acquisitions was done with the help of gem stone imaging (GSI) software to characterize these lesions. All the above lesions were analyzed qualitatively in the arterial phase for lesion conspicuity as well as quantitatively using the monochromatic data sets and nodule Iodine concentration on material density maps, respectively. This data was studied with respect to predictability of HCC using the spectral CT technique. Iodine density of the lesion, surrounding liver parenchyma, and lesion to liver parenchyma ratio (LLR) were derived and statistically analyzed. Histopathology of the lesion in question was treated as gold standard for analysis. RESULTS It was observed via statistical analysis that the value of iodine density of the lesion on material density sets of ≥29.5 mg/dl, enabled a discriminatory power of 86.5%, sensitivity of 90.5% with 95% confidence Interval (CI) (69.2-98.8%) and specificity of 81.2% with 95% Confidence Interval (54.4-95.9%) in predicting HCC. Qualitative assessment also showed higher lesion conspicuity with spectral CT image sets as compared to routine CT data. CONCLUSION This study reveals that spectral imaging is an excellent qualitative as well as a quantitative tool for assessing and predicting hepatocellular carcinoma in cirrhotic patients.
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Affiliation(s)
- S T Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Ajeet Singh Bhadoria
- Department of Community Medicine, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110 070, India
| | - Yamini Venigalla
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - G K Chibber
- Department of Research, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110 070, India
| | - Chagan Bihari
- Department of Hepatopathology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110 070, India
| | - Archana Rastogi
- Department of Hepatopathology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110 070, India
| | - S K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
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Dual-Energy CT of Rectal Cancer Specimens: A CT-based Method for Mesorectal Lymph Node Characterization. Dis Colon Rectum 2016; 59:640-7. [PMID: 27270516 DOI: 10.1097/dcr.0000000000000601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND An accurate method to assess malignant lymph nodes in the mesorectum is needed. Dual-energy CT scans simultaneously with 2 levels of energy and thereby provides information about tissue composition based on the known effective Z value of different tissues. Each point investigated is represented by a certain effective Z value, which allows for information on its composition. OBJECTIVE We wanted to standardize a method for dual-energy scanning of rectal specimens to evaluate the sensitivity and specificity of benign versus malignant lymph node differentiation. Histopathological evaluation of the nodes was our reference. DESIGN This was a descriptive and prospective study. SETTINGS Seventeen rectal specimens were examined in 2 series. The first series was conducted with 3 specimens from patients who were not given perioperative contrast; 3 had iodine-based contrast and 3 had gadolinium-based contrast. We concluded that iodine was the contrast agent of choice and therefore included 8 more patients in a second series, given iodine-based contrast, for further analysis. PATIENTS Quantitative imaging data were collected from 197 individual lymph nodes from 17 specimens, from patients with rectal cancer. MAIN OUTCOME MEASURES We measured accuracy of differentiating benign from malignant lymph nodes by investigating the following: 1) gadolinium, iodine, and water concentrations in lymph nodes; 2) dual-energy ratio; 3) dual-energy index; and 4) effective Z value. RESULTS Optimal discriminations between benign and malignant lymph nodes were obtained using the following cutoff values: 1) effective Z at 7.58 (sensitivity, 100%; specificity, 90%; and accuracy, 93%), 2) dual-energy ratio at 1.0 × 10 (sensitivity, 96%; specificity, 87%; and accuracy, 90%), 3) dual-energy index at 0.03 (sensitivity, 97%; specificity, 88%; and accuracy, 91%), and 4) iodine concentration at 2.58 μg/mL (sensitivity, 86%; specificity, 92%; and accuracy, 89%). LIMITATIONS The investigation is conducted on isolated surgical specimens from rectal cancer operations. CONCLUSIONS Dual-energy CT can be performed on rectal specimens. The discrimination between benign and malignant nodes seems promising when using iodine as contrast.
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Boraschi P, Della Pina MC, Donati F. Graft complications following orthotopic liver transplantation: Role of non-invasive cross-sectional imaging techniques. Eur J Radiol 2016; 85:1271-83. [DOI: 10.1016/j.ejrad.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/10/2016] [Accepted: 04/13/2016] [Indexed: 02/07/2023]
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Grajo JR, Patino M, Prochowski A, Sahani DV. Dual energy CT in practice: Basic principles and applications. APPLIED RADIOLOGY 2016. [DOI: 10.37549/ar2291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Manuel Patino
- Massachusetts General Hospital, Harvard Medical School
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Appearance and Frequency of Gas Interface Artifacts Involving Small Bowel on Rapid-Voltage-Switching Dual-Energy CT Iodine-Density Images. AJR Am J Roentgenol 2016; 206:301-6. [PMID: 26797356 DOI: 10.2214/ajr.15.14374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study is to describe the appearance and frequency of gas interface artifacts in the jejunum that may mimic severe bowel disease on iodine-density images generated from rapid-voltage-switching dual-energy CT (DECT) scans. MATERIALS AND METHODS Two readers retrospectively reviewed 108 consecutive abdominal rapid-voltage-switching DECT scans to record the presence of image artifacts in jejunal segments with different degrees of gaseous luminal filling, classified as full, partial, or absent. Readers viewed iodine-density images and corresponding 140-kVp and 65-keV virtual monochromatic images and classified the jejunal artifacts on iodine-density images as pseudostratified appearance of the bowel wall, pseudopneumatosis, pseudohyperenhancement, or pseudohypoenhancement. We correlated the presence of the artifacts with clinical features suggesting bowel disease. RESULTS Image artifacts were found in 91 of 108 scans (84.3%), appeared in 148 of 265 jejunal segments (55.8%), and included each type except for pseudohypoenhancement. Artifacts occurred exclusively when gas was present in the bowel lumen and were seen in 59 of 59 (100%) fully gas-distended segments, 89 of 98 (90.8%) partially gas-distended segments, and none of 108 gas-absent segments (p < 0.0001). In fully and partially gas-distended jejunal segments (n = 157), 148 (94.3%) segments had two or more artifacts. None of the patients was found to have clinical bowel-related injury on follow-up of medical records. CONCLUSION Pseudostratified appearance, pseudopneumatosis, and pseudohyperenhancement, but not pseudohypoenhancement, artifacts are common in gas-filled jejunal segments on iodine-density images generated from rapid-voltage-switching DECT scans and are not seen in the corresponding 140-kVp or 65-keV images. Knowledge of the appearance of such iodine-density image artifacts will avoid potential examination interpretation pitfalls.
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Kim S, Shuman WP. Clinical Applications of Dual-Energy Computed Tomography in the Liver. Semin Roentgenol 2016; 51:284-291. [PMID: 27743564 DOI: 10.1053/j.ro.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sooah Kim
- Department of Radiology, University of Washington, Seattle, WA.
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Solomon J, Wilson J, Samei E. Characteristic image quality of a third generation dual-source MDCT scanner: Noise, resolution, and detectability. Med Phys 2016; 42:4941-53. [PMID: 26233220 DOI: 10.1118/1.4923172] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this work was to assess the inherent image quality characteristics of a new multidetector computed tomography system in terms of noise, resolution, and detectability index as a function of image acquisition and reconstruction for a range of clinically relevant settings. METHODS A multisized image quality phantom (37, 30, 23, 18.5, and 12 cm physical diameter) was imaged on a SOMATOM Force scanner (Siemens Medical Solutions) under variable dose, kVp, and tube current modulation settings. Images were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) with iterative strengths of 3, 4, and 5. Image quality was assessed in terms of the noise power spectrum (NPS), task transfer function (TTF), and detectability index for a range of detection tasks (contrasts of approximately 45, 90, 300, -900, and 1000 HU, and 2-20 mm diameter) based on a non-prewhitening matched filter model observer with eye filter. RESULTS Image noise magnitude decreased with decreasing phantom size, increasing dose, and increasing ADMIRE strength, offering up to 64% noise reduction relative to FBP. Noise texture in terms of the NPS was similar between FBP and ADMIRE (<5% shift in peak frequency). The resolution, based on the TTF, improved with increased ADMIRE strength by an average of 15% in the TTF 50% frequency for ADMIRE-5. The detectability index increased with increasing dose and ADMIRE strength by an average of 55%, 90%, and 163% for ADMIRE 3, 4, and 5, respectively. Assessing the impact of mA modulation for a fixed average dose over the length of the phantom, detectability was up to 49% lower in smaller phantom sections and up to 26% higher in larger phantom sections for the modulated scan compared to a fixed tube current scan. Overall, the detectability exhibited less variability with phantom size for modulated scans compared to fixed tube current scans. CONCLUSIONS Image quality increased with increasing dose and decreasing phantom size. The CT system exhibited nonlinear noise and resolution properties, especially at very low-doses, large phantom sizes, and for low-contrast objects. Objective image quality metrics generally increased with increasing dose and ADMIRE strength, and with decreasing phantom size. The ADMIRE algorithm could offer comparable image quality at reduced doses or improved image quality at the same dose. The use of tube current modulation resulted in more consistent image quality with changing phantom size.
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Affiliation(s)
- Justin Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Health System, Durham, North Carolina 27705
| | - Joshua Wilson
- Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Health System, Durham, North Carolina 27705; Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705; and Departments of Biomedical Engineering and Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina 27705
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Comparison of Virtual Unenhanced Images Derived From Dual-Energy CT With True Unenhanced Images in Evaluation of Gallstone Disease. AJR Am J Roentgenol 2016; 206:74-80. [PMID: 26700337 DOI: 10.2214/ajr.15.14570] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare gallstones on virtual unenhanced images and true unenhanced images acquired with dual-energy CT (DECT). MATERIALS AND METHODS We enrolled 112 patients with right upper quadrant pain and clinically suspected acute cholecystitis or gallstone who underwent DECT--including unenhanced, arterial, and portal phases. Eighty-three gallstones with composition proven by semiquantitative Fourier transform infrared spectroscopy from 45 patients who had undergone cholecystectomy (40 cholesterol gallstones from 21 patients, 43 calcium gallstones from 24 patients) were included. CT images were retrospectively evaluated for stone size, contrast-to-noise ratio (CNR) of gallstone to bile, and visibility and density of gallstones for each image set. The visibility of each type of stone was compared with a paired t test. RESULTS Both cholesterol and calcium stones measured smaller on virtual unenhanced images than on true unenhanced images, yielding a lower sensitivity of virtual unenhanced images for detecting small gallstones. Mean CNR of cholesterol stones was 2.45 ± 1.32 versus 1.67 ± 1.55 (p < 0.032) and that of calcium stones was 10.59 ± 7.15 and 14.11 ± 9.81 (p < 0.001) for virtual unenhanced and true unenhanced images, respectively. For calcium stones, two readers found 43 of 43 (100%) on true unenhanced images; one reader found 41 of 43 (95%) and the other, 37 of 43 (86%) on virtual unenhanced images. For cholesterol stones, one reader found 20 of 40 (50%) and the other 19 of 40 (47%) on true unenhanced images versus 34 of 40 (85%) and 30 of 40 (75%), respectively, on virtual unenhanced images. The visibility of cholesterol stones was higher on virtual unenhanced images, but that of calcium stones was lower. CONCLUSION Virtual unenhanced images at DECT allow better visualization of cholesterol gallstones, but true unenhanced images allow better visualization of calcium and small gallstones.
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Diagnostic Performance of Split-Bolus Portal Venous Phase Dual-Energy CT Urography in Patients With Hematuria. AJR Am J Roentgenol 2016; 206:1013-22. [DOI: 10.2214/ajr.15.15112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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160
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Ahmad Z, Gupta AK, Sharma R, Bhalla AS, Kumar U, Sreenivas V. Dual energy computed tomography: a novel technique for diagnosis of gout. Int J Rheum Dis 2016; 19:887-96. [PMID: 27125882 DOI: 10.1111/1756-185x.12874] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the sensitivity and specificity of dual energy computed tomography (DECT) for diagnosing gout compared with a composite gold standard (CGS) comprising joint aspiration and/or American College of Rheumatology clinico-radiographic criteria. METHODS Ninety patients of suspected gout underwent radiography and DECT of bilateral feet and knees. Radiographs and non-contrast CT (NCCT) were assessed for morphological characteristics, following which DECT was used to identify urate deposits. RESULTS With CGS as a reference (n = 90), sensitivity of radiographs was 15% (95% confidence interval [CI]: 6-27%) while specificity was 100% (95% CI: 90-100%). Sensitivity of NCCT was 26% (95% CI: 15-40%) while specificity was 97% (95% CI: 85-99%). Sensitivity of DECT was 82% (95% CI: 68-90%) while specificity was 89% (95% CI: 73-96%). Fifty-five patients underwent joint aspiration. Sensitivity and specificity of radiographs and NCCT with aspiration as a reference (n = 55) were not much different from that of CGS. However, DECT showed a higher sensitivity of 100% (95% CI: 86-100%) and a lower specificity of 48% (95%CI: 28-68%) with aspiration alone. CONCLUSIONS Dual energy computed tomography had higher sensitivity compared to conventional imaging with CGS as a reference; however, its specificity dropped with aspiration as a reference. It may be a useful adjunct for the diagnosis of gout, especially in the acute and inter-critical stage.
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Affiliation(s)
- Zohra Ahmad
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Gupta
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
| | - Uma Kumar
- Departments of Medicine and Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Departments of and Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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161
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Song I, Yi JG, Park JH, Kim SM, Lee KS, Chung MJ. Virtual Non-Contrast CT Using Dual-Energy Spectral CT: Feasibility of Coronary Artery Calcium Scoring. Korean J Radiol 2016; 17:321-9. [PMID: 27134521 PMCID: PMC4842852 DOI: 10.3348/kjr.2016.17.3.321] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/03/2016] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. Materials and Methods This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. Results Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Measured coronary calcium volumes from VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Among the three VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p < 0.001 for all pairs). Conclusion The use of VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC.
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Affiliation(s)
- Inyoung Song
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jeong Geun Yi
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jeong Hee Park
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.; Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
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162
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Chen CY, Hsu JS, Jaw TS, Kuo YT, Wu DC, Lee CH, Shih MCP, Tsai TH, Kuo CH, Chen YT, Yang LH, Liu GC. Lowering radiation dose during dedicated colorectal cancer MDCT: comparison of low tube voltage and sinogram-affirmed iterative reconstruction at 80 kVp versus blended dual-energy images in a population of patients with low body mass index. ACTA ACUST UNITED AC 2016; 40:2867-76. [PMID: 25860034 DOI: 10.1007/s00261-015-0412-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess the diagnostic accuracy, cancer staging, image quality, and radiation dose of 80-kVp computed tomography (CT) images for patients with colorectal cancers (CRCs) using sinogram-affirmed iterative reconstruction (SAFIRE). METHODS Sixty-four consecutive patients (mean weight 62.5 ± 11.3 kg, mean BMI 24.1 ± 3.3 kg/m(2)) with known CRC underwent dual-energy CT. Data were reconstructed as a weighted average (WA) 120-kVp dataset. Both filtered back projection (FBP) and SAFIRE were applied to reconstruct the WA 120-Kvp (Protocol A, B) and 80-kVp (Protocol C, D) image sets. The image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the cancers, the normal reference tissues, and the effective dose for each protocol were assessed. The cancer detection, staging, and image quality were evaluated. Analysis of variance was used for statistical analysis. RESULTS Compared with the FBP datasets at WA 120-kVp (Protocol A) and 80-kVp (Protocol C), the SAFIRE-reconstructed images (Protocols B, D) demonstrated significantly lower image noise (P < 0.0083). Protocol D yielded significantly higher CNRs and SNRs for the CRCs and normal reference tissues than did Protocols A and C (P < 0.0083). Protocol D also exhibited a significantly higher CNR for the CRC and some normal reference tissues than did Protocol B (P < 0.0083). For hypovascular liver metastases (n = 10), Protocol D yielded better SNRs and significantly higher CNRs than did Protocol A (P < 0.0083). Overall, accuracy for tumor staging and liver metastasis was 95.3% (61/64) and 100%, respectively, in all of the 4 protocols. The mean effective dose decreased 41% from the WA 120-kVp to the 80-kVp protocols (6.23 vs. 3.68 mSv). CONCLUSIONS The 80-kVp technique with SAFIRE provided high SNR, high CNR, and good accuracy for staging in nonobese patients with CRC. Our study results should be extrapolated to patient populations with a high BMI with caution. Further studies of high BMI patients are therefore warranted.
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Affiliation(s)
- Chiao-Yun Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jui-Sheng Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Section of Abdominal Imaging, Department of Medical Imaging, Chi Mei Medical Center, Tainan City, Taiwan
| | - Deng-Chyang Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Tzu-Hsueh Tsai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Hwa Yang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gin-Chung Liu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Fulwadhva UP, Wortman JR, Sodickson AD. Use of Dual-Energy CT and Iodine Maps in Evaluation of Bowel Disease. Radiographics 2016; 36:393-406. [DOI: 10.1148/rg.2016150151] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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164
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Guo DD, Liu Y, Gao JB, Wang F, Li JY. Correlation between normalized iodine concentration and HER2 protein expression in gastric cancer. Shijie Huaren Xiaohua Zazhi 2016; 24:573-578. [DOI: 10.11569/wcjd.v24.i4.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the correlation of normalized iodine concentration with human epidermal growth factor receptor 2 (HER2) protein expression in gastric cancer, so as to evaluate the biological characteristics of tumors indirectly.
METHODS: Sixty-one patients with pathologically proven gastric cancer underwent dual-energy CT at our hospital. The iodine concentrations in the tumor parenchyma and aorta of the same axial slice during arterial and venous phases were measured, and then the normalized iodine concentration (NIC) was calculated. The correlation between NIC and HER2 expression was analyzed statistically.
RESULTS: HER2 protein expression was positive in 19 (31.15%) cases. The NICs in arterial and venous phases in the HER2 positive group were 0.298 ± 0.399 and 0.677 ± 0.868, respectively, which were both higher than those in the HER2 negative group. The expression of HER2 was moderately correlated with NICs in the tumor parenchyma in the arterial and venous phases. The correlation coefficients were 0.772 and 0.788, respectively. The correlation in the venous phase was higher than that in the arterial phase.
CONCLUSION: The NIC in gastric cancer tissue has a correlation with HER2 protein expression, and the NIC can be used to evaluate the biological characteristics of tumors.
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Split-Bolus Portal Venous Phase Dual-Energy CT Urography: Protocol Design, Image Quality, and Dose Reduction. AJR Am J Roentgenol 2016; 205:W492-501. [PMID: 26496571 DOI: 10.2214/ajr.14.13687] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the image quality of split-bolus portal venous phase urography and the potential reduction of radiation dose by using a second-generation dual-source dual-energy CT (DECT) scanner. MATERIALS AND METHODS DECT urography was performed in 84 patients. Unenhanced CT was performed 20 minutes after drinking 800 mL of water. The split-bolus protocol consisted of a sequence of injections, as follows: 200 mL of normal saline (2.0 mL/s), 50 mL of contrast medium (2.5 mL/s) at 0 second, 70 mL of contrast medium (2.5 mL/s) at 360 seconds, and a saline flush of 25 mL. The scan was started at 420 seconds. Virtual unenhanced images were reconstructed from contrast-enhanced images. The mean CT density and signal-to-noise ratio (SNR) of the renal parenchyma, vessels, upper urinary tract, normal reference tissues, and tumors were measured for image quantitative analysis. Image quality and opacification of the collecting systems were rated by two radiologists using 3- or 4-point scales. RESULTS The SNR of all measured sites, except the renal pelvis, showed a statistically significant correlation (p < 0.001) between the true unenhanced and virtual unenhanced images. The overall sensitivity of stone detection was 87.5% (28/32) in virtual unenhanced images. Image quality of the renal parenchyma, arteries, and veins was excellent in 59.5%, 75.0%, and 97.6% of cases, respectively. Opacification of the intrarenal collecting systems, proximal, middle, and distal ureters, and bladder was complete in 92.9%, 83.9%, 78.6%, 77.4%, and 26.2% of patients, respectively. Omitting the unenhanced scan can reduce the mean radiation dose from 15.6 to 6.7 mSv. CONCLUSION Portal venous phase split-bolus DECT urography provides sufficient image quality with potential to reduce radiation exposure.
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Comparison of Contrast-Enhanced Multiphase Renal Protocol CT Versus MRI for Diagnosis of Papillary Renal Cell Carcinoma. AJR Am J Roentgenol 2016; 206:319-25. [DOI: 10.2214/ajr.15.14932] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Platon A, Becker M, Becker CD, Lock E, Wolff H, Perneger T, Poletti PA. Illegal intra-corporeal packets: can dual energy CT be used for the evaluation of cocaine concentration? A cross sectional study. BMC Med Imaging 2016; 16:3. [PMID: 26762344 PMCID: PMC4712503 DOI: 10.1186/s12880-016-0106-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022] Open
Abstract
Background The recent implementation of the dual energy technology on CT-scanners has opened new perspectives in tissue and material characterization. This study aims to evaluate whether dual energy CT can be used to assess the concentration of cocaine of intra-intestinal illegal packets. Methods The study was approved by the institutional review board of our institution (CER 13_027_R). From November 2010 to May 2013, all consecutive conveyors in whom a low-dose abdominal CT (LDCT) revealed the presence of illegal intra-corporeal drug packets underwent a dual energy CT series (gemstone spectral imaging) targeted on one container. The mean radiological density (HU) of these packets was measured on the LDCT series, and on the monochromatic dual energy series, at 40 and 140 keV. The difference between the HU at 40 and 140 keV was reported as ∆HU. The effective atomic number Z(eff) was also measured on the monochromatic series. A chemical analysis was performed after expulsion to select cocaine containing packets, and to determine their cocaine concentrations. A correlation analysis was performed between HU, ∆HU and Z(eff), with regard to the percentage of cocaine. Results Fifty-four cocaine conveyors were included. The mean cocaine content of the packets was 36.8 % (range 11.2–80, SD 15.4), the mean radiologic density 105 HU, the mean Z(eff) 8.7 and the mean ∆HU 163. The cocaine content was correlated with the ∆HU (0.57, p < 0.001), with the Z(eff) (r = 0.56, p < 0.001) but not with radiologic density (r = 0.25, p = 0.064). ∆HU >200 was 0.9 (9 of 10) sensitive and 0.82 (36 of 44) specific to predict a cocaine concentration higher than 50 %. Conclusion Measuring ∆HU or Z(eff) on dual energy monochromatic CT series can be used to detect ingested packets with cocaine concentration >50 %.
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Affiliation(s)
- Alexandra Platon
- Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211,, Geneva, Switzerland
| | - Minerva Becker
- Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211,, Geneva, Switzerland
| | - Christoph D Becker
- Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211,, Geneva, Switzerland
| | - Eric Lock
- Scientific Police, Geneva State Police, Geneva, Switzerland
| | - Hans Wolff
- Division of Correctional Medicine and Psychiatry, University Hospital of Geneva, ch. du Petit-Bel-Air 2, 1225,, Chêne-Bourg, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211,, Geneva, Switzerland.
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 1. J Comput Assist Tomogr 2016; 40:841-845. [DOI: 10.1097/rct.0000000000000531] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quiney B, Harris A, McLaughlin P, Nicolaou S. Dual-energy CT increases reader confidence in the detection and diagnosis of hypoattenuating pancreatic lesions. ACTA ACUST UNITED AC 2015; 40:859-64. [PMID: 25270000 DOI: 10.1007/s00261-014-0254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To prospectively compare detection and reader confidence of pancreatic lesions using a standard multi-detector computed tomography (MDCT) imaging protocol to a dual-energy computed tomography (DECT) imaging protocol with additional virtual non-contrast series. METHODS 60 subjects imaged for suspected or known pancreatic lesions were included. Subjects underwent pancreatic MDCT including non-contrast, pancreatic phase, and portal venous phase (PVP). The PVP was performed in dual energy mode. Virtual non-contrast and blended 120 kVp weighted images were created from the DECT data. Overall noise and absolute attenuation differences of pancreatic lesions and normal pancreatic tissue were measured. Images were read by two staff radiologists blinded to the underlying diagnosis. MDCT and DECT scans were reviewed separately to evaluate image quality and level of confidence in diagnosis of a pancreatic lesion. RESULTS Image quality was ranked excellent for 90 % and 95 % of the 120 kVp studies and 93 % and 95 % of the 100 kVp studies by readers 1 and 2, respectively. VNC was ranked sufficient quality or better by both readers. Average attenuation difference was 74 HU (120 kVp) and 71 HU (100 kVp). Average noise was 11.31 HU (120 kVp) and 15.89 HU (100 kVp). No lesions were missed by either approach. There was increased confidence in diagnostic interpretation in 14 % (± 9 % [95 % CI]) and 9 % (± 7 % [95 % CI]) of DECT scans compared to MDCT. CONCLUSIONS DECT compared to MDCT pancreatic imaging leads to increased reader confidence with identical diagnostic sensitivity for pathologically proven cases. This approach could be implemented as a single phase acquisition study with calculated VNC leading to a significant dose savings to the patient.
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Affiliation(s)
- Brendan Quiney
- Department of Radiology, Faculty of Medicine, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 4E3, Canada,
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Thaiss WM, Sauter AW, Bongers M, Horger M, Nikolaou K. Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology. Eur J Radiol 2015; 84:2368-79. [DOI: 10.1016/j.ejrad.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
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Karaca L, Yuceler Z, Kantarci M, Çakır M, Sade R, Calıkoglu C, Ogul H, Bayrakturan UG. The feasibility of dual-energy CT in differentiation of vertebral compression fractures. Br J Radiol 2015; 89:20150300. [PMID: 26537691 DOI: 10.1259/bjr.20150300] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the ability of dual-energy CT (DECT), compared with MRI, to identify vertebral compression fractures in acute trauma patients. METHODS This institutional review board-approved study included 23 consecutive patients with 32 vertebral fractures who underwent both DECT and MRI of the spine between February 2014 and September 2014. A total of 209 vertebrae were evaluated for the presence of abnormal bone marrow attenuation on DECT and signal on MRI by five experienced radiologists. The specificity, sensitivity, predictive values and intraobserver and interobserver agreements were calculated. RESULTS MRI revealed a total of 47 vertebrae (22.4% of all vertebrae) and DECT revealed 44 vertebrae (21.0% of all vertebrae) with oedema. Using MRI as the reference standard, DECT had sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of 89.3, 98.7, 95.4, 96.9 and 96.6%, respectively. With respect to establishing the presence of oedema, the interobserver agreement was almost perfect (k = 0.82), and the intraobserver agreement was substantial (k = 0.80). CONCLUSION Compared with MRI, DECT can provide an accurate demonstration of acute vertebral fractures and can be used as an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI. ADVANCES IN KNOWLEDGE Distinguishing of acute and chronic vertebral compression fracture is important for treatment choices. DECT is very fast compared with MRI and is an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI.
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Affiliation(s)
- Leyla Karaca
- 1 Atatürk University, Medical School, Department of Radiology, Erzurum, Turkey
| | - Zeynep Yuceler
- 1 Atatürk University, Medical School, Department of Radiology, Erzurum, Turkey.,2 Eregli State Hospital, Radiology Department, Zonguldak, Turkey
| | - Mecit Kantarci
- 1 Atatürk University, Medical School, Department of Radiology, Erzurum, Turkey
| | - Murteza Çakır
- 3 Ataturk University, Medical School, Department of Neurosurgery, Erzurum, Turkey
| | - Recep Sade
- 1 Atatürk University, Medical School, Department of Radiology, Erzurum, Turkey
| | - Cagatay Calıkoglu
- 3 Ataturk University, Medical School, Department of Neurosurgery, Erzurum, Turkey
| | - Hayri Ogul
- 1 Atatürk University, Medical School, Department of Radiology, Erzurum, Turkey
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Ohana M, Labani A, Jeung M, Ghannudi S, Gaertner S, Roy C. Iterative reconstruction in single source dual-energy CT pulmonary angiography: Is it sufficient to achieve a radiation dose as low as state-of-the-art single-energy CTPA? Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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173
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Patel BN, Gupta RT, Zani S, Jeffrey RB, Paulson EK, Nelson RC. How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas. ABDOMINAL IMAGING 2015; 40:2932-44. [PMID: 26482048 DOI: 10.1007/s00261-015-0549-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Disease involving the pancreas can be a significant diagnostic challenge to the interpreting radiologist. Moreover, the majority of disease processes involving the pancreas carry high significant morbidity and mortality either due to their natural process or related to their treatment options. As such, it is critical for radiologists to not only provide accurate information from imaging to guide patient management, but also deliver that information in a clear manner so as to aid the referring physician. This is no better exemplified than in the case of pre-operative staging for pancreatic adenocarcinoma. Furthermore, with the changing healthcare landscape, it is now more important than ever to ensure that the value of radiology service to other providers is high. In this review, we will discuss how the radiologist can add value to the referring physician by employing novel imaging techniques in the pre-operative evaluation as well as how the information can be conveyed in the most meaningful manner through the use of structured reporting. We will also familiarize the radiologist with the imaging appearance of common complications that occur after pancreatic surgery.
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Almutairi A, Sun Z, Poovathumkadavi A, Assar T. Dual Energy CT Angiography of Peripheral Arterial Disease: Feasibility of Using Lower Contrast Medium Volume. PLoS One 2015; 10:e0139275. [PMID: 26418007 PMCID: PMC4587806 DOI: 10.1371/journal.pone.0139275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/09/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE One of the main drawbacks associated with Dual Energy Computed Tomography Angiography (DECTA) is the risk of developing contrast medium-induced nephropathy (CIN). The aim of the present study was firstly, to design an optimal CT imaging protocol by determining the feasibility of using a reduced contrast medium volume in peripheral arterial DECTA, and secondly, to compare the results with those obtained from using routine contrast medium volume. METHODS Thirty four patients underwent DECTA for the diagnosis of peripheral arterial disease. They were randomly divided into two groups: Group 1 (routine contrast volume group) with n = 17, injection rate 4-5 ml/s, and 1.5 ml/kg of contrast medium, and Group 2 ((low contrast volume group), with n = 17, injection rate 4-5ml/s, and contrast medium volume 0.75 ml/kg. A fast kilovoltage-switching 64-slice CT scanner in the dual-energy mode was employed for the study. A total of 6 datasets of monochromatic images at 50, 55, 60, 65, 70 and 75 keV levels were reconstructed with adaptive statistical iterative reconstruction (ASIR) at 50%. A 4-point scale was the tool for qualitative analysis of results. The two groups were compared and assessed quantitatively for image quality on the basis of signal-to-noise ratio (SNR) and contrast-to-noise-ratio (CNR). Radiation and contrast medium doses were also compared. RESULTS The overall mean CT attenuation and mean noise for all lower extremity body parts was significantly lower for the low volume contrast group (p<0.001), and varied significantly between groups (p = 0.001), body parts (p<0.001) and keVs (p<0.001). The interaction between group body parts was significant with CT attenuation and CNR (p = 0.002 and 0.003 respectively), and marginally significant with SNR (p = 0.047), with minimal changes noticed between the two groups. Group 2 (low contrast volume group) displayed the lowest image noise between 65 and 70 keV, recorded the highest SNR and CNR at 65 keV, and produced significantly lower results with respect to contrast medium volume and duration of contrast injection (p<0.001). The effect of radiation dose was not statistically significant between the two groups. CONCLUSIONS DECTA images created at 65 keV and 50% ASIR with low contrast medium volume protocol, yielded results that were comparable to routine contrast medium volume, with acceptable diagnostic images produced during the evaluation of peripheral arteries.
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Affiliation(s)
- Abdulrahman Almutairi
- Department of Medical Radiation Sciences, School of Science, Curtin University, Perth, 6845, Western Australia, Australia
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam, 31444, Saudi Arabia
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University, Perth, 6845, Western Australia, Australia
- * E-mail:
| | | | - Tarek Assar
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam, 31444, Saudi Arabia
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Li JH, Du YM, Huang HM. Accuracy of dual-energy computed tomography for the quantification of iodine in a soft tissue-mimicking phantom. J Appl Clin Med Phys 2015; 16:418–426. [PMID: 26699312 PMCID: PMC5690187 DOI: 10.1120/jacmp.v16i5.5519] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/21/2015] [Accepted: 04/19/2015] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to evaluate the accuracy of dual-energy CT (DECT) for quantifying iodine using a soft tissue-mimicking phantom across various DECT acquisition parameters and dual-source CT (DSCT) scanners. A phantom was constructed with plastic tubes containing soft tissue-mimicking materials with known iodine concentrations (0-20 mg/mL). Experiments were performed on two DSCT scanners, one equipped with an integrated detector and the other with a conventional detector. DECT data were acquired using two DE modes (80 kV/Sn140 kV and 100 kV/Sn140 kV) with four pitch values (0.6, 0.8, 1.0, and 1.2). Images were reconstructed using a soft tissue kernel with and without beam hardening correction (BHC) for iodine. Using the dedicated DE software, iodine concentrations were measured and compared to true concentrations. We also investigated the effect of reducing gantry rotation time on the DECT-based iodine measurement. At iodine concentrations higher than 10 mg/mL, the relative error in measured iodine concentration increased slightly. This error can be decreased by using the kernel with BHC, compared with the kernel without BHC. Both 80 kV/Sn140 kV and 100 kV/Sn140 kV modes could provide accurate quantification of iodine content. Increasing pitch value or reducing gantry rotation time had only a minor impact on the DECT-based iodine measurement. The DSCT scanner, equipped with the new integrated detector, showed more accurate iodine quantification for all iodine concentrations higher than 10 mg/mL. An accurate quantification of iodine can be obtained using the second-generation DSCT scanner in various DE modes with pitch values up to 1.2 and gantry rotation time down to 0.28 s. For iodine concentrations ≥ 10 mg/mL, using the new integrated detector and the kernel with BHC can improve the accuracy of DECT-based iodine measurements.
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Affiliation(s)
- Jung-Hui Li
- Chang Gung Memorial Hospital, Kaohsiung Medical Center.
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Gabbai M, Leichter I, Mahgerefteh S, Sosna J. Spectral material characterization with dual-energy CT: comparison of commercial and investigative technologies in phantoms. Acta Radiol 2015; 56:960-9. [PMID: 25182803 DOI: 10.1177/0284185114545150] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dual-energy computed tomography (DECT) enables tissue discrimination based on the X-ray attenuations at different photon energies emitted by the tube. The spectral dependencies of net X-ray attenuation can be analyzed and used to characterize specific materials. PURPOSE To evaluate the capability of DECT to characterize and differentiate high-density materials, using spectral analysis. MATERIAL AND METHODS Images of phantoms containing iodine, barium, gadolinium, and calcium solutions in five concentrations were obtained from three DECT scanners and with sequential scanning at different kV values from three conventional MDCT devices. DECT studies were performed with commercial dual-source and rapid kV-switching systems, and a spectral-detector CT (SDCT) prototype based on dual-layer detector technology. Spectral maps describing Hounsfield Units (HU) in low- versus high-energy images were calculated and characterizing curves for all materials were compared. RESULTS Spectral low- to- high energy maps yielded linear curves (R(2) = 0.98-0.999) with increasing slopes for calcium, gadolinium, barium, and iodine, respectively. Slope differences between all material pairs were highest (reaching 45%) for DECT with dual-source (140/80 kV) and rapid kV-switching (60/80 keV), reaching statistical significance (P < 0.05) with most techniques. Slope differences between all material pairs for sequential scanning were lower (reaching 32%). Slope differences lacked statistical significance for iodine-barium with two sequential-acquisition techniques and the dual-source DECT scanner, and the calcium-gadolium pair with the dual-source scanner. CONCLUSION All designated techniques for dual-energy scanning provide robust and material-specific spectral characterization and differentiation of barium, iodine, calcium, and gadolinium, though to varying degrees.
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Affiliation(s)
- Michal Gabbai
- Department of Radiology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Isaac Leichter
- Department of Radiology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
- Department of Applied Physics, Lev Academic Center, Jerusalem, Israel
| | - Samuel Mahgerefteh
- Department of Radiology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA, USA
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Anzidei M, Di Martino M, Sacconi B, Saba L, Boni F, Zaccagna F, Geiger D, Kirchin MA, Napoli A, Bezzi M, Catalano C. Evaluation of image quality, radiation dose and diagnostic performance of dual-energy CT datasets in patients with hepatocellular carcinoma. Clin Radiol 2015; 70:966-73. [PMID: 26095726 DOI: 10.1016/j.crad.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/19/2015] [Accepted: 05/12/2015] [Indexed: 01/05/2023]
Abstract
AIM To evaluate image quality and diagnostic accuracy of different dual-energy computed tomography (DECT) datasets for identification of hepatocellular carcinoma (HCC), assess the reliability of virtual unenhanced (VU) images in replacing standard unenhanced (SU) images, and quantify effective dose (ED) at different tube voltages. MATERIAL AND METHODS Thirty cirrhotic patients underwent liver contrast-enhanced DECT. Two blinded observers retrospectively evaluated conventional unenhanced and VU images, 140 kVp/80 kVp/mixed tube potential arterial datasets and conventional portal-venous/late phases in consensus. Final diagnosis was based on pathological proof or imaging criteria. Image quality, ED, sensitivity, and specificity of arterial datasets were calculated. RESULTS Thirty-eight HCC and 18 benign lesions were detected at 80 kVp, 33 HCC and 22 benign lesions were detected at 140 kVp, and 36 HCC and 20 benign lesions were detected at mixed tube potentials. Final diagnosis confirmed 37 HCC and 20 benign lesions. There was no significant difference in diagnostic confidence between 80 kVp, 140 kVp, and mixed tube potential arterial datasets (p>0.05). Image quality was adequate for all datasets, with increased quality at higher tube potential (80 versus 140 kVp, p=0.001; mixed versus 140 kVp, p=0.001; 80 kVp versus mixed, p=0.0024). Significant ED reduction was observed between 140 and 80 kVp datasets (p<0.001). CONCLUSIONS The 140 kVp dataset provided higher image quality. The 80 kVp images were more sensitive in detecting HCC. VU images are adequate in replacing SU images. The ED of the 80 kVp dataset was significantly lower.
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Affiliation(s)
- M Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - M Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - B Sacconi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy
| | - F Boni
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - F Zaccagna
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - D Geiger
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | | | - A Napoli
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - M Bezzi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy
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Zhao F, Liang J, Chen D, Wang C, Yang X, Chen X, Cao F. Automatic segmentation method for bone and blood vessel in murine hindlimb. Med Phys 2015; 42:4043-54. [DOI: 10.1118/1.4922200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sun X, Shao X, Chen H. The value of energy spectral CT in the differential diagnosis between benign and malignant soft tissue masses of the musculoskeletal system. Eur J Radiol 2015; 84:1105-8. [DOI: 10.1016/j.ejrad.2015.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/20/2015] [Accepted: 02/28/2015] [Indexed: 11/24/2022]
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Lewis G, Hoey ETD, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg 2015; 5:423-32. [PMID: 26029645 DOI: 10.3978/j.issn.2223-4292.2015.01.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
Pulmonary arterial hypertension (PAH) may be suspected based on the clinical history, physical examination and electrocardiogram findings but imaging is usually central to confirming the diagnosis, establishing a cause and guiding therapy. The diagnostic pathway of PAH involves a variety of complimentary investigations of which computed tomography pulmonary angiography (CTPA) has established a central role both in helping identify an underlying cause for PAH and assessing resulting functional compromise. In particular CTPA is considered as the gold standard technique for the diagnosis of thromboembolic disease. This article reviews the CTPA evaluation in PAH, describing CTPA techniques, a systematic approach to interpretation and spectrum of key imaging findings.
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Affiliation(s)
- Gareth Lewis
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - John H Reynolds
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Jerome Ment
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
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Almutairi A, Sun Z, Al Safran Z, Poovathumkadavi A, Albader S, Ifdailat H. Optimal Scanning Protocols for Dual-Energy CT Angiography in Peripheral Arterial Stents: An in Vitro Phantom Study. Int J Mol Sci 2015; 16:11531-49. [PMID: 26006234 PMCID: PMC4463716 DOI: 10.3390/ijms160511531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify the optimal dual-energy computed tomography (DECT) scanning protocol for peripheral arterial stents while achieving a low radiation dose, while still maintaining diagnostic image quality, as determined by an in vitro phantom study. METHODS Dual-energy scans in monochromatic spectral imaging mode were performed on a peripheral arterial phantom with use of three gemstone spectral imaging (GSI) protocols, three pitch values, and four kiloelectron volts (keV) ranges. A total of 15 stents of different sizes, materials, and designs were deployed in the phantom. Image noise, the signal-to-noise ratio (SNR), different levels of adaptive statistical iterative reconstruction (ASIR), and the four levels of monochromatic energy for DECT imaging of peripheral arterial stents were measured and compared to determine the optimal protocols. RESULTS A total of 36 scans with 180 datasets were reconstructed from a combination of different protocols. There was a significant reduction of image noise with a higher SNR from monochromatic energy images between 65 and 70 keV in all investigated preset GSI protocols (p < 0.05). In addition, significant effects were found from the main effect analysis for these factors: GSI, pitch, and keV (p = 0.001). In contrast, there was significant interaction on the unstented area between GSI and ASIR (p = 0.015) and a very high significant difference between keV and ASIR (p < 0.001). A radiation dose reduction of 50% was achieved. CONCLUSIONS The optimal scanning protocol and energy level in the phantom study were GSI-48, pitch value 0.984, and 65 keV, which resulted in lower image noise and a lower radiation dose, but with acceptable diagnostic images.
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Affiliation(s)
- Abdulrahman Almutairi
- Department of Medical Radiation Sciences, Curtin University, Perth, 6102 Western Australia, Australia.
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, 6102 Western Australia, Australia.
| | - Zakariya Al Safran
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
| | | | - Suha Albader
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
| | - Husam Ifdailat
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
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An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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183
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Dual-energy CT after radiofrequency ablation of liver, kidney, and lung lesions: a review of features. Insights Imaging 2015; 6:363-79. [PMID: 25941033 PMCID: PMC4444790 DOI: 10.1007/s13244-015-0408-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 11/09/2022] Open
Abstract
Early detection of residual tumour and local tumour progression (LTP) after radiofrequency (RF) ablation is crucial in the decision whether or not to re-ablate. In general, standard contrast-enhanced computed tomography (CT) is used to evaluate the technique effectiveness; however, it is difficult to differentiate post-treatment changes from residual tumour. Dual-energy CT (DECT) is a relatively new technique that enables more specific tissue characterisation of iodine-enhanced structures because of the isolation of iodine in the imaging data. Necrotic post-ablation zones can be depicted as avascular regions by DECT on greyscale- and colour-coded iodine images. Synthesised monochromatic images from dual-energy CT with spectral analysis can be used to select the optimal keV to achieve the highest contrast-to-noise ratio between tissues. This facilitates outlining the interface between the ablation zone and surrounding tissue. Post-processing of DECT data can lead to an improved characterisation and delineation of benign post-ablation changes from LTP. Radiologists need to be familiar with typical post-ablation image interpretations when using DECT techniques. Here, we review the spectrum of changes after RF ablation of liver, kidney, and lung lesions using single-source DECT imaging, with the emphasis on the additional information obtained and pitfalls encountered with this relatively new technique. Teaching Points •Technical success of RF ablation means complete destruction of the tumour. •Assessment of residual tumour on contrast-enhanced CT is hindered by post-ablative changes. •DECT improves material differentiation and may improve focal lesion characterisation. •Iodine maps delineate the treated area from the surrounding parenchyma well.
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184
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Secchi F, De Cecco CN, Spearman JV, Silverman JR, Ebersberger U, Sardanelli F, Schoepf UJ. Monoenergetic extrapolation of cardiac dual energy CT for artifact reduction. Acta Radiol 2015; 56:413-8. [PMID: 24615417 DOI: 10.1177/0284185114527867] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Monoenergetic extrapolation of cardiac dual-energy computed tomography (DECT) could be useful in artifact reduction in clinical practice. PURPOSE To evaluate the potential of monoenergetic extrapolation of cardiac DECT data for reducing artifacts from metal and high iodine contrast concentration. MATERIAL AND METHODS With IRB approval and in HIPAA compliance, 35 patients (22 men, 61 ± 12 years) underwent cardiac DECT with dual-source CT (100 kVp and 140 kVp). Contrast material injection protocols were adapted to the patient's weight using non-ionic low-osmolar 370 mgI/mL iopromide. Datasets were transferred to a stand-alone workstation and dedicated monoenergetic analysis software was used for postprocessing. Reconstructions with the following five photon energies were generated: 40 keV, 60 keV, 80 keV, 100 keV, and 120 keV. Artifact severity was graded on a 5-point Likert scale (0, massive artifact; 5, absence of artifact). The size of artifact and image noise (expressed as HU) in anatomic structures adjacent to the artifact were measured. Quantitative and subjective image quality was compared using Friedman and Wilcoxon tests. RESULTS We observed artifacts arising from densely concentrated contrast material in the superior vena cava (SVC) in 18 patients, from sternal wires in 14, from bypass clips in eight, and from coronary artery stents in seven. Artifact size in monoenergetic reconstructions from 40 to 120 keV decreased from 21.3 to 19 mm for the SVC (P < 0.001), from 8.4 to 2.6 mm for sternal wires (P < 0.001), from 6.4 to 2.2 mm for bypass clips (P < 0.001), and from 5.9 to 2.7 mm for stents (P < 0.001), respectively. The quality score changed from 0.2 to 3.8 for the SVC (P < 0.001), from 0.1 to 4 for sternal wires (P < 0.001), from 0 to 3.9 for bypass clips (P < 0.001), and from 0 to 3.9 for stents (P < 0.001). Lowest noise in adjacent structures was found at 80 keV for the SVC (39.1 HU), for sternal wires (33.3), for bypass clips (26.9), and for stents (33.9). CONCLUSION A significant reduction of high-attenuation artifacts can be achieved by use of higher monoenergetic energy levels with cardiac DECT. However, image noise in anatomic structures affected by artifacts is lowest at 80 keV, which suggests an evaluation approach that makes use of multiple energy levels for a complete diagnosis.
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Affiliation(s)
- Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese, Italy
| | - Carlo Nicola De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza” – Polo Pontino, Latina, Italy
| | - James Vance Spearman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Robert Silverman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Ullrich Ebersberger
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Francesco Sardanelli
- IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese, Italy
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Abstract
Because of the different attenuations of tissues at different energy levels, dual-energy CT offers tissue differentiation and characterization, reduction of artifacts, and remodeling of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), hereby creating new opportunities and insights in CT imaging. The applications for dual-energy imaging in neuroradiology are various and still expanding. Automated bone removal is used in CT angiography and CT venography of the intracranial vessels. Monoenergetic reconstructions can be used in patients with or without metal implants in the brain and spine to reduce artifacts, improve CNR and SNR, or to improve iodine conspicuity. Differentiation of iodine and hemorrhage is used in high-density lesions, after intra-arterial recanalization in stroke patients or after administration of contrast media. Detection of underlying (vascular and non-vascular) pathology and spot sign can be used in patients presenting with (acute) intracranial hemorrhage.
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Affiliation(s)
- Alida A. Postma
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annika A. R. Stadler
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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186
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Meng B, Cong W, Xi Y, De Man B, Wang G. Energy Window Optimization for X-Ray K-Edge Tomographic Imaging. IEEE Trans Biomed Eng 2015; 63:1623-30. [PMID: 25794386 DOI: 10.1109/tbme.2015.2413816] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
GOAL In K-edge tomographic imaging with photon counting detectors, the energy window width of photon counting detectors significantly affects the signal-to-noise ratio (SNR) of measured intensity data and the contrast-to-noise ratio (CNR) of reconstructed images. In this paper, we present an optimization method to determine an optimal window width around a K-edge for optimal SNR and CNR. METHODS An objective function is designed to describe SNR of the projection data based on the Poisson distribution of detected X-ray photons. Then, a univariate optimization method is applied to obtain an X-ray energy window width. RESULTS Numerical simulations are performed to evaluate the proposed method, and the results show that the optimal energy window width obtained from the proposed method produces not only optimal SNR data in the projection domain but also optimal CNR values in the image domain. CONCLUSION The proposed method in the projection domain can determine an optimal energy window width for X-ray photon counting imaging, and achieve optimality in both projection and image domains. SIGNIFICANCE Our study provides a practical way to determine the optimal energy window width of photon counting detectors, which helps improve contrast resolution for X-ray K-edge tomographic imaging.
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187
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Herr K, Muglia VF, Koff WJ, Westphalen AC. Imaging of the adrenal gland lesions. Radiol Bras 2015; 47:228-39. [PMID: 25741090 PMCID: PMC4337123 DOI: 10.1590/0100-3984.2013.1762] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 10/03/2013] [Indexed: 12/21/2022] Open
Abstract
With the steep increase in the use of cross-sectional imaging in recent years, the
incidentally detected adrenal lesion, or "incidentaloma", has become an increasingly
common diagnostic problem for the radiologist, and a need for an approach to
classifying these lesions as benign, malignant or indeterminate with imaging has
spurred an explosion of research. While most incidentalomas represent benign disease,
typically an adenoma, the possibility of malignant involvement of the adrenal gland
necessitates a reliance on imaging to inform management decisions. In this article,
we review the literature on adrenal gland imaging, with particular emphasis on
computed tomography, magnetic resonance imaging, and photon-emission tomography, and
discuss how these findings relate to clinical practice. Emerging technologies, such
as contrast-enhanced ultrasonography, dual-energy computed tomography, and magnetic
resonance spectroscopic imaging will also be briefly addressed.
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Affiliation(s)
- Keith Herr
- MD, Assistant Professor, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Valdair F Muglia
- MD, Habiliation, Associate Professor, Department of Internal Medicine - Radiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Walter José Koff
- MD, Habilitation, Full Professor, Department of Surgery - Urology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Antonio Carlos Westphalen
- MD, PhD, Associate Professor, Departments of Radiology and Biomedical Imaging and Urology, School of Medicine, University of California, San Francisco, CA, USA
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188
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Lamb P, Sahani DV, Fuentes-Orrego JM, Patino M, Ghosh A, Mendonça PRS. Stratification of patients with liver fibrosis using dual-energy CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:807-815. [PMID: 25181365 DOI: 10.1109/tmi.2014.2353044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Assessing the severity of liver fibrosis has direct clinical implications for patient diagnosis and treatment. Liver biopsy, typically considered the gold standard, has limited clinical utility due to its invasiveness. Therefore, several imaging-based techniques for staging liver fibrosis have emerged, such as magnetic resonance elastography (MRE) and ultrasound elastography (USE), but they face challenges that include limited availability, high cost, poor patient compliance, low repeatability, and inaccuracy. Computed tomography (CT) can address many of these limitations, but is still hampered by inaccuracy in the presence of confounding factors, such as liver fat. Dual-energy CT (DECT), with its ability to discriminate between different tissue types, may offer a viable alternative to these methods. By combining the "multi-material decomposition" (MMD) algorithm with a biologically driven hypothesis we developed a method for assessing liver fibrosis from DECT images. On a twelve-patient cohort the method produced quantitative maps showing the spatial distribution of liver fibrosis, as well as a fibrosis score for each patient with statistically significant correlation with the severity of fibrosis across a wide range of disease severities. A preliminary comparison of the proposed algorithm against MRE showed good agreement between the two methods. Finally, the application of the algorithm to longitudinal DECT scans of the cohort produced highly repeatable results. We conclude that our algorithm can successfully stratify patients with liver fibrosis and can serve to supplement and augment current clinical practice and the role of DECT imaging in staging liver fibrosis.
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189
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Mileto A, Nelson RC, Marin D, Roy Choudhury K, Ho LM. Dual-Energy Multidetector CT for the Characterization of Incidental Adrenal Nodules: Diagnostic Performance of Contrast-enhanced Material Density Analysis. Radiology 2015; 274:445-54. [DOI: 10.1148/radiol.14140876] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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190
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Abstract
Dual-energy computed tomography (DECT) imaging is a promising method used in oncology for accurate detection/diagnosis of malignant and benign lesions. Use of dual-energy spectral, weighted average, color-coded map, and virtual unenhanced images provides increased visual detection and easy lesion delineation. Lesion detectability, sensitivity, and conspicuity are significantly improved using DECT. Material characterization and decomposition are promising using DECT. Both anatomical and functional information related to oncology can be provided by DECT using single contrast-enhanced CT.
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191
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Liu WD, Wu XW, Hu JM, Wang B, Liu B. Monochromatic energy computed tomography image for active intestinal hemorrhage: A model investigation. World J Gastroenterol 2015; 21:214-220. [PMID: 25574093 PMCID: PMC4284337 DOI: 10.3748/wjg.v21.i1.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of computed tomography (CT) spectral imaging in the evaluation of intestinal hemorrhage.
METHODS: Seven blood flow rates were simulated in vitro. Energy spectral CT and mixed-energy CT scans were performed for each rate (0.5, 0.4, 0.3, 0.2, 0.1, 0.05 and 0.025 mL/min). The detection rates and the contrast-to-noise ratios (CNRs) of the contrast agent extravasation regions were compared between the two scanning methods in the arterial phase (AP) and the portal venous phase (PVP). Comparisons of the CNR values between the PVP and the AP were made for each energy level and carried out using a completely random t test. A χ2 test was used to compare the detection rates obtained from the two scanning methods.
RESULTS: The total detection rates for energy spectral CT and mixed-energy CT in the AP were 88.57% (31/35) and 65.71% (23/35), respectively, and the difference was significant (χ2 = 5.185, P = 0.023); the total detection rates in the PVP were 100.00% (35/35) and 91.4% (32/35), respectively, and the difference was not significant (χ2 = 1.393, P = 0.238). In the AP, the CNR of the contrast agent extravasation regions was 3.58 ± 2.09 on the mixed-energy CT images, but the CNRs were 8.78 ± 7.21 and 8.83 ± 6.75 at 50 and 60 keV, respectively, on the single-energy CT images, which were significantly different (3.58 ± 2.09 vs 8.78 ± 7.21, P = 0.031; 3.58 ± 2.09 vs 8.83 ± 6.75, P = 0.029). In the PVP, the differences between the CNRs at 40, 50 and 60 keV different monochromatic energy levels and the polychromatic energy images were significant (19.35 ± 10.89 vs 11.68 ± 6.38, P = 0.010; 20.82 ± 11.26 vs 11.68 ± 6.38, P = 0.001; 20.63 ± 10.07 vs 11.68 ± 6.38, P = 0.001). The CNRs at the different energy levels in the AP and the PVP were significantly different (t = -2.415, -2.380, -2.575, -2.762, -2.945, -3.157, -3.996 and -3.189).
CONCLUSION: Monochromatic energy imaging spectral CT is superior to polychromatic energy images for the detection of intestinal hemorrhage, and the detection was easier in the PVP compared with the AP.
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192
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Rosenkrantz AB, Mendiratta-Lala M, Bartholmai BJ, Ganeshan D, Abramson RG, Burton KR, Yu JPJ, Scalzetti EM, Yankeelov TE, Subramaniam RM, Lenchik L. Clinical utility of quantitative imaging. Acad Radiol 2015; 22:33-49. [PMID: 25442800 PMCID: PMC4259826 DOI: 10.1016/j.acra.2014.08.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 12/24/2022]
Abstract
Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently used in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Mishal Mendiratta-Lala
- Henry Ford Hospital, Abdominal and Cross-sectional Interventional Radiology, Detroit, Michigan
| | - Brian J Bartholmai
- Division of Radiology Informatics, Mayo Clinic in Rochester, Rochester, Minnesota
| | | | - Richard G Abramson
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kirsteen R Burton
- Department of Medical Imaging and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John-Paul J Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ernest M Scalzetti
- Department of Radiology, SUNY Upstate Medical University, Syracuse New York
| | - Thomas E Yankeelov
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
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193
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Multidetector CT and three-dimensional CT angiography of upper extremity arterial injury. Emerg Radiol 2014; 22:269-82. [DOI: 10.1007/s10140-014-1288-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023]
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194
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An C, Chun YM, Kim S, Lee YH, Yun MJ, Suh JS, Song HT. Dual-energy computed tomography arthrography of the shoulder joint using virtual monochromatic spectral imaging: optimal dose of contrast agent and monochromatic energy level. Korean J Radiol 2014; 15:746-56. [PMID: 25469086 PMCID: PMC4248630 DOI: 10.3348/kjr.2014.15.6.746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/14/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To optimize the dose of contrast agent and the level of energy for dual-energy computed tomography (DECT) arthrography of the shoulder joint and to evaluate the benefits of the optimized imaging protocol. Materials and Methods Dual-energy scans with monochromatic spectral imaging mode and conventional single energy scans were performed on a shoulder phantom with 10 concentrations from 0 to 210 mg/mL of iodinated contrast medium at intervals of 15 or 30 mg/mL. Image noise, tissue contrast, and beam hardening artifacts were assessed to determine the optimum dose of contrast agent and the level of monochromatic energy for DECT shoulder arthrography in terms of the lowest image noise and the least beam hardening artifacts while good tissue contrast was maintained. Material decomposition (MD) imaging for bone-iodine differentiation was qualitatively assessed. The optimized protocol was applied and evaluated in 23 patients. Results The optimal contrast dose and energy level were determined by the phantom study at 60 mg/mL and 72 keV, respectively. This optimized protocol for human study reduced the image noise and the beam-hardening artifacts by 35.9% and 44.5%, respectively. Bone-iodine differentiation by MD imaging was not affected by the iodine concentration or level of energy. Conclusion Dual-energy scan with monochromatic spectral imaging mode results in reduced image noise and beam hardening artifacts.
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Affiliation(s)
- Chansik An
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | | | - Jin-Suck Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Ho-Taek Song
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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195
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Clinical applications of dual-energy CT in head and neck imaging. Eur Arch Otorhinolaryngol 2014; 273:547-53. [PMID: 25472819 DOI: 10.1007/s00405-014-3417-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Dual-energy CT provides insights into the material properties of the tissues and can differentiate between tissues that have similar attenuation on conventional, single energy CT imaging. It has several useful and promising applications in head and neck imaging that an otolaryngologist could use to deliver improved clinical care. These applications include metal artifact reduction, atherosclerotic plaque and tumor characterization, detection of parathyroid lesions, and delineation of paranasal sinus ventilation. Dual-energy CT can potentially improve image quality, reduce radiation dose, and provide specific diagnostic information for certain head and neck lesions. This article reviews some current and potential otolaryngology applications of dual-energy CT.
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196
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Shi L, Yan F, Pan Z, Liu B, Liu H, Wang B, Zhang H, Yu Y. Stomach virtual non-enhanced CT with second-generation, dual-energy CT: a preliminary study. PLoS One 2014; 9:e112295. [PMID: 25393001 PMCID: PMC4231030 DOI: 10.1371/journal.pone.0112295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 10/09/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare the true non-enhanced (TNE) and virtual non-enhanced (VNE) data sets in patients who underwent gastric preoperative dual-energy CT (DECT) and to evaluate potential radiation dose reduction by omitting a TNE scan. Methods A total of 74 patients underwent gastric DECT. The mean CT values, length, image quality and effective radiation doses for VNE and TNE images were compared. Results There was no statistical difference in maximal thickness of gastric tumors and maximal diameter of enlarged lymph nodes among the TNE and VNE images (P>0.05). The mean CT value differences between TNE and VNE were statistically significant for all tissue types, except for aorta attenuation measurements (P<0.05), but the absolute differences were under 10 HU. Lower noise was found for VNE images than TNE images (P<0.01). Image quality of VNE was diagnostic but lower than that of TNE (P<0.01). The dose reduction achieved by omitting the TNE acquisition was 21.40±4.44%. Conclusion VNE scan may potentially replace TNE as part of a multi-phase gastric preoperative staging imaging protocol with consequent saving in radiation dose.
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Affiliation(s)
- Lei Shi
- Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (FY); (HZ)
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Liu
- Siemens Health care, Shanghai, China
| | - Huanhuan Liu
- Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Baisong Wang
- Department of Biomedical statistics, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (FY); (HZ)
| | - Yingyan Yu
- Shanghai Institute of Digestive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Clark ZE, Bolus DN, Little MD, Morgan DE. Abdominal rapid-kVp-switching dual-energy MDCT with reduced IV contrast compared to conventional MDCT with standard weight-based IV contrast: an intra-patient comparison. ACTA ACUST UNITED AC 2014; 40:852-8. [PMID: 25261257 DOI: 10.1007/s00261-014-0253-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fuentes-Orrego JM, Pinho D, Kulkarni NM, Agrawal M, Ghoshhajra BB, Sahani DV. New and Evolving Concepts in CT for Abdominal Vascular Imaging. Radiographics 2014; 34:1363-1384. [DOI: 10.1148/rg.345130070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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The applicability of using different energy levels in CT imaging for differentiation or identification of dental restorative materials. Forensic Sci Med Pathol 2014; 10:543-9. [PMID: 25115671 DOI: 10.1007/s12024-014-9595-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The goal of this study was to investigate whether different computed tomography (CT) energy levels could supply additional information for the differentiation of dental materials for forensic investigations. METHODS Nine different commonly used restorative dental materials were investigated in this study. A total of 75 human third molars were filled with the restorative dental materials and then scanned using the forensic reference phantom in singlesource mode. The mean Hounsfield unit values and standard deviations (SDs) of each material were calculated at 120, 80 and 140 kVp. RESULTS Most of the dental materials could be differentiated at 120 kVp. We found that greater X-ray density of a material resulted in higher SDs and that the material volume could influence the measurements. CONCLUSION Differentiation of dental materials in CT was possible in many cases using single-energy CT scans at 120 kVp. Because of the number of dental restorative materials available and scanner and scan parameter dependence, as well as the CT imaging artifacts, the identification (in contrast to differentiation) was problematic.
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