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Comparison of the performance of conventional and spectral-based tagged stool cleansing algorithms at CT colonography

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

Abstract

Objectives

To compare the performance of conventional versus spectral-based electronic stool cleansing for iodine-tagged CT colonography (CTC) using a dual-layer spectral detector scanner.

Methods

We retrospectively evaluated iodine contrast stool-tagged CTC scans of 30 consecutive patients (mean age: 69 ± 8 years) undergoing colorectal cancer screening obtained on a dual-layer spectral detector CT scanner. One reader identified locations of electronic cleansing artifacts (n = 229) on conventional and spectral cleansed images. Three additional independent readers evaluated these locations using a conventional cleansing algorithm (Intellispace Portal) and two experimental spectral cleansing algorithms (i.e., fully transparent and translucent tagged stool). For each cleansed image set, readers recorded the severity of over- and under-cleansing artifacts on a 5-point Likert scale (0 = none to 4 = severe) and readability compared to uncleansed images. Wilcoxon’s signed-rank tests were used to assess artifact severity, type, and readability (worse, unchanged, or better).

Results

Compared with conventional cleansing (66% score ≥ 2), the severity of overall cleansing artifacts was lower in transparent (60% score ≥ 2, p = 0.011) and translucent (50% score ≥ 2, p < 0.001) spectral cleansing. Under-cleansing artifact severity was lower in transparent (49% score ≥ 2, p < 0.001) and translucent (39% score ≥ 2, p < 0.001) spectral cleansing compared with conventional cleansing (60% score ≥ 2). Over-cleansing artifact severity was worse in transparent (17% score ≥ 2, p < 0.001) and translucent (14% score ≥ 2, p = 0.023) spectral cleansing compared with conventional cleansing (9% score ≥ 2). Overall readability was significantly improved in transparent (p < 0.001) and translucent (p < 0.001) spectral cleansing compared with conventional cleansing.

Conclusions

Spectral cleansing provided more robust electronic stool cleansing of iodine-tagged stool at CTC than conventional cleansing.

Key Points

• Spectral-based electronic cleansing of tagged stool at CT colonography provides higher quality images with less perception of artifacts than does conventional cleansing.

• Spectral-based electronic cleansing could potentially advance minimally cathartic approach for CT colonography. Further clinical trials are warranted.

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Abbreviations

CTC:

Computed tomography colonography

CTDIvol:

Computed tomography dose index

HU:

Hounsfield units

OC:

Optical colonoscopy

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Acknowledgements

The authors would like to thank Liran Goshen, Amar Dhanantwari, Jörg Sabcynski, and Tobias Klinder (of Philips CT, Clinical Science, and Research, respectively) for numerous fruitful discussions, algorithmic exploration, and the preparation of the CT images using conventional electronic cleansing.

Funding

This study has received funding by a grant from Philips Healthcare, Cleveland, OH, USA, and the National Institutes of Health under Award Number R01CA226868. The content is solely the responsibility of the authors and does not necessarily represent the official views of Philips Healthcare or the National Institutes of Health. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA

    Sergio Grosu, Chansik An, Markus M. Obmann & Benjamin M. Yeh

  2. Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Sergio Grosu

  3. Philips Research Laboratories Hamburg, Röntgenstraße 24, 22335, Hamburg, Germany

    Rafael Wiemker

  4. Department of Radiology and Nuclear Imaging, University Hospital Basel, Petersgraben 4, CH - 4051, Basel, Switzerland

    Markus M. Obmann

  5. CT/AMI Clinical Science, Philips Healthcare, 100 Park Avenue, Orange Village, OH, 44122, USA

    Eddy Wong

  6. Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY, 10467-2401, USA

    Judy Yee

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  1. Sergio Grosu
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  2. Rafael Wiemker
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  7. Benjamin M. Yeh
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Corresponding author

Correspondence to Sergio Grosu.

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Guarantor

The scientific guarantor of this publication is Benjamin Yeh, MD (Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143; Benjamin.Yeh@ucsf.edu).

Conflict of interest

Rafael Wiemker, PhD, and Eddy Wong, PhD, were employed by Philips Healthcare.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

• case-control study

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Grosu, S., Wiemker, R., An, C. et al. Comparison of the performance of conventional and spectral-based tagged stool cleansing algorithms at CT colonography. Eur Radiol 32, 7936–7945 (2022). https://doi.org/10.1007/s00330-022-08831-2

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  • DOI: https://doi.org/10.1007/s00330-022-08831-2

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