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Agostini A, Borgheresi A, Mariotti F, Ottaviani L, Carotti M, Valenti M, Giovagnoni A. New frontiers in oncological imaging with Computed Tomography: from morphology to function. Semin Ultrasound CT MR 2023; 44:214-227. [DOI: 10.1053/j.sult.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Qiu L, Pu XH, Xu H, Yu TF, Yuan M. Dual-energy computed tomography iodine uptake in differential diagnosis of inflammatory and malignant pulmonary nodules. Diagn Interv Radiol 2022; 28:563-568. [PMID: 36550756 PMCID: PMC9885669 DOI: 10.5152/dir.2022.201091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic performance of iodine uptake parameters using dual-energy computed tomography (DECT) in discriminating inflammatory nodules from malignant tumors. METHODS This retrospective study included 116 solid pulmonary nodules from 112 patients who were admitted to our hospital between January and September 2018. All nodules were confirmed by surgery or puncture. The degree of enhancement of a single-section region of interest was evalu ated. After total tumor volume-of-interest segmentation, the mean iodine density of the whole tumor was measured. Meanwhile, iodine uptake parameters, including total iodine uptake vol ume, total iodine concentration, vital iodine uptake volume, and vital iodine concentration, were calculated, and a predictive model was established. The overall ability to discriminate between inflammatory and malignant nodules was analyzed using an independent samples t-test for normally distributed variables. The diagnostic accuracy and prognostic performance of DECT parameters were evaluated and compared using receiver operating characteristic curve analysis and logistic regression analysis. A multivariate logistic regression analysis was used to determine the prognostic factors and goodness-of-fit of the whole tumor mean iodine and iodine uptake parameters for discriminating malignant nodules. RESULTS There were 116 non-calcified nodules, including 64 inflammatory nodules and 52 malignant nodules. The degree of enhancement in malignant nodules was significantly lower than that in inflammatory nodules (P=.043). All iodine uptake parameters in malignant nodules were signifi cantly higher than those in inflammatory nodules (P < .001). The area under the receiver operat ing curve value, accuracy, sensitivity, and specificity of the established model based on iodine uptake parameters were 0.803, 76.72%, 82.69%, and 84.37%, respectively, which exhibited bet ter diagnostic performance than the degree of enhancement on weighted average images with respective values of 0.609, 59.48%, 61.54%, and 59.38%. CONCLUSION The iodine uptake parameters of DECT exhibited better diagnostic accuracy in discriminating inflammatory nodules from malignant nodules than the degree of enhancement on weighted average images.
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Affiliation(s)
- Lin Qiu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue-Hui Pu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong-Fu Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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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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Ersahin D, Rasla J, Singh A. Dual energy CT applications in oncological imaging. Semin Ultrasound CT MR 2022; 43:344-351. [PMID: 35738819 DOI: 10.1053/j.sult.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer is the second leading cause of death in the United States, killing more than 600.000 people each year.1 Despite several screening programs available, cancer diagnosis is often made incidentally during imaging studies performed for other reasons. Once the diagnosis is made, treatment assessment and surveillance of these patients heavily rely on radiological tools. Computed tomography (CT) in particular is one of the most commonly ordered modalities due to wide availability even in the most remote locations, and fast results. However, conventional CT often cannot definitively characterize a neoplastic lesion unless it was tailored toward answering a specific question. Furthermore, characterizing small lesions can be difficult with CT. An innovative technique called dual-energy CT (DECT) offers solutions to some of the challenges of conventional CT in oncological imaging.
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Santos Armentia E, Martín Noguerol T, Silva Priegue N, Delgado Sánchez-Gracián C, Trinidad López C, Prada González R. Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging. RADIOLOGIA 2022; 64:333-347. [DOI: 10.1016/j.rxeng.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
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Santos Armentia E, Martín-Noguerol T, Silva Priegue N, Delgado Sánchez-Gracián C, Trinidad López C, Prada González R. Análisis de las fortalezas, oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Xu JJ, Taudorf M, Ulriksen PS, Achiam MP, Resch TA, Nielsen MB, Lönn LB, Hansen KL. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10100814. [PMID: 33066281 PMCID: PMC7602017 DOI: 10.3390/diagnostics10100814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn’s disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn’s disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Correspondence:
| | - Mikkel Taudorf
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Peter Sommer Ulriksen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Lars Birger Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
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Wang P, Xiao Z, Tang Z, Wang J. Dual-energy CT in the differentiation of stage T1 nasopharyngeal carcinoma and lymphoid hyperplasia. Eur J Radiol 2020; 124:108824. [PMID: 31954331 DOI: 10.1016/j.ejrad.2020.108824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/03/2019] [Accepted: 12/30/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To explore the value of dual-energy CT for the differentiation between stage T1 nasopharyngeal carcinoma (NPCT1) and lymphoid hyperplasia (LH). METHOD Patients with histopathological proven nasopharyngeal lesions (stage T1 NPCs, n = 30; LHs, n = 47) who underwent dual-energy CT were enrolled in this retrospective study. Quantitative parameters derived from dual-energy CT were measured. Statistical analyses were performed using the independent sample t-test, Wilcoxon rank sum test, and receiver operating characteristic curve (ROC) analysis. RESULTS There was significantly higher iodine concentration (IC), normalized iodine concentration (NIC, to internal jugular vein) in NPCT1 compared with LH (p < 0.001). The effective atomic number (Zeff) was significantly higher in NPCT1 than that in LH (p < 0.001). The virtual monochromatic images (VMIs) at 50 keV-110 keV (20 keV-interval) of NPCT1 were all significantly higher than those of LH (all p <0.001). The slope (k) value of spectral attenuation curve was also significantly higher in NPCT1 than LH (p < 0.001). There was no significant difference in virtual noncontrast (VNC) and 130 keV-190 keV (20 keV-interval) between the NPCT1 and LH. For discriminating NPCT1 from LH, the area under curve (AUC) using 70 keV was the highest in all single parameter (AUC, 0.92; sensitivity, 80.00 %; specificity, 91.49 %). Combined multiple parameters (IC, NIC, Zeff, 50 keV, 70 keV, 90 keV, slope (k)) by performing multivariate logistic regression model significantly improve the diagnostic capability in differentiating these two entities, with AUC, sensitivity, and specificity values of 0.99, 93.33 %, 97.87 %, respectively. CONCLUSIONS Dual-energy CT can be helpful for the differentiation between NPCT1 and LH lesions.
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Affiliation(s)
- Peng Wang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China
| | - Zebin Xiao
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China
| | - Zuohua Tang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China.
| | - Jie Wang
- Department of Otolaryngology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China
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Agostini A, Borgheresi A, Mari A, Floridi C, Bruno F, Carotti M, Schicchi N, Barile A, Maggi S, Giovagnoni A. Dual-energy CT: theoretical principles and clinical applications. Radiol Med 2019; 124:1281-1295. [PMID: 31792703 DOI: 10.1007/s11547-019-01107-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023]
Abstract
The physical principles of dual-energy computed tomography (DECT) are as old as computed tomography (CT) itself. To understand the strengths and the limits of this technology, a brief overview of theoretical basis of DECT will be provided. Specific attention will be focused on the interaction of X-rays with matter, on the principles of attenuation of X-rays in CT toward the intrinsic limits of conventional CT, on the material decomposition algorithms (two- and three-basis-material decomposition algorithms) and on effective Rho-Z methods. The progresses in material decomposition algorithms, in computational power of computers and in CT hardware, lead to the development of different technological solutions for DECT in clinical practice. The clinical applications of DECT are briefly reviewed in relation to the specific algorithms.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy.
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy.
| | - Alessandra Borgheresi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Alberto Mari
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Chiara Floridi
- Department of Health Sciences, Diagnostic and Interventional Radiology, Hospital "San Paolo", University of Milan, Milan, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Marina Carotti
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Nicolò Schicchi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Stefania Maggi
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
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Locally advanced gastric cancer: total iodine uptake to predict the response of primary lesion to neoadjuvant chemotherapy. J Cancer Res Clin Oncol 2018; 144:2207-2218. [PMID: 30094537 DOI: 10.1007/s00432-018-2728-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Pathologic response to neoadjuvant chemotherapy is a prognostic factor in many cancer types. However, the existing evaluative criteria are deficient. We sought to prospectively evaluate the total iodine uptake derived from dual-energy computed tomography (DECT) in predicting treatment efficacy and progression-free survival (PFS) time in gastric cancer after neoadjuvant chemotherapy. METHODS From October 2012 to December 2015, 44 patients with locally advanced gastric cancer were examined with DECT 1 week before and three cycles after neoadjuvant chemotherapy. The percentage changes in tumor area (%ΔS), diameter (%ΔD), and density (%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. The percentage changes in tumor volume (%ΔV) and total iodine uptake of portal phase (%ΔTIU-p) were also calculated to determine cut-off values by ROC curves. The correlation between the different criteria and histopathologic tumor regression grade (Becker score) or PFS were statistically analyzed. RESULTS Forty-four patients were divided into responders and non-responders according to 43.34% volume reduction (P = 0.002) and 63.87% (P = 0.002) TIU-p reduction, respectively. The %ΔTIU-p showed strong (r = 0.602, P = 0.000) and %ΔV showed moderate (r = 0.416, P = 0.005), while the WHO (r = 0.075, P = 0.627), RECIST (r = 0.270, P = 0.077) and Choi criteria (r = 0.238, P = 0.120) showed no correlation with the Becker score. The differences in PFS time between the responder and non-responder groups were significant according to %ΔTIU-p and Choi criteria (P = 0.001 and P = 0.013, respectively). CONCLUSIONS The TIU-p can help predict pathological regression in advanced gastric cancer patients after neoadjuvant chemotherapy. In addition, the %ΔTIU-p could be one of the potentially valuable predictive parameters of the PFS time.
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Baerends E, Oostveen LJ, Smit CT, Das M, Sechopoulos I, Brink M, de Lange F, Prokop M. Comparing dual energy CT and subtraction CT on a phantom: which one provides the best contrast in iodine maps for sub-centimetre details? Eur Radiol 2018; 28:5051-5059. [PMID: 29808430 PMCID: PMC6223839 DOI: 10.1007/s00330-018-5496-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare contrast-to-noise ratios (CNRs) and iodine discrimination thresholds on iodine maps derived from dual energy CT (DECT) and subtraction CT (SCT). METHODS A contrast-detail phantom experiment was performed with 2 to 15 mm diameter tubes containing water or iodinated contrast concentrations ranging from 0.5 mg/mL to 20 mg/mL. DECT scans were acquired at 100 kVp and at 140 kVp+Sn filtration. SCT scans were acquired at 100 kVp. Iodine maps were created by material decomposition (DECT) or by subtraction of water scans from iodine scans (SCT). Matched exposure levels varied from 8 to 15 mGy. Iodine discrimination thresholds (Cr) and response times were determined by eight observers. RESULTS The adjusted mean CNR was 1.9 times higher for SCT than for DECT. Exposure level had no effect on CNR. All observers discriminated all details ≥10 mm at 12 and 15 mGy. For sub-centimetre details, the lowest calculated Cr was ≤ 0.50 mg/mL for SCT and 0.64 mg/mL for DECT. The smallest detail was discriminated at ≥4.4 mg/mL with SCT and at ≥7.4 mg/mL with DECT. Response times were lower for SCT than DECT. CONCLUSIONS SCT results in higher CNR and reduced iodine discrimination thresholds compared to DECT for sub-centimetre details. KEY POINTS • Subtraction CT iodine maps exhibit higher CNR than dual-energy iodine maps • Lower iodine concentrations can be discriminated for sub-cm details with SCT • Response times are lower using SCT compared to dual-energy CT.
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Affiliation(s)
- Evelinda Baerends
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands
| | - Luuk J Oostveen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands.
| | - Casper T Smit
- Department of Medical Physics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marco Das
- Department of Medical Physics, MUMC+, Maastricht, The Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands
| | - Monique Brink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (route 766), 6500 HB, Nijmegen, The Netherlands
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Quantification of Iodine Concentration Using Single-Source Dual-Energy Computed Tomography in a Calf Liver. J Comput Assist Tomogr 2018; 42:222-229. [PMID: 29489589 DOI: 10.1097/rct.0000000000000685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the accuracy of single-source dual-energy computed tomography (ssDECT) in iodine quantification using various segmentation methods in an ex vivo model. METHODS Ten sausages, injected with variable quantities of iodinated contrast, were inserted into 2 livers and scanned with ssDECT. Material density iodine images were reconstructed. Three radiologists segmented each sausage. Iodine concentration, volume, and absolute quantity were measured. Agreement between the measured and injected iodine was assessed with the concordance correlation coefficient (CCC). Intrareader agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS Air bubbles were observed in sausage (IX). Sausage (X) was within the same view as hyper-attenuating markers used for localization. With IX and X excluded, CCC and ICC were greater than 0.98 and greater than 0.88. When included, CCC and ICC were greater than 0.94 and greater than 0.79. CONCLUSIONS Iodine quantification was reproducible and precise. However, accuracy reduced in sausages consisting of air filled cavities and within the same view as hyperattenuating markers.
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Parakh A, Patino M, Muenzel D, Kambadakone A, Sahani DV. Role of rapid kV-switching dual-energy CT in assessment of post-surgical local recurrence of pancreatic adenocarcinoma. Abdom Radiol (NY) 2018; 43:497-504. [PMID: 29138890 DOI: 10.1007/s00261-017-1390-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the performance of material-specific iodine (MS-I) images generated by rapid kV-switching single-source dual-energy computed tomography (rsDECT) for distinguishing post-operative changes from local tumor recurrence in patients on follow-up for pancreatic adenocarcinoma after surgical resection. METHODS In this IRB-approved HIPPA-compliant study, retrospective review of 51 patients who underwent surgical resection of pancreatic adenocarcinoma was conducted and were followed up using contrast-enhanced rsDECT (Discovery CT 750HD, GE Healthcare, Milwaukee, WI). Independent qualitative assessment for presence of local tumor recurrence was performed by two radiologists who evaluated 65 keV (single-energy CT-equivalent interpretation) and 65 keV with MS-I (rsDECT interpretation) in separate sessions. Quantitative analysis of Hounsfield unit (HU, on 65 keV) and normalized iodine concentration (NIC on MS-I images; iodine concentration ratio in post-operative tissue to aorta) was measured. Follow-up imaging, temporal change of CEA and CA 19-9 or biopsy served as reference standard for presence and absence of local recurrence. Sensitivity and specificity of readers and quantitative parameters was calculated and receiver operating characteristic curves and Fisher's exact test were generated. A p value < 0.05 was considered statistically significant. RESULTS A total of 51 patients (27 females, 24 males) with mean age of 64 years built the final cohort. Local recurrence was absent in 23 (Group A) and present in 28 (Group B) patients. The follow-up imaging was performed within 7 months of rsDECT. For both readers, the addition of MS-I increased the specificity for tissue characterization and improved reader confidence as compared to 65 keV (specificity: 80% and 56%, respectively) images alone. Quantitative analysis revealed a significantly lower NIC (0.28 vs. 0.35; p < 0.05) for non-recurrent tissue. However, HU was not significantly different for non-recurrent and recurrent tissue (0.63 vs. 0.70; p > 0.05). CONCLUSION In inherently complex cases of post-operative pancreatic adenocarcinoma, MS-I images from rsDECT can be a useful adjunct to conventional scans in characterizing loco-regional soft tissue.
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Affiliation(s)
- Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Manuel Patino
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniela Muenzel
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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State-of-the-Art Diagnosis and Treatment of Melanoma. J Comput Assist Tomogr 2018; 42:331-339. [DOI: 10.1097/rct.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Initial Results of a Single-Source Dual-Energy Computed Tomography Technique Using a Split-Filter: Assessment of Image Quality, Radiation Dose, and Accuracy of Dual-Energy Applications in an In Vitro and In Vivo Study. Invest Radiol 2017; 51:491-8. [PMID: 26895193 DOI: 10.1097/rli.0000000000000257] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the image quality, radiation dose, and accuracy of virtual noncontrast images and iodine quantification of split-filter dual-energy computed tomography (CT) using a single x-ray source in a phantom and patient study. MATERIALS AND METHODS In a phantom study, objective image quality and accuracy of iodine quantification were evaluated for the split-filter dual-energy mode using a tin and gold filter. In a patient study, objective image quality and radiation dose were compared in thoracoabdominal CT of 50 patients between the standard single-energy and split-filter dual-energy mode. The radiation dose was estimated by size-specific dose estimate. To evaluate the accuracy of virtual noncontrast imaging, attenuation measurements in the liver, spleen, and muscle were compared between a true noncontrast premonitoring scan and the virtual noncontrast images of the dual-energy scans. Descriptive statistics and the Mann-Whitney U test were used. RESULTS In the phantom study, differences between the real and measured iodine concentration ranged from 2.2% to 21.4%. In the patient study, the single-energy and dual-energy protocols resulted in similar image noise (7.4 vs 7.1 HU, respectively; P = 0.43) and parenchymal contrast-to-noise ratio (CNR) values for the liver (29.2 vs 28.5, respectively; P = 0.88). However, the vascular CNR value for the single-energy protocol was significantly higher than for the dual-energy protocol (10.0 vs 7.1, respectively; P = 0.006). The difference in the measured attenuation between the true and the virtual noncontrast images ranged from 3.1 to 6.7 HU. The size-specific dose estimate of the dual-energy protocol was, on average, 17% lower than that of the single-energy protocol (11.7 vs 9.7 mGy, respectively; P = 0.008). CONCLUSIONS Split-filter dual-energy compared with single-energy CT results in similar objective image noise in addition to dual-energy capabilities at 17% lower radiation dose. Because of beam hardening, split-filter dual-energy can lead to decreased CNR values of iodinated structures.
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Dual-energy computed tomography in patients with cutaneous malignant melanoma: Comparison of noise-optimized and traditional virtual monoenergetic imaging. Eur J Radiol 2017; 95:1-8. [DOI: 10.1016/j.ejrad.2017.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/27/2017] [Accepted: 07/19/2017] [Indexed: 02/06/2023]
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Chen X, Xu Y, Duan J, Li C, Sun H, Wang W. Correlation of iodine uptake and perfusion parameters between dual-energy CT imaging and first-pass dual-input perfusion CT in lung cancer. Medicine (Baltimore) 2017; 96:e7479. [PMID: 28700488 PMCID: PMC5515760 DOI: 10.1097/md.0000000000007479] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To investigate the potential relationship between perfusion parameters from first-pass dual-input perfusion computed tomography (DI-PCT) and iodine uptake levels estimated from dual-energy CT (DE-CT).The pre-experimental part of this study included a dynamic DE-CT protocol in 15 patients to evaluate peak arterial enhancement of lung cancer based on time-attenuation curves, and the scan time of DE-CT was determined. In the prospective part of the study, 28 lung cancer patients underwent whole-volume perfusion CT and single-source DE-CT using 320-row CT. Pulmonary flow (PF, mL/min/100 mL), aortic flow (AF, mL/min/100 mL), and a perfusion index (PI = PF/[PF + AF]) were automatically generated by in-house commercial software using the dual-input maximum slope method for DI-PCT. For the dual-energy CT data, iodine uptake was estimated by the difference (λ) and the slope (λHU). λ was defined as the difference of CT values between 40 and 70 KeV monochromatic images in lung lesions. λHU was calculated by the following equation: λHU = |λ/(70 - 40)|. The DI-PCT and DE-CT parameters were analyzed by Pearson/Spearman correlation analysis, respectively.All subjects were pathologically proved as lung cancer patients (including 16 squamous cell carcinoma, 8 adenocarcinoma, and 4 small cell lung cancer) by surgery or CT-guided biopsy. Interobserver reproducibility in DI-PCT (PF, AF, PI) and DE-CT (λ, λHU) were relatively good to excellent (intraclass correlation coefficient [ICC]Inter = 0.8726-0.9255, ICCInter = 0.8179-0.8842; ICCInter = 0.8881-0.9177, ICCInter = 0.9820-0.9970, ICCInter = 0.9780-0.9971, respectively). Correlation coefficient between λ and AF, and PF were as follows: 0.589 (P < .01) and 0.383 (P < .05). Correlation coefficient between λHU and AF, and PF were as follows: 0.564 (P < .01) and 0.388 (P < .05).Both the single-source DE-CT and dual-input CT perfusion analysis method can be applied to assess blood supply of lung cancer patients. Preliminary results demonstrated that the iodine uptake relevant parameters derived from DE-CT significantly correlated with perfusion parameters derived from DI-PCT.
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Uhrig M, Simons D, Bonekamp D, Schlemmer HP. Improved detection of melanoma metastases by iodine maps from dual energy CT. Eur J Radiol 2017; 90:27-33. [PMID: 28583644 DOI: 10.1016/j.ejrad.2017.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/29/2016] [Accepted: 02/15/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Metastatic disease in melanoma has an unpredictable nature with deposits in rare locations such as musculature. Dual energy CT (DECT) provides high contrast-visualization of enhancement by using spectral properties of iodine. Purpose of this study was to evaluate whether iodine maps from DECT improve lesion detection in staging examinations of melanoma patients. METHODS This retrospective study was approved by IRB and written informed consent was obtained from all patients. 75 contrast-enhanced DECT scans (thorax and abdomen) from 75 melanoma patients (n=69 stage IV; n=6 stage III) were analysed. For each patient, conventional CT and iodine maps were reviewed independently by two radiologists. The number of lesions detected by reviewing the iodine maps following conventional CT was recorded. Unweighted Cohens Kappa coefficient (κ) was used for concordance analysis, Wilcoxon test for comparing lesion detection rates. RESULTS In 26 patients, at least one reader found additional lesions on iodine maps (inter-reader agreement 89%, κ=0.74 (0.742-0.747)). Compared to grey-scale images, mean detection rate for metastases improved from 86% (range 82-90) to 94% (90-99%) (p≤0.01), for muscle metastases from 8% (8-8%) to 99% (98-100%) (p≤0.06). Findings included 2 pulmonary emboli. CONCLUSION Iodine maps from DECT improve detection of metastases, especially muscle metastases, and relevant findings in staging examinations of melanoma patients.
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Affiliation(s)
- Monika Uhrig
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
| | - David Simons
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - David Bonekamp
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
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Hellbach K, Sterzik A, Sommer W, Karpitschka M, Hummel N, Casuscelli J, Ingrisch M, Schlemmer M, Graser A, Staehler M. Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 2016; 27:2532-2537. [PMID: 27678131 DOI: 10.1007/s00330-016-4597-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the potential role of dual energy CT (DECT) to visualize antiangiogenic treatment effects in patients with metastatic renal cell cancer (mRCC) while treated with tyrosine-kinase inhibitors (TKI). METHODS 26 patients with mRCC underwent baseline and follow-up single-phase abdominal contrast enhanced DECT scans. Scans were performed immediately before and 10 weeks after start of treatment with TKI. Virtual non-enhanced (VNE) and colour coded iodine images were generated. 44 metastases were measured at the two time points. Hounsfield unit (HU) values for VNE and iodine density (ID) as well as iodine content (IC) in mg/ml of tissue were derived. These values were compared to the venous phase DECT density (CTD) of the lesions. Values before and after treatment were compared using a paired Student's t test. RESULTS Between baseline and follow up, mean CTD and DECT-derived ID both showed a significant reduction (p < 0.005). The relative reduction measured in percent was significantly greater for ID than for CTD (49.8 ± 36,3 % vs. 29.5 ± 20.8 %, p < 0.005). IC was also significantly reduced under antiangiogenic treatment (p < 0.0001). CONCLUSIONS Dual energy CT-based quantification of iodine content of mRCC metastases allows for significantly more sensitive and reproducible detection of antiangiogenic treatment effects. KEY POINTS • A sign of tumour response to antiangiogenic treatment is reduced tumour perfusion. • DECT allows visualizing iodine uptake, which serves as a marker for vascularization. • More sensitive detection of antiangiogenic treatment effects in mRCC is possible.
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Affiliation(s)
- K Hellbach
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - A Sterzik
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - W Sommer
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Karpitschka
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - N Hummel
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - J Casuscelli
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Ingrisch
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Schlemmer
- Department of Palliative Care, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Germany
| | - A Graser
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
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Imaging approaches to assess the therapeutic response of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): current perspectives and future trends of an exciting field in development. Cancer Metastasis Rev 2016; 34:823-42. [PMID: 26433592 PMCID: PMC4661203 DOI: 10.1007/s10555-015-9598-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a family of neoplasms with a complex spectrum of clinical behavior. Although generally more indolent than carcinomas, once they progress beyond surgical resectability, they are essentially incurable. Systemic treatment options have substantially expanded in recent years for the management of advanced disease. Imaging plays a major role in new drug development, as it is the main tool used to objectively evaluate response to novel agents. However, current standard response criteria have proven suboptimal for the assessment of the antiproliferative effect of many targeted agents, particularly in the context of slow-growing tumors such as well-differentiated NETs. The aims of this article are to discuss the advantages and limitations of conventional radiological techniques and standard response assessment criteria and to review novel imaging modalities in development as well as alternative cancer- and therapy-specific criteria to assess drug efficacy in the field of GEP-NETs.
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Altenbernd J, Wetter A, Forsting M, Umutlu L. Treatment response after radioembolisation in patients with hepatocellular carcinoma-An evaluation with dual energy computed-tomography. Eur J Radiol Open 2016; 3:230-5. [PMID: 27622200 PMCID: PMC5009187 DOI: 10.1016/j.ejro.2016.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The aim of this prospective study was to examine the diagnostic value of dual-energy CT (DECT) in the assessment of response of HCC after radioembolisation (RE). MATERIAL AND METHODS 40 HCC patients with 82 measurable target lesions were included in this study. At baseline and follow-up examination target lesions were evaluated with (IU), AASLD and Choi measurement criteria. Disease control was defined as the sum of complete response (CR), partial response (PR), progression disease (PD) and stable disease (SD). RESULTS With Choi and IU more patients were considered than PR and less than PD and SD. According to AASLD more patients were measured as SD and PD than PR. 26/40 patients were classified as PR with IU. In contrast measurements with AASLD in only 8/26 patients were also classified as PR. 6/12 SD patients measured with IU were measured as PD with AASLD. 4/26 patients classified with IU as PR were described as SD with CHOI, 10/14 SD patients measured with CHOI were SD according to IU, the other 4 patients were PR with IU. 2/4 PD patients according to CHOI were SD with IU. CONCLUSION More patients by IU were classified as SD versus PD and PR versus SD. We attribute this to the more detailed consideration of the HU differences between the virtual native and contrast-enhanced series generated by DECT. Iodine uptake (IU) in HCC measured and visualized with DECT is a promising imaging method for the assessment of treatment response after radioembolisations. KEY POINTS -dual energy CT of hypervascular tumors such as HCC allows to quantify contrast enhancement without native imaging. -this can be used to evaluate the therapy response after Radioembolization.
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Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
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Uhrig M, Simons D, Kachelrieß M, Pisana F, Kuchenbecker S, Schlemmer HP. Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose. Cancer Imaging 2016; 16:15. [PMID: 27329159 PMCID: PMC4915171 DOI: 10.1186/s40644-016-0073-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/14/2016] [Indexed: 01/28/2023] Open
Abstract
Background Dual energy CT (DECT) has proven its potential in oncological imaging. Considering the repeated follow-up examinations, radiation dose should not exceed conventional single energy CT (SECT). Comparison studies on the same scanner with a large number of patients, considering patient geometries and image quality, and exploiting full potential of SECT dose reduction are rare. Purpose of this retrospective study was to compare dose of dual source DECT versus dose-optimized SECT abdominal imaging in clinical routine. Methods One hundred patients (62y (±14)) had either contrast-enhanced SECT including automatic voltage control (44) or DECT (56). CT dose index (CTDIvol), size-specific dose-estimate (SSDE) and dose-length product (DLP) were reported. Image noise (SD) was recorded as mean of three ROIs placed in subcutaneous fat and normalized to dose by \documentclass[12pt]{minimal}
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\begin{document}$$ SDn=SD\times \sqrt{CDTIvol} $$\end{document}SDn=SD×CDTIvol. For dose-normalized contrast-to-noise ratio (CNRD), mean attenuation of psoas muscle (CTmuscle) and subcutaneous fat (CTfat) were compared by CNRD = (CTmuscle − CTfat)/SDn. Statistical significance was tested with two-sided t-test (α = 0.05). Results There was no significant difference (p < 0.05) between DECT and SECT: Mean CTDIvol was 14.2 mGy (±3.9) (DECT) and 14.3 mGy (±4.5) (SECT). Mean DLP was 680 mGy*cm (±220) (DECT) and 665 mGy*cm (±231) (SECT). Mean SSDE was 15.7 mGy (±1.9) (DECT) and 16.1 mGy (±2.5) (SECT). Mean SDn was 42.2 (±13.9) HU \documentclass[12pt]{minimal}
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\begin{document}$$ *\sqrt{\mathrm{mGy}} $$\end{document}*mGy (DECT) and 47.8 (±14.9) HU \documentclass[12pt]{minimal}
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\begin{document}$$ *\sqrt{\mathrm{mGy}} $$\end{document}*mGy (SECT). Mean CNRD was 3.9 (±1.3) \documentclass[12pt]{minimal}
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\begin{document}$$ {\mathrm{mGy}}^{-\frac{1}{2}} $$\end{document}mGy−12. (DECT) and 4.0 (±1.3) \documentclass[12pt]{minimal}
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\begin{document}$$ {\mathrm{mGy}}^{-\frac{1}{2}} $$\end{document}mGy−12 (SECT). Conclusion Abdominal DECT is feasible without increasing radiation dose or deteriorating image quality, even compared to dose-optimized SECT including automatic voltage control. Thus DECT can contribute to sophisticated oncological imaging without dose penalty.
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Affiliation(s)
- Monika Uhrig
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
| | - David Simons
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Marc Kachelrieß
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Francesco Pisana
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Stefan Kuchenbecker
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
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Uhrig M, Simons D, Ganten MK, Hassel JC, Schlemmer HP. Histogram analysis of iodine maps from dual energy computed tomography for monitoring targeted therapy of melanoma patients. Future Oncol 2015; 11:591-606. [PMID: 25686115 DOI: 10.2217/fon.14.265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM Iodine quantification with dual energy computed tomography (DECT) enables quantitative assessment of contrast medium uptake. Our purpose was to investigate patterns of enhancement under BRAF inhibitor therapy by performing histogram analyses (HAs) of iodine maps. MATERIALS & METHODS A total of 11 stage IV melanoma patients (32 metastases) underwent DECT at baseline and at least one follow up. Iodine uptake and HAs including maximum HU value (MAX), mean HU value (MEAN) and standard deviation (STD) was calculated. RESULTS For BRAF-responders MEAN, MAX and STD decreased significantly (p < 0.05). Nonresponder showed increasing MAX and STD for six out of seven lesions, while MEAN and Iodine uptake decreased (four) and increased (three). CONCLUSION HA based on DECT enables a quantitative and functional criterion and contributes to accurate response assessment for promising targeted therapies.
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Affiliation(s)
- Monika Uhrig
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280; D-69120 Heidelberg, Germany
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Wu GY, Suo ST, Kong W, Jin D, Zhang J, Xu JR. Evaluation of clinical outcomes of antiangiogenic-targeted therapy in patients with pulmonary metastatic renal cell carcinoma using non-contrast-enhanced computed tomography. Acad Radiol 2014; 21:1434-40. [PMID: 25097010 DOI: 10.1016/j.acra.2014.06.007] [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] [Received: 04/01/2014] [Revised: 05/31/2014] [Accepted: 06/17/2014] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to assess whether changes to radiographic parameters before and after treatment with antiangiogenic drugs would improve performance in predicting tumor response with non-contrast-enhanced computed tomography (NCECT) compared to Response Evaluation Criteria in Solid Tumors (RECIST). MATERIAL AND METHODS The exploration sample group and the validation sample group consisted of 58 and 25 patients, respectively, who had pulmonary metastatic renal cell carcinoma and were receiving antiangiogenic drugs. All patients underwent NCECT scans at baseline and at first evaluation (after two cycles of treatment) with the same scan protocol. Tumor diameter, attenuation value, entropy, and uniformity of the exploration sample group were examined by receiver operating characteristic (ROC) analysis and stepwise discriminant analysis. The threshold value derived from ROC analysis and discriminant function of the exploration sample group were also used for the validation sample group and were compared to RECIST using Kaplan-Meier survival curves. RESULTS According to the model obtained from the exploration group, Kaplan-Meier curves for patients without disease progression were significantly different for the discriminant analysis of the validation sample group (P = .04) and better than individually using RECIST (P = .08), percentage change for attenuation value (P = .49), entropy (P = .47, .89, .72, .73, and .58), and uniformity (P = .53, .72, .51, .39, and .16; without filtration, at scale values of 1.0, 1.5, 2.0, and 2.5, respectively). CONCLUSIONS Combined with changes to imaging parameters, including size, attenuation value, and uniformity between pre- and post-treatment, discrimination analysis can help predict biologic response to antiangiogenic drugs and provide a more accurate response assessment than RECIST criteria.
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Affiliation(s)
- Guang-yu Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Rd, Pudong, Shanghai 200120, China
| | - Shi-teng Suo
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Rd, Pudong, Shanghai 200120, China
| | - Wen Kong
- Department of Urinary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Di Jin
- Department of Urinary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Jin Zhang
- Department of Urinary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Jian-rong Xu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Rd, Pudong, Shanghai 200120, China.
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Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response. Eur Radiol 2014; 24:1981-8. [PMID: 24895031 DOI: 10.1007/s00330-014-3223-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 04/11/2014] [Accepted: 05/07/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the potential contribution of iodine uptake calculation from dual-phase dual-energy CT (DE-CT) for lymph node staging and therapy response monitoring in lung cancer patients. METHODS Retrospective analysis of 27 patients with non-small cell lung carcinoma (NSCLC), who underwent dual-phase DE-CT before and after chemotherapy, was performed. Iodine uptake (mg/mL) and total iodine uptake (mg) were calculated using prototype software in the early (arterial) and late (venous) post-contrast circulatory phase in 110 mediastinal lymph nodes. The arterial enhancement fraction (AEF) was calculated and compared with lymph node size and response to chemotherapy. RESULTS A significant difference of AEF was observed between enlarged (90.4%; 32.3-238.5%) and non-enlarged (72.7%; -37.5-237.5%) lymph nodes (p = 0.044) before treatment onset. A significantly different change of AEF in responding (decrease of 26.3%; p = 0.022) and non-responding (increase of 43.0%; p = 0.031) lymph nodes was demonstrated. A higher value of AEF before treatment was observed in lymph nodes with subsequent favourable response (88.6% vs. 77.7%; p = 0.122), but this difference did not reach statistical significance. CONCLUSIONS The dual-phase DE-CT examination with quantification of ratio of early and late post-contrast iodine uptake is a feasible and promising method for the functional evaluation of mediastinal lymph nodes including therapy response assessment. KEY POINTS • Dual-phase DE-CT is beneficial for mediastinal lymph node assessment in NSCLC. • Arterial to venous iodine uptake ratio was higher in enlarged lymph nodes. • Change of arterial enhancement fraction correlated to therapy response.
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Recent developments of dual-energy CT in oncology. Eur Radiol 2014; 24:930-9. [DOI: 10.1007/s00330-013-3087-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/14/2013] [Accepted: 12/06/2013] [Indexed: 12/27/2022]
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