Renal Lesion Characterization by Dual-Layer Dual-Energy CT: Comparison of Virtual and True Unenhanced Images

Cao, Jinjin; Lennartz, Simon; Pisuchpen, Nisanard; Mroueh, Nayla; Kongboonvijit, Sasiprang; Parakh, Anushri; Sahani, Dushyant V.; Kambadakone, Avinash

doi:10.2214/ajr.21.27272

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…For example, a previous study by Meyer et al reported a difference in HU values between true and virtual non-contrast images of 7.4 HU ± 7.2 in unenhanced, low-attenuation lesions and 11.6 HU ± 10.2 HU in unenhanced, high-attenuation lesions with a maximum difference in attenuation between VNC and true non-contrast images of up to 48.1 HU [ 13 ]. Another analysis by Cao et al of 86 cysts found false-positive enhancement in DE-CT-derived VNC greater than 20 HU in 9% of simple and in 27% of hyperattenuating cysts [ 12 ]. Erroneous classification has direct implication on patients care, as a false-positive apparent enhancement would characterize a lesion as potentially malignant resulting in unnecessary workup and costs [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this context, dual-energy integrating detector CT (DE EID-CT) with the possibility to calculate virtual non-contrast (VNC) images based on the unique linear attenuation coefficient of each substance was thought to provide additional information about renal lesion density and contrast enhancement if true non-contrast images were not available [ 10 , 11 ]. However, previous studies reported inconclusive findings regarding the accuracy of HU measurements using DE EID-CT-derived VNC images with the risk of misclassifying lesions by over- or underestimating their true density and contrast enhancement [ 12 , 13 ]. Therefore, DE EID-CT VNC images were not able to substitute for true non-contrast images in the workup of renal lesions so far.…”

Section: Introductionmentioning

confidence: 99%

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Value of virtual non-contrast images to identify uncomplicated cystic renal lesions: photon-counting detector CT vs. dual-energy integrating detector CT

Rau,

Stein

et al. 2024

Radiol med

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Purpose To investigate the value of photon-counting detector CT (PCD-CT) derived virtual non-contrast (VNC) reconstructions to identify renal cysts in comparison with conventional dual-energy integrating detector (DE EID) CT-derived VNC reconstructions. Material and methods We prospectively enrolled consecutive patients with simple renal cysts (Bosniak classification—Version 2019, density ≤ 20 HU and/or enhancement ≤ 20 HU) who underwent multiphase (non-contrast, arterial, portal venous phase) PCD-CT and for whom non-contrast and portal venous phase DE EID-CT was available. Subsequently, VNC reconstructions were calculated for all contrast phases and density as well as contrast enhancement within the cysts were measured and compared. MRI and/or ultrasound served as reference standards for lesion classification. Results 19 patients (1 cyst per patient; age 69.5 ± 10.7 years; 17 [89.5%] male) were included. Density measurements on PCD-CT non-contrast and VNC reconstructions (arterial and portal venous phase) revealed no significant effect on HU values (p = 0.301). In contrast, a significant difference between non-contrast vs. VNC images was found for DE EID-CT (p = 0.02). For PCD-CT, enhancement for VNC reconstructions was < 20 HU for all evaluated cysts. DE EID-CT measurements revealed an enhancement of > 20 HU in five lesions (26.3%) using the VNC reconstructions, which was not seen with the non-contrast images. Conclusion PCD-CT-derived VNC images allow for reliable and accurate characterization of simple cystic renal lesions similar to non-contrast scans whereas VNC images calculated from DE EID-CT resulted in substantial false characterization. Thus, PCD-CT-derived VNC images may substitute for non-contrast images and reduce radiation dose and follow-up imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Value of virtual non-contrast images to identify uncomplicated cystic renal lesions: photon-counting detector CT vs. dual-energy integrating detector CT

Rau,

Stein

et al. 2024

Radiol med

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“…In another study, Meyer et al showed that virtual unenhanced images allow for accurate renal lesion characterization, albeit with a lower specificity compared to true unenhanced images [64]. Accordingly, Cao et al recently found that virtual enhancement calculated from the portal venous phase and virtual unenhanced images correctly identified all enhancing lesions within their study cohort, yet noted that in some cases, virtual unenhanced images diverged from true unenhanced image attenuation with regard to the evaluation of cystic lesions [65]. In the clinical routine, virtual unenhanced and iodine images can be used synergistically to rule out enhancement in ambiguous renal lesions.…”

Section: Kidneysmentioning

confidence: 99%

Dual-energy CT revisited: a focused review of clinical use cases

Lennartz,

Zopfs,

Große Hokamp

2024

Rofo

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Background Dual-energy CT (DECT) has been available for more than 15 years and has undergone continuous technical development and refinement. Recently, the first photon-counting CT scanner became clinically available and has the potential to further expand the possibilities of spectral imaging. Numerous studies on DECT have been published since its creation, highlighting the clinical applications of the various reconstructions enabled by DECT. Methods The aim of this focused review is to succinctly summarize basic principles and available technical concepts of DECT and to discuss established applications relevant to the daily clinical routine. Results/Conclusion DECT is instrumental for a broad variety of clinical use cases. While some DECT applications can enhance day-to-day clinical practice, others are still subject to broad-scale validation and should therefore be handled with restraint in the clinical routine. Key points:

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“…Also, new renal cysts may represent a relatively common finding in follow-up studies. VNC can help assess the internal content of the renal cysts, differentiating between simple cysts (which are fluid-filled and typically benign) and complex cysts or solid lesions (which may indicate malignancy or other concerning features) [ 59 ]. In clinical practice, benign renal cysts usually exhibit attenuation close to that of water on non-contrast images, appearing hypodense or with low attenuation values.…”

Section: Virtual Non-contrast (Vnc)mentioning

confidence: 99%

Dual-Energy CT in Oncologic Imaging

Foti,

Ascenti,

Agostini

et al. 2024

Tomography

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Dual-energy CT (DECT) is an innovative technology that is increasingly widespread in clinical practice. DECT allows for tissue characterization beyond that of conventional CT as imaging is performed using different energy spectra that can help differentiate tissues based on their specific attenuation properties at different X-ray energies. The most employed post-processing applications of DECT include virtual monoenergetic images (VMIs), iodine density maps, virtual non-contrast images (VNC), and virtual non-calcium (VNCa) for bone marrow edema (BME) detection. The diverse array of images obtained through DECT acquisitions offers numerous benefits, including enhanced lesion detection and characterization, precise determination of material composition, decreased iodine dose, and reduced artifacts. These versatile applications play an increasingly significant role in tumor assessment and oncologic imaging, encompassing the diagnosis of primary tumors, local and metastatic staging, post-therapy evaluation, and complication management. This article provides a comprehensive review of the principal applications and post-processing techniques of DECT, with a specific focus on its utility in managing oncologic patients.

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Renal Lesion Characterization by Dual-Layer Dual-Energy CT: Comparison of Virtual and True Unenhanced Images

Cited by 10 publications

References 32 publications

Value of virtual non-contrast images to identify uncomplicated cystic renal lesions: photon-counting detector CT vs. dual-energy integrating detector CT

Value of virtual non-contrast images to identify uncomplicated cystic renal lesions: photon-counting detector CT vs. dual-energy integrating detector CT

Dual-energy CT revisited: a focused review of clinical use cases

Dual-Energy CT in Oncologic Imaging

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