Feasibility and Accuracy of Dual-Source Dual-Energy CT for Noninvasive Determination of Hepatic Iron Accumulation

Joe, Eugene; Kim, Se Hyung; Lee, Kyuho; Jang, Jeong Hun; Lee, Jae Young; Lee, Jeong Min; Han, Joon Koo; Choi, Byung Ihn

doi:10.1148/radiol.11110060

Cited by 71 publications

(36 citation statements)

References 19 publications

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“…We also plan to extend the capabilities of our LFQ algorithm to allow for the detection and characterization of iron [83]- [85], which can accumulate in the liver in some forms of liver disease, such as alcoholic liver disease [86]. We will couple this work with a new MMD-based algorithm targeting liver fibrosis and cirrhosis, one of the most outstanding unmet clinical needs in abdominal imaging with CT.…”

Section: Discussionmentioning

confidence: 99%

A Flexible Method for Multi-Material Decomposition of Dual-Energy CT Images

Mendonça

Lamb

Sahani³

2014

IEEE Trans. Med. Imaging

176

202

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The ability of dual-energy computed-tomographic (CT) systems to determine the concentration of constituent materials in a mixture, known as material decomposition, is the basis for many of dual-energy CT's clinical applications. However, the complex composition of tissues and organs in the human body poses a challenge for many material decomposition methods, which assume the presence of only two, or at most three, materials in the mixture. We developed a flexible, model-based method that extends dual-energy CT's core material decomposition capability to handle more complex situations, in which it is necessary to disambiguate among and quantify the concentration of a larger number of materials. The proposed method, named multi-material decomposition (MMD), was used to develop two image analysis algorithms. The first was virtual unenhancement (VUE), which digitally removes the effect of contrast agents from contrast-enhanced dual-energy CT exams. VUE has the ability to reduce patient dose and improve clinical workflow, and can be used in a number of clinical applications such as CT urography and CT angiography. The second algorithm developed was liver-fat quantification (LFQ), which accurately quantifies the fat concentration in the liver from dual-energy CT exams. LFQ can form the basis of a clinical application targeting the diagnosis and treatment of fatty liver disease. Using image data collected from a cohort consisting of 50 patients and from phantoms, the application of MMD to VUE and LFQ yielded quantitatively accurate results when compared against gold standards. Furthermore, consistent results were obtained across all phases of imaging (contrast-free and contrast-enhanced). This is of particular importance since most clinical protocols for abdominal imaging with CT call for multi-phase imaging. We conclude that MMD can successfully form the basis of a number of dual-energy CT image analysis algorithms, and has the potential to improve the clinical utility of dual-energy CT in disease management.

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Section: Discussionmentioning

confidence: 99%

A Flexible Method for Multi-Material Decomposition of Dual-Energy CT Images

Mendonça

Lamb

Sahani³

2014

IEEE Trans. Med. Imaging

176

202

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“…However, in a combined phantom and clinical DSDE study, the difference of averaged attenuation between the 140-and 80-kV(p) images was used to differentiate patients with greater than 10% hepatic iron, but similar methods were unable to identify hepatic steatosis in vivo. 24 In a phantom and mouse model of hepatic steatosis, Artz et al 25 demonstrated that attenuation and fat density of the liver parenchyma using unenhanced RSDE correlated highly with phantom triglyceride content, but in the model, only attenuation correlated highly with hepatocyte triglyceride content; the fat material density images did not perform as well. Using novel postprocessing of RSDE monoenergetic image subtraction (termed Dual-energy subtraction imaging [DESI]) in a patient population, Zheng et al 26 were able to identify varying degrees of fat accumulation.…”

Section: Dual-energy Ct Evaluation Of Hepatic Fat Contentmentioning

confidence: 99%

“…Most of the initial reports using dual-source (DSDE) or rapid kilovolt (peak)-switching single-source (RSDE) dual-energy CT for fat quantification in phantom, animal, and human studies have been performed in unenhanced conditions. [22][23][24][25][26] However, given the prevalence of asymptomatic NAFLD and NASH, patients not yet known to have hepatic steatosis often undergo contrastenhanced abdominal CT, without an unenhanced series. The identification and quantification of liver fat content in the post-contrast-enhanced setting using RSDE material density analysis is the topic of this present investigation.…”

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confidence: 99%

Material Density Hepatic Steatosis Quantification on Intravenous Contrast-Enhanced Rapid Kilovolt (Peak)–Switching Single-Source Dual-Energy Computed Tomography

Patel

Kumbla

Berland

et al. 2013

Journal of Computer Assisted Tomography

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The RSDE milligram-per-milliliter fat values correlate well with hepatic steatosis defined by the L-S difference less than 1 on conventional MDCT. A threshold of 1027 mg/mL can identify 90% of steatotic livers when post-IV contrast RSDE is used, without obtaining additional CU scans. However, regression equations were not helpful to convert an individual participant's milligram-per-milliliter fat or milligram-per-milliliter water-derived from RSDE material density images to CU MDCT HU for the estimation of liver fat content.

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“…Fischer MA et al quantified liver iron content with coexisting fat and also quantified liver fat in the presence of iron and iodine in their ex vivo study with dual-energy CT [16], [17]. In addition, Joe assessed the hepatic iron in liver phantoms and liver transplant recipients by calculating the CT attenuation (HU) difference between high and low tube voltages with DECT [23]. Although they were correlated well with the pathology in their study, however, we believe that the CT value differences in that study reflected mixed information, because the CT values at each tube voltage showed attenuation for both iron and other liver parenchyma (e.g., fat in the liver).…”

Section: Discussionmentioning

confidence: 99%

Separation of Hepatic Iron and Fat by Dual-Source Dual-Energy Computed Tomography Based on Material Decomposition: An Animal Study

Song²,

Yan

2014

PLoS ONE

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ObjectiveTo explore the feasibility of dual-source dual-energy computed tomography (DSDECT) for hepatic iron and fat separation in vivo.Materials and MethodsAll of the procedures in this study were approved by the Research Animal Resource Center of Shanghai Ruijin Hospital. Sixty rats that underwent DECT scanning were divided into the normal group, fatty liver group, liver iron group, and coexisting liver iron and fat group, according to Prussian blue and HE staining. The data for each group were reconstructed and post-processed by an iron-specific, three-material decomposition algorithm. The iron enhancement value and the virtual non-iron contrast value, which indicated overloaded liver iron and residual liver tissue, respectively, were measured. Spearman's correlation and one-way analysis of variance (ANOVA) were performed, respectively, to analyze statistically the correlations with the histopathological results and differences among groups.ResultsThe iron enhancement values were positively correlated with the iron pathology grading (r = 0.729, p<0.001). Virtual non-iron contrast (VNC) values were negatively correlated with the fat pathology grading (r = −0.642,p<0.0001). Different groups showed significantly different iron enhancement values and VNC values (F = 25.308,p<0.001; F = 10.911, p<0.001, respectively). Among the groups, significant differences in iron enhancement values were only observed between the iron-present and iron-absent groups, and differences in VNC values were only observed between the fat-present and fat-absent groups.ConclusionSeparation of hepatic iron and fat by dual energy material decomposition in vivo was feasible, even when they coexisted.

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Feasibility and Accuracy of Dual-Source Dual-Energy CT for Noninvasive Determination of Hepatic Iron Accumulation

Abstract: DSDE CT is accurate for diagnosing clinically important hepatic iron accumulation without confounding influence of hepatic steatosis, with diagnostic performance on par with MR.

Cited by 71 publications

References 19 publications

A Flexible Method for Multi-Material Decomposition of Dual-Energy CT Images

A Flexible Method for Multi-Material Decomposition of Dual-Energy CT Images

Material Density Hepatic Steatosis Quantification on Intravenous Contrast-Enhanced Rapid Kilovolt (Peak)–Switching Single-Source Dual-Energy Computed Tomography

Separation of Hepatic Iron and Fat by Dual-Source Dual-Energy Computed Tomography Based on Material Decomposition: An Animal Study

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