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Pannenbecker P, Heidenreich JF, Huflage H, Gruschwitz P, Patzer TS, Weng AM, Grunz JP, Kunz AS, Bley TA, Petritsch B. The Best of Both Worlds: Ultra-high-pitch Pulmonary Angiography with Free-Breathing Technique by Means of Photon-Counting Detector CT for Diagnosis of Acute Pulmonary Embolism. Acad Radiol 2024:S1076-6332(24)00386-6. [PMID: 38969575 DOI: 10.1016/j.acra.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
RATIONALE AND OBJECTIVES To assess image quality and radiation dose of ultra-high-pitch CT pulmonary angiography (CTPA) with free-breathing technique for diagnosis of pulmonary embolism using a photon-counting detector (PCD) CT compared to matched energy-integrating detector (EID)-based single-energy CTPA. MATERIALS AND METHODS Fifty-one PCD-CTPAs were prospectively compared to 51 CTPAs on a third-generation dual-source EID-CT. CTPAs were acquired with an ultra-high-pitch protocol with free-breathing technique (40 mL contrast medium, pitch 3.2) at 140 kV (PCD) and 70-100 kV (EID). Iodine maps were reconstructed from spectral PCD-CTPAs. Image quality of CTPAs and iodine maps was assessed independently by three radiologists. Additionally, CT attenuation numbers within pulmonary arteries as well as signal-to-noise and contrast-to-noise ratios (SNR, CNR) were compared. Administered radiation dose was compared. RESULTS CT attenuation was higher in the PCD-group (all P < 0.05). CNR and SNR were higher in lobar pulmonary arteries in PCD-CTPAs (P < 0.05), whereas no difference was ascertained within the pulmonary trunk (P > 0.05). Image quality of PCD-CTPA was rated best by all readers (excellent/good image quality in 96.1% of PCD-CTPAs vs. 50.9% of EID-CTPAs). PCD-CT produced no non-diagnostic scans vs. three non-diagnostic (5.9%) EID-CTPAs. Radiation dose was lower with PCD-CT than with EID-CT (effective dose 1.33 ± 0.47 vs. 1.80 ± 0.82 mSv; all P < 0.05). CONCLUSION Ultra-high-pitch CTPA with free-breathing technique with PCD-CT allows for superior image quality with significantly reduced radiation dose and full spectral information. With the ultra-high pitch, only PCD-CTPA enables reconstruction of iodine maps containing additional functional information.
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Affiliation(s)
- Pauline Pannenbecker
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.).
| | - Julius F Heidenreich
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Henner Huflage
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Philipp Gruschwitz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Theresa S Patzer
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas M Weng
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Jan-Peter Grunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas S Kunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Thorsten A Bley
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Bernhard Petritsch
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.); Hospital Klagenfurt am Wörthersee, Department of Diagnostic and Interventional Radiology, Klagenfurt am Wörthersee, Austria (B.P.)
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Li Q, Zhang P, Zhang R, Zhang J, Tian R, Gao T, Huang Y, Zhang P, Wei W, Hong R, Wang G, Zhao J. Virtual Monoenergetic Images Facilitate Better Identification of the Arc of Riolan During Splenic Flexure Takedown. J Comput Assist Tomogr 2024; 48:640-646. [PMID: 38346810 DOI: 10.1097/rct.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study aimed to investigate whether virtual monoenergetic images (VMIs) can aid radiologists and surgeons in better identifying the arc of Riolan (AOR) and to determine the optimal kilo electron volt (keV) level. METHODS Thirty-three patients were included. Conventional images (CIs) and VMI (40-100 keV) were reconstructed using arterial phase spectral-based images. The computed tomography (CT) attenuation and noise of the AOR, the CT attenuation of the erector spinal muscle, and the background noise on VMI and CI were measured, respectively. The signal-to-noise ratio, contrast-to-noise ratio (CNR), and signal intensity ratio were calculated. The image quality of the AOR was evaluated according to a 4-point Likert grade. RESULTS The CT attenuation, noise, CNR, and signal intensity ratio of the AOR were significantly higher in VMI at 40 and 50 keV compared with CI ( P < 0.001); VMI at 40 keV was significantly higher than 50 keV ( P < 0.05). No significant difference in signal-to-noise ratio, background noise, and CT attenuation of the spinal erector muscle was observed between VMI and CI ( P > 0.05). virtual monoenergetic image at 40 keV produced the best subjective scores. CONCLUSIONS Virtual monoenergetic image at 40 keV makes it easier to observe the AOR with optimized subjective and objective image quality. This may prompt radiologists and surgeons to actively search for it and encourage surgeons to preserve it during splenic flexure takedown.
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Affiliation(s)
- Qian Li
- From the Departments of Radiology
| | - Pengfei Zhang
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | | | - Jianfeng Zhang
- The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University
| | - Ruoxi Tian
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | - Tianyi Gao
- Department of Hepatobiliary Surgery, The Third Hospital of Hebei Medical University
| | - Yu Huang
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | | | - Wei Wei
- From the Departments of Radiology
| | - Rui Hong
- From the Departments of Radiology
| | - Guiying Wang
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Remy-Jardin M, Oufriche I, Guiffault L, Duhamel A, Flohr T, Schmidt B, Remy J. Diagnosis of acute pulmonary embolism: when photon-counting-detector CT replaces energy-integrating-detector CT in daily routine. Eur Radiol 2024:10.1007/s00330-024-10724-5. [PMID: 38634875 DOI: 10.1007/s00330-024-10724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To compare the diagnostic approach of acute pulmonary embolism (PE) with photon-counting-detector CT (PCD-CT) and energy-integrating-detector CT (EID-CT). MATERIALS AND METHODS Two cohorts underwent CT angiographic examinations with EID-CT (Group 1; n = 158) and PCD-CT (Group 2; n = 172), (b) with two options in Group 1, dual energy (Group 1a) or single energy (Group 1b) and a single option in Group 2 (spectral imaging with single source). RESULTS In Group 2, all patients benefited from spectral imaging, only accessible to 105 patients (66.5%) in Group 1, with a mean acquisition time significantly shorter (0.9 ± 0.1 s vs 4.0 ± 0 .3 s; p < 0.001) and mean values of CTDIvol and DLP reduced by 46.3% and 47.7%, respectively. Comparing the quality of 70 keV (Group 2) and averaged (Group 1a) images: (a) the mean attenuation within pulmonary arteries did not differ (p = 0.13); (b) the image noise was significantly higher (p < 0.001) in Group 2 with no difference in subjective image noise (p = 0.29); and (c) 89% of examinations were devoid of artifacts in Group 2 vs 28.6% in Group 1a. The percentage of diagnostic examinations was 95.2% (100/105; Group 1a), 100% (53/53; Group 1b), and 95.3% (164/172; Group 2). There were 4.8% (5/105; Group 1a) and 4.7% (8/172; Group 2) of non-diagnostic examinations, mainly due to the suboptimal quality of vascular opacification with the restoration of a diagnostic image quality on low-energy images. CONCLUSION Compared to EID-CT, morphology and perfusion imaging were available in all patients scanned with PCD-CT, with the radiation dose reduced by 48%. CLINICAL RELEVANCE STATEMENT PCD-CT enables scanning patients with the advantages of both spectral imaging, including high-quality morphologic imaging and lung perfusion for all patients, and fast scanning-a combination that is not simultaneously accessible with EID-CT while reducing the radiation dose by almost 50%.
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Affiliation(s)
- Martine Remy-Jardin
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France.
- IMALLIANCE-Haut-de-France, Valenciennes, France.
- Department of Thoracic Imaging, University of Lille, Lille, France.
| | - Idir Oufriche
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Lucas Guiffault
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Alain Duhamel
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France
- Department of Biostatistics, University of Lille, CHU Lille, Lille, France
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Bernhard Schmidt
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Jacques Remy
- Department of Thoracic Imaging, University of Lille, Lille, France
- Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France
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Pannenbecker P, Heidenreich JF, Grunz JP, Huflage H, Gruschwitz P, Patzer TS, Feldle P, Bley TA, Petritsch B. Image Quality and Radiation Dose of CTPA With Iodine Maps: A Prospective Randomized Study of High-Pitch Mode Photon-Counting Detector CT Versus Energy-Integrating Detector CT. AJR Am J Roentgenol 2024; 222:e2330154. [PMID: 37966036 DOI: 10.2214/ajr.23.30154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND. Dual-energy CT pulmonary angiography (CTPA) with energy-integrating detector (EID) technology is limited by the inability to use high-pitch technique. OBJECTIVE. The purpose of this study was to compare the image quality of anatomic images and iodine maps between high-pitch photon-counting detector (PCD) CTPA and dual-energy EID CTPA. METHODS. This prospective study included 117 patients (70 men and 47 women; median age, 65 years) who underwent CTPA to evaluate for pulmonary embolism between March 2022 and November 2022. Fifty-eight patients were randomized to undergo PCD CTPA (pitch, 2.0), and 59 were randomized to undergo EID CTPA (pitch, 0.55). For each examination, 120-kV polychromatic images, 60-keV virtual monogenetic images (VMIs), and iodine maps were reconstructed. One radiologist measured CNR and SNR. Three radiologists independently assessed subjective image quality (on a scale of 1-4, with a score of 1 denoting highest quality). Radiation dose was recorded. RESULTS. SNR and CNR were higher for PCD CTPA than for EID CTPA for polychromatic images and VMIs, for all assessed vessels other than the left upper lobe artery. For example, for PCD CTPA versus EID CTPA, the right lower lobe artery on polychromatic images had an SNR of 34.5 versus 28.0 (p = .003) and a CNR of 29.2 versus 24.4 (p = .001), and on VMIs it had an SNR of 43.2 versus 32.7 (p = .005) and a CNR of 37.4 versus 29.3 (p = .002). For both scanners for readers 1 and 2, the median image quality score for polychromatic images and VMIs was 1, although distributions indicated significantly better scores for PCD CTPA than for EID CTPA for polychromatic images for reader 1 (p = .02) and reader 2 (p = .005) and for VMIs for reader 1 (p = .001) and reader 2 (p = .006). The image quality of anatomic image sets was not different between PCD CTPA and EID CTPA for reader 3 (p > .05). The image quality of iodine maps was not different between PCD CTPA and EID CTPA for any reader (p > .05). For PCD CTPA versus EID CTPA, the CTDIvol was 3.9 versus 4.5 mGy (p = .03), and the DLP was 123.5 mGy × cm versus 157.0 mGy × cm (p < .001). CONCLUSION. High-pitch PCD CTPA provided anatomic images with better subjective and objective image quality versus dual-energy EID CTPA, with lower radiation dose. Iodine maps showed no significant difference in image quality between scanners. CLINICAL IMPACT. CTPA may benefit from the PCD CT technique.
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Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Feldle
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
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Melzig C, Hartmann S, Steuwe A, Egger J, Do TD, Geisbüsch P, Kauczor HU, Rengier F, Fink MA. BMI-Adapted Double Low-Dose Dual-Source Aortic CT for Endoleak Detection after Endovascular Repair: A Prospective Intra-Individual Diagnostic Accuracy Study. Diagnostics (Basel) 2024; 14:280. [PMID: 38337796 PMCID: PMC10855180 DOI: 10.3390/diagnostics14030280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To assess the diagnostic accuracy of BMI-adapted, low-radiation and low-iodine dose, dual-source aortic CT for endoleak detection in non-obese and obese patients following endovascular aortic repair. METHODS In this prospective single-center study, patients referred for follow-up CT after endovascular repair with a history of at least one standard triphasic (native, arterial and delayed phase) routine CT protocol were enrolled. Patients were divided into two groups and allocated to a BMI-adapted (group A, BMI < 30 kg/m2; group B, BMI ≥ 30 kg/m2) double low-dose CT (DLCT) protocol comprising single-energy arterial and dual-energy delayed phase series with virtual non-contrast (VNC) reconstructions. An in-patient comparison of the DLCT and routine CT protocol as reference standard was performed regarding differences in diagnostic accuracy, radiation dose, and image quality. RESULTS Seventy-five patients were included in the study (mean age 73 ± 8 years, 63 (84%) male). Endoleaks were diagnosed in 20 (26.7%) patients, 11 of 53 (20.8%) in group A and 9 of 22 (40.9%) in group B. Two radiologists achieved an overall diagnostic accuracy of 98.7% and 97.3% for endoleak detection, with 100% in group A and 95.5% and 90.9% in group B. All examinations were diagnostic. The DLCT protocol reduced the effective dose from 10.0 ± 3.6 mSv to 6.1 ± 1.5 mSv (p < 0.001) and the total iodine dose from 31.5 g to 14.5 g in group A and to 17.4 g in group B. CONCLUSION Optimized double low-dose dual-source aortic CT with VNC, arterial and delayed phase images demonstrated high diagnostic accuracy for endoleak detection and significant radiation and iodine dose reductions in both obese and non-obese patients compared to the reference standard of triple phase, standard radiation and iodine dose aortic CT.
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Affiliation(s)
- Claudius Melzig
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sibylle Hartmann
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andrea Steuwe
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Jan Egger
- Institute for AI in Medicine, University Medicine Essen, 45147 Essen, Germany
| | - Thuy D. Do
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart, Katharinenhospital, 70199 Stuttgart, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Fabian Rengier
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias A. Fink
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Kazimierczak W, Kazimierczak N, Lemanowicz A, Nowak E, Migdalski A, Jawien A, Jankowski T, Serafin Z. Improved Detection of Endoleaks in Virtual Monoenergetic Images in Dual-Energy CT Angiography Following EVAR. Acad Radiol 2023; 30:2813-2824. [PMID: 37062628 DOI: 10.1016/j.acra.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES The objective of this prospective study was to evaluate the virtual monoenergetic images (VMI) and virtual noncontrast (VNC) phase in the detection of endoleaks after endovascular abdominal aortic repair (EVAR). The potential dose reduction of abbreviated examination protocols was calculated. MATERIALS AND METHODS Ninety-seven patients after the EVAR procedure were enrolled in this study. An initial single-source noncontrast acquisition was followed by two dual-energy acquisitions (arterial and 60 s delayed). Fast-kVp switching scanner was used. VNC images were reconstructed from the delayed phase. First examination session (reference) included a full triphasic study protocol consisting of true noncontrast (TNC) images and two postcontrast phases, the latter ones presented as classical polyenergetic reconstructions. Reading sessions II and III were performed by two independent and blinded readers evaluating VMIs in abbreviated protocols-biphasic (VNC + arterial, delayed phase), monophasic (VNC + delayed phase). The diagnostic accuracy of sessions II and III was calculated. RESULTS The calculated sensitivity of the biphasic protocol with the use of VMIs in endoleak detection was 100%, with a statistically significant increase in the number of endoleaks detected in comparison with the reference study. The monophasic protocol showed 83.33% sensitivity. The use of abbreviated examination protocols led to a decrease in the mean effective dose (ED) of 23.28% (biphasic protocol) and 61.37% (monophasic protocol). CONCLUSION The use of VMIs increases the number of endoleaks diagnosed with a possible radiation reduction by up to ¼ (biphasic protocol). Further reduction to a monophasic protocol leads to over 60% dose reduction but with a decrease in diagnostic accuracy.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067.
| | | | - Adam Lemanowicz
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Ewa Nowak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Arkadiusz Migdalski
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Arkadiusz Jawien
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | | | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
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Pannenbecker P, Huflage H, Grunz JP, Gruschwitz P, Patzer TS, Weng AM, Heidenreich JF, Bley TA, Petritsch B. Photon-counting CT for diagnosis of acute pulmonary embolism: potential for contrast medium and radiation dose reduction. Eur Radiol 2023; 33:7830-7839. [PMID: 37311805 PMCID: PMC10598187 DOI: 10.1007/s00330-023-09777-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the image quality of an ultra-low contrast medium and radiation dose CT pulmonary angiography (CTPA) protocol for the diagnosis of acute pulmonary embolism using a clinical photon-counting detector (PCD) CT system and compare its performance to a dual-energy-(DE)-CTPA protocol on a conventional energy-integrating detector (EID) CT system. METHODS Sixty-four patients either underwent CTPA with the novel scan protocol on the PCD-CT scanner (32 patients, 25 mL, CTDIvol 2.5 mGy·cm) or conventional DE-CTPA on a third-generation dual-source EID-CT (32 patients, 50 mL, CTDIvol 5.1 mGy·cm). Pulmonary artery CT attenuation, signal-to-noise ratio, and contrast-to-noise-ratio were assessed as objective criteria of image quality, while subjective ratings of four radiologists were compared at 60 keV using virtual monoenergetic imaging and polychromatic standard reconstructions. Interrater reliability was determined by means of the intraclass correlation coefficient (ICC). Effective dose was compared between patient cohorts. RESULTS Subjective image quality was deemed superior by all four reviewers for 60-keV PCD scans (excellent or good ratings in 93.8% of PCD vs. 84.4% of 60 keV EID scans, ICC = 0.72). No examinations on either system were considered "non-diagnostic." Objective image quality parameters were significantly higher in the EID group (mostly p < 0.001), both in the polychromatic reconstructions and at 60 keV. The ED (1.4 vs. 3.3 mSv) was significantly lower in the PCD cohort (p < 0.001). CONCLUSIONS PCD-CTPA allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism, while maintaining good to excellent image quality compared to conventional EID-CTPA. CLINICAL RELEVANCE STATEMENT Clinical PCD-CT allows for spectral assessment of pulmonary vasculature with high scan speed, which is beneficial in patients with suspected pulmonary embolism, frequently presenting with dyspnea. Simultaneously PCD-CT enables substantial reduction of contrast medium and radiation dose. KEY POINTS • The clinical photon-counting detector CT scanner used in this study allows for high-pitch multi-energy acquisitions. • Photon-counting computed tomography allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism. • Subjective image quality was rated best for 60-keV photon-counting scans.
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Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany.
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
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Kazimierczak W, Nowak E, Kazimierczak N, Jankowski T, Jankowska A, Serafin Z. The value of metal artifact reduction and iterative algorithms in dual energy CT angiography in patients after complex endovascular aortic aneurysm repair. Heliyon 2023; 9:e20700. [PMID: 37876478 PMCID: PMC10590777 DOI: 10.1016/j.heliyon.2023.e20700] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023] Open
Abstract
Rationale and objectives Evaluation of the diagnostic value of linearly blended (LB) and virtual monoenergetic images (VMI) reconstruction techniques with and without metal artifacts reduction (MAR) and of adaptive statistical iterative reconstructions (ASIR) in the assessment of target vessels after branched/fenestrated endovascular aortic repair (f/brEVAR) procedures. Materials and methods CT scans of 28 patients were used in this study. Arterial phase of examination was obtained using a dual-energy fast-kVp switching scanner. CT numbers in the aorta, celiac trunk, superior mesenteric artery, and renal arteries were measured in the following reconstructions: LB, VMI 60 keV, VMI MAR 60 keV, VMI ASIR 60 % 60 keV. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated for each reconstruction. Luminal diameters (measurements at 2 levels of stent) and subjective image quality (5-point Likert scale) were assessed (2 readers, blinded to the type of reconstruction). Results The highest mean values of CNR and SNR in vascular structures were obtained in VMI MAR 60 keV (CNR 12.526 ± 2.46, SNR 17.398 ± 2.52), lower in VMI 60 keV (CNR 11.508 ± 2.01, SNR 16.524 ± 2.07) and VMI ASIR (CNR 11.086 ± 1.78, SNR 15.928 ± 1.82), and the lowest in LB (CNR 6.808 ± 0.79, SNR 11.492 ± 0.79) reconstructions. There were no statistically significant differences in the measurements of the stent width between reconstructions (p > 0.05). The highest subjective image quality was obtained in the ASIR VMI (4.25 ± 0.44) and the lowest in the MAR VMI (1.57 ± 0.5) reconstruction. Conclusion Despite obtaining the highest values of SNR and CNR in the MAR VMI reconstruction, the subjective diagnostic value was the lowest for this technique due to significant artifacts. The type of reconstruction did not significantly affect vessel diameter measurements (p > 0.05). Iterative reconstructions raised both objective and subjective image quality.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Ewa Nowak
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Tomasz Jankowski
- Jankowscy Private Dental Practice, Czerwonego Krzyża 24, 68-200, Żary, Poland
| | - Agnieszka Jankowska
- Jankowscy Private Dental Practice, Czerwonego Krzyża 24, 68-200, Żary, Poland
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
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9
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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10
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Si-Mohamed SA, Zumbihl L, Turquier S, Boccalini S, Mornex JF, Douek P, Cottin V, Boussel L. Lung Dual-Energy CT Perfusion Blood Volume as a Marker of Severity in Chronic Thromboembolic Pulmonary Hypertension. Diagnostics (Basel) 2023; 13:diagnostics13040769. [PMID: 36832256 PMCID: PMC9955200 DOI: 10.3390/diagnostics13040769] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
In chronic thromboembolic pulmonary hypertension (CTEPH), assessment of severity requires right heart catheterization (RHC) through cardiac index (CI). Previous studies have shown that dual-energy CT allows a quantitative assessment of the lung perfusion blood volume (PBV). Therefore, the objective was to evaluate the quantitative PBV as a marker of severity in CTEPH. In the present study, thirty-three patients with CTEPH (22 women, 68.2 ± 14.8 years) were included from May 2017 to September 2021. Mean quantitative PBV was 7.6% ± 3.1 and correlated with CI (r = 0.519, p = 0.002). Mean qualitative PBV was 41.1 ± 13.4 and did not correlate with CI. Quantitative PBV AUC values were 0.795 (95% CI: 0.637-0.953, p = 0.013) for a CI ≥ 2 L/min/m2 and 0.752 (95% CI: 0.575-0.929, p = 0.020) for a CI ≥ 2.5 L/min/m2. In conclusion, quantitative lung PBV outperformed qualitative PBV for its correlation with the cardiac index and may be used as a non-invasive marker of severity in CTPEH patients.
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Affiliation(s)
- Salim A. Si-Mohamed
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
- Correspondence: ; Tel.: +33-04-7235-7335
| | - Léa Zumbihl
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
| | - Ségolène Turquier
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Sara Boccalini
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Jean-Francois Mornex
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Philippe Douek
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Loic Boussel
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
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11
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Multi-Energy CT Applications. Radiol Clin North Am 2023; 61:1-21. [DOI: 10.1016/j.rcl.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Value of low-keV virtual monoenergetic plus dual-energy computed tomographic imaging for detection of acute pulmonary embolism. PLoS One 2022; 17:e0277060. [DOI: 10.1371/journal.pone.0277060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective
To compare diagnostic values between the 40 keV virtual monoenergetic plus (40 keV VMI+) dual source dual energy computed tomography (DSDECT) pulmonary angiography images and the standard mixed (90 and 150 kV) images for the detection of acute pulmonary embolism (PE).
Methods
Chest DSDECTs of 64 patients who were suspected of having acute PE were retrospectively reviewed by two independent reviewers. The assessments of acute PE of all patients on a per-location basis were compared between the 40 keV VMI+ and the standard mixed datasets (reference standard) with a two-week interval.
Results
This study consisted of 64 patients (33 women and 31 men; mean age, 60.2 years; range 18–90 years), with a total of 512 locations. The interobserver agreement (Kappa) for detection of acute PE using the 40 keV VMI+ images and the standard mixed CT images were 0.7478 and 0.8750 respectively. The area under receiver operating characteristics (AuROC) for diagnosis of acute PE using the 40 keV VMI+ was 0.882. Four locations (0.78%) revealed a false negative result. Hypodense filling defects were identified in twelve locations (1.95%) in the 40 keV VMI+ images but had been interpreted as a negative study in the standard mixed CT images. The repeated reviews revealed that each location contained a hypodense filling defect but was overlooked on the standard mixed CT images.
Conclusions
Low-energy VMI + DSDECT images have beneficial in improving the diagnostic value of acute PE in doubtful or disregarded standard mixed images.
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13
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Yalynska T, Polacin M, Frauenfelder T, Martini K. Impact of Photon Counting Detector CT Derived Virtual Monoenergetic Images on the Diagnosis of Pulmonary Embolism. Diagnostics (Basel) 2022; 12:diagnostics12112715. [PMID: 36359558 PMCID: PMC9689164 DOI: 10.3390/diagnostics12112715] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose: To assess the impact of virtual-monoenergetic-image (VMI) energies on the diagnosis of pulmonary embolism (PE) in photon-counting-detector computed-tomography (PCD-CT). Methods: Eighty patients (median age 60.4 years) with suspected PE were retrospectively included. Scans were performed on PCD-CT in the multi-energy mode at 120 kV. VMIs from 40−70 keV in 10 keV intervals were reconstructed. CT-attenuation was measured in the pulmonary trunk and the main branches of the pulmonary artery. Signal-to-noise (SNR) ratio was calculated. Two radiologists evaluated subjective-image-quality (noise, vessel-attenuation and sharpness; five-point-Likert-scale, non-diagnostic−excellent), the presence of hardening artefacts and presence/visibility of PE. Results: Signal was highest at the lowest evaluated VMI (40 keV; 1053.50 HU); image noise was lowest at the highest VMI (70 keV; 15.60 HU). Highest SNR was achieved at the lowest VMI (p < 0.05). Inter-reader-agreement for subjective analysis was fair to excellent (k = 0.373−1.000; p < 0.001). Scores for vessel-attenuation and sharpness were highest at 40 keV (both:5, range 4/3−5; k = 1.000); scores for image-noise were highest at 70 keV (4, range 3−5). The highest number of hardening artifacts were reported at 40 keV (n = 22; 28%). PE-visualization was rated best at 50 keV (4.7; range 4−5) and decreased with increasing VMI-energy (r = −0.558; p < 0.001). Conclusions: While SNR was best at 40 keV, subjective PE visibility was rated highest at 50 keV, potentially owing to the lower image noise and hardening artefacts.
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14
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Toia GV, Mileto A, Wang CL, Sahani DV. Quantitative dual-energy CT techniques in the abdomen. Abdom Radiol (NY) 2022; 47:3003-3018. [PMID: 34468796 DOI: 10.1007/s00261-021-03266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Advances in dual-energy CT (DECT) technology and spectral techniques are catalyzing the widespread implementation of this technology across multiple radiology subspecialties. The inclusion of energy- and material-specific datasets has ushered overall improvements in CT image contrast and noise as well as artifacts reduction, leading to considerable progress in radiologists' ability to detect and characterize pathologies in the abdomen. The scope of this article is to provide an overview of various quantitative clinical DECT applications in the abdomen and pelvis. Several of the reviewed applications have not reached mainstream clinical use and are considered investigational. Nonetheless awareness of such applications is critical to having a fully comprehensive knowledge base to DECT and fostering future clinical implementation.
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Affiliation(s)
- Giuseppe V Toia
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Mailbox 3252, Madison, WI, 53792, USA.
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Carolyn L Wang
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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15
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Martin SS, Kolaneci J, Czwikla R, Booz C, Gruenewald LD, Albrecht MH, Thompson ZM, Lenga L, Yel I, Vogl TJ, Wichmann JL, Koch V. Dual-Energy CT for the Detection of Portal Vein Thrombosis: Improved Diagnostic Performance Using Virtual Monoenergetic Reconstructions. Diagnostics (Basel) 2022; 12:diagnostics12071682. [PMID: 35885585 PMCID: PMC9317258 DOI: 10.3390/diagnostics12071682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To investigate the diagnostic performance of noise-optimized virtual monoenergetic images (VMI+) in dual-energy CT (DECT) of portal vein thrombosis (PVT) compared to standard reconstructions. Method: This retrospective, single-center study included 107 patients (68 men; mean age, 60.1 ± 10.7 years) with malignant or cirrhotic liver disease and suspected PVT who had undergone contrast-enhanced portal-phase DECT of the abdomen. Linearly blended (M_0.6) and virtual monoenergetic images were calculated using both standard VMI and noise-optimized VMI+ algorithms in 20 keV increments from 40 to 100 keV. Quantitative measurements were performed in the portal vein for objective contrast-to-noise ratio (CNR) calculation. The image series showing the greatest CNR were further assessed for subjective image quality and diagnostic accuracy of PVT detection by two blinded radiologists. Results: PVT was present in 38 subjects. VMI+ reconstructions at 40 keV revealed the best objective image quality (CNR, 9.6 ± 4.3) compared to all other image reconstructions (p < 0.01). In the standard VMI series, CNR peaked at 60 keV (CNR, 4.7 ± 2.1). Qualitative image parameters showed the highest image quality rating scores for the 60 keV VMI+ series (median, 4) (p ≤ 0.03). The greatest diagnostic accuracy for the diagnosis of PVT was found for the 40 keV VMI+ series (sensitivity, 96%; specificity, 96%) compared to M_0.6 images (sensitivity, 87%; specificity, 92%), 60 keV VMI (sensitivity, 87%; specificity, 97%), and 60 keV VMI+ reconstructions (sensitivity, 92%; specificity, 97%) (p ≤ 0.01). Conclusions: Low-keV VMI+ reconstructions resulted in significantly improved diagnostic performance for the detection of PVT compared to other DECT reconstruction algorithms.
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Affiliation(s)
- Simon S. Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA;
- Correspondence: ; Tel.: +49-(0)69-6301-80414; Fax: +49-(0)69-6301-7288
| | - Jetlir Kolaneci
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Rouben Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Leon D. Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Moritz H. Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Zachary M. Thompson
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Julian L. Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (J.K.); (R.C.); (C.B.); (L.D.G.); (M.H.A.); (L.L.); (I.Y.); (T.J.V.); (J.L.W.); (V.K.)
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16
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Cantarinha A, Bassil C, Savignac A, Devilder M, Maxwell F, Crézé M, Purcell YM, Bellin MF, Meyrignac O, Dillenseger JP. "Triple low" free-breathing CTPA protocol for patients with dyspnoea. Clin Radiol 2022; 77:e628-e635. [PMID: 35688771 DOI: 10.1016/j.crad.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the performance of a "triple-low" free-breathing protocol for computed tomography pulmonary angiography (CTPA) evaluated on patients with dyspnoea and suspected pulmonary embolism and discuss its application in routine clinical practice for the study of the pulmonary parenchyma and vasculature. MATERIAL AND METHODS This study was conducted on a selected group of dyspnoeic patients referred for CTPA. The protocol was designed using fast free-breathing acquisition and a small, fixed volume (35 ml) of contrast agent in order to achieve a low-exposure dose. For each examination, radiodensity of the pulmonary trunk and ascending aorta, and the dose-length product (DLP) were recorded. A qualitative analysis was performed of pulmonary arterial enhancement and the pulmonary parenchyma. RESULTS This study included 134 patients. Contrast enhancement of the pulmonary arteries (409 ± 159 HU) was systematically >250 HU. The duration of acquisition ranged from 0.9 to 1.3 seconds for free-breathing imaging. The mean DLP was in the range of low-dose chest CT acquisitions (145 ± 73 mGy·cm). The analysis was deemed optimal in 90% (120/134) of cases for the pulmonary parenchyma. Sixty-nine per cent (92/134) of cases demonstrated homogeneous enhancement of the pulmonary arteries to the subsegmental level. Only 6% (8/134) of examinations were considered uninterpretable. CONCLUSION The present "triple-low" CTPA protocol allows convenient analysis of the pulmonary parenchyma and arteries without hindrance by respiratory motion artefacts in dyspnoeic patients.
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Affiliation(s)
- A Cantarinha
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - C Bassil
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - A Savignac
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - M Devilder
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - F Maxwell
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - M Crézé
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Y M Purcell
- Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - M-F Bellin
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - O Meyrignac
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - J-P Dillenseger
- Faculté de Médecine, Maïeutique, et Sciences de la Santé, Université de Strasbourg, Strasbourg, France; ICube-UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France.
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17
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Noda Y, Kawai N, Kawamura T, Kobori A, Miyase R, Iwashima K, Kaga T, Miyoshi T, Hyodo F, Kato H, Matsuo M. Radiation and iodine dose reduced thoraco-abdomino-pelvic dual-energy CT at 40 keV reconstructed with deep learning image reconstruction. Br J Radiol 2022; 95:20211163. [PMID: 35230135 PMCID: PMC10996425 DOI: 10.1259/bjr.20211163] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of a simultaneous reduction of radiation and iodine doses in dual-energy thoraco-abdomino-pelvic CT reconstructed with deep learning image reconstruction (DLIR). METHODS Thoraco-abdomino-pelvic CT was prospectively performed in 111 participants; 52 participants underwent a standard-dose single-energy CT with a standard iodine dose (600 mgI/kg; SD group), while 59 underwent a low-dose dual-energy CT with a reduced iodine dose [300 mgI/kg; double low-dose (DLD) group]. CT data were reconstructed with a hybrid iterative reconstruction in the SD group and a high-strength level of DLIR at 40 keV in the DLD group. Two radiologists measured the CT numbers of the descending and abdominal aorta, portal vein, hepatic vein, inferior vena cava, liver, pancreas, spleen, and kidney, and background noise. Two other radiologists assessed diagnostic acceptability using a 5-point scale. The CT dose-index volume (CTDIvol), iodine weight, CT numbers of anatomical structures, background noise, and diagnostic acceptability were compared between the two groups using Mann-Whitney U test. RESULTS The median CTDIvol [10 mGy; interquartile range (IQR), 9-13 mGy vs 4 mGy; IQR, 4-5 mGy] and median iodine weight (35 g; IQR, 31-38 g vs 16 g; IQR, 14-18 g) were lower in the DLD group than in the SD group (p < 0.001 for each). The CT numbers of all anatomical structures and background noise were higher in the DLD group than in the SD group (p < 0.001 for all). The diagnostic image quality was obtained in 100% (52/52) of participants in the SD group and 95% (56/59) of participants in the DLD group. CONCLUSION Virtual monochromatic images at 40 keV reconstructed with DLIR could achieve half doses of radiation and iodine while maintaining diagnostic image quality. ADVANCES IN KNOWLEDGE Virtual monochromatic images at 40 keV reconstructed with DLIR algorithm allowed to reduce the doses of radiation and iodine while maintaining diagnostic image quality.
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Affiliation(s)
| | | | | | | | - Rena Miyase
- Department of Radiology, Gifu University,
Gifu, Japan
| | - Ken Iwashima
- Department of Radiology, Gifu University,
Gifu, Japan
| | - Tetsuro Kaga
- Department of Radiology, Gifu University,
Gifu, Japan
| | - Toshiharu Miyoshi
- Department of Radiology Services, Gifu University
Hospital, Gifu,
Japan
| | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu
University, Gifu,
Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University,
Gifu, Japan
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18
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Ananthakrishnan L, Kay FU, Zeikus EA, Chu ES, Chang J, Barr JD, Rofsky NM, Abbara S. What the Baby Formula and Medical Contrast Material Shortages Have in Common: Insights and Recommendations for Managing the Iodinated Contrast Media Shortage. Radiol Cardiothorac Imaging 2022; 4:e220101. [PMID: 35833167 PMCID: PMC9274312 DOI: 10.1148/ryct.220101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 05/25/2023]
Abstract
The impact of supply chain and supply chain logistics, including personnel directly and indirectly related to the movement of supplies, has come to light in a variety of industries since the global COVID-19 pandemic. Acutely, the experience with baby formula and iodinated contrast material exposes key vulnerabilities to supply chains. The rather sudden diminished availability of iodinated contrast material has forced health care systems to engage in more judicious use of product through catalyzing the adoption of behaviors that had been recommended and deemed reasonable prior to the shortage. The authors describe efforts at a large, academic safety net county health system to conserve iodinated contrast media by optimizing contrast media use in the CT department and changing ordering patterns of referring providers. Special attention is given to opportunities to conserve contrast material in cardiothoracic imaging, including low kV and dual-energy CT techniques. A values-based leadership philosophy and collaboration with key stakeholders facilitate effective response to the critical shortage and rapid deployment of iodinated contrast media conservation strategies. Last, while the single-supplier model is efficient and cost-effective, its application to critically necessary services such as health care must be questioned considering disruptions related to the COVID-19 pandemic. Keywords: CT, Intravenous Contrast Agents, CT-Spectral Imaging (Dual Energy) ©RSNA, 2022.
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19
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Michael AE, Boriesosdick J, Schoenbeck D, Lopez-Schmidt I, Kroeger JR, Moenninghoff C, Horstmeier S, Pennig L, Borggrefe J, Niehoff JH. Photon Counting CT Angiography of the Head and Neck: Image Quality Assessment of Polyenergetic and Virtual Monoenergetic Reconstructions. Diagnostics (Basel) 2022; 12:diagnostics12061306. [PMID: 35741116 PMCID: PMC9222087 DOI: 10.3390/diagnostics12061306] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of the present study was the evaluation of the image quality of polyenergetic and monoenergetic reconstructions (PERs and MERs) of CT angiographies (CTAs) of the head and neck acquired with the novel photon counting CT (PCCT) method in clinical routine. Methods: Thirty-seven patients were enrolled in this retrospective study. Quantitative image parameters of the extracranial, intracranial and cerebral arteries were evaluated for the PER and MER (40–120 keV). Additionally, two radiologists rated the perceived image quality. Results: The mean CTDIvol used in the PCCT was 8.31 ± 1.19 mGy. The highest signal within the vessels was detected in the 40 keV MER, whereas the lowest noise was detected in the 115 keV MER. The most favorable contrast-to-noise-ratio (CNR) and signal-to-noise-ratio (SNR) were detected in the PER and low keV MER. In the qualitative image analysis, the PER was superior to the MER in all rated criteria. For MER, 60–65 keV was rated as best image quality. Conclusion: Overall, PCCT offers excellent image quality for CTAs of the head and neck. At the current state, the PER of the PCCT seems to be the most favorable reconstruction for diagnostic reporting.
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Affiliation(s)
- Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
- Correspondence: ; Tel.: +49-571-790-4601
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Ingo Lopez-Schmidt
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Sebastian Horstmeier
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Lenhard Pennig
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
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20
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Dual-layer spectral detector CT for contrast agent concentration, dose and injection rate reduction: Utility in imaging of the superior mesenteric artery. Eur J Radiol 2022; 150:110246. [DOI: 10.1016/j.ejrad.2022.110246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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21
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Prospective Study of Low-Radiation and Low-Iodine Dose Aortic CT Angiography in Obese and Non-Obese Patients: Image Quality and Impact of Patient Characteristics. Diagnostics (Basel) 2022; 12:diagnostics12030675. [PMID: 35328228 PMCID: PMC8947155 DOI: 10.3390/diagnostics12030675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to prospectively analyse image quality and radiation dose of body mass index (BMI)-adapted low-radiation and low-iodine dose CTA of the thoracoabdominal aorta in obese and non-obese patients. This prospective, single-centre study included patients scheduled for aortic CTA between November 2017 and August 2020 without symptoms of high-grade heart failure. A BMI-adapted protocol was used: Group A/Group B, BMI < 30/≥ 30 kg/m2, tube potential 80/100 kVp, total iodine dose 14.5/17.4 g. Intraindividual comparison with the institutional clinical routine aortic CTA protocol was performed. The final study cohort comprised 161 patients (mean 71.1 ± 9.4 years, 32 women), thereof 126 patients in Group A (mean BMI 25.4 ± 2.8 kg/m2) and 35 patients in Group B (34.0 ± 3.4 kg/m2). Mean attenuation over five aortoiliac measurement positions for Group A/B was 354.9 ± 78.2/262.1 ± 73.0 HU. Mean effective dose for Group A/B was 3.05 ± 0.46/6.02 ± 1.14 mSv. Intraindividual comparison in 50 patients demonstrated effective dose savings for Group A/B of 34.4 ± 14.5/25.4 ± 14.1% (both p < 0.001), and iodine dose savings for Group A/B of 54/44.8%. Regression analysis showed that female sex and increasing age were independently associated with higher vascular attenuation. In conclusion, BMI-adapted, low-radiation and low-iodine dose CTA of the thoracoabdominal aorta delivers diagnostic image quality in non-obese and obese patients without symptoms of high-grade heart failure, with superior image quality in females and the elderly.
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22
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Impact of Contrast Enhancement and Virtual Monoenergetic Image Energy Levels on Emphysema Quantification. Invest Radiol 2022; 57:359-365. [DOI: 10.1097/rli.0000000000000848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Vlahos I, Jacobsen MC, Godoy MC, Stefanidis K, Layman RR. Dual-energy CT in pulmonary vascular disease. Br J Radiol 2022; 95:20210699. [PMID: 34538091 PMCID: PMC8722250 DOI: 10.1259/bjr.20210699] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023] Open
Abstract
Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
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Affiliation(s)
- Ioannis Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rick R Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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24
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Dai G, Duan J, Zheng L, He M, Dai Y, Zhang M, Chu S. Comparison of lung image quality between CT Ark and Brilliance 64 CT during COVID-19. BMC Med Imaging 2021; 21:192. [PMID: 34903187 PMCID: PMC8666470 DOI: 10.1186/s12880-021-00720-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/26/2021] [Indexed: 01/22/2023] Open
Abstract
AIM This study is to compare the lung image quality between shelter hospital CT (CT Ark) and ordinary CT scans (Brilliance 64) scans. METHODS The patients who received scans with CT Ark or Brilliance 64 CT were enrolled. Their lung images were divided into two groups according to the scanner. The objective evaluation methods of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were used. The subjective evaluation methods including the evaluation of the fine structure under the lung window and the evaluation of the general structure under the mediastinum window were compared. Kappa method was used to assess the reliability of the subjective evaluation. The subjective evaluation results were analyzed using the Wilcoxon rank sum test. SNR and CNR were tested using independent sample t tests. RESULTS There was no statistical difference in somatotype of enrolled subjects. The Kappa value between the two observers was between 0.68 and 0.81, indicating good consistency. For subjective evaluation results, the rank sum test P value of fine structure evaluation and general structure evaluation by the two observers was ≥ 0.05. For objective evaluation results, SNR and CNR between the two CT scanners were significantly different (P<0.05). Notably, the absolute values of SNR and CNR of the CT Ark were larger than Brilliance 64 CT scanner. CONCLUSION CT Ark is fully capable of scanning the lungs of the COVID-19 patients during the epidemic in the shelter hospital.
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Affiliation(s)
- Gonghua Dai
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China
| | - Jiying Duan
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China
| | - Liang Zheng
- Research Center for Translation Medicine, East Hospital, Tongji University, Shanghai, 200120, China
| | - Miao He
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China
| | - Yanshan Dai
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China
- China International Emergency Medical Team, Shanghai, 200120, China
| | - Mingming Zhang
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China
- China International Emergency Medical Team, Shanghai, 200120, China
| | - Shuguang Chu
- Department of Radiology, East Hospital, Tongji University, No. 150, Jimo Road, Pudong New District, Shanghai, 200120, China.
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25
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Exploring the best monochromatic energy level in dual energy spectral imaging for coronary stents after percutaneous coronary intervention. Sci Rep 2021; 11:17576. [PMID: 34475491 PMCID: PMC8413443 DOI: 10.1038/s41598-021-97035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022] Open
Abstract
In this study, the optimal monochromatic energy level in dual-energy spectral CT required for imaging coronary stents after percutaneous coronary intervention (PCI) was explored. Thirty-five consecutive patients after PCI were examined using the dual-energy spectral CT imaging mode. The original images were reconstructed at 40–140 keV (10-keV interval) monochromatic levels. The in-stent and out-stent CT values at each monochromatic level were measured to calculate the signal-to-noise ratio(SNR) and contrast-to-noise ratio (CNR) for the vessel and the CT value difference between the in-stent and out-stent lumen (dCT (in–out)), which reflects the artificial CT number increase due to the beam hardening effect caused by the stents. The subjective image quality of the stent and in-stent vessel was evaluated by two radiologists using a 5-point scale. With the increase in energy level, the CT value, SNR, CNR, and dCT (in–out) all decreased. At 80 keV, the mean CT value in-stent reached (345.24 ± 93.43) HU and dCT (in–out) started plateauing. In addition, the subjective image quality of the stents and vessels peaked at 80 keV. The 80 keV monochromatic images are optimal for imaging cardiac patients with stents after PCI, balancing the enhancement and SNR and CNR in the vessels while minimizing the beam hardening artifacts caused by the stents.
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26
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Noda Y, Nakamura F, Kawai N, Suzuki R, Miyoshi T, Ishihara T, Hyodo F, Kambadakone AR, Matsuo M. Optimized Bolus Threshold for Dual-Energy CT Angiography with Monoenergetic Images: A Randomized Clinical Trial. Radiology 2021; 300:615-623. [PMID: 34128721 DOI: 10.1148/radiol.2021210102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The bolus-tracking technique from single-energy CT has been applied to dual-energy CT (DECT) without optimization or validation. Further optimization is imperative because of a paucity of literature and differences in the attenuation profile of virtual monoenergetic images (VMIs). Purpose To determine the optimal trigger threshold with bolus-tracking technique for DECT angiography (DECTA) in a phantom study and assess the feasibility of an optimized threshold for bolus-tracking technique in DECTA at 40 keV with a 50% reduced iodine dose in human participants. Materials and Methods A phantom study with rapid kilovoltage-switching DECT was performed to determine the optimal threshold for each kiloelectron-volt VMI. In a prospective study, consecutive participants who underwent whole-body CT angiography (CTA) from August 2018 to July 2019 were randomized into three groups: single-energy CTA (SECTA) with standard iodine dose (600 mg of iodine per kilogram), DECTA with 50% reduced iodine dose (300 mg of iodine per kilogram) by using a conventional threshold, and DECTA with 300 mg of iodine per kilogram by using an optimized threshold. A trigger threshold of 100 HU at 120 kVp was used as a reference for comparison. Injected iodine doses and aortic CT numbers were compared among the three groups using Kruskal-Wallis test. Results Ninety-six participants (mean age ± standard deviation, 72 years ± 9; 80 men) were evaluated (32 participants in each group). The optimized threshold for VMIs at 40 keV was 30 HU. The median iodine dose was lower in the optimized DECTA group (13 g) compared with conventional DECTA (19 g) and SECTA (26 g) groups (P < .017 for each comparison). The median aortic CT numbers were higher in the order corresponding to conventional DECTA (655-769 HU), optimized DECTA (543-610 HU), and SECTA (343-359 HU) groups (P < .001). Conclusion The optimized trigger threshold of 30 HU for bolus-tracking technique during dual-energy CT angiography at 40 keV achieved lower iodine load while maintaining aortic enhancement. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.
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Affiliation(s)
- Yoshifumi Noda
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fumihiko Nakamura
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Nobuyuki Kawai
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Ryosuke Suzuki
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Toshiharu Miyoshi
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Takuma Ishihara
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fuminori Hyodo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Avinash R Kambadakone
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Masayuki Matsuo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
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Simulated twin-phase pancreatic CT generated using single portal venous phase dual-energy CT acquisition in pancreatic ductal adenocarcinoma. Abdom Radiol (NY) 2021; 46:2610-2619. [PMID: 33454806 DOI: 10.1007/s00261-020-02921-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of a simulated twin-phase pancreatic protocol CT generated from a single portal venous phase (PVP) dual-energy CT (DECT) acquisition in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS In this retrospective study, we included 63 patients with PDAC who underwent pancreatic protocol (pancreatic phase [PP] and PVP) DECT. Two data sets were created from this original acquisition-(1) Standard protocol (50 keV PP/65 keV PVP) and (2) Simulated protocol (40 keV/65 keV PVP). Using a 5-point scale, three readers scored image quality, tumor conspicuity, and arterial involvement by the PDAC. Signal-to-noise ratio (SNR) of the pancreas and tumor-to-pancreas contrast-to-noise ratio (CNR) were calculated. Qualitative scores, quantitative parameters, and radiation dose were compared between standard and simulated protocols. RESULTS No significant difference in detection rate of PDAC was seen between the standard (58/63, 92.1%) and simulated protocols (56/63, 88.9%) (P = 0.76). Subjective scoring for arterial involvement for celiac (P = 0.86), superior mesenteric (P = 0.88), splenic (P = 0.86), common hepatic (P = 0.52), gastroduodenal (P = 0.95), first jejunal (P = 0.48) arteries, and aorta (P = 1.00) were comparable between two protocols. The image quality (P = 0.14), the SNR of the pancreas (P = 0.15), and CNR (P = 0.54) were comparable between two protocols. The projected mean dose-length product (DLP) (629.6 ± 148.3 mGy cm) in the simulated protocol showed a 44% reduction in radiation dose compared to the standard protocol (mean DLP, 1123.3 ± 268.9 mGy cm) (P < 0.0001). CONCLUSIONS Low keV images generated from a PVP DECT acquisition allows creation of a twin-phase pancreatic protocol CT with comparable diagnostic accuracy for detecting PDAC with significant reduction in radiation dose. Reduced radiation dose is desirable in surveillance and screening for pancreatic diseases.
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Petritsch B, Pannenbecker P, Weng AM, Grunz JP, Veldhoen S, Bley TA, Kosmala A. Split-filter dual-energy CT pulmonary angiography for the diagnosis of acute pulmonary embolism: a study on image quality and radiation dose. Quant Imaging Med Surg 2021; 11:1817-1827. [PMID: 33936967 DOI: 10.21037/qims-20-740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Computed tomography (CT) pulmonary angiography is the diagnostic reference standard in suspected pulmonary embolism (PE). Favorable results for dual-energy CT (DECT) images have been reported for this condition. Nowadays, dual-energy data acquisition is feasible with different technical options, including a single-source split-filter approach. Therefore, the aim of this retrospective study was to investigate image quality and radiation dose of thoracic split-filter DECT in comparison to conventional single-energy CT in patients with suspected PE. Methods A total of 110 CT pulmonary angiographies were accomplished either as standard single-energy CT with automatic tube voltage selection (ATVS) (n=58), or as split-filter DECT (n=52). Objective [pulmonary artery CT attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] and subjective image quality [four-point Likert scale; three readers (R)] were compared among the two study groups. Size-specific dose estimates (SSDE), dose-length-product (DLP) and volume CT dose index (CTDIvol) were assessed for radiation dose analysis. Results Split-filter DECT images yielded 67.7% higher SNR (27.0 vs. 16.1; P<0.001) and 61.9% higher CNR (22.5 vs. 13.9; P<0.001) over conventional single-energy images, whereas CT attenuation was significantly lower (344.5 vs. 428.2 HU; P=0.013). Subjective image quality was rated good or excellent in 93.0%/98.3%/77.6% (R1/R2/R3) of the single-energy CT scans, and 84.6%/82.7%/80.8% (R1/R2/R3) of the split-filter DECT scans. SSDE, DLP and CTDIvol were significantly lower for conventional single-energy CT compared to split-filter DECT (all P<0.05), which was associated with 26.7% higher SSDE. Conclusions In the diagnostic workup of acute PE, the split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners. The existing opportunity to assess pulmonary "perfusion" based on analysis of iodine distribution maps is associated with higher radiation dose in terms of increased SSDE than conventional single-energy CT with ATVS. Moreover, a proportion of up to 3.8% non-diagnostic examinations in the current reference standard test for PE is not negligible.
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Affiliation(s)
- Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Hamid S, Nasir MU, So A, Andrews G, Nicolaou S, Qamar SR. Clinical Applications of Dual-Energy CT. Korean J Radiol 2021; 22:970-982. [PMID: 33856133 PMCID: PMC8154785 DOI: 10.3348/kjr.2020.0996] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 01/05/2023] Open
Abstract
Dual-energy CT (DECT) provides insights into the material properties of tissues and can differentiate between tissues with similar attenuation on conventional single-energy imaging. In the conventional CT scanner, differences in the X-ray attenuation between adjacent structures are dependent on the atomic number of the materials involved, whereas in DECT, the difference in the attenuation is dependent on both the atomic number and electron density. The basic principle of DECT is to obtain two datasets with different X-ray energy levels from the same anatomic region and material decomposition based on attenuation differences at different energy levels. In this article, we discuss the clinical applications of DECT and its potential robust improvements in performance and postprocessing capabilities.
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Affiliation(s)
- Saira Hamid
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada.
| | - Muhammad Umer Nasir
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron So
- Department of Medical Biophyics, Schulich School of Medicine and Dentistry Western University London, Ontario, Canada
| | - Gordon Andrews
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Sadia Raheez Qamar
- Department of Medical Imaging, Sunnybrook Hospital, University of Toronto, Toronto, Canada
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Wen Q, Yue Y, Shang J, Lu X, Gao L, Hou Y. The application of dual-layer spectral detector computed tomography in solitary pulmonary nodule identification. Quant Imaging Med Surg 2021; 11:521-532. [PMID: 33532253 DOI: 10.21037/qims-20-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differentiating between malignant solitary pulmonary nodules (SPNs) and other lung diseases remains a substantial challenge. The latest generation of dual-energy computed tomography (CT), which realizes dual-energy technology at the detector level, has clinical potential for distinguishing lung cancer from other benign SPNs. This study aimed to evaluate the performance of dual-layer spectral detector CT (SDCT) for the differentiation of SPNs. Methods Spectral images of 135 SPNs confirmed by pathology were retrospectively analyzed in both the arterial phase (AP) and the venous phase (VP). Patients were classified into two groups [the malignant group (n=93) and the benign group (n=42)], with the malignant group further divided into small cell lung cancer (SCLC, n=30) and non-small cell lung cancer (NSCLC, n=63) subtypes. The slope of the spectral Hounsfield Unit (HU) curve (λHU), normalized iodine concentration (NIC), CT values of 40 keV monochromatic images (CT40keV), and normalized arterial enhancement fraction (NAEF) in contrast-enhanced images were calculated and compared between the benign and malignant groups, as well as between the SCLC and NSCLC subgroups. ROC curve analysis was performed to assess the diagnostic performance of the above parameters. Seventy cases were randomly selected and independently measured by two radiologists, and intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to calculate the reliability of the measurements. Results Except for NAEF (P=0.23), the values of the parameters were higher in the malignant group than in the benign group (all P<0.05). NIC, λHU, and CT40keV performed better in the VP (NICVP, λVPHU, and CTVP40keV) (P<0.001), with an area under the ROC curve (AUC) of 0.93, 0.89, and 0.89 respectively. With respective cutoffs of 0.31, 1.83, and 141.00 HU, the accuracy of NICVP, λVPHU, and CTVP40keV was 91.11%, 85.19%, and 88.15%, respectively. In the subgroup differentiating NSCLC and SCLC, the diagnostic performances of NICAP (AUC =0.89) were greater than other parameters. NICAP had an accuracy of 86.02% when the cutoff was 0.14. ICC and Bland-Altman analyses indicated that the measurement of SDCT has great reproducibility. Conclusions Quantitative measures from SDCT can help to differentiate benign from malignant SPNs and may help with the further subclassification of malignant cancer into SCLC and NSCLC.
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Affiliation(s)
- Qingyun Wen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Lu Gao
- Department of Radiology, Liaoning Cancer Hospital, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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El Kayal N, Mohallel A, Maintz D, Eid M, Emara DM. Improved detectability of hypoattenuating focal pancreatic lesions by dual-layer computed tomography using virtual monoenergetic images. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multidetector CT is the mainstay for radiologic evaluation of pancreatic pathology. Still, imaging of focal pancreatic lesions using MDCT is faced by a number of challenges that are related to the limited contrast between the lesion and surrounding parenchyma, such as detecting early-stage pancreatic cancer and subtle features of cystic lesions that point to malignancy. Dual-layer CT is the first dual-energy CT machine based on separation of high- and low-energy photons at the detector level. If improved contrast between the lesions and normal pancreatic parenchyma could be achieved on CT images, we may expect enhanced CT detection of pancreatic lesions. The purpose of this study was to evaluate whether virtual monoenergetic reconstructions generated using contrast-enhanced dual-layer CT could improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions.
Results
Fifty-four lesions were identified and verified by histopathology or follow-up CT, MRCP, and/or EUS along with clinical data. Across the virtual monoenergetic spectrum, 40 KeV images had the highest contrast-to-noise and signal-to-noise ratios (p < 0.001, p < 0.001) and were significantly higher than conventional images (p < 0.001). Subjective scores for lesion visibility at low kiloelectron volt monoenergetic (40 and 50 KeV) images greatly exceeded conventional images (p < 0.001).
Conclusion
Low kiloelectron volt monoenergetic reconstructions of contrast-enhanced dual-layer CT significantly improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions.
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Petritsch B, Pannenbecker P, Weng AM, Veldhoen S, Grunz JP, Bley TA, Kosmala A. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. ROFO-FORTSCHR RONTG 2020; 193:427-436. [PMID: 33003244 DOI: 10.1055/a-1245-0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Comparison of dual-source dual-energy CT (DS-DECT) and split-filter dual-energy CT (SF-DECT) regarding image quality and radiation dose in patients with suspected pulmonary embolism. MATERIALS AND METHODS We retrospectively analyzed pulmonary dual-energy CT angiography (CTPA) scans performed on two different CT scanners in 135 patients with suspected pulmonary embolism (PE). Scan parameters for DS-DECT were 90/Sn150 kV (n = 68 patients), and Au/Sn120 kV for SF-DECT (n = 67 patients). The iodine delivery rate was 1400 mg/s in the DS-DECT group vs. 1750 mg/s in the SF-DECT group. Color-coded iodine distribution maps were generated for both protocols. Objective (CT attenuation of pulmonary trunk [HU], signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective image quality parameters (two readers [R], five-point Likert scale), as well as radiation dose parameters (effective radiation dose, size-specific dose estimations [SSDE]) were compared. RESULTS All CTPA scans in both groups were of diagnostic image quality. Subjective CTPA image quality was rated as good or excellent in 80.9 %/82.4 % (R1 / R2) of DS-DECT scans, and in 77.6 %/76.1 % of SF-DECT scans. For both readers, the image quality of split-filter iodine distribution maps was significantly lower (p < 0.05) with good or excellent ratings in only 43.3 %/46.3 % (R1 / R2) vs. 83.8 %/88.2 % for maps from DS-DECT. The HU values of the pulmonary trunk did not differ between the two techniques (p = n. s.), while both the SNR and CNR were significantly higher in the split-filter group (p < 0.001; p = 0.003). Both effective radiation dose (2.70 ± 1.32 mSv vs. 2.89 ± 0.94 mSv) and SSDE (4.71 ± 1.63 mGy vs. 5.84 ± 1.11 mGy) were significantly higher in the split-filter group (p < 0.05). CONCLUSION The split-filter allows for dual-energy imaging of suspected pulmonary embolism but is associated with lower iodine distribution map quality and higher radiation dose. KEY POINTS · The split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners.. · Compared to the assessed dual-source dual-energy system, split-filter dual-energy imaging of a suspected pulmonary embolism is associated with lower iodine distribution map quality and higher radiation dose.. · Both the split-filter and the dual-source scanner provide diagnostic image quality in CTPA.. CITATION FORMAT · Petritsch B, Pannenbecker P, Weng AM et al. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. Fortschr Röntgenstr 2021; 193: 427 - 436.
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Affiliation(s)
- Bernhard Petritsch
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Kosmala A, Gruschwitz P, Veldhoen S, Weng AM, Krauss B, Bley TA, Petritsch B. Dual-energy CT angiography in suspected pulmonary embolism: influence of injection protocols on image quality and perfused blood volume. Int J Cardiovasc Imaging 2020; 36:2051-2059. [PMID: 32506286 PMCID: PMC8692293 DOI: 10.1007/s10554-020-01911-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
To compare intravenous contrast material (CM) injection protocols for dual-energy CT pulmonary angiography (CTPA) in patients with suspected acute pulmonary embolism with regard to image quality and pulmonary perfused blood volume (PBV) values. A total of 198 studies performed with four CM injection protocols varying in CM volume and iodine delivery rates (IDR) were retrospectively included: (A) 60 ml at 5 ml/s (IDR = 1.75gI/s), (B) 50 ml at 5 ml/s (IDR = 1.75gI/s), (C) 50 ml at 4 ml/s (IDR = 1.40gI/s), (D) 40 ml at 3 ml/s (IDR = 1.05gI/s). Image quality and PBV values at different resolution settings were compared. Pulmonary arterial tract attenuation was highest for protocol A (397 ± 110 HU; p vs. B = 0.13; vs. C = 0.02; vs. D < 0.001). CTPA image quality of protocol A was rated superior compared to protocols B and D by reader 1 (p = 0.01; < 0.001), and superior to protocols B, C and D by reader 2 (p < 0.001; 0.02; < 0.001). Otherwise, there were no significant differences in CTPA quality ratings. Subjective iodine map ratings did not vary significantly between protocols A, B, and C. Both readers rated protocol D inferior to all other protocols (p < 0.05). PBV values did not vary significantly between protocols A and B at resolution settings of 1, 4 and 10 (p = 0.10; 0.10; 0.09), while otherwise PBV values displayed a decreasing trend from protocol A to D (p < 0.05). Higher CM volume and IDR are associated with superior CTPA and iodine map quality and higher absolute PBV values.
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Affiliation(s)
- Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Bernhard Krauss
- Siemens Healthcare GmbH, Research and Development, Forchheim, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Advanced monoenergetic reconstruction technique for dual-energy computed tomography to evaluate endoleaks after endovascular stent-graft placement. Abdom Radiol (NY) 2020; 45:2569-2575. [PMID: 32488555 DOI: 10.1007/s00261-020-02602-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the usefulness of the advanced monoenergetic imaging (AMI) reconstruction technique for dual-energy computed tomography to evaluate endoleaks after endovascular stent-graft placement. MATERIALS AND METHODS Ninety-five dual-phase (early and delayed phases) enhanced CT examinations were performed for 60 patients who underwent endovascular stent-graft placement. AM images were reconstructed at 40 keV and compared with the standard 120-kVp images (SI). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the aorta and endoleak were measured. Two radiologists subjectively assessed endoleak delineation and contrast enhancement conditions using a 5-point Likert scale (1: poor-5: excellent). RESULTS Mean SNRs of the aorta were higher by AMI (early; 34.7 ± 10.2 [SD], delay; 11.4 ± 3.2) than by SI (early; 23.1 ± 6.3, delay; 8.6 ± 2.2) (P < 0.001). SNRs of the endoleak were higher by AMI (early; 26.3 ± 7.5, delay; 10.5 ± 3.1) than by SI (early; 18.2 ± 4.7, delay; 8.3 ± 2.1) (P < 0.001). CNRs by AMI (early; 32.9 ± 9.8, delay; 8.9 ± 2.8) were higher than those by SI (early; 19.5 ± 6.0, delay; 4.7 ± 1.6) in both phases (P < 0.001). Endoleak delineation and contrast enhancement conditions by AMI (4.4 ± 1.0 and 4.5 ± 0.6) were higher than those by SI (3.4 ± 1.0 and 3.3 ± 0.8) in the delayed phase (P < 0.001). There was no difference in the early phase. CONCLUSION AMI may be useful for evaluating endoleaks after endovascular stent-graft placement.
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Noda Y, Goshima S, Kaga T, Ando T, Miyoshi T, Kawai N, Kawada H, Tanahashi Y, Matsuo M. Virtual monochromatic image at lower energy level for assessing pancreatic ductal adenocarcinoma in fast kV-switching dual-energy CT. Clin Radiol 2020; 75:320.e17-320.e23. [DOI: 10.1016/j.crad.2019.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
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Huang X, Gao S, Ma Y, Lu X, Jia Z, Hou Y. The optimal monoenergetic spectral image level of coronary computed tomography (CT) angiography on a dual-layer spectral detector CT with half-dose contrast media. Quant Imaging Med Surg 2020; 10:592-603. [PMID: 32269920 DOI: 10.21037/qims.2020.02.17] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To investigate the optimal monoenergetic level of spectral reconstructions in coronary computed tomography angiography (coronary CTA) on a dual-layer spectral detector computed tomography (SDCT) with half-dose contrast media. Methods Two hundred patients with suspected coronary artery disease (CAD) were enrolled in this prospective coronary CTA study and randomly divided into a routine-dose contrast media group and a half-dose contrast media group (each n=100). Coronary CTA was performed using SDCT with prospective electrocardiogram (ECG)-gated mode. A tube voltage of 120 kVp was used, along with an automated tube current modulation. A dose of iodixanol 270 mgI/mL of 0.8 and 0.4 mL/kg was administered to the routine and half-dose groups, respectively. For the routine-dose group, 120 kVp polychromatic images with a model-based iterative reconstruction (IMR) (Group A) were reconstructed. For the half-dose group, three monoenergetic levels of images were reconstructed (Group B, 45 keV; Group C, 50 keV; and Group D, 55 keV). Objective indicators [mean CT values; noise; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR)] and subjective indicators (contrast, sharpness, subjective noise, and acceptability) in each group were compared. Results There were no significant differences in demographics or radiation dose (1.83±0.51 vs. 1.80±0.53 mSv, P=0.78) between the routine- and half-dose groups. The average iodine loads were 15.33±2.26 and 7.48±1.14 g, respectively. Mean CT values, SNR, CNR, and subjective contrast in Group C were higher than those in Group A (P<0.05), and there were no significant differences in other indicators between Group C and Group A (P>0.05). The objective and subjective noise in Group B were worse than those in Group A (P<0.05). The contrast, sharpness, and acceptability of Group D were all worse than those of Group A (P<0.05). Conclusions Compared to routine polychromatic images, 50 keV monoenergetic images can provide equivalent or improved coronary image quality in coronary CTA performed on SDCT with half the amount of contrast media.
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Affiliation(s)
- Xin Huang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Sizhe Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang 110016, China
| | - Zheng Jia
- CT Clinical Science, Philips Healthcare, Shenyang 110016, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Metin Y, Metin NO, Özdemir O, Taşçı F, Kul S. The role of low keV virtual monochromatic imaging in increasing the conspicuity of primary breast cancer in dual-energy spectral thoracic CT examination for staging purposes. Acta Radiol 2020; 61:168-174. [PMID: 31237772 DOI: 10.1177/0284185119858040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The additive value of dual-energy spectral computerized tomography (DESCT) in breast cancer imaging is still unknown. Purpose To investigate the role of DESCT in improving the conspicuity of primary breast cancer. Material and Methods Twenty-nine patients who were histopathologically diagnosed with breast cancer and underwent DESCT for staging of lung metastasis were evaluated retrospectively. The visual conspicuity of breast cancer was scored by two readers separately in reconstructed virtual monochromatic images obtained at 40, 60, 80, and 100 keV. A circular region of interest slightly smaller than the maximum contrasted portion of the primary breast cancer was manually placed. Iodine enhancement (HU) and iodine content (mg/mL) values of tumor, normal breast tissue and pectoral muscle, and contrast-to-noise values of images at four different energy levels were calculated. Results The lesion conspicuity score peaked at 40-keV series for both readers and was significantly higher than those at other energy levels (all P < 0.001). Lesion iodine enhancement was highest at 40-keV virtual monochromatic image reconstructions ( P < 0.001). The iodine content was significantly higher in tumor than normal breast tissue, and pectoral muscle ( P < 0.001). The highest contrast-to-noise value was obtained at 60 keV (4.0 ± 2.5), followed by 40 keV (3.9 ± 2.2), without a significant difference ( P = 0.33). Conclusion The conspicuity of primary breast cancer was significantly higher in low keV virtual monochromatic images obtained by DESCT. This gives us hope that DESCT may play an effective role in detecting incidental breast lesions. It also raises the question of whether quantitative values obtained by DESCT can be used for characterization of primary breast lesion.
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Affiliation(s)
- Yavuz Metin
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgül Orhan Metin
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Oğuzhan Özdemir
- Department of Radiology, Medical Park Hospital, Bursa, Turkey
| | - Filiz Taşçı
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Sibel Kul
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Rajiah P, Ciancibello L, Novak R, Sposato J, Landeras L, Gilkeson R. Ultra-low dose contrast CT pulmonary angiography in oncology patients using a high-pitch helical dual-source technology. ACTA ACUST UNITED AC 2020; 25:195-203. [PMID: 31063136 DOI: 10.5152/dir.2019.17498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to determine if the image quality and vascular enhancement are preserved in computed tomography pulmonary angiography (CTPA) studies performed with ultra-low contrast and optimized radiation dose using high-pitch helical mode of a second generation dual source scanner. METHODS We retrospectively evaluated oncology patients who had CTPA on a 128-slice dual-source scanner, with a high-pitch helical mode (3.0), following injection of 30 mL of Ioversal at 4 mL/s with body mass index (BMI) dependent tube potential (80-120 kVp) and current (130-150 mAs). Attenuation, noise, and signal-to-noise ratio (SNR) were measured in multiple pulmonary arteries. Three independent readers graded the images on a 5-point Likert scale for central vascular enhancement (CVE), peripheral vascular enhancement (PVE), and overall quality. RESULTS There were 50 males and 101 females in our study. BMI ranged from 13 to 38 kg/m2 (22.8±4.4 kg/m2). Pulmonary embolism was present in 29 patients (18.9%). Contrast enhancement and SNR were excellent in all the pulmonary arteries (395.3±131.1 and 18.3±5.7, respectively). Image quality was considered excellent by all the readers, with average reader scores near the highest possible score of 5.0 (CVE, 4.83±0.48; PVE, 4.68±0.65; noise/quality, 4.78±0.47). The average radiation dose length product (DLP) was 161±60 mGy.cm. CONCLUSION Using a helical high-pitch acquisition technique, CTPA images of excellent diagnostic quality, including visualization of peripheral segmental/sub-segmental branches can be obtained using an ultra-low dose of iodinated contrast and low radiation dose.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Ciancibello
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ronald Novak
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
| | - Jennifer Sposato
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Landeras
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Image Quality of ECG-Triggered High-Pitch, Dual-Source Computed Tomography Angiography for Cardiovascular Assessment in Children. Curr Probl Diagn Radiol 2020; 49:23-28. [DOI: 10.1067/j.cpradiol.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
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Iodine dose optimization in portal venous phase virtual monochromatic images of the abdomen: Prospective study on rapid kVp switching dual energy CT. Eur J Radiol 2020; 122:108746. [DOI: 10.1016/j.ejrad.2019.108746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 02/04/2023]
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Kraus MS, Selo N, Kiefer LS, Esser M, Albtoush OM, Weiss J, Wichmann JL, Bamberg F, Othman AE. Advanced Virtual Monoenergetic Imaging: Improvement of Visualization and Differentiation of Intramuscular Lesions in Portal-Venous-phase Contrast-enhanced Dual-energy CT. Acad Radiol 2019; 26:1457-1465. [PMID: 30879946 DOI: 10.1016/j.acra.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effect of advanced monoenergetic imaging (MEI+) postprocessing algorithm on the visualization of various intramuscular lesions on portal-venous-phase contrast-enhanced dual-energy computed tomography (DECT). MATERIAL AND METHODS Thirty-nine patients (64.3 ± 11.1 years; 26 males) with various intramuscular lesions ranging from malignancy, bleeding, inflammation, edematous changes, and benign neoplasms were included and underwent DECT (100/Sn150kV). Postprocessing with MEI+ technique was used to reconstruct images at four different keV levels (40, 60, 80, 100) and compared to the standard portal-venous-phase CT (CTpv) images. Image quality was assessed qualitatively (conspicuity, delineation, sharpness, noise, and confidence) by two independent readers using 5-point Likert scales, 5 = excellent; as well as quantitatively by calculating signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR), and area under the receiver operating characteristic (ROC) curve (AUC) for lesion characterization. RESULTS Highest lesion enhancement and diagnostic confidence were observed in MEI+ 40 keV, with significant differences to CTpv (p < 0.001), as well as for malignant lesions (highest conspicuity, noise, and sharpness in MEI+ 40 keV; p < 0.001). CNR calculations revealed highest values for MEI+ 40 keV followed by 60 keV with significant differences to CTpv, and increasing energy levels. ROC analysis showed highest diagnostic accuracy for 40-keV MEI+ datasets regarding the detection of malignant/benign lesions with AUC values of 98.9% (95%-confidence interval: 96.5, 100) and a standard error of 1.2, further AUC values decreased to 83.6% for MEI+100. CONCLUSION MEI+ at low keV levels can significantly improve lesion detection of benign versus malignant intramuscular entities in patients undergoing portal-venous-phase DECT scans due to increased CNR.
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Albrecht MH, Vogl TJ, Martin SS, Nance JW, Duguay TM, Wichmann JL, De Cecco CN, Varga-Szemes A, van Assen M, Tesche C, Schoepf UJ. Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT. Radiology 2019; 293:260-271. [DOI: 10.1148/radiol.2019182297] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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43
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Watanabe R, Funama Y, Takaki T, Oda S, Nakaura T, Murakami S, Aoki T. Additive value of split-bolus single-phase CT scan protocol for preoperative assessment of lung cancer patients referred for video-assisted thoracic surgery. Radiol Phys Technol 2019; 12:409-416. [PMID: 31654374 DOI: 10.1007/s12194-019-00541-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
We aimed to assess the additive value of the split-bolus single-phase computed tomography (CT) scan protocol to preoperatively assess patients with lung cancer, who were referred for video-assisted thoracic surgery, when compared to a standard staging CT protocol. We included 160 patients with lung cancer who underwent a split-bolus single-phase CT scan protocol (split-bolus protocol), which can acquire whole-body staging CT and pulmonary artery-vein separation CT angiography (PA-PV CTA) in a single acquisition and 160 patients who underwent whole-body staging CT (standard protocol). We compared the quality of the staging CT images of hepatic parenchyma, portal vein, and hepatic vein between both protocols. We also investigated image quality on PA-PV CTA images in the split-bolus protocol and recorded the number of patients that underwent the 3D PA-PV CTA imaging process. The split-bolus protocol for staging CT images demonstrated a slightly higher enhancement with regard to the hepatic parenchyma (p = 0.007) and hepatic vein (p = 0.006) than the standard protocol. There was no significant difference in the quality of the staging CT images between both protocols (p = 0.067). The mean CT number for the main pulmonary artery and the left atrium for the PA-PV CTA images in the split-bolus protocol were 289.1 HU and 172.8 HU, respectively. Among the images associated with the split-bolus protocol, 98.1% were of appropriate quality for 3D PA-PV CTA imaging. The split-bolus protocol is a dose-efficient protocol to acquire the staging CT and PA-PV CTA images in a single session and provides sufficient image quality for preoperative assessment in patients with lung cancer.
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Affiliation(s)
- Ryo Watanabe
- Graduate School of Health Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Takeshi Takaki
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Seitaro Oda
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seiichi Murakami
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
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Kim TM, Choi YH, Cheon JE, Kim WS, Kim IO, Park JE, Shin SM, Pak SY, Krauss B. Optimal Kiloelectron Volt for Noise-Optimized Virtual Monoenergetic Images of Dual-Energy Pediatric Abdominopelvic Computed Tomography: Preliminary Results. Korean J Radiol 2019; 20:283-294. [PMID: 30672168 PMCID: PMC6342763 DOI: 10.3348/kjr.2017.0507] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To compare quantitative and qualitative image quality parameters in pediatric abdominopelvic dual-energy CT (DECT) using noise-optimized virtual monoenergetic image (VMI) and conventional VMI at different kiloelectron volt (keV) levels. Materials and Methods Thirty-six consecutive abdominopelvic DECT scans were retrospectively included. Noise-optimized VMI and conventional VMI were reconstructed at seven energy levels, from 40 keV to 100 keV at 10 keV intervals. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the liver, pancreas, and aorta were objectively measured and compared. Image quality was evaluated subjectively regarding image noise, image blurring of solid organ, bowel image quality and severity of beam-hardening artifacts. Optimal monoenergetic levels in keV for both algorithms were determined based on overall image quality score. Results The maximal CNR and SNR values for all investigated organs were observed at 40 keV in noise-optimized VMI (CNR and SNR of liver, pancreas, aorta in order [CNR; 20.93, 17.34, 46.75: SNR; 37.39, 33.80, 63.21]), at 60–70 keV and at 70 keV in conventional VMI (CNR; 8.12, 5.67, 15.97: SNR; 19.57, 16.66, 26.65). In qualitative image analysis, noise-optimized VMI and conventional VMI showed the best overall image quality scores at 60 keV and at 70 keV, respectively. Noise-optimized VMI at 60 keV showed superior CNRs, SNRs, and overall image quality scores compared to conventional VMI at 70 keV (p < 0.001). Conclusion Optimal energy levels for noise-optimized VMI and conventional VMI were 60 keV and at 70 keV, respectively. Noise-optimized VMI shows superior CNRs, SNRs and subjective image quality over conventional VMI, at the optimal energy level.
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Affiliation(s)
- Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Jung Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Su Mi Shin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Dual-Energy Computed Tomography in Thoracic Imaging—Current Practices and Utility. J Thorac Imaging 2019; 35:W43-W50. [DOI: 10.1097/rti.0000000000000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Leitman EM, McDermott S. Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovasc Diagn Ther 2019; 9:S37-S58. [PMID: 31559153 DOI: 10.21037/cdt.2018.08.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pulmonary arteries are not just affected by thrombus. Various acquired and congenital conditions can also affect the pulmonary arteries. In this review we discuss cross sectional imaging modalities utilized for the imaging of the pulmonary arteries. Acquired pulmonary artery entities, including pulmonary artery sarcoma (PAS), vasculitis, aneurysm, and arteriovenous malformations, and congenital anomalies in adults, including proximal interruption of the pulmonary artery, pulmonary sling, pulmonary artery stenosis, and idiopathic dilatation of the pulmonary trunk, are also discussed. An awareness of these entities and their imaging findings is important for radiologists interpreting chest imaging.
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Affiliation(s)
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
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47
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Arendt CT, Czwikla R, Lenga L, Wichmann JL, Albrecht MH, Booz C, Martin SS, Leithner D, Tischendorf P, Blandino A, Vogl TJ, D'Angelo T. Improved coronary artery contrast enhancement using noise-optimised virtual monoenergetic imaging from dual-source dual-energy computed tomography. Eur J Radiol 2019; 122:108666. [PMID: 31786506 DOI: 10.1016/j.ejrad.2019.108666] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE To define optimal kiloelectron volt (keV) settings for virtual monoenergetic imaging (VMI) reconstruction at dual-energy coronary computed tomography angiography (DE-CCTA). METHOD Fifty-one DE-CCTA data sets (33 men; mean age, 63.9 ± 13.2 years) were reconstructed as standard linearly-blended images (F_0.6; 60% of 90 kVp, 40% of 150 kVpSn), and with traditional (VMI) and noise-optimised (VMI+) algorithms from 40 to 100 keV in 10-keV intervals. Objective image quality was assessed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. Three observers subjectively evaluated vascular contrast, image sharpness, noise and delineation of coronary plaques. RESULTS Median values for objective image analysis were highest in VMI + series at 40 keV (SNR, 44.5; CNR: 33.5), significantly superior (allp < 0.001) to the best VMI series at 70 keV (SNR, 28.1; CNR, 18.4) and standard F_0.6 images (SNR, 23.2; CNR, 15.6). Overall subjective metrics achieved higher scores at 40-keV VMI+ series in comparison to 70-keV VMI series and F_0.6 images (all p < 0.001), with optimal vascular contrast (5; ICC, 0.90), good image sharpness (4; 0.88), low noise (4; 0.82), and optimal plaque delineation (5; 0.89). CONCLUSIONS DE-CCTA image reconstruction with 40-keV VMI + allows for significant improvement of both objective and subjective image quality.
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Affiliation(s)
- Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rouben Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alfredo Blandino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tommaso D'Angelo
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina, Messina, Italy
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Alharthy A, D’Mello M, Alabsi H, Murray N, Metwally O, Elbanna KY, Mohammed MF, Khosa F. Vascular Imaging: Utilization of Dual-Energy Computed Tomography. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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49
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Sekiguchi T, Ozawa Y, Hara M, Nakagawa M, Goto T, Shibamoto Y. Visibility of the hilar lymph nodes using advanced virtual monoenergetic low-keV images for preoperative evaluation of lung cancer. Br J Radiol 2019; 92:20180734. [PMID: 31430185 DOI: 10.1259/bjr.20180734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of our study was to evaluate the visibility of the hilar lymph nodes (LNs) using advanced virtual monoenergetic low-keV images compared with early-phase contrast-enhanced CT. METHODS Dual energy contrast-enhanced CT was performed for pre-operative evaluation of lung cancer at 20 and 60 s after administration of contrast media in 50 patients (32 males and 18 females; mean age, 69 years). Five kinds of images (A: 20 s/120 kV; B: 60 s/40 keV; C: 60 s/50 keV; D: 60 s/120 kV; E: 60 s/100 kV) were reconstructed. We measured the CT number of the bilateral main pulmonary arteries (PAs), pulmonary veins (PVs) and hilar LNs, and evaluated the differences in CT number (Hounsfield units, HUs) between the PA/PV and LNs (PA-LN and PV-LN contrast). Artifacts from the superior vena cava (SVC) were also evaluated. RESULTS The mean PA-LN contrast (HU) was 415 in image group A, 299 in B, 180 in C, 80 in D, and 100 in E. The mean PV-LN contrasts in each group were 306, 287, 177, 78, and 99, respectively. Image group B showed the second highest PA-LN contrast following image group A. There was no significant difference in the PV-LN contrast between image groups A and B. The PA-LN and PV-LN contrasts of image groups B and C were significantly higher than those of E. SVC artifacts were lower in the delayed-phase images (Group B-E) than in Group A. CONCLUSION To evaluate the hilar LNs with a single image series, advanced virtual monoenergetic 40-keV imaging at the delayed 60-s phase seems to be the most valuable. ADVANCES IN KNOWLEDGE Advanced virtual monoenergetic image is useful for evaluation of both hilar LNs and tumors in the delayed phase without artifact derived from the streak artifact from dense contrast media in the SVC.
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Affiliation(s)
- Tomoya Sekiguchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Masaki Hara
- Department of Radiology, Nagoya City West Medical Center
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
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Iuga AI, Doerner J, Siedek F, Haneder S, Byrtus J, Luetkens JA, Maintz D, Hickethier T. Computed tomography pulmonary angiograms using a novel dual-layer spectral detector: Adjusted window settings are essential for diagnostic image quality. Medicine (Baltimore) 2019; 98:e16606. [PMID: 31415352 PMCID: PMC6831234 DOI: 10.1097/md.0000000000016606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine optimal window settings for conventional polyenergetic and virtual monoenergetic images derived from computed tomography pulmonary angiogram (CTPA) examinations of a novel dual-layer spectral detector computed tomography system (DLCT). METHODS Monoenergetic (40 keV) and polyenergetic images of 50 CTPA examinations were calculated and the best individual window width and level (W/L) values were manually assessed. Optimized values were obtained afterwards based on regression analysis. Diameters of standardized pulmonary artery segments and subjective image quality parameters were evaluated and compared. RESULTS Attenuation and contrast-to-noise values were higher in monoenergetic than in polyenergetic images (P≤.001). Averaged best individual W/L for polyenergetic and monoenergetic were 1020/170 and 2070/480 HU, respectively.All adjusted W/L-settings varied significantly compared to standard settings (700/100 HU) and obtained higher subjective image quality scores. A systematic overestimation of artery diameters for standard window settings in monoenergetic images was observed. CONCLUSIONS Appropriate W/L-settings are required to assess polyenergetic and monoenergetic CTPA images of a novel DLCT. W/L-settings of 1020/170 HU and 2070/480 HU were found to be the best averaged values for polyenergetic and monoenergetic CTPA images, respectively.
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Affiliation(s)
- Andra-Iza Iuga
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Jonas Doerner
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Florian Siedek
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Jonathan Byrtus
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Julian A. Luetkens
- Institute of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Tilman Hickethier
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
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