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Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions: what are the advantages and trade-offs in conspicuity and image quality? A pilot study

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Abstract

Purpose

Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images.

Methods

Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100 kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70 keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques.

Results

Mean lesion size was 1.5 ± 1.2 cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50 keV half-dose DE-VM images were superior compared to other half-dose image sets (p < 0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p ≥ 0.05; 1.19 vs. 1.24–1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70 keV (p < 0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40–50 keV the least (p < 0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p < 0.01).

Conclusion

For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.

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Abbreviations

SE-LTP:

Single-energy, low tube potential

DE-VM:

Dual-energy, virtual monoenergetic

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, 55905, USA

    G. Jay Hanson, Gregory J. Michalak, Robert Childs, Brian McCollough, Anil N. Kurup, David M. Hough, Judson M. Frye, Jeff L. Fidler, Sudhakar K. Venkatesh, Shuai Leng, Lifeng Yu, Cynthia H. McCollough & J. G. Fletcher

  2. Siemens Healthcare, 40 Liberty Blvd, Malvern, PA, 19355, USA

    Ahmed F. Halaweish

  3. Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    W. Scott Harmsen

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  1. G. Jay Hanson
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  2. Gregory J. Michalak
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  15. J. G. Fletcher
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Corresponding author

Correspondence to J. G. Fletcher.

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Funding

The project described was supported by Grant Numbers U01 EB17185 and R01 EB17095 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

Dr. McCollough receives Grant support from Siemens Healthcare. Dr. Halaweish is an employee of Siemens Healthcare. No other authors declare a conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants involved in the study. This article does not contain any animal studies.

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Hanson, G.J., Michalak, G.J., Childs, R. et al. Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions: what are the advantages and trade-offs in conspicuity and image quality? A pilot study. Abdom Radiol 43, 1404–1412 (2018). https://doi.org/10.1007/s00261-017-1327-9

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  • DOI: https://doi.org/10.1007/s00261-017-1327-9

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