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Virtual monochromatic reconstructions of dual energy CT in abdominal trauma: optimization of energy level improves pancreas laceration conspicuity and diagnostic confidence

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Abstract

Purpose

Pancreatic injury is associated with significant morbidity and mortality. Pancreatic lacerations can be challenging to identify as the pancreas is not scanned at peak enhancement in most trauma CT protocols. This study qualitatively and quantitively assessed pancreatic lacerations with virtual monoenergetic dual-energy CT (DE CT) to establish an optimal energy level for visualization of pancreatic lacerations.

Methods

Institutional review board approval was obtained. We retrospectively examined 17 contrast-enhanced CT studies in patients with blunt trauma with MRCP, ERCP, or surgically proven pancreatic lacerations. All studies were performed in our Emergency Department from 2016 to 2019 with a 128 slice dual-source DE CT scanner. Conventional 120 kVp and noise-optimized virtual monoenergetic imaging (VMI) datasets were created. VMI energy levels were constructed from 40 to 100 keV in 10 keV increments and analyzed quantitatively and qualitatively. Pancreatic laceration attenuation, background parenchymal attenuation, and noise were calculated. Qualitative assessment was performed by two independent readers.

Results

The optimal CNR for the assessment of pancreatic lacerations was observed at VMI-40 in comparison with standard reconstructions and the remaining VMI energy levels (p = 0.001). Readers reported improved contrast resolution, diagnostic confidence, and laceration conspicuity at VMI at 40 keV (p = 0.016, p = 0.002, and p = 0.0012 respectively). However, diagnostic acceptability and subjective noise were improved on conventional polyenergentic images (p = 0.0006 and p = 0.001 respectively).

Conclusion

Dual energy CT at VMI-40 maximizes the CNR of pancreatic laceration, improves diagnostic confidence, and increases laceration conspicuity.

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Authors and Affiliations

  1. Department of Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada

    Gavin Sugrue, John P. Walsh, Yilin Zhang, Bonnie Niu, Francesco Macri, Elina Khasanova, Omar Metwally, Nicolas Murray & Savvas Nicolaou

Authors
  1. Gavin Sugrue
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  2. John P. Walsh
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  3. Yilin Zhang
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  4. Bonnie Niu
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  6. Elina Khasanova
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  7. Omar Metwally
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  8. Nicolas Murray
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  9. Savvas Nicolaou
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Contributions

Conceptualization: Gavin Sugrue and John Walsh. Methodology: Gavin Sugrue, John Walsh Yilin Zhang, and Bonnie Niu. Formal analysis and investigation: Gavin Sugrue, John Walsh Omar Metwally, and Francesco Macri. Writing—original draft preparation: Gavin Sugrue and Elina Khasanova. Writing—review and editing: Gavin Sugrue, John Walsh, and Omar Metwally. Supervision: Savvas Nicolaou and Nicolas Murray.

Corresponding author

Correspondence to Gavin Sugrue.

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Conflict of interest

Dr. Savvas Nicolaou: Research grant, Siemens.

Availability of data and material

All our data and materials as well as software application or custom code support our published claims and comply with field standards.

Code availability (software application or custom code)

Not applicable.

Authors disclosures

Gavin Sugrue, MD: none; John Walsh, MD: none; Yilin Zhang: none; Bonnie Niu, BSc: none; Francesco Macri, MD: none; Elina Khasanova, MD: none; Omar Metwally, MD: none; Nicolas Murray, MD: none; Savvas Nicolaou, MD: Institutional research grant from Siemens Healthineers.

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Institutional review board approved the study.

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Sugrue, G., Walsh, J.P., Zhang, Y. et al. Virtual monochromatic reconstructions of dual energy CT in abdominal trauma: optimization of energy level improves pancreas laceration conspicuity and diagnostic confidence. Emerg Radiol 28, 1–7 (2021). https://doi.org/10.1007/s10140-020-01791-4

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  • DOI: https://doi.org/10.1007/s10140-020-01791-4

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