Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience

Hokamp, Nils Große; Höink, A. J.; Doerner, Jonas; Jordan, David W.; Pahn, Gregor; Persigehl, Thorsten; Maintz, David; Haneder, Stefan

doi:10.1007/s00261-017-1411-1

Cited by 57 publications

(43 citation statements)

References 34 publications

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“…In the past decade, dual-energy CT (DECT) raised interest in the field of liver imaging, since it has been shown to improve soft tissue contrast by means of virtual monoenergetic images (VMIs). DECT systems register low-and high-energy data attenuation profiles enabling a reconstruction of VMIs, which approximate images from an acquisition with a true monoenergetic X-ray beam [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

et al. 2020

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Objectives To investigate whether the increased soft tissue contrast of virtual monoenergetic images (VMIs) obtained from a spectral detector computed tomography (SDCT) system improves washout assessment of arterially hyper-enhancing liver lesions. Methods Fifty-nine arterially hyper-enhancing lesions in 31 patients (age 65 ± 9 years, M/W 20/11) were included in this IRB-approved study. All patients underwent multi-phase SDCT for HCC screening. MRI, CEUS or biopsy within 3 months served as standard of reference to classify lesions as LiRADS 3 or 4/5. VMIs and conventional images (CIs) were reconstructed. Visual analysis was performed on 40, 60, and 80 kiloelectronvolt (keV) and CIs by 3 radiologists. Presence and visibility of washout were assessed; image quality and confidence of washout evaluation were evaluated on 5-point Likert scales. Signal-to-noise ratio (SNR), lesion-to-liver contrast-to-noise ratio (CNR) (|HUlesion–HUliver|/SDliver) and washout (|HUlesion–HUliver|) were calculated. Statistical assessment was performed using ANOVA and Wilcoxon test. Results On subjective lesion analysis, the highest level of diagnostic confidence and highest sensitivity for the detection of lesion washout were found for 40-keV VMIs (40 keV vs. CI, 81.3 vs. 71.3%). Image quality parameters were significantly better in low-kiloelectronvolt VMIs than in CIs (p < 0.05; e.g. SNRliver: 40 keV vs. CIs, 12.5 ± 4.1 vs. 5.6 ± 1.6). In LiRADS 4/5 lesions, CNR and quantitative washout values were significantly higher in 40-keV VMIs compared to CIs (p < 0.05; e.g. CNR and washout in 40 keV vs. CIs, 2.3 ± 1.6 vs. 0.8 ± 0.5 and 29.0 ± 19.1 vs. 12.9 ± 6.9 HU, respectively). Conclusion By increasing lesion contrast, low-kiloelectronvolt VMIs obtained from SDCT improve washout assessment of hyper-enhancing liver lesions with respect to washout visibility and diagnostic confidence. Key Points • Low-kiloelectronvolt virtual monoenergetic images from spectral detector CT facilitate washout assessment in arterially hyper-enhancing liver lesions. • Image quality and quantitative washout parameters as well as subjective washout visibility and diagnostic confidence benefit from low-kiloelectronvolt virtual monoenergetic images.

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Section: Introductionmentioning

confidence: 99%

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

et al. 2020

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“…This result is likely due to advantages regarding image noise enabled by the detector-based approach. 24,31 While we compared VMI 65keV with a state-ofthe-art hybrid iterative reconstruction algorithm, whether most recent model-based image reconstructions can outperform noise reduction enabled by means of VMI remains elusive. 32 So far, only a few studies have investigated dose reduction in head imaging by means of VMI compared with polychromatic CT using a kilovolt-switching dual-energy CT system.…”

Section: Discussionmentioning

confidence: 99%

“…They are typically available in a range from 40 to 200 keV, depending on the dual-energy CT system used. 23,24 Different emission-based dual-energy CT systems have been available for several years using emission spectra with lower and higher mean energy. 25,26 More recently, a detector-based approach was introduced, referred to as spectral detector CT.…”

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“…Here, low-and high-energy photons are registered separately using a dual-layer detector. 24,26 The upper layer is yttrium-based and registers lower energy photons, while the lower layer is gadolinium oxysulfide-based, registering higher energy photons. 8,24,26 In a recent study, VMI from spectral detector CT showed superior image quality in examinations of the head compared with conventional images (CI).…”

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confidence: 99%

“…24,26 The upper layer is yttrium-based and registers lower energy photons, while the lower layer is gadolinium oxysulfide-based, registering higher energy photons. 8,24,26 In a recent study, VMI from spectral detector CT showed superior image quality in examinations of the head compared with conventional images (CI). Corticomedullary differentiation was found to be best in 65-keV VMI (VMI 65keV ), while in lower kiloelectron volt images, beam-hardening artifacts close to the calvaria distorted image quality.…”

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Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT

Reimer

Flatten

Lichtenstein

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Our aim was to evaluate whether improved gray-white matter differentiation in cranial CT by means of 65-keV virtual monoenergetic images enables a radiation dose reduction compared to conventional images. MATERIALS AND METHODS: One hundred forty consecutive patients undergoing 171 spectral detector CTs of the head between February and November 2017 (56 6 19 years of age; male/female ratio, 56%/44%) were retrospectively included. The tube currenttime product was reduced during the study period, resulting in 61, 55, and 55 patients being examined with 320, 290, and 260 mAs, respectively. All other scanning parameters were kept identical. The volume CT dose index was recorded. ROIs were placed in gray and white matter on conventional images and copied to identical positions in 65-keV virtual monoenergetic images. The contrastto-noise ratio was calculated. Two radiologists blinded to the reconstruction technique evaluated image quality on a 5-point Likert-scale. Statistical assessment was performed using ANOVA and Wilcoxon test adjusted for multiple comparisons.

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Gastrointestinal Imaging: Oncology (Liver, Pancreas, Bowel Cancer, and Treatment Response)

Lennartz

Hokamp

2022

Spectral Imaging

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Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience

Abstract: VMIs improve assessment of arterially hyper-enhancing liver lesions since they increase lesion contrast while maintaining low image noise throughout the entire keV spectrum. These data suggest that to consider VMI screening after arterially hyper-enhancing liver lesions.

Cited by 57 publications

References 34 publications

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT

Gastrointestinal Imaging: Oncology (Liver, Pancreas, Bowel Cancer, and Treatment Response)

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