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Hypodense liver lesions in patients with hepatic steatosis: do we profit from dual-energy computed tomography?

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate dual-energy CT (DECT) imaging of hypodense liver lesions in patients with hepatic steatosis, having a high incidence in the general population and among cancer patients receiving chemotherapy.

Methods

One hundred and five patients with hepatic steatosis (liver parenchyma <40 HU) underwent contrast-enhanced DECT with reconstruction of pure iodine (PI), optimum contrast (OC), 80 kVp, and 120 kVp-equivalent data sets. Image noise (IN), lesion to liver signal to noise (SNR) and contrast to noise (CNR) ratios were quantitatively analysed; image quality was rated on a 5-point scale (1, excellent; 2, good; 3, fair; 4, poor; 5, non-diagnostic) by two independent reviewers.

Results

In 21 patients with hypodense liver lesions, IN was lowest in PI followed by 120 kVp-equivalent and OC, and highest in 80 kVp. SNR was highest in PI (1.30), followed by 120 kVp-equivalent (0.72) and 80 kVp (0.63), and lowest in OC (0.55). CNR was highest in 120 kVp-equivalent (4.95), followed by OC (4.55) and 80 kVp (4.14), and lowest in PI (3.63). The 120 kVp-equivalent series exhibited best overall qualitative image score (1.88), followed by OC (1.98), 80 kVp (3.00) and PI (3.67).

Conclusion

In our study, the 120 kVp-equivalent series was best suited for visualization of hypodense lesions within steatotic liver parenchyma, while using DECT currently seems to offer no additional diagnostic advantage.

Key Points

• Hepatic steatosis has high incidence in the general population and following chemotherapy.

• Hypodense liver lesions can be obscured by steatotic liver parenchyma in CT.

• Low kV p -CT shows no advantage in detecting hypodense lesions in steatotic livers.

• Additional DECT image information does not improve visualization of hypodense lesions in steatosis.

• 120 kV p -equivalent imaging yields best quantitative and qualitative image analysis results.

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Acknowledgments

The contents of the manuscript have been previously presented as an oral presentation at ECR 2014 in Vienna.

The scientific guarantor of this publication is Dr. Wolfram Stiller. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Johanna Nattenmüller, Waldemar Hosch, Tri-Thien Nguyen, Stephan Skornitzke, Andreas Jöres, Lars Grenacher, Hans-Ulrich Kauczor, Christof M. Sommer & Wolfram Stiller

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  1. Johanna Nattenmüller
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  2. Waldemar Hosch
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  3. Tri-Thien Nguyen
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  4. Stephan Skornitzke
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  7. Hans-Ulrich Kauczor
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  8. Christof M. Sommer
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  9. Wolfram Stiller
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Correspondence to Wolfram Stiller.

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Nattenmüller, J., Hosch, W., Nguyen, TT. et al. Hypodense liver lesions in patients with hepatic steatosis: do we profit from dual-energy computed tomography?. Eur Radiol 25, 3567–3576 (2015). https://doi.org/10.1007/s00330-015-3772-6

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  • DOI: https://doi.org/10.1007/s00330-015-3772-6

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