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Vattay B, Szilveszter B, Boussoussou M, Vecsey-Nagy M, Lin A, Konkoly G, Kubovje A, Schwarz F, Merkely B, Maurovich-Horvat P, Williams MC, Dey D, Kolossváry M. Impact of virtual monoenergetic levels on coronary plaque volume components using photon-counting computed tomography. Eur Radiol 2023; 33:8528-8539. [PMID: 37488295 PMCID: PMC10667372 DOI: 10.1007/s00330-023-09876-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Virtual monoenergetic images (VMIs) from photon-counting CT (PCCT) may change quantitative coronary plaque volumes. We aimed to assess how plaque component volumes change with respect to VMIs. METHODS Coronary CT angiography (CTA) images were acquired using a dual-source PCCT and VMIs were reconstructed between 40 and 180 keV in 10-keV increments. Polychromatic images at 120 kVp (T3D) were used as reference. Quantitative plaque analysis was performed on T3D images and segmentation masks were copied to VMI reconstructions. Calcified plaque (CP; > 350 Hounsfield units, HU), non-calcified plaque (NCP; 30 to 350 HU), and low-attenuation NCP (LAP; - 100 to 30 HU) volumes were calculated using fixed thresholds. RESULTS We analyzed 51 plaques from 51 patients (67% male, mean age 65 ± 12 years). Average attenuation and contrast-to-noise ratio (CNR) decreased significantly with increasing keV levels, with similar values observed between T3D and 70 keV images (299 ± 209 vs. 303 ± 225 HU, p = 0.15 for mean HU; 15.5 ± 3.7 vs. 15.8 ± 3.5, p = 0.32 for CNR). Mean NCP volume was comparable between T3D and 100-180-keV reconstructions. There was a monotonic decrease in mean CP volume, with a significant difference between all VMIs and T3D (p < 0.05). LAP volume increased with increasing keV levels and all VMIs showed a significant difference compared to T3D, except for 50 keV (28.0 ± 30.8 mm3 and 28.6 ± 30.1 mm3, respectively, p = 0.63). CONCLUSIONS Estimated coronary plaque volumes significantly differ between VMIs. Normalization protocols are needed to have comparable results between future studies, especially for LAP volume which is currently defined using a fixed HU threshold. CLINICAL RELEVANCE STATEMENT Different virtual monoenergetic images from photon-counting CT alter attenuation values and therefore corresponding plaque component volumes. New clinical standards and protocols are required to determine the optimal thresholds to derive plaque volumes from photon-counting CT. KEY POINTS • Utilizing different VMI energy levels from photon-counting CT for the analysis of coronary artery plaques leads to substantial changes in attenuation values and corresponding plaque component volumes. • Low-energy images (40-70 keV) improved contrast-to-noise ratio, however also increased image noise. • Normalization protocols are needed to have comparable results between future studies, especially for low-attenuation plaque volume which is currently defined using a fixed HU threshold.
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Affiliation(s)
- Borbála Vattay
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary.
| | - Melinda Boussoussou
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary
| | - Milán Vecsey-Nagy
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite 400, CA, 90048, Los Angeles, USA
| | - Gábor Konkoly
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary
| | - Anikó Kubovje
- Semmelweis University Medical Imaging Center, Korányi Sándor Street 2., 1082, Budapest, Hungary
| | - Florian Schwarz
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Béla Merkely
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University Heart and Vascular Center, Városmajor Street 68., 1122, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Semmelweis University Medical Imaging Center, Korányi Sándor Street 2., 1082, Budapest, Hungary
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite 400, CA, 90048, Los Angeles, USA
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29 Haller Utca, 1096, Budapest, Hungary.
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi Út 96/B, 1034, Budapest, Hungary.
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Watanabe T, Furuse Y, Akasaka T, Sasaki N, Mukai-Yatagai N, Yamamoto K. Feasibility of effective atomic number assessment in coronary intervention for chronic total occlusion. J Cardiovasc Med (Hagerstown) 2021; 22:146-148. [PMID: 33351535 DOI: 10.2459/jcm.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Molwitz I, Leiderer M, Özden C, Yamamura J. Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review. ROFO-FORTSCHR RONTG 2020; 192:1137-1153. [DOI: 10.1055/a-1212-6017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background With dual-energy computed tomography (DECT) it is possible to quantify certain elements and tissues by their specific attenuation, which is dependent on the X-ray spectrum. This systematic review provides an overview of the suitability of DECT for fat quantification in clinical diagnostics compared to established methods, such as histology, magnetic resonance imaging (MRI) and single-energy computed tomography (SECT).
Method Following a systematic literature search, studies which validated DECT fat quantification by other modalities were included. The methodological heterogeneity of all included studies was processed. The study results are presented and discussed according to the target organ and specifically for each modality of comparison.
Results Heterogeneity of the study methodology was high. The DECT data was generated by sequential CT scans, fast-kVp-switching DECT, or dual-source DECT. All included studies focused on the suitability of DECT for the diagnosis of hepatic steatosis and for the determination of the bone marrow fat percentage and the influence of bone marrow fat on the measurement of bone mineral density. Fat quantification in the liver and bone marrow by DECT showed valid results compared to histology, MRI chemical shift relaxometry, magnetic resonance spectroscopy, and SECT. For determination of hepatic steatosis in contrast-enhanced CT images, DECT was clearly superior to SECT. The measurement of bone marrow fat percentage via DECT enabled the bone mineral density quantification more reliably.
Conclusion DECT is an overall valid method for fat quantification in the liver and bone marrow. In contrast to SECT, it is especially advantageous to diagnose hepatic steatosis in contrast-enhanced CT examinations. In the bone marrow DECT fat quantification allows more valid quantification of bone mineral density than conventional methods. Complementary studies concerning DECT fat quantification by split-filter DECT or dual-layer spectral CT and further studies on other organ systems should be conducted.
Key points:
Citation Format
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Affiliation(s)
- Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Leiderer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kay FU. Dual-energy CT and coronary imaging. Cardiovasc Diagn Ther 2020; 10:1090-1107. [PMID: 32968662 PMCID: PMC7487394 DOI: 10.21037/cdt.2020.04.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy computed tomography has been proposed for enhancing the evaluation of coronary artery disease in many fronts. However, the clinical translation of such applications has followed a slower pace of clinical translation. This paper will review the evidence supporting the use of dual-energy computed tomography in coronary artery disease (CAD) and provide some practical illustrations, while underscoring the challenges and gaps in knowledge that have contributed to this phenomenon.
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Affiliation(s)
- Fernando Uliana Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Low serum level of sirtuin 1 predicts coronary atherosclerosis plaques during computed tomography angiography among an asymptomatic cohort. Coron Artery Dis 2019; 30:621-625. [DOI: 10.1097/mca.0000000000000804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Yi Y, Zhao XM, Wu RZ, Wang Y, Vembar M, Jin ZY, Wang YN. Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT. Int Heart J 2019; 60:608-617. [PMID: 31105142 DOI: 10.1536/ihj.18-340] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to investigate the performance of low keV mono-energetic reconstructions in spectral coronary computed tomography angiography (CCTA) using spectral detector CT (SDCT) with reduced contrast media and radiation dose.Sixty patients were randomly assigned to Groups A and B (both n = 30) to undergo CCTA on a dual-layer SDCT with tube voltage 120 kVp and 100 kVp (average tube current: 108.5 and 73.8 mAs, respectively), with contrast media volume of 36 mL used in both groups. The mono-energetic 40-80 keV and conventional 120 kVp images in Group A and conventional 100 kVp images in Group B were reconstructed. Quantitative and qualitative image quality (IQ) were evaluated in the aortic root and distal segments of the coronary arteries.The patient characteristics were not significantly different between the two groups (all P≥ 0.47), nor was the effective radiation dose (1.5 ± 0.3 and 1.4 ± 0.3 mSv, P = 0.20). The quantitative IQ in aorta and coronary arteries of mono-energetic 40-60 keV was superior to conventional 120 kVp and 100 kVp images (all P < 0.05). The noise in spectral images was lower compared to conventional images (all P < 0.01). The subjective IQ score of 40-50 keV images was not significantly different from that of 100 kVp images (P > 0.8).The mono-energetic 40-50 keV reconstructions from spectral CCTA using SDCT provide improved IQ compared to conventional techniques while facilitating reduced radiation dose and contrast media.
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Affiliation(s)
- Yan Yi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xue-Mei Zhao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Run-Ze Wu
- CT Clinical Science, Philips Healthcare, Cleveland
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Mani Vembar
- CT Clinical Science, Philips Healthcare, Cleveland
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Oda S, Takaoka H, Katahira K, Honda K, Nakaura T, Nagayama Y, Taguchi N, Kidoh M, Utsunomiya D, Funama Y, Noda K, Oshima S, Yamashita Y. Low contrast material dose coronary computed tomographic angiography using a dual-layer spectral detector system in patients at risk for contrast-induced nephropathy. Br J Radiol 2018; 92:20180215. [PMID: 30407841 DOI: 10.1259/bjr.20180215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE: To evaluate the effects of virtual monochromatic imaging (VMI) using dual-layer spectral detector CT on the image quality of coronary CT angiography (CCTA) acquired by using a low contrast material (CM) dose. METHODS: We used a VMI 50keV protocol with a 50% CM dose (140 mgI kg-1) to scan 30 patients with renal insufficiency and a 120 kVp with the standard CM dose (280 mgI kg-1) to scan 30 controls without renal insufficiency. Quantitative parameters, including CT attenuation, image noise, and contrast-to-noise ratio (CNR), were measured. The visual image quality factors of contrast enhancement, image noise, beam-hardening artefact, vessel sharpness, and overall image quality were scored on a 4-point scale. RESULTS: The mean CT attenuation of the ascending aorta was significantly higher for 50 keV VMI than for 120 kVp. Image noise was significantly lower under the 50 keV VMI. CNR and the mean visual score for contrast enhancement were significantly higher for 50 keV VMI. There were no significant differences in the other visual image quality parameters between the two protocols. CONCLUSION: Dual-layer spectral detector CT using 50 keV VMI enabled reducing the CM dose by 50 % without CCAT image quality degradation in patients with renal insufficiency. ADVANCES IN KNOWLEDGE: The VMI 50 keV protocol using dual-layer spectral detector CT and a CM dose reduced by 50 % (140 mgI kg-1) can improve the diagnostic image quality of CCTA.
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Affiliation(s)
- Seitaro Oda
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Hiroko Takaoka
- 2 Department of Diagnostic Radiology, Kumamoto Chuo Hospital , Kumamoto , Japan
| | - Kazuhiro Katahira
- 2 Department of Diagnostic Radiology, Kumamoto Chuo Hospital , Kumamoto , Japan
| | - Keiichi Honda
- 2 Department of Diagnostic Radiology, Kumamoto Chuo Hospital , Kumamoto , Japan
| | - Takeshi Nakaura
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Yasunori Nagayama
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Narumi Taguchi
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Masafumi Kidoh
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Daisuke Utsunomiya
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
| | - Yoshinori Funama
- 3 Department of Medical Physics, Kumamoto University , Kumamoto , Japan
| | - Katsuo Noda
- 4 Department of Cardiology, Kumamoto Chuo Hospital , Kumamoto , Japan
| | - Shuichi Oshima
- 4 Department of Cardiology, Kumamoto Chuo Hospital , Kumamoto , Japan
| | - Yasuyuki Yamashita
- 1 Department of Diagnostic Radiology, Kumamoto University , Kumamoto , Japan
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Abstract
Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the varied manifestations of vascular disease. Vascular imaging encompasses a wide variety of pathology. Designing vascular imaging protocols can be challenging owing to the non-uniform velocity of blood in the aorta, differences in cardiac output between patients, and the effect of different disease states on blood flow. In this review, we provide the rationale behind—and a practical guide to—designing and implementing straightforward vascular computed tomography (CT) and magnetic resonance imaging (MRI) protocols. Teaching Points • There is a wide range of vascular pathologies requiring bespoke imaging protocols. • Variations in cardiac output and non-uniform blood velocity complicate vascular imaging. • Contrast media dose, injection rate and duration affect arterial enhancement in CTA. • Iterative CT reconstruction can improve image quality and reduce radiation dose. • MRA is of particular value when imaging small arteries and venous studies.
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