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Fink N, Emrich T, Schoepf UJ, Zsarnoczay E, O’Doherty J, Halfmann MC, Griffith JP, Pinos D, Suranyi P, Baruah D, Kabakus IM, Ricke J, Varga-Szemes A. Improved Detection of Small and Low-Density Plaques in Virtual Noncontrast Imaging-based Calcium Scoring at Photon-Counting Detector CT. Radiol Cardiothorac Imaging 2024; 6:e230328. [PMID: 39023373 PMCID: PMC11369658 DOI: 10.1148/ryct.230328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 03/26/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
Purpose To investigate the impact of plaque size and density on virtual noncontrast (VNC)-based coronary artery calcium scoring (CACS) using photon-counting detector CT and to provide safety net reconstructions for improved detection of subtle plaques in patients whose VNC-based CACS would otherwise be erroneously zero when compared with true noncontrast (TNC)-based CACS. Materials and Methods In this prospective study, CACS was evaluated in a phantom containing calcifications with different diameters (5, 3, and 1 mm) and densities (800, 400, and 200 mg/cm3) and in participants who underwent TNC and contrast-enhanced cardiac photon-counting detector CT (July 2021-March 2022). VNC images were reconstructed at different virtual monoenergetic imaging (55-80 keV) and quantum iterative reconstruction (QIR) levels (QIR,1-4). TNC scans at 70 keV with QIR off served as the reference standard. In vitro CACS was analyzed using standard settings (3.0-mm sections, kernel Qr36, 130-HU threshold). Calcification detectability and CACS of small and low-density plaques were also evaluated using 1.0-mm sections, kernel Qr44, and 120- or 110-HU thresholds. Safety net reconstructions were defined based on background Agatston scores and evaluated in vivo in TNC plaques initially nondetectable using standard VNC reconstructions. Results The in vivo cohort included 63 participants (57.8 years ± 15.5 [SD]; 37 [59%] male, 26 [41%] female). Correlation and agreement between standard CACSVNC and CACSTNC were higher in large- and medium-sized and high- and medium-density than in low-density plaques (in vitro: intraclass correlation coefficient [ICC] ≥ 0.90; r > 0.9 vs ICC = 0.20-0.48; r = 0.5-0.6). Small plaques were not detectable using standard VNC reconstructions. Calcification detectability was highest using 1.0-mm sections, kernel Qr44, 120- and 110-HU thresholds, and QIR level of 2 or less VNC reconstructions. Compared with standard VNC, using safety net reconstructions (55 keV, QIR 2, 110-HU threshold) for in vivo subtle plaque detection led to higher detection (increased by 89% [50 of 56]) and improved correlation and agreement of CACSVNC with CACSTNC (in vivo: ICC = 0.51-0.61; r = 0.6). Conclusion Compared with TNC-based calcium scoring, VNC-based calcium scoring was limited for small and low-density plaques but improved using safety net reconstructions, which may be particularly useful in patients with low calcium scores who would otherwise be treated based on potentially false-negative results. Keywords: Coronary Artery Calcium CT, Photon-Counting Detector CT, Virtual Noncontrast, Plaque Size, Plaque Density Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Nicola Fink
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Tilman Emrich
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - U. Joseph Schoepf
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Emese Zsarnoczay
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Jim O’Doherty
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Moritz C. Halfmann
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Joseph P. Griffith
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Daniel Pinos
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Pal Suranyi
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Dhiraj Baruah
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Ismail M. Kabakus
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Jens Ricke
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Akos Varga-Szemes
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
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Lennartz S, Zopfs D, Große Hokamp N. Dual-energy CT revisited: a focused review of clinical use cases. ROFO-FORTSCHR RONTG 2024; 196:794-806. [PMID: 38176436 DOI: 10.1055/a-2203-2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Haag F, Emmrich SS, Hertel A, Rink JS, Nörenberg D, Schoenberg SO, Froelich MF. Virtual Non-Contrast versus True Native in Photon-Counting CT: Stability of Density of Upper Abdominal Organs and Vessels. Diagnostics (Basel) 2024; 14:1130. [PMID: 38893656 PMCID: PMC11171968 DOI: 10.3390/diagnostics14111130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The clinical use of photon-counting CT (PCCT) allows for the generation of virtual non-contrast (VNC) series from contrast-enhanced images. In routine clinical practice, specific issues such as ruling out acute bleeding require non-contrast images. The aim of this study is to evaluate the use of PCCT-derived VNC reconstructions in abdominal imaging. PCCT scans of 17 patients including early arterial, portal venous and native sequences were enrolled. VNC reconstructions have been calculated. In every sequence and VNC reconstruction, 10 ROIs were measured (portal vein, descending aorta, inferior vena cava, liver parenchyma, spleen parenchyma, erector spinae muscle, subcutaneous adipose tissue, first lumbar vertebral body, air, and psoas muscle) and density values were compared. The VNC reconstructions show significant changes in density compared to the contrast-enhanced images. However, there were no significant differences present between the true non-contrast (TNC) and any VNC reconstructions in the observed organs and vessels. Significant differences (p < 0.05) between the measured mean density values in the TNC versus VNC reconstructions were found in fat and bone tissue. The PCCT-derived VNC reconstructions seemed to be comparable to the TNC images, despite some deviations shown in the adipose tissue and bone structures. However, the further benefits in terms of specific clinical issues need to be evaluated.
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Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
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Risch F, Schwarz F, Kroencke T, Decker JA. Heart rate sensitivity of virtual non-contrast calcium scores derived from photon counting detector CT data: a phantom study. LA RADIOLOGIA MEDICA 2024; 129:401-410. [PMID: 38319495 PMCID: PMC10943147 DOI: 10.1007/s11547-024-01773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To assess the reliability of virtual non-contrast (VNC) derived coronary artery calcium quantities in relation to heart rate and the VNC algorithm used compared to reference true non-contrast (TNC), considering several clinically established acquisition modes. MATERIAL AND METHODS An ad hoc built coronary phantom containing four calcified lesions and an iodinated lumen was scanned using three cardiac acquisition modes three times within an anthropomorphic cardiac motion phantom simulating different heart rates (0, 60, 80, 100 bpm) and reconstructed with a conventional (VNCconv) and a calcium-sensitive (VNCpc) VNC algorithm. TNC reference was scanned at 0 bpm with non-iodinated lumen. Calcium scores were assessed in terms of number of lesions detected, Agatston and volume scores and global noise was measured. Paired t-test and Wilcoxon test were performed to test measurements for significant difference. RESULTS For both VNC algorithms used, calcium levels or noise were not significantly affected by heart rate. Measurements on VNCpc reconstructions best reproduced TNC results, but with increased variability (Agatston scores at 0 bpm for TNC, VNCconv, and VNCpc were 47.1 ± 1.1, 6.7 ± 2.8 (p < 0.001), and 45.3 ± 7.6 (p > 0.05), respectively). VNC reconstructions showed lower noise levels compared to TNC, especially for VNCpc (noiseheart on TNC, VNCconv and VNCpc at 0 bpm was 5.0 ± 0.4, 4.5 ± 0.2, 4.2 ± 0.2). CONCLUSION No significant heart rate dependence of VNC-based calcium scores was observed in an intra-reconstruction comparison. VNCpc reproduces TNC scores better than VNCconv without significant differences and decreased noise, however, with an increasing average deviation with rising heart rates. VNC-based CACS should be used with caution as the measures show higher variability compared to reference TNC and therefore hold the potential of incorrect risk categorization.
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Affiliation(s)
- Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
- Medical Faculty, Ludwig Maximilian University Munich, Munich, Germany
- Clinic for Diagnostic and Interventional Radiology, Donau-Isar-Klinikum, Deggendorf, Germany
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University Augsburg, Augsburg, Germany.
| | - Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Haag NP, Michael AE, Lennartz S, Panknin C, Niehoff JH, Borggrefe J, Shahzadi I, Zwanenburg A, Kroeger JR. Coronary Artery Calcium Scoring Using Virtual Versus True Noncontrast Images From Photon-Counting Coronary CT Angiography. Radiology 2024; 310:e230545. [PMID: 38530174 DOI: 10.1148/radiol.230545] [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: 03/27/2024]
Abstract
Background Coronary artery calcium scoring (CACS) for coronary artery disease requires true noncontrast (TNC) CT alongside contrast-enhanced coronary CT angiography (CCTA). Photon-counting CT provides an algorithm (PureCalcium) for reconstructing virtual noncontrast images from CCTA specifically for CACS. Purpose To assess CACS differences based on PureCalcium images derived from contrast-enhanced photon-counting CCTA compared with TNC images and evaluate the impact of these differences on the clinically relevant classification of patients into plaque burden groups. Materials and Methods Photon-counting CCTA images acquired between August 2022 and May 2023 were retrospectively identified. Agatston scores were derived from both TNC and PureCalcium images and tested for differences with use of the Wilcoxon signed-rank test. The agreement was assessed with use of equivalence tests, Bland-Altman analysis, and intraclass correlation coefficient. Plaque burden groups were established based on Agatston scores, and agreement was evaluated using weighted Cohen kappa. The dose-length product was analyzed. Results Among 170 patients (mean age, 63 years ± 13 [SD]; 92 male), 111 had Agatston scores higher than 0. Median Agatston scores did not differ between TNC and PureCalcium images (4.8 [IQR, 0-84.4; range, 0.0-2151.8] vs 2.7 [IQR, 0-90.7; range, 0.0-2377.1]; P = .99), with strong correlation (intraclass correlation coefficient, 0.98 [95% CI: 0.97, 0.99]). The equivalence test was inconclusive, with a 95% CI of 0.90, 1.19. Bland-Altman analysis showed wide repeatability limits, indicating low agreement between the two scores. With use of the PureCalcium algorithm, 125 of 170 patients (74%) were correctly classified into plaque burden groups (excellent agreement, κ = 0.88). Patients without plaque burden were misclassified at higher than normal rates (P < .001). TNC image acquisition contributed a mean of 19.7% ± 8.8 of the radiation dose of the entire examination. Conclusion PureCalcium images show potential to replace TNC images for measuring Agatston scores, thereby reducing radiation dose in CCTA. There was strong correlation in calcium scores between TNC and PureCalcium, but limited agreement. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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Affiliation(s)
- Nina P Haag
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Arwed E Michael
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Simon Lennartz
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Christoph Panknin
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Julius H Niehoff
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Jan Borggrefe
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Iram Shahzadi
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Alex Zwanenburg
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
| | - Jan Robert Kroeger
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.)
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Flohr T, Schmidt B, Ulzheimer S, Alkadhi H. Cardiac imaging with photon counting CT. Br J Radiol 2023; 96:20230407. [PMID: 37750856 PMCID: PMC10646663 DOI: 10.1259/bjr.20230407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
CT of the heart, in particular ECG-controlled coronary CT angiography (cCTA), has become clinical routine due to rapid technical progress with ever new generations of CT equipment. Recently, CT scanners with photon-counting detectors (PCD) have been introduced which have the potential to address some of the remaining challenges for cardiac CT, such as limited spatial resolution and lack of high-quality spectral data. In this review article, we briefly discuss the technical principles of photon-counting detector CT, and we give an overview on how the improved spatial resolution of photon-counting detector CT and the routine availability of spectral data can benefit cardiac applications. We focus on coronary artery calcium scoring, cCTA, and on the evaluation of the myocardium.
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Affiliation(s)
- Thomas Flohr
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Bernhard Schmidt
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Stefan Ulzheimer
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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7
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Braun FM, Risch F, Decker JA, Woźnicki P, Bette S, Becker J, Rippel K, Scheurig-Münkler C, Kröncke TJ, Schwarz F. Image Characteristics of Virtual Non-Contrast Series Derived from Photon-Counting Detector Coronary CT Angiography-Prerequisites for and Feasibility of Calcium Quantification. Diagnostics (Basel) 2023; 13:3402. [PMID: 37998539 PMCID: PMC10670685 DOI: 10.3390/diagnostics13223402] [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: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
In photon-counting detector CT (PCD-CT), coronary artery calcium scoring (CACS) can be performed using virtual non-contrast (VNC) series derived from coronary CT angiography (CCTA) datasets. Our study analyzed image characteristics of VNC series in terms of the efficacy of virtual iodine "removal" and image noise to determine whether the prerequisites for calcium quantification were satisfied. We analyzed 38 patients who had undergone non-enhanced CT followed by CCTA on a PCD-CT. VNC reconstructions were performed at different settings and algorithms (conventional VNCConv; PureCalcium VNCPC). Virtual iodine "removal" was investigated by comparing histograms of heart volumes. Noise was assessed within the left ventricular cavity. Calcium was quantified on the true non-contrast (TNC) and all VNC series. The histograms were comparable for TNC and all VNC. Image noise between TNC and all VNC differed slightly but significantly. VNCConv CACS showed a significant underestimation regardless of the reconstruction setting, while VNCPC CACS were comparable to TNC. Correlations between TNC and VNC were excellent, with a higher predictive accuracy for VNCPC. In conclusion, the iodine contrast can be effectively subtracted from CCTA datasets. The remaining VNC series satisfy the requirements for CACS, yielding results with excellent correlation compared to TNC-based CACS and high predicting accuracy.
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Affiliation(s)
- Franziska M. Braun
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Franka Risch
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Josua A. Decker
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Piotr Woźnicki
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Stefanie Bette
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Judith Becker
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Katharina Rippel
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Christian Scheurig-Münkler
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Thomas J. Kröncke
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
| | - Florian Schwarz
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (F.M.B.); (J.A.D.); (P.W.); (S.B.); (J.B.); (C.S.-M.); (F.S.)
- DONAUISAR Clinic Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, Germany
- Medical Faculty, Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany
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Böttcher B, Zsarnoczay E, Varga-Szemes A, Schoepf UJ, Meinel FG, van Assen M, De Cecco CN. Dual-Energy Computed Tomography in Cardiac Imaging. Radiol Clin North Am 2023; 61:995-1009. [PMID: 37758366 DOI: 10.1016/j.rcl.2023.05.004] [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: 10/03/2023]
Abstract
Dual-energy computed tomography (DECT) acquires images using two energy spectra and offers a variation of reconstruction techniques for improved cardiac imaging. Virtual monoenergetic images decrease artifacts improving coronary plaque and stent visualization. Further, contrast attenuation is increased allowing significant reduction of contrast dose. Virtual non-contrast reconstructions enable coronary artery calcium scoring from contrast-enhanced scans. DECT provides advanced plaque imaging with detailed analysis of plaque components, indicating plaque stability. Extracellular volume assessment using DECT offers noninvasive detection of myocardial fibrosis. This review aims to outline the current cardiac applications of DECT, summarize recent literature, and discuss their findings.
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Affiliation(s)
- Benjamin Böttcher
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Uwe Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging and Imaging Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc. 1365 Clifton Road NE, Suite - AT503, Atlanta, GA 30322, USA.
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Vecsey-Nagy M, Varga-Szemes A, Emrich T, Zsarnoczay E, Nagy N, Fink N, Schmidt B, Nowak T, Kiss M, Vattay B, Boussoussou M, Kolossváry M, Kubovje A, Merkely B, Maurovich-Horvat P, Szilveszter B. Calcium scoring on coronary computed angiography tomography with photon-counting detector technology: Predictors of performance. J Cardiovasc Comput Tomogr 2023; 17:328-335. [PMID: 37635032 DOI: 10.1016/j.jcct.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Obtaining accurate coronary artery calcium (CAC) score measurements from CCTA datasets with virtual non-iodine (VNI) algorithms would reduce acquisition time and radiation dose. We aimed to assess the agreement of VNI-derived and conventional true non-contrast (TNC)-based CAC scores and to identify the predictors of accuracy. METHODS CCTA datasets were acquired with either 120 or 140 kVp. CAC scores and volumes were calculated from TNC and VNI images in 197 consecutive patients undergoing CCTA. CAC density score, mean volume/lesion, aortic Hounsfield units and standard deviations were then measured. Finally, percentage deviation (VNI - TNC/TNC∗100) of CTA-derived CAC scores from non-enhanced scans was calculated for each patient. Predictors (including anthropometric and acquisition parameters, as well as CAC characteristics) of the degree of discrepancy were evaluated using linear regression analysis. RESULTS While the agreement between TNC and VNI was substantial (mean bias, 6.6; limits of agreement, 178.5/145.3), a non-negligible proportion of patients (36/197, 18.3%) were falsely reclassified as CAC score = 0 on VNI. The use of higher tube voltage significantly decreased the percentage deviation relative to TNC-based values (β = -0.21 [95%CI: 0.38 to -0.03], p = 0.020) and a higher CAC density score also proved to be an independent predictor of a smaller difference (β = -0.22 [95%CI: 0.37 to -0.07], p = 0.006). CONCLUSION The performance of VNI-based calcium scoring may be improved by increased tube voltage protocols, while the accuracy may be compromised for calcified lesions of lower density. The implementation of VNI in clinical routine, however, needs to be preceded by a solution for detecting smaller lesions as well.
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Affiliation(s)
- M Vecsey-Nagy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - A Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - T Emrich
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - E Zsarnoczay
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - N Nagy
- Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - N Fink
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - B Schmidt
- Siemens Healthcare GmbH, Forchheim, Germany
| | - T Nowak
- Siemens Healthcare GmbH, Forchheim, Germany
| | - M Kiss
- Siemens Healthcare GmbH, Forchheim, Germany
| | - B Vattay
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - M Boussoussou
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - M Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, Budapest, Hungary
| | - A Kubovje
- Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - B Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - B Szilveszter
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary.
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10
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Mergen V, Ghouse S, Sartoretti T, Manka R, Euler A, Kasel AM, Alkadhi H, Eberhard M. Cardiac Virtual Noncontrast Images for Calcium Quantification with Photon-counting Detector CT. Radiol Cardiothorac Imaging 2023; 5:e220307. [PMID: 37404795 PMCID: PMC10316300 DOI: 10.1148/ryct.220307] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 07/06/2023]
Abstract
Purpose To assess the accuracy of aortic valve calcium (AVC), mitral annular calcium (MAC), and coronary artery calcium (CAC) quantification and risk stratification using virtual noncontrast (VNC) images from late enhancement photon-counting detector CT as compared with true noncontrast images. Materials and Methods This retrospective, institutional review board-approved study evaluated patients undergoing photon-counting detector CT between January and September 2022. VNC images were reconstructed from late enhancement cardiac scans at 60, 70, 80, and 90 keV using quantum iterative reconstruction (QIR) strengths of 2-4. AVC, MAC, and CAC were quantified on VNC images and compared with quantification of AVC, MAC, and CAC on true noncontrast images using Bland-Altman analyses, regression models, intraclass correlation coefficients (ICC), and Wilcoxon tests. Agreement between severe aortic stenosis likelihood categories and CAC risk categories determined from VNC and true noncontrast images was assessed by weighted κ analysis. Results Ninety patients were included (mean age, 80 years ± 8 [SD]; 49 male patients). Scores were similar on true noncontrast images and VNC images at 80 keV for AVC and MAC, regardless of QIR strengths, and VNC images at 70 keV with QIR 4 for CAC (all P > .05). The best results were achieved using VNC images at 80 keV with QIR 4 for AVC (mean difference, 3; ICC = 0.992; r = 0.98) and MAC (mean difference, 6; ICC = 0.998; r = 0.99), and VNC images at 70 keV with QIR 4 for CAC (mean difference, 28; ICC = 0.996; r = 0.99). Agreement between calcification categories was excellent on VNC images at 80 keV for AVC (κ = 0.974) and on VNC images at 70 keV for CAC (κ = 0.967). Conclusion VNC images from cardiac photon-counting detector CT enables patient risk stratification and accurate quantification of AVC, MAC, and CAC.Keywords: Coronary Arteries, Aortic Valve, Mitral Valve, Aortic Stenosis, Calcifications, Photon-counting Detector CT Supplemental material is available for this article © RSNA, 2023.
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Photon Counting Detector CT-Based Virtual Noniodine Reconstruction Algorithm for In Vitro and In Vivo Coronary Artery Calcium Scoring: Impact of Virtual Monoenergetic and Quantum Iterative Reconstructions. Invest Radiol 2023:00004424-990000000-00091. [PMID: 36822677 DOI: 10.1097/rli.0000000000000959] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of virtual monoenergetic imaging (VMI) and quantum iterative reconstruction (QIR) on the accuracy of coronary artery calcium scoring (CACS) using a virtual noniodine (VNI) reconstruction algorithm on a first-generation, clinical, photon counting detector computed tomography system. MATERIALS AND METHODS Coronary artery calcium scoring was evaluated in an anthropomorphic chest phantom simulating 3 different patient sizes by using 2 extension rings (small: 300 × 200 mm, medium: 350 × 250 mm, large: 400 × 300 mm) and in patients (n = 61; final analyses only in patients with coronary calcifications [n = 34; 65.4 ± 10.0 years; 73.5% male]), who underwent nonenhanced and contrast-enhanced, electrocardiogram-gated, cardiac computed tomography on a photon counting detector system. Phantom and patient data were reconstructed using a VNI reconstruction algorithm at different VMI (55-80 keV) and QIR (strength 1-4) levels (CACSVNI). True noncontrast (TNC) scans at 70 keV and QIR "off" were used as reference for phantom and patient studies (CACSTNC). RESULTS In vitro and in vivo CACSVNI showed strong correlation (r > 0.9, P < 0.001 for all) and excellent agreement (intraclass correlation coefficient > 0.9 for all) with CACSTNC at all investigated VMI and QIR levels. Phantom and patient CACSVNI significantly increased with decreasing keV levels (in vitro: from 475.2 ± 26.3 at 80 keV up to 652.5 ± 42.2 at 55 keV; in vivo: from 142.5 [7.4/737.7] at 80 keV up to 248.1 [31.2/1144] at 55 keV; P < 0.001 for all), resulting in an overestimation of CACSVNI at 55 keV compared with CACSTNC at 70 keV in some cases (in vitro: 625.8 ± 24.4; in vivo: 225.4 [35.1/959.7]). In vitro CACS increased with rising QIR at low keV. In vivo scores were significantly higher at QIR 1 compared with QIR 4 only at 60 and 80 keV (60 keV: 220.3 [29.6-1060] vs 219.5 [23.7/1048]; 80 keV: 152.0 [12.0/735.6] vs 142.5 [7.4/737.7]; P < 0.001). CACSVNI was closest to CACSTNC at 60 keV, QIR 2 (+0.1%) in the small; 55 keV, QIR 1 (±0%) in the medium; 55 keV, QIR 4 (-0.1%) in the large phantom; and at 60 keV, QIR 1 (-2.3%) in patients. CONCLUSIONS Virtual monoenergetic imaging reconstructions have a significant impact on CACSVNI. The effects of different QIR levels are less consistent and seem to depend on several individual conditions, which should be further investigated.
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Velangi PS, Agdamag AC, Nijjar PS, Pogatchnik B, Nijjar PS. Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Coronary Computed Tomography Angiography-Based Calcium Scoring: In Vitro and In Vivo Validation of a Novel Virtual Noniodine Reconstruction Algorithm on a Clinical, First-Generation Dual-Source Photon Counting-Detector System. Invest Radiol 2022; 57:536-543. [PMID: 35318969 DOI: 10.1097/rli.0000000000000868] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate coronary computed tomography angiography (CCTA)-based in vitro and in vivo coronary artery calcium scoring (CACS) using a novel virtual noniodine reconstruction (PureCalcium) on a clinical first-generation photon-counting detector-computed tomography system compared with virtual noncontrast (VNC) reconstructions and true noncontrast (TNC) acquisitions. MATERIALS AND METHODS Although CACS and CCTA are well-established techniques for the assessment of coronary artery disease, they are complementary acquisitions, translating into increased scan time and patient radiation dose. Hence, accurate CACS derived from a single CCTA acquisition would be highly desirable. In this study, CACS based on PureCalcium, VNC, and TNC, reconstructions was evaluated in a CACS phantom and in 67 patients (70 [59/80] years, 58.2% male) undergoing CCTA on a first-generation photon counting detector-computed tomography system. Coronary artery calcium scores were quantified for the 3 reconstructions and compared using Wilcoxon test. Agreement was evaluated by Pearson and Spearman correlation and Bland-Altman analysis. Classification of coronary artery calcium score categories (0, 1-10, 11-100, 101-400, and >400) was compared using Cohen κ. RESULTS Phantom studies demonstrated strong agreement between CACSPureCalcium and CACSTNC (60.7 ± 90.6 vs 67.3 ± 88.3, P = 0.01, r = 0.98, intraclass correlation [ICC] = 0.98; mean bias, 6.6; limits of agreement [LoA], -39.8/26.6), whereas CACSVNC showed a significant underestimation (42.4 ± 75.3 vs 67.3 ± 88.3, P < 0.001, r = 0.94, ICC = 0.89; mean bias, 24.9; LoA, -87.1/37.2). In vivo comparison confirmed a high correlation but revealed an underestimation of CACSPureCalcium (169.3 [0.7/969.4] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.98; mean bias, -113.5; LoA, -470.2/243.2). In comparison, CACSVNC showed a similarly high correlation, but a substantially larger underestimation (24.3 [0/272.3] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.54; mean bias, -551.6; LoA, -2037.5/934.4). CACSPureCalcium showed superior agreement of CACS classification (κ = 0.88) than CACSVNC (κ = 0.60). CONCLUSIONS The accuracy of CACS quantification and classification based on PureCalcium reconstructions of CCTA outperforms CACS derived from VNC reconstructions.
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Inkinen SI, Juntunen MAK, Ketola J, Korhonen K, Sepponen P, Kotiaho A, Pohjanen VM, Nieminen M. Virtual monochromatic imaging reduces beam hardening artefacts in cardiac interior photon counting computed tomography: a phantom study with cadaveric specimens. Biomed Phys Eng Express 2021; 8. [PMID: 34911047 DOI: 10.1088/2057-1976/ac4397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
In interior cardiac computed tomography (CT) imaging, the x-ray beam is collimated to a limited field-of-view covering the heart volume, which decreases the radiation exposure to surrounding tissues. Spectral CT enables the creation of virtual monochromatic images (VMIs) through a computational material decomposition process. This study investigates the utility of VMIs for beam hardening (BH) reduction in interior cardiac CT, and further, the suitability of VMIs for coronary artery calcium (CAC) scoring and volume assessment is studied using spectral photon counting detector CT (PCD-CT).Ex vivocoronary artery samples (N = 18) were inserted in an epoxy rod phantom. The rod was scanned in the conventional CT geometry, and subsequently, the rod was positioned in a torso phantom and re-measured in the interior PCD-CT geometry. The total energy (TE) 10-100 keV reconstructions from PCD-CT were used as a reference. The low energy 10-60 keV and high energy 60-100 keV data were used to perform projection domain material decomposition to polymethyl methacrylate and calcium hydroxylapatite basis. The truncated basis-material sinograms were extended using the adaptive detruncation method. VMIs from 30-180 keV range were computed from the detruncated virtual monochromatic sinograms using filtered back projection. Detrending was applied as a post-processing method prior to CAC scoring. The results showed that BH artefacts from the exterior structures can be suppressed with high (≥100 keV) VMIs. With appropriate selection of the monoenergy (46 keV), the underestimation trend of CAC scores and volumes shown in Bland-Altman (BA) plots for TE interior PCD-CT was mitigated, as the BA slope values were -0.02 for the 46 keV VMI compared to -0.21 the conventional TE image. To conclude, spectral PCD-CT imaging using VMIs could be applied to reduce BH artefacts interior CT geometry, and further, optimal selection of VMI may improve the accuracy of CAC scoring assessment in interior PCD-CT.
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Affiliation(s)
- Satu I Inkinen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Mikael A K Juntunen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Juuso Ketola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,The South Savo Social and Health Care Authority, Mikkeli Central Hospital, Mikkeli, Finland
| | - Kristiina Korhonen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Pasi Sepponen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Antti Kotiaho
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miika Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
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16
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Zhou Q, Huang X, Xie Y, Liu X, Li S, Zhou J. Role of quantitative energy spectrum CT parameters in differentiating thymic epithelial tumours and thymic cysts. Clin Radiol 2021; 77:136-141. [PMID: 34857380 DOI: 10.1016/j.crad.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore the utility of multiple energy spectrum computed tomography (CT) parameters in distinguishing thymic epithelial tumours (TETs) from thymic cysts among lesions <5 cm in diameter. MATERIALS AND METHODS Data pertaining to 56 patients with TETs and thymic cysts <5 cm in diameter were assessed retrospectively. All patients underwent surgical resection and the diagnosis was confirmed histopathologically. Thirty-five patients with TETs (average age, 51.97 years) and 21 patients with thymic cysts (average age, 50.54 years) were included. The region of interest for the lesion on the energy spectrum CT was delineated on the post-processing workstation, and multiple parameters of the energy spectrum CT were obtained. The diagnostic efficacies of the parameters were analysed using receiver operating characteristic (ROC) curves. RESULTS To distinguish small TETs from thymic cysts, a single-energy CT value of 60 keV showed good differential diagnostic performance in the arterial phase (cut-off value = 68.42 HU; area under the curve [AUC] = 0.978), a single-energy CT value of 70 keV showed good differential diagnostic performance in the venous phase (cut-off value = 59.77 HU; AUC = 0.956). In the arterial and venous phases, effective atomic numbers of 8.065 and 8.175, respectively, were used as cut-off values to distinguish small TETs from thymic cysts (AUC = 0.972 and AUC = 0.961, respectively). Iodine concentrations of 10.99 and 11.05 were used as cut-off values to distinguish small TETs from thymic cysts (AUC = 0.956 and AUC = 0.924, respectively). CONCLUSION According to the present study, energy spectrum CT parameters may have clinical value in the differential diagnosis of TETs and thymic cysts.
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Affiliation(s)
- Q Zhou
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Second Clinical School, Lanzhou University, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China
| | - X Huang
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Second Clinical School, Lanzhou University, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China
| | - Y Xie
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Second Clinical School, Lanzhou University, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China
| | - X Liu
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Second Clinical School, Lanzhou University, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China
| | - S Li
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Second Clinical School, Lanzhou University, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China
| | - J Zhou
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
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Green CA, Solomon JB, Ruchala KJ, Samei E. Design and implementation of a practical quality control program for dual-energy CT. J Appl Clin Med Phys 2021; 22:249-260. [PMID: 34472700 PMCID: PMC8504583 DOI: 10.1002/acm2.13396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
A novel routine dual‐energy computed tomography (DECT) quality control (QC) program was developed to address the current deficiency of routine QC for this technology. The dual‐energy quality control (DEQC) program features (1) a practical phantom with clinically relevant materials and concentrations, (2) a clinically relevant acquisition, reconstruction, and postprocessing protocol, and (3) a fully automated analysis software to extract quantitative data for database storage and trend analysis. The phantom, designed for easy set up for standalone or adjacent imaging next to the ACR phantom, was made in collaboration with an industry partner and informed by clinical needs to have four iodine inserts (0.5, 1, 2, and 5 mg/ml) and one calcium insert (100 mg/ml) equally spaced in a cylindrical water‐equivalent background. The imaging protocol was based on a clinical DECT abdominal protocol capable of producing material specific concentration maps, virtual unenhanced images, and virtual monochromatic images. The QC automated analysis software uses open‐source technologies which integrates well with our current automated CT QC database. The QC program was tested on a GE 750 HD scanner and two Siemens SOMATOM FLASH scanners over a 3‐month period. The automated algorithm correctly identified the appropriate region of interest (ROI) locations and stores measured values in a database for monitoring and trend analysis. Slight variations in protocol settings were noted based on manufacturer. Overall, the project proved to provide a convenient and dependable clinical tool for routine oversight of DE CT imaging within the clinic.
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Affiliation(s)
- Crystal A Green
- Department of Radiology, Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Justin B Solomon
- Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ehsan Samei
- Department of Radiology, Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
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18
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Walker D, Udare A, Chatelain R, McInnes M, Flood T, Schieda N. Utility of material-specific fat images derived from rapid-kVp-switch dual-energy renal mass CT for diagnosis of renal angiomyolipoma. Acta Radiol 2021; 62:1263-1272. [PMID: 32957794 DOI: 10.1177/0284185120959819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal angiomyolipoma (AML) are benign masses that require detection of macroscopic fat for accurate diagnosis. PURPOSE To evaluate fat material-specific images derived from dual-energy computed tomography (DECT) to diagnose renal AML. MATERIAL AND METHODS This retrospective case-control study evaluated 25 renal AML and 44 solid renal masses (41 renal cell carcinomas, three other tumors) imaged with rapid-kVp-switch DECT (120 kVp non-contrast-enhanced [NECT], 70-keV corticomedullary [CM], and 120-kVp nephrographic [NG]-phase CECT) during 2017-2018. A radiologist measured attenuation (Hounsfield Units [HU]) on NECT, CM-CECT, NG-CECT, and fat concentration (mg/mL) using fat-water base-pair images. RESULTS At NECT, 100% (44/44) non-AML and 4.0% (1/25) AML measured >-15 HU. At CM-CECT and NG-CECT, 24.0% (6/25) and 20.0% (5/25) AML measured >-15 HU (size 6-20 mm). To diagnose AML, area under receiver operating characteristic curve (AUC) using -15 HU was: 0.98 (95% confidence interval [CI] 0.98-1.00) NECT, 0.88 (95% CI 0.79-0.91) CM-CECT, and 0.90 (95% CI 0.82-0.98) NG-CECT. At DECT, fat concentration was higher in AML (163.7 ± 333.9 [-553.0 to 723.5] vs. -2858.1 ± 460.3 [-2421.2 to -206.0] mg/mL, P<0.001). AUC to diagnose AML using ≥-206.0 mg/mL threshold was 0.98 (95% CI 0.95-1.0) with sensitivity/specificity of 92.0%/96.7%. Of AML, 8.0% (2/25) were incorrectly classified; one of these was fat-poor. AUC was higher for fat concentration compared to HU measurements on CM-CECT and NG-CECT (P=0.009-0.050) and similar to NECT (P=0.98). CONCLUSION DECT material-specific fat images can help confirm the presence of macroscopic fat in renal AML which may be useful to establish a diagnosis if unenhanced CT is unavailable.
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Affiliation(s)
- Daniel Walker
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Amar Udare
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Robert Chatelain
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Matthew McInnes
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Trevor Flood
- Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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19
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Zhang T, Wu C, Li Z, Ding Y, Wen L, Wang L. CAMPO Precision128 Max ENERGY Spectrum CT Combined with Multiple Parameters to Evaluate the Benign and Malignant Pleural Effusion. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5526977. [PMID: 33728032 PMCID: PMC7935599 DOI: 10.1155/2021/5526977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/30/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
The emergence of energy spectrum CT provides greater diagnostic value for clinical practice. Its advantage is that it can provide more functional imaging parameters and accurate image information for clinical practice, which represents a mainstream direction of CT technology development at present. This paper mainly studies the clinical trial of CAMPO Precision128 Max ENERGY spectrum CT combined with multiple parameters to evaluate the benign and malignant pleural effusion. This paper analyzes the principle and key performance parameters of energy spectrum CT imaging, the etiology of pleural effusion, and its conventional diagnostic methods and uses energy spectrum CT to detect the benign and malignant pleural effusion. In this paper, two groups of patients with different types of pleural effusions were scanned by line spectrum chest CT scans, and energy spectrum analysis software was used to measure and calculate the CT values of conventional mixed energy values of ROI of patients with pleural effusions. For the CT value and energy curve slope measurement value of different single energy keV, independent sample t-test was used to analyze and compare the two sets of data, and finally it has been found out that the two sets of data were similar. According to the experimental results, the curves of energy spectrum of the two groups of data are similar in the descending curve of bow-back. The slope of energy spectrum curve in the leakage group was lower than that in the exudate group, showing statistical significance (P < 0.05). The slope of energy spectrum curve K in the malignant pleural effusion group was significantly higher than that in the benign pleural effusion group, and the difference was statistically significant (P < 0.05). The trend of energy spectrum curves of the two is roughly the same, while at the high energy level, part of the energy spectrum curves of the two are overlapped. The above conclusion indicates that energy spectrum CT plays a certain role in the differential diagnosis of pleural effusion. At the same time, energy spectrum CT also provides a noninvasive and rapid examination method for clinical differentiation of pleural effusion, which has certain clinical application value and prospect.
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Affiliation(s)
- Tianyu Zhang
- CT Section of The Second Hospital Affiliated Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
| | - Cuicui Wu
- Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
| | - Zhongtao Li
- Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
| | - Yan Ding
- Ultrasound Department, The Third Hospital Affiliated Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
| | - Lijuan Wen
- Radiology Center, The Third Hospital Affiliated Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
| | - Li Wang
- Radiology Center, The Third Hospital Affiliated Qiqihar Medical University, Qiqihar 161000, Heilongjiang, China
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20
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Lee SY, Kim TH, Han K, Shin JM, Kim JY, Kim D, Park CH. Feasibility of Coronary Artery Calcium Scoring on Dual-Energy Chest Computed Tomography: A Prospective Comparison with Electrocardiogram-Gated Calcium Score Computed Tomography. J Clin Med 2021; 10:jcm10040653. [PMID: 33567707 PMCID: PMC7915048 DOI: 10.3390/jcm10040653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale and Objectives: This study aimed to evaluate the feasibility of assessment using the coronary artery calcium score (CACS) in dual-energy chest computed tomography (CT). Materials and Methods: We prospectively enrolled 30 patients (19 male, 11 female; mean age, 63.73 ± 9.40 years) who clinically required contrast-enhanced chest CT. The patients underwent electrocardiogram-gated cardiac calcium-scoring CT with a slice thickness of 2.5 mm followed by a sequentially non-gated contrast-enhanced dual-energy chest CT using 140/80 fast kVp switching technology with slice thicknesses of 1.25 mm and 2.5 mm. Virtual unenhanced (VUE) images were then reconstructed from the dual-energy CT using the material suppressed iodine (MSI) technique. Results: The mean heart rates were 63.33 ± 12.01 beats per minute. The mean CACS on the coronary calcium-scoring CT was 361.1 ± 435.5, and CACSs of the VUE images were 76.8 ± 128.6 (2.5 mm slice) and 108.7 ± 165.1 (1.25 mm slice). The correlation coefficients of CACS between the coronary calcium-scoring CT with the VUE 2.5 mm and 1.25 mm images were 0.888 and 0.904, respectively. The inter-observer agreements for the calcium score measurement between the calcium-scoring CT, VUE 2.5 mm, and VUE 1.25 mm were 1.000, 0.999, and 1.000, respectively. Conclusions: In conclusion, assessment of CACS using dual-energy chest CT might be feasible when using MSI virtual unenhanced dual-energy chest CT images with a slice thickness of 1.25 mm.
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Affiliation(s)
- Sun Yong Lee
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
| | - Tae Hoon Kim
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
| | - Kyunghwa Han
- Department of Radiology and The Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jae Min Shin
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
| | - Ji Young Kim
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
| | - Daein Kim
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
| | - Chul Hwan Park
- Department of Radiology and The Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.Y.L.); (T.H.K.); (J.M.S.); (J.Y.K.); (D.K.)
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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21
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Park A, Lee YH, Seo HS. Could both intrinsic and extrinsic iodine be successfully suppressed on virtual non-contrast CT images for detecting thyroid calcification? Jpn J Radiol 2021; 39:580-588. [PMID: 33506433 DOI: 10.1007/s11604-021-01095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/13/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Although virtual non-contrast (VNC) successfully removes iodinated contrast, uncertainty exists regarding the feasibility of VNC to suppress iodine for detecting thyroid calcification. Therefore, we evaluated whether both intrinsic and extrinsic iodine attenuation were suppressed on VNC images. MATERIAL AND METHODS We enrolled 128 patients (male: female 17:111; age 48.0 ± 10.4 years) who underwent dual-layer dual-energy CT (DL-DECT) examination before their thyroid cancer surgeries. Two additional sets of VNC (VNCu, VNCc) images were retrospectively generated from their true unenhanced (TUE) and true contrast-enhanced (TCE) series. We compared CT attenuation values measured on the VNCu and VNCc images by drawing identical regions of interest encompassing thyroid parenchyma, then subjectively determined the concordance of calcification. RESULTS Although CT attenuation discrepancies between the VNCu and VNCc were significant (2.0 ± 5.7HU, p < 0.001),61.7%, 89.1%, and 100.0% of all measurements were < 5HU, < 10HU, and < 15HU. Based on Bland-Altman analysis, the limits of agreement were - 9.2HU and 13.2HU, whereas the proportional differences were small for VNC images generated from both TUE and TCE images. There was no discordance between two VNC image sets in detecting thyroid calcification. CONCLUSIONS VNC technique could be a feasible method to suppress both intrinsic and extrinsically administered iodine for detecting thyroid calcification.
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Affiliation(s)
- Arim Park
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.,Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Hyung Suk Seo
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
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22
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Noid G, Schott D, Paulson E, Zhu J, Shah J, Li XA. Technical Note: Using virtual noncontrast images from dual-energy CT to eliminate the need of precontrast CT for x-ray radiation treatment planning of abdominal tumors †. Med Phys 2021; 48:1365-1371. [PMID: 33386614 DOI: 10.1002/mp.14702] [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: 08/23/2020] [Revised: 10/27/2020] [Accepted: 12/09/2020] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Radiation therapy (RT) planning frequently utilizes contrast-enhanced CT. However, dose calculations should not be performed on a contrast-enhanced CT because the patient will not receive bolus during treatment. It is typical to acquire CT twice during RT simulation: once before injection of bolus and once after. The registration between these datasets introduces errors. In this work, we investigate the use of virtual noncontrast images (VNC) derived from dual-energy CT (DECT) to eliminate the precontrast CT and the registration error. METHODS CT datasets, including conventional 120 kVp pre- and postcontrast CTs and postcontrast DECT, acquired for ten pancreatic cancer patients were evaluated. The DECTs were acquired simultaneously using a dual source (DS) CT simulator. VNC and virtual mono-energetic images (VMI) were derived from DECTs. Gross tumor volumes (GTV), planning target volumes (PTV), and organs at risks (OAR) were delineated on the postcontrast CT and then populated to the precontrast CT and the VNC. An IMRT plan (50.4 Gy in 28 fractions) was then optimized on the precontrast CT. Dose distributions were recalculated on the VNC images. Contours from the pre- and postcontrast CTs and the dose distributions based on both were compared. RESULTS On average, the distance of centroids of the populated duodenum contours on precontrast CT differed by 6.0 ± 4.0 mm from those on postcontrast CTs. The dose distributions on the precontrast CT and VNC were almost identical. The PTV mean and maximum doses differed by 0.1% and 0.2% between the two plans, respectively. CONCLUSION The VNC derived from DECT can be used to replace the conventional precontrast CT scan for RT planning, eliminating the need for an additional precontrast CT scan and eliminating the registration errors. Thus, VNC can become an important asset to the future of RT.
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Affiliation(s)
- George Noid
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Diane Schott
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Justin Zhu
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jainil Shah
- Siemens Medical Solutions USA, Inc., Malvern, PA, USA
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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23
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Calcium scoring using virtual non-contrast images from a dual-layer spectral detector CT: comparison to true non-contrast data and evaluation of proportionality factor in a large patient collective. Eur Radiol 2021; 31:6193-6199. [PMID: 33474570 PMCID: PMC8270810 DOI: 10.1007/s00330-020-07677-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/23/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Determination of coronary artery calcium scoring (CACS) in non-contrast computed tomography (CT) images has been shown to be an important prognostic factor in coronary artery disease (CAD). The objective of this study was to evaluate the accuracy of CACS from virtual non-contrast (VNC) imaging generated from spectral data in comparison to standard (true) non-contrast (TNC) imaging in a representative patient cohort with clinically approved software. METHODS One hundred three patients referred to coronary CTA with suspicion of CAD were investigated on a dual-layer spectral detector CT (SDCT) scanner. CACS was calculated from both TNC and VNC images by software certified for medical use. Patients with a CACS of 0 were excluded from analysis. RESULTS The mean age of the study population was 61 ± 11 years with 48 male patients (67%). Inter-quartile range of clinical CACS was 22-282. Correlation of measured CACS from true- and VNC images was high (0.95); p < 0.001. The slope was 3.83, indicating an underestimation of VNC CACS compared to TNC CACS by that factor. Visual analysis of the Bland-Altman plot of CACS showed good accordance with both methods after correction of VNC CACS by the abovementioned factor. CONCLUSIONS In clinical diagnostics of CAD, the determination of CACS is feasible using VNC images generated from spectral data obtained on a dual-layer spectral detector CT. When multiplied by a correction factor, results were in good agreement with the standard technique. This could enable radiation dose reductions by obviating the need for native scans typically used for CACS. KEY POINTS • Calcium scoring is feasible from contrast-enhanced CT images using a dual-layer spectral detector CT scanner. • When multiplied by a correction factor, calcium scoring from virtual non-contrast images shows good agreement with the standard technique. • Omitting native scans for calcium scoring could enable radiation dose reduction.
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Zhou J, Zhou Y, Hu H, Shen MP, Ge YQ, Tao XW, Xu XQ, Su GY, Wu FY. Feasibility study of using virtual non-contrast images derived from dual-energy CT to replace true non-contrast images in patients diagnosed with papillary thyroid carcinoma. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:711-720. [PMID: 34092693 DOI: 10.3233/xst-210884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility of using virtual non-contrast (VNC) images derived from dual-energy computed tomography (DECT) to replace true non-contrast (TNC) images of papillary thyroid carcinoma (PTC) patients. METHODS Images of 96 PTC patients were retrospectively analyzed. TNC images were acquired under the single-energy mode of DECT after the plain scanning. The arterial and venous phase VNC (VNC-a and VNC-v) images were generated by the post-processing algorithm from the arterial phase and venous phase of contrast-enhanced CT images, respectively. Mean attenuation values, image noise, number and length of calcification were measured. Radiation dose was also calculated. Last, subjective score of image quality was evaluated by a 5-point scale. RESULTS Signal-to-noise ratio (SNR) of each tissue in TNC images is significantly higher than that of VNC images (p<0.050). Contrast-to-noise ratio (CNR) of fat, muscle, thyroid nodules and internal carotid artery in TNC images is significantly higher than that of VNC images, while CNR in TNC images is lower for cervical vertebra (p<0.001). Calcification is detected on TNC images of 44 patients, while it is omitted on VNC images of 14 patients (31.8%). The subjective score of TNC images is higher than VNC images (p<0.001). The effective dose reduction is 47.6% by avoiding plain scanning. CONCLUSIONS Considering the different attenuation value, SNR, CNR and especially reduced detection rate of calcification, we deem that VNC images cannot be directly used to replace TNC images in PTC patients, despite the reduced radiation dose.
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Affiliation(s)
- Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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25
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Kay FU. Dual-energy CT and coronary imaging. Cardiovasc Diagn Ther 2020; 10:1090-1107. [PMID: 32968662 PMCID: PMC7487394 DOI: 10.21037/cdt.2020.04.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy computed tomography has been proposed for enhancing the evaluation of coronary artery disease in many fronts. However, the clinical translation of such applications has followed a slower pace of clinical translation. This paper will review the evidence supporting the use of dual-energy computed tomography in coronary artery disease (CAD) and provide some practical illustrations, while underscoring the challenges and gaps in knowledge that have contributed to this phenomenon.
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Affiliation(s)
- Fernando Uliana Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Choe YH. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology. Korean J Radiol 2019; 20:1555-1561. [PMID: 31854145 PMCID: PMC6923209 DOI: 10.3348/kjr.2019.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nadjiri J, Kaissis G, Meurer F, Weis F, Laugwitz KL, Straeter AS, Muenzel D, Noël PB, Rummeny EJ, Rasper M. Accuracy of Calcium Scoring calculated from contrast-enhanced Coronary Computed Tomography Angiography using a dual-layer spectral CT: A comparison of Calcium Scoring from real and virtual non-contrast data. PLoS One 2018; 13:e0208588. [PMID: 30521612 PMCID: PMC6283621 DOI: 10.1371/journal.pone.0208588] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 11/20/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose Modern non-invasive evaluation of Coronary Artery Disease (CAD) requires non-contrast low dose Computed Tomography (CT) imaging for determination of Calcium Scoring (CACS) and contrast-enhanced imaging for evaluation of vascular stenosis. Several methods for calculation of CACS from contrast-enhanced images have been proposed before. The main principle for that is generation of virtual non-contrast images by iodine subtraction from a contrast-enhanced spectral CT dataset. However, those techniques have some limitations: Dual-Source CT imaging can lead to increased radiation exposure, and switching of the tube voltage (rapid kVp switching) can be associated with slower rotation speed of the gantry and is thus prone to motion artefacts that are especially critical in cardiac imaging. Both techniques cannot simultaneously acquire spectral data. A novel technique to overcome these difficulties is spectral imaging with a dual-layer detector. After absorption of the lower energetic photons in the first layer, the second layer detects a hardened spectrum of the emitted radiation resulting in registration of two different energy spectra at the same time. The objective of the present investigation was to evaluate the accuracy of virtual non-contrast CACS computed from spectral data in comparison to standard non-contrast imaging. Methods We consecutively investigated 20 patients referred to Coronary Computed Tomography Angiography (CCTA) with suspicion of CAD using a Dual-Layer spectral CT system (IQon; Philips Healthcare, The Netherlands). CACS was calculated from both, real- and virtual non-contrast images by certified software for medical use. Correlation analyses for real- and virtual non-contrast images and agreement evaluation with Bland-Altman-Plots were performed. Results Mean patient age was 57.7 ± 14 years (n = 20). 13 patients (65%) were male. Inter-quartile-range of clinical CACS was 0–448, the mean was 334. Correlation of CACS from real- and virtual non-contrast images was very high (0.94); p < 0.0001. The slope was 2.3 indicating that values from virtual non-contrast images are approximately half of the results obtained from real non-contrast data. Visual analysis of Bland-Altman-Plot shows good accordance of both methods when results from virtual non-contrast data are multiplied by the slope of the logistic regression model (2.3). The acquired power of this results is 0.99. Conclusion Determination of Calcium Score from contrast enhanced CCTA using spectral imaging with a dual-layer detector is feasible and shows good agreement with the conventional technique when a proportionality factor is applied. The observed difference between both methods is due to an underestimation of plaque volume, and—to an even greater extend -an underestimation of plaque density with the virtual non-contrast approach. Our data suggest that radiation exposure can be reduced through omitting additional native scans for patients referred to CCTA when using a dual-layer spectral system without the usual limitations of dual energy analysis.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Weis
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexandra S. Straeter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Rasper
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Li Q, Berman BP, Hagio T, Gavrielides MA, Zeng R, Sahiner B, Gong Q, Fang Y, Liu S, Petrick N. Coronary artery calcium quantification using contrast-enhanced dual-energy computed tomography scans in comparison with unenhanced single-energy scans. Phys Med Biol 2018; 63:175006. [PMID: 30101756 PMCID: PMC6183065 DOI: 10.1088/1361-6560/aad9be] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Extracting coronary artery calcium (CAC) scores from contrast-enhanced computed tomography (CT) images using dual-energy (DE) based material decomposition has been shown feasible, mainly through patient studies. However, the quantitative performance of such DE-based CAC scores, particularly per stenosis, is underexamined due to lack of reference standard and repeated scans. In this work we conducted a comprehensive quantitative comparative analysis of CAC scores obtained with DE and compare to conventional unenhanced single-energy (SE) CT scans through phantom studies. Synthetic vessels filled with iodinated blood mimicking material and containing calcium stenoses of different sizes and densities were scanned with a third generation dual-source CT scanner in a chest phantom using a DE coronary CT angiography protocol with three exposures/CTDIvol: auto-mAs/8 mGy (automatic exposure), 160 mAs/20 mGy and 260 mAs/34 mGy and 10 repeats. As a control, a set of vessel phantoms without iodine was scanned using a standard SE CAC score protocol (3 mGy). Calcium volume, mass and Agatston scores were estimated for each stenosis. For DE dataset, image-based three-material decomposition was applied to remove iodine before scoring. Performance of DE-based calcium scores were analyzed on a per-stenosis level and compared to SE-based scores. There was excellent correlation between the DE- and SE-based scores (correlation coefficient r: 0.92-0.98). Percent bias for the calcium volume and mass scores varied as a function of stenosis size and density for both modalities. Precision (coefficient of variation) improved with larger and denser stenoses for both DE- and SE-based calcium scores. DE-based scores (20 mGy and 34 mGy) provided comparable per-stenosis precision to SE-based (3 mGy). Our findings suggest that on a per-stenosis level, DE-based CAC scores from contrast-enhanced CT images can achieve comparable quantification performance to conventional SE-based scores. However, DE-based CAC scoring required more dose compared with SE for high per-stenosis precision so some caution is necessary with clinical DE-based CAC scoring.
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Affiliation(s)
- Qin Li
- US Food and Drug Administration, CDRH/OSEL/DIDSR, Silver Spring, MD, United States of America
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De Santis D, Eid M, De Cecco CN, Jacobs BE, Albrecht MH, Varga-Szemes A, Tesche C, Caruso D, Laghi A, Schoepf UJ. Dual-Energy Computed Tomography in Cardiothoracic Vascular Imaging. Radiol Clin North Am 2018; 56:521-534. [PMID: 29936945 DOI: 10.1016/j.rcl.2018.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual energy computed tomography is becoming increasingly widespread in clinical practice. It can expand on the traditional density-based data achievable with single energy computed tomography by adding novel applications to help reach a more accurate diagnosis. The implementation of this technology in cardiothoracic vascular imaging allows for improved image contrast, metal artifact reduction, generation of virtual unenhanced images, virtual calcium subtraction techniques, cardiac and pulmonary perfusion evaluation, and plaque characterization. The improved diagnostic performance afforded by dual energy computed tomography is not associated with an increased radiation dose. This review provides an overview of dual energy computed tomography cardiothoracic vascular applications.
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Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Marwen Eid
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Lazarettstraße 36, Munich 80636, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
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Affiliation(s)
- Ying Wang
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael T Osborne
- Department of Radiology, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian Tung
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ming Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yaming Li
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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Yin XP, Gao BL, Li CY, Zhou H, Zhao L, Zheng YT, Zhao YX. Optimal Monochromatic Imaging of Spectral Computed Tomography Potentially Improves the Quality of Hepatic Vascular Imaging. Korean J Radiol 2018; 19:578-584. [PMID: 29962864 PMCID: PMC6005939 DOI: 10.3348/kjr.2018.19.4.578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 02/01/2018] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the efficiency of spectral computed tomography (CT) optimal monochromatic images in improving imaging quality of liver vessels. Materials and Methods The imaging data of 35 patients with abdominal CT angiography were retrospectively analyzed. Hepatic arteries, portal veins, and hepatic veins were reconstructed with mixed energy (quality check, QC), 70 keV and optimal monochromatic mode. Comparative parameters were analyzed including CT value, image noise (IN), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and subjective qualitative analysis. Results The optimal monochromatic value for assessment of the common hepatic artery, portal vein, and hepatic vein ranged between 49 keV and 53 keV, with a mean of 51 keV. There were statistically significant differences (p < 0.001) among the optimal monochromatic, 70 keV and QC images with regards to the hepatic vascular CT value, IN, CNR, SNR, and subjective qualitative score. CNR of the common hepatic artery in the optimal monochromatic, 70 keV and QC groups was 24.6 ± 10.9, 18.1 ± 8.3, and 11.6 ± 4.6, respectively (p < 0.001) with subjective scores of 4.7 ± 0.2, 4.0 ± 0.3, and 3.6 ± 0.4, respectively (p < 0.001). CNR of the hepatic portal vein was 6.9 ± 2.7, 4.3 ± 1.9, and 3.0 ± 2.1, respectively (p < 0.001) with subjective scores of 4.5 ± 0.3, 3.9 ± 0.4, and 3.3 ± 0.3, respectively (p < 0.001). CNR of the hepatic vein was 5.7 ± 2.3, 4.2 ± 1.9, and 2.7 ± 1.4, respectively with subjective scores of 4.3 ± 0.3, 3.8 ± 0.4, and 3.2 ± 0.3, respectively (p < 0.001). Conclusion Optimal monochromatic images can lead to improvement in the imaging parameters and optimization of the image quality of the common hepatic artery, hepatic portal vein and hepatic vein compared with conventional mixed kV and with 70 keV datasets.
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Affiliation(s)
- Xiao-Ping Yin
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Bu-Lang Gao
- Department of Medical Research, Shijiazhuang First Hospital, Shijiazhuang 050011, China
| | - Cai-Ying Li
- The Second Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Huan Zhou
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Liang Zhao
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Ya-Ting Zheng
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Yong-Xia Zhao
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
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Lambert JW, Sun Y, Ordovas KG, Gould RG, Wang S, Yeh BM. Improved Calcium Scoring at Dual-Energy Computed Tomography Angiography Using a High-Z Contrast Element and Novel Material Separation Technique. J Comput Assist Tomogr 2018; 42:459-466. [PMID: 28937491 PMCID: PMC5860919 DOI: 10.1097/rct.0000000000000676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study was to compare the accuracy of existing dual-energy computed tomography (CT) angiography coronary artery calcium scoring methods to those obtained using an experimental tungsten-based contrast material and a recently described contrast material extraction process (CMEP). METHODS Phantom coronary arteries of varied diameters, with different densities and arcs of simulated calcified plaque, were sequentially filled with water, iodine, and tungsten contrast materials and scanned within a thorax phantom at rapid-kVp-switching dual-energy CT. Calcium and contrast density images were obtained by material decomposition (MD) and CMEP. Relative calcium scoring errors among the 4 reconstructed datasets were compared with a ground truth, 120-kVp dataset. RESULTS Compared with the 120-kVp dataset, tungsten CMEP showed a significantly lower mean absolute error in calcium score (6.2%, P < 0.001) than iodine CMEP, tungsten MD, and iodine MD (9.9%, 15.7%, and 40.8%, respectively). CONCLUSIONS Novel contrast elements and material separation techniques offer improved coronary artery calcium scoring accuracy and show potential to improve the use of dual-energy CT angiography in a clinical setting.
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Affiliation(s)
- Jack W Lambert
- From the University of California, San Francisco, San Francisco, CA
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33
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Canellas R, Ackman JB, Digumarthy SR, Price M, Otrakji A, McDermott S, Sharma A, Kalra MK. Submillisievert chest dual energy computed tomography: a pilot study. Br J Radiol 2017; 91:20170735. [PMID: 29125334 DOI: 10.1259/bjr.20170735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess if diagnostic dual energy CT (DECT) of the chest can be achieved at submillisievert (sub-mSv) doses. METHODS Our IRB-approved prospective study included 20 patients who were scanned on dual-source multidector CT(MDCT). All patients gave written informed consent for acquisition of additional image series at reduced radiation dose on a dual-source MDCT (80/140 kV) within 10 s after the standard of care acquisition. Dose reduction was achieved by reducing the quality reference milliampere-second, with combined angular exposure control. Four readers, blinded to all clinical data, evaluated the image sets. Image noise, signal-to-noise and contrast-to-noise ratio were assessed. Volumetric CT dose index (CTDIvol), doselength product (DLP), size specific dose estimate, and effective dose were also recorded. RESULTS The mean age and body mass index of the patients were 71 years ± 9 and 24 kg m-2 ± 3, respectively. Although images became noisier, overall image quality and image sharpness on blended images were considered good or excellent in all cases (20/20). All findings made on the reduced dose images presented with good demarcation. The intraobserver and interobserver agreements were κ = 0.83 and 0.73, respectively. Mean CTDIvol, size specific dose estimate, DLP and effective dose for reduced dose DECT were: 1.3 ± 0.2 mGy, 1.8 ± 0.2 mGy, 51 ± 9.9 mGy.cm and 0.7 ± 0.1 mSv, respectively. CONCLUSION Routine chest DECT can be performed at sub-mSv doses with good image quality and without loss of relevant diagnostic information. Advances in knowledge: (1) Contrast-enhanced DECT of the chest can be performed at sub-mSv doses, down to mean CTDIvol 1.3 mGy and DLP 51 mGy.cm in patients with body mass index <31 kg m-2. (2) To our knowledge, this is the first time that sub-mSv doses have been successfully applied in a patient study using a dual source DECT scanner.
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Affiliation(s)
- Rodrigo Canellas
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeanne B Ackman
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa Price
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexi Otrakji
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Kalisz K, Halliburton S, Abbara S, Leipsic JA, Albrecht MH, Schoepf UJ, Rajiah P. Update on Cardiovascular Applications of Multienergy CT. Radiographics 2017; 37:1955-1974. [DOI: 10.1148/rg.2017170100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tamm EP, Le O, Liu X, Layman RR, Cody DD, Bhosale PR. "How to" incorporate dual-energy imaging into a high volume abdominal imaging practice. Abdom Radiol (NY) 2017; 42:688-701. [PMID: 28070657 DOI: 10.1007/s00261-016-1035-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Dual-energy CT imaging has many potential uses in abdominal imaging. It also has unique requirements for protocol creation depending on the dual-energy scanning technique that is being utilized. It also generates several new types of images which can increase the complexity of image creation and image interpretation. The purpose of this article is to review, for rapid switching and dual-source dual-energy platforms, methods for creating dual-energy protocols, different approaches for efficiently creating dual-energy images, and an approach to navigating and using dual-energy images at the reading station all using the example of a pancreatic multiphasic protocol. It will also review the three most commonly used types of dual-energy images: "workhorse" 120kVp surrogate images (including blended polychromatic and 70 keV monochromatic), high contrast images (e.g., low energy monochromatic and iodine material decomposition images), and virtual unenhanced images. Recent developments, such as the ability to create automatically on the scanner the most common dual-energy images types, namely new "Mono+" images for the DSDECT (dual-source dual-energy CT) platform will also be addressed. Finally, an approach to image interpretation using automated "hanging protocols" will also be covered. Successful dual-energy implementation in a high volume practice requires careful attention to each of these steps of scanning, image creation, and image interpretation.
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Affiliation(s)
- Eric P Tamm
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1473, PO Box 301402, Houston, TX, 77230, USA.
| | - Ott Le
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1473, PO Box 301402, Houston, TX, 77230, USA
| | - Xinming Liu
- Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1472, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Rick R Layman
- Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1472, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Dianna D Cody
- Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1472, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Priya R Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, Unit 1473, PO Box 301402, Houston, TX, 77230, USA
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den Harder AM, Wolterink JM, Willemink MJ, Schilham AM, de Jong PA, Budde RP, Nathoe HM, Išgum I, Leiner T. Submillisievert coronary calcium quantification using model-based iterative reconstruction: A within-patient analysis. Eur J Radiol 2016; 85:2152-2159. [DOI: 10.1016/j.ejrad.2016.09.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/16/2022]
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