Dual-Energy CT in the Assessment of Mediastinal Lymph Nodes: Comparative Study of Virtual Non-Contrast and True Non-Contrast Images

Abstract

ObjectiveTo evaluate the reliability of virtual non-contrast (VNC) images reconstructed from contrast-enhanced, dual-energy scans compared with true non-contrast (TNC) images in the assessment of high CT attenuation or calcification of mediastinal lymph nodes.Materials and MethodsA total of 112 mediastinal nodes from 45 patients who underwent non-contrast and dual-energy contrast-enhanced scans were analyzed. Node attenuation in TNC and VNC images was compared both objectively, using computed tomography (CT) attenuation, and subjectively, via visual scoring (0, attenuation ≤ the aorta; 1, > the aorta; 2, calcification). The relationship among attenuation difference between TNC and VNC images, CT attenuation in TNC images, and net contrast enhancement (NCE) was analyzed.ResultsCT attenuation in TNC and VNC images showed moderate agreement (intraclass correlation coefficient, 0.612). The mean absolute difference was 7.8 ± 7.6 Hounsfield unit (HU) (range, 0-36 HU), and the absolute difference was equal to or less than 10 HU in 65.2% of cases (73/112). Visual scores in TNC and VNC images showed fair agreement (κ value, 0.335). Five of 16 nodes (31.3%) which showed score 1 (n = 15) or 2 (n = 1) in TNC images demonstrated score 1 in VNC images. The TNC-VNC attenuation difference showed a moderate positive correlation with CT attenuation in TNC images (partial correlation coefficient [PCC] adjusted by NCE: 0.455) and a weak negative correlation with NCE (PCC adjusted by CT attenuation in TNC: -0.245).ConclusionVNC images may be useful in the evaluation of mediastinal lymph nodes by providing additional information of high CT attenuation of nodes, although it is underestimated compared with TNC images.

Application of Dual-Energy Spectral Computed Tomography to Thoracic Oncology Imaging

“…HU = Hounsfield unit, TNC = true non-enhanced imaging, VNC = virtual non-contrast or unenhanced imaging https://doi.org/10.3348/kjr.2019.0711 kjronline.org limitations. In a previous study, a moderate agreement was obtained between TNC and VNC in the evaluation of the CT attenuation of mediastinal LNs (intraclass correlation coefficient, 0.612) (17). In addition, there was an underestimation of high CT attenuation or calcification of the LNs in VNC compared to TNC.…”

Diffusion-weighted MR imaging of mediastinal lymphadenopathy in children

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Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

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