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“How to” incorporate dual-energy imaging into a high volume abdominal imaging practice

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Abstract

Dual-energy CT imaging has many potential uses in abdominal imaging. It also has unique requirements for protocol creation depending on the dual-energy scanning technique that is being utilized. It also generates several new types of images which can increase the complexity of image creation and image interpretation. The purpose of this article is to review, for rapid switching and dual-source dual-energy platforms, methods for creating dual-energy protocols, different approaches for efficiently creating dual-energy images, and an approach to navigating and using dual-energy images at the reading station all using the example of a pancreatic multiphasic protocol. It will also review the three most commonly used types of dual-energy images: “workhorse” 120kVp surrogate images (including blended polychromatic and 70 keV monochromatic), high contrast images (e.g., low energy monochromatic and iodine material decomposition images), and virtual unenhanced images. Recent developments, such as the ability to create automatically on the scanner the most common dual-energy images types, namely new “Mono+” images for the DSDECT (dual-source dual-energy CT) platform will also be addressed. Finally, an approach to image interpretation using automated “hanging protocols” will also be covered. Successful dual-energy implementation in a high volume practice requires careful attention to each of these steps of scanning, image creation, and image interpretation.

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References

  1. Shuman WP, Green DE, Busey JM, et al. (2014) Dual-energy liver CT: effect of monochromatic imaging on lesion detection, conspicuity, and contrast-to-noise ratio of hypervascular lesions on late arterial phase. AJR Am J Roentgenol 203:601–606

    Article  PubMed  Google Scholar 

  2. Patel BN, Thomas JV, Lockhart ME, Berland LL, Morgan DE (2013) Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: optimization of energy level viewing significantly increases lesion contrast. Clin Radiol 68:148–154

    Article  CAS  PubMed  Google Scholar 

  3. Bhosale P, Le O, Balachandran A, et al. (2015) Quantitative and qualitative comparison of single-source dual-energy computed tomography and 120-kVp computed tomography for the assessment of pancreatic ductal adenocarcinoma. J Comput Assist Tomogr 39:907–913

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lin XZ, Wu ZY, Tao R, et al. (2012) Dual energy spectral CT imaging of insulinoma-value in preoperative diagnosis compared with conventional multi-detector CT. Eur J Radiol 81:2487–2494

    Article  PubMed  Google Scholar 

  5. Apfaltrer P, Sudarski S, Schneider D, et al. (2014) Value of monoenergetic low-kV dual energy CT datasets for improved image quality of CT pulmonary angiography. Eur J Radiol 83:322–328

    Article  PubMed  Google Scholar 

  6. Meier A, Wurnig M, Desbiolles L, et al. (2015) Advanced virtual monoenergetic images: improving the contrast of dual-energy CT pulmonary angiography. Clin Radiol 70:1244–1251

    Article  CAS  PubMed  Google Scholar 

  7. De Cecco CN, Muscogiuri G, Schoepf UJ, et al. (2016) Virtual unenhanced imaging of the liver with third-generation dual-source dual-energy CT and advanced modeled iterative reconstruction. Eur J Radiol 85:1257–1264

    Article  PubMed  Google Scholar 

  8. Finkenstaedt T, Manoliou A, Toniolo M, et al. (2016) Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26:3989–3999

    Article  PubMed  Google Scholar 

  9. Korn A, Bender B, Thomas C, et al. (2011) Dual energy CTA of the carotid bifurcation: advantage of plaque subtraction for assessment of grade of the stenosis and morphology. Eur J Radiol 80:e120–e125

    Article  CAS  PubMed  Google Scholar 

  10. Johnson TR (2012) Dual-energy CT: general principles. AJR Am J Roentgenol 199:S3–S8

    Article  PubMed  Google Scholar 

  11. Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271:327–342

    Article  PubMed  Google Scholar 

  12. Silva AC, Morse BG, Hara AK, et al. (2011) Dual-energy (spectral) CT: applications in abdominal imaging. Radiographics 31:1031–1046 (discussion 1047–1050)

    Article  PubMed  Google Scholar 

  13. Morgan DE (2014) Dual-energy CT of the abdomen. Abdom Imaging 39:108–134

    Article  PubMed  Google Scholar 

  14. Megibow AJ, Sahani D (2012) Best practice: implementation and use of abdominal dual-energy CT in routine patient care. AJR Am J Roentgenol 199:S71–S77

    Article  PubMed  Google Scholar 

  15. Ascenti G, Krauss B, Mazziotti S, et al. (2012) Dual-energy computed tomography (DECT) in renal masses: nonlinear vs. linear blending. Acad Radiol 19:1186–1193

    Article  PubMed  Google Scholar 

  16. Mileto A, Ramirez-Giraldo JC, Marin D, et al. (2014) Nonlinear image blending for dual-energy MDCT of the abdomen: can image quality be preserved if the contrast medium dose is reduced? AJR Am J Roentgenol 203:838–845

    Article  PubMed  Google Scholar 

  17. Apel A, Fletcher JG, Fidler JL, et al. (2011) Pilot multi-reader study demonstrating potential for dose reduction in dual energy hepatic CT using non-linear blending of mixed kV image datasets. Eur Radiol 21:644–652

    Article  PubMed  Google Scholar 

  18. Hardie AD, Picard MM, Camp ER, et al. (2015) Application of an advanced image-based virtual monoenergetic reconstruction of dual source dual-energy CT data at low keV increases image quality for routine pancreas imaging. J Comput Assist Tomogr 39:716–720

    Article  PubMed  Google Scholar 

  19. Albrecht MH, Scholtz JE, Kraft J, et al. (2015) Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer. Eur Radiol 25:2493–2501

    Article  PubMed  Google Scholar 

  20. Matsumoto K, Jinzaki M, Tanami Y, et al. (2011) Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT. Radiology 259:257–262

    Article  PubMed  Google Scholar 

  21. McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 276:637–653

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chai Y, Xing J, Gao J, et al. (2016) Feasibility of virtual nonenhanced images derived from single-source fast kVp-switching dual-energy CT in evaluating gastric tumors. Eur J Radiol 85:366–372

    Article  PubMed  Google Scholar 

  23. Song I, Yi JG, Park JH, et al. (2016) Virtual non-contrast CT using dual-energy spectral CT: feasibility of coronary artery calcium scoring. Korean J Radiol 17:321–329

    Article  PubMed  PubMed Central  Google Scholar 

  24. Glazer DI, Maturen KE, Kaza RK, et al. (2014) Adrenal incidentaloma triage with single-source (fast-kilovoltage switch) dual-energy CT. AJR Am J Roentgenol 203:329–335

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mileto A, Nelson RC, Marin D, Roy Choudhury K, Ho LM (2015) Dual-energy multidetector CT for the characterization of incidental adrenal nodules: diagnostic performance of contrast-enhanced material density analysis. Radiology 274:445–454

    Article  PubMed  Google Scholar 

  26. Ascenti G, Mileto A, Krauss B, et al. (2013) Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification vs. standard enhancement measurements. Eur Radiol 23:2288–2295

    Article  PubMed  Google Scholar 

  27. Albrecht MH, Scholtz JE, Husers K, et al. (2015) Advanced image-based virtual monoenergetic dual-energy CT angiography of the abdomen: optimization of kiloelectron volt settings to improve image contrast. Eur Radiol 26:1863–1870

    Article  PubMed  Google Scholar 

  28. van Elmpt W, Landry G, Das M, Verhaegen F (2016) Dual energy CT in radiotherapy: current applications and future outlook. Radiother Oncol 119:137–144

    Article  PubMed  Google Scholar 

  29. Carrascosa P, Capunay C, Rodriguez-Granillo GA, et al. (2014) Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study. Int J Cardiovasc Imaging 30:1613–1620

    Article  PubMed  Google Scholar 

  30. Bongartz T, Glazebrook KN, Kavros SJ, et al. (2015) Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis 74:1072–1077

    Article  CAS  PubMed  Google Scholar 

  31. Frellesen C, Fessler F, Hardie AD, et al. (2015) Dual-energy CT of the pancreas: improved carcinoma-to-pancreas contrast with a noise-optimized monoenergetic reconstruction algorithm. Eur J Radiol 84:2052–2058

    Article  PubMed  Google Scholar 

  32. McNamara MM, Little MD, Alexander LF, et al. (2015) Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas: complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT. Abdom Imaging 40:1230–1240

    Article  PubMed  Google Scholar 

  33. Therasse P, Arbuck SG, Eisenhauer EA, et al. (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  CAS  Google Scholar 

  34. Schwartz LH, Litiere S, de Vries E, et al. (2016) RECIST 1.1-Update and clarification: from the RECIST committee. Eur J Cancer 62:132–137

    Article  PubMed  Google Scholar 

  35. Miller AB, Hoogstraten B, Staquet MF, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Article  CAS  PubMed  Google Scholar 

  36. Wichmann JL, Hardie AD, Schoepf UJ, et al. (2016) Single- and dual-energy CT of the abdomen: comparison of radiation dose and image quality of 2nd and 3rd generation dual-source CT. Eur Radiol . doi:10.1007/s00330-016-4383-6

    Google Scholar 

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Correspondence to Eric P. Tamm.

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No funding was received for this study.

Conflict of interest

Eric P. Tamm has received research grants from General Electric healthcare “in kind” research support. Dianna D. Cody has received a speaker honorarium from General Electric healthcare “in kind” research support, Philips Healthcare scientific advisory board, ACR CT accreditation reviewer. The other authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Tamm, E.P., Le, O., Liu, X. et al. “How to” incorporate dual-energy imaging into a high volume abdominal imaging practice. Abdom Radiol 42, 688–701 (2017). https://doi.org/10.1007/s00261-016-1035-x

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