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Lacroix M, Mulé S, Herin E, Pigneur F, Richard P, Zegai B, Baranes L, Djabbari M, Brunetti F, de'Angelis N, Laurent A, Tacher V, Kobeiter H, Luciani A. Virtual unenhanced imaging of the liver derived from 160-mm rapid-switching dual-energy CT (rsDECT): Comparison of the accuracy of attenuation values and solid liver lesion conspicuity with native unenhanced images. Eur J Radiol 2020; 133:109387. [PMID: 33166833 DOI: 10.1016/j.ejrad.2020.109387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/06/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the reliability of attenuation values of the liver parenchyma and focal liver lesions on virtual unenhanced images from arterial (VUEart) and portal venous phases (VUEport) compared to native unenhanced (NU) attenuation values in patients referred for assessment of malignant liver lesions. METHODS Seventy-three patients with confirmed primary or metastatic liver tumors who underwent a multiphase contrast-enhanced rapid-switching kVp dual-energy CT (rsDECT) were included in this IRB-approved retrospective study. Both qualitative and quantitative analyses - including the lesion-to-liver contrast-to-noise ratio (LL-CNR) - were performed and compared between NU and both VUEart and VUEport images. RESULTS The mean liver attenuation values were significantly lower in VUEart images (56.7 ± 6.7 HU) than in NU images (59.6 ± 7.5 HU, p = 0.008), and were comparable between VUEart and VUEport images (57.9 ± 6 UH, p = 0.38) and between VUEport and NU images (p = 0.051). The mean liver lesions attenuation values were comparable between NU, VUEart and VUEport images (p = 0.60). Strong and significant correlations values were found both in liver lesions and tumor-free parenchyma (r = 0.82-0.91, p < 0.01). The mean LL-CNR was significantly higher in VUEart and VUEport images than in NU images (1.7 ± 1 and 1.6 ± 1.1 vs 0.9 ± 0.6; p < 0.001), but was comparable between VUEart and VUEport images (p > 0.9). Lesion conspicuity was significantly higher in VUEport images than in NU images (p < 0.001). CONCLUSION VUEport images derived from 3rd generation rsDECT could confidently replace NU images in patients undergoing assessment for malignant liver lesions. These images provide comparable attenuation values in both liver lesions and liver parenchyma while reducing the radiation dose and scanning time.
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Affiliation(s)
- Maxime Lacroix
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France.
| | - Sébastien Mulé
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; INSERM IMRB, U 955, Equipe 18, Créteil, France
| | - Edouard Herin
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Frédéric Pigneur
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | | | - Benhalima Zegai
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Laurence Baranes
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Marjan Djabbari
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Francesco Brunetti
- Service de chirurgie digestive, AP-HP, Hôpital Henri Mondor, 94010 Créteil, France
| | - Nicola de'Angelis
- Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; Service de chirurgie digestive, AP-HP, Hôpital Henri Mondor, 94010 Créteil, France
| | - Alexis Laurent
- Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; Service de chirurgie digestive, AP-HP, Hôpital Henri Mondor, 94010 Créteil, France
| | - Vania Tacher
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Hicham Kobeiter
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France
| | - Alain Luciani
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; INSERM IMRB, U 955, Equipe 18, Créteil, France
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Assessing Chemotherapeutic Response in Pancreatic Ductal Adenocarcinoma: Histogram Analysis of Iodine Concentration and CT Number in Single-Source Dual-Energy CT. AJR Am J Roentgenol 2018; 211:1221-1226. [PMID: 30332288 DOI: 10.2214/ajr.18.19791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility of histographic analysis of iodine concentration (IC) and CT number on single-source dual-energy CT (DECT) to assess response to first-line chemotherapy in patients with pancreatic ductal adenocarcinoma (PDAC) who received first-line chemotherapy but not radiation therapy. SUBJECTS AND METHODS This prospective study was approved by our institutional review board, and patients gave written informed consent. Sixty consecutive patients with PDAC undergoing first-line chemotherapy underwent DECT during the pancreatic parenchymatous phase (PPP) and the equilibrium phase (EP). The IC and CT number of PDAC were measured using PPP and EP iodine-based material decomposition and monochromatic images (65 keV), respectively. Histographic parameters for the IC and CT number of PDACs were obtained, and differences in mean IC (ΔIC) and CT number (ΔHU) between the PPP and the EP were calculated. These parameters were then compared between the response (partial response or stable disease) and nonresponse (progressive disease) groups. RESULTS Among the histographic parameters, the kurtosis of IC during the PPP (p = 0.018) and ΔIC (p = 0.0004) were identified as significant for differentiating between the two groups. IC diagnostic factor was calculated using the following coefficients of logistic regression analysis: 0.52 - (1.45 × kurtosis of IC during PPP) + (0.69 × ΔIC). The sensitivity, specificity, and area under the ROC curve for differentiating between the two groups were 97.7%, 70.6%, and 0.889, respectively. CONCLUSION The IC diagnostic factor is a potential biomarker for assessing chemotherapeutic response in patients with PDAC.
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Cannaò PM, Secchi F, Alì M, D'Angelo ID, Scarabello M, Di Leo G, Sardanelli F. High-quality low-dose cardiovascular computed tomography (CCT) in pediatric patients using a 64-slice scanner. Acta Radiol 2018; 59:1247-1253. [PMID: 29368540 DOI: 10.1177/0284185117752981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cardiovascular computed tomography (CCT) technology is rapidly advancing allowing to perform good quality examinations with a radiation dose as low as 1.2 mSv. However, latest generation scanners are not available in all centers. Purpose To estimate radiation dose and image quality in pediatric CCT using a standard 64-slice scanner. Material and Methods A total of 100 patients aged 6.9 ± 5.4 years (mean ± standard deviation) who underwent a 64-slice CCT scan using 80, 100, or 120 kVp, were retrospectively evaluated. Radiation effective dose was calculated on the basis of the dose length product. Two independent readers assessed the image quality through signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and a qualitative score (3 = very good, 2 = good, 1 = poor). Non-parametric tests were used. Results Fifty-five exams were not electrocardiographically (ECG) triggered, 20 had a prospective ECG triggering, and 25 had retrospective ECG triggering. The median effective dose was 1.3 mSv (interquartile range [IQR] = 0.8-2.7 mSv). Median SNR was 30.6 (IQR = 23.4-33.6) at 120 kVp, 29.4 (IQR = 23.7-34.8) at 100 kVp, and 24.7 (IQR = 19.4-34.3) at 80 kVp. Median CNR was 21.0 (IQR = 14.8-24.4), 19.1 (IQR = 15.6-23.9), and 25.3 (IQR = 19.4-33.4), respectively. Image quality was very good, good, and poor in 56, 39, and 5 patients, respectively. No significant differences were found among voltage groups for SNR ( P = 0.486), CNR ( P = 0.336), and subjective image quality ( P = 0.296). The inter-observer reproducibility was almost perfect (κ = 0.880). Conclusion High-quality pediatric CCT can be performed using a 64-slice scanner, with a radiation effective dose close to 2 mSv in about 50% of the cases.
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Affiliation(s)
| | - Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, Donato Milanese, Italy
| | - Marco Alì
- PhD Course in Integrative Biomedical Research, Università degli Studi di Milano, Milan, Italy
| | - Ida Daniela D'Angelo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Marco Scarabello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Donato Milanese, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy
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The Usefulness of Dual-Layer Spectral Computed Tomography for Myelography: A Case Report and Review of the Literature. Case Rep Orthop 2018; 2018:1468929. [PMID: 29686915 PMCID: PMC5857345 DOI: 10.1155/2018/1468929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
We describe a case of lumbar stenosis in which retrospective spectral analysis using dual-layer spectral detector computed tomography (CT) had the ability to expand the evaluable region in the spinal canal. Spinal canal stenosis is a common condition whose symptoms (such as lower back and leg pain with walking) deteriorate the quality of life. Generally, magnetic resonance imaging (MRI) and CT myelography are performed to diagnose canal stenosis. Dual-layer spectral detector CT can yield virtual monochromatic imaging and retrospective on-demand spectral analysis without a prescan setting. Spectral analysis could expand the evaluable region in the spinal canal for increasing the contrast enhancement in the canal.
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 4: Abdominal and Pelvic Applications. J Comput Assist Tomogr 2017; 41:8-14. [PMID: 27824670 DOI: 10.1097/rct.0000000000000546] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This is the fourth of a series of 4 white papers that represent expert consensus documents developed by the Society of Computed Body Tomography and Magnetic Resonance through its task force on dual-energy computed tomography. This article, part 4, discusses DECT for abdominal and pelvic applications and, at the end of each, will offer our consensus opinions on the current clinical utility of the application and opportunities for further research.
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Li Y, Li Y, Jackson A, Li X, Huang N, Guo C, Zhang H. Comparison of virtual unenhanced CT images of the abdomen under different iodine flow rates. Abdom Radiol (NY) 2017; 42:312-321. [PMID: 27470507 DOI: 10.1007/s00261-016-0842-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effect of varying iodine flow rate (IFR) and iodine concentration on the quality of virtual unenhanced (VUE) images of the abdomen obtained with dual-energy CT. METHODS 94 subjects underwent unenhanced and triphasic contrast-enhanced CT scan of the abdomen, including arterial phase, portal venous phase, and delayed phase using dual-energy CT. Patients were randomized into 4 groups with different IFRs or iodine concentrations. VUE images were generated at 70 keV. The CT values, image noise, SNR and CNR of aorta, portal vein, liver, liver lesion, pancreatic parenchyma, spleen, erector spinae, and retroperitoneal fat were recorded. Dose-length product and effective dose for an examination with and without plain phase scan were calculated to assess the potential dose savings. Two radiologists independently assessed subjective image quality using a five-point scale. The Kolmogorov-Smirnov test was used first to test for normal distribution. Where data conformed to a normal distribution, analysis of variance was used to compare mean HU values, image noise, SNRs and CNRs for the 4 image sets. Where data distribution was not normal, a nonparametric test (Kruskal-Wallis test followed by stepwise step-down comparisons) was used. The significance level for all tests was 0.01 (two-sided) to allow for type 2 errors due to multiple testing. RESULTS The CT numbers (HU) of VUE images showed no significant differences between the 4 groups (p > 0.05) or between different phases within the same group (p > 0.05). VUE images had equal or higher SNR and CNR than true unenhanced images. VUE images received equal or lower subjective image quality scores than unenhanced images but were of acceptable quality for diagnostic use. Calculated dose-length product and estimated dose showed that the use of VUE images in place of unenhanced images would be associated with a dose saving of 25%. CONCLUSIONS VUE images can replace conventional unenhanced images. VUE images are not affected by varying iodine flow rates and iodine concentrations, and diagnostic examinations could be acquired with a potential dose saving of 25%.
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Affiliation(s)
- Yongrui Li
- Department of Radiology, The First Hospital of JiLin University, Changchun, 130000, Jilin, China
| | - Ye Li
- Department of Radiology, The First Hospital of JiLin University, Changchun, 130000, Jilin, China
| | - Alan Jackson
- Wolfson Molecular Imaging Center, University of Manchester, Withington, Manchester, M20 3LJ, UK
| | - Xiaodong Li
- Department of Radiology, The First Hospital of JiLin University, Changchun, 130000, Jilin, China
| | - Ning Huang
- GE Healthcare (Life Science), Beijing, 100176, China
| | - Chunjie Guo
- Department of Radiology, The First Hospital of JiLin University, Changchun, 130000, Jilin, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of JiLin University, Changchun, 130000, Jilin, China.
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Gao SY, Zhang XP, Cui Y, Sun YS, Tang L, Li XT, Zhang XY, Shan J. Fused monochromatic imaging acquired by single source dual energy CT in hepatocellular carcinoma during arterial phase: an initial experience. Chin J Cancer Res 2014; 26:437-43. [PMID: 25232217 DOI: 10.3978/j.issn.1000-9604.2014.08.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/27/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore whether single and fused monochromatic images can improve liver tumor detection and delineation by single source dual energy CT (ssDECT) in patients with hepatocellular carcinoma (HCC) during arterial phase. METHODS Fifty-seven patients with HCC who underwent ssDECT scanning at Beijing Cancer Hospital were enrolled retrospectively. Twenty-one sets of monochromatic images from 40 to 140 keV were reconstructed at 5 keV intervals in arterial phase. The optimal contrast-noise ratio (CNR) monochromatic images of the liver tumor and the lowest-noise monochromatic images were selected for image fusion. We evaluated the image quality of the optimal-CNR monochromatic images, the lowest-noise monochromatic images and the fused monochromatic images, respectively. The evaluation indicators included the spatial resolution of the anatomical structure, the noise level, the contrast and CNR of the tumor. RESULTS In arterial phase, the anatomical structure of the liver can be displayed most clearly in the 65-keV monochromatic images, with the lowest image noise. The optimal-CNR monochromatic images of HCC tumor were 50-keV monochromatic images in which the internal structural features of the liver tumors were displayed most clearly and meticulously. For tumor detection, the fused monochromatic images and the 50-keV monochromatic images had similar performances, and were more sensitive than 65-keV monochromatic images. CONCLUSIONS We achieved good arterial phase images by fusing the optimal-CNR monochromatic images of the HCC tumor and the lowest-noise monochromatic images. The fused images displayed liver tumors and anatomical structures more clearly, which is potentially helpful for identifying more and smaller HCC tumors.
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Affiliation(s)
- Shun-Yu Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Peng Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yong Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lei Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jun Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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