Advertisement

CardioVascular and Interventional Radiology

, Volume 42, Issue 2, pp 250–259 | Cite as

Arterial Phase CTA Replacement by a Virtual Arterial Phase Reconstruction from a Venous Phase CTA: Preliminary Results Using Detector-Based Spectral CT

  • Anish A. PatelEmail author
  • Patrick D. Sutphin
  • Yin Xi
  • Suhny Abbara
  • Sanjeeva P. Kalva
Clinical Investigation Imaging
Part of the following topical collections:
  1. Imaging

Abstract

Objective

To assess the feasibility of creating virtual monoenergetic arterial images from venous phase CTA obtained on a detector-based spectral CT scanner and quantitatively compare the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios of the major arteries to those on polyenergetic true arterial phase images.

Methods

In this retrospective study, 23 patients (15 men and 8 women, median age 68 years) who underwent triple-phase CTA on a spectral CT scanner for aortic endograft surveillance were included. The venous phase CTA of each study was reconstructed to generate virtual monoenergetic images at various keV, which were compared to true arterial phase CTA images. SNR and CNR of the aortoiliac arteries were evaluated by testing the differences in means and non-inferiority of virtual arterial images to true arterial images. Effective radiation dose was calculated for standard triple-phase studies in comparison with dual-phase and single-phase spectral CT examinations.

Results

Virtual monoenergetic images demonstrated non-inferior (P < 0.05) arterial SNR and CNR compared to true arterial images at 40 keV for all arteries, at 45–50 keV for the thoracic and suprarenal aorta, and at 45–55 keV for the infrarenal aorta and iliac arteries. Significantly higher (P < 0.05) arterial attenuation was obtained at 40 keV for the aortoiliac arteries. Mean effective dose for conventional triple-phase studies was 32.5 mSv in comparison with 21.3 mSv for dual-phase non-contrast/venous scans and 11.3 mSv for single-phase venous scans.

Conclusions

Detector-based spectral CT enables creation of virtual monoenergetic arterial images from venous phase CTA with equivalent and in some cases significantly higher SNR/CNR of major arteries compared to images from true arterial phase polyenergetic CTA.

Keywords

CT angiography Spectral CT Dual-energy CT Aorta 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no 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. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ananthakrishnan L, Rajiah P, Ahn R, et al. Spectral detector CT-derived virtual non-contrast images: comparison of attenuation values with unenhanced CT. Abdom Radiol (NY). 2017;42(3):702–9.CrossRefGoogle Scholar
  2. 2.
    McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 2015;276(3):637–53.CrossRefGoogle Scholar
  3. 3.
    Rajiah P, Abbara S, Halliburton SS. Spectral detector CT for cardiovascular applications. Diagn Interv Radiol. 2017;23(3):187–93.CrossRefGoogle Scholar
  4. 4.
    Kalva SP, Sahani DV, Hahn PF, Saini S. Using the K-edge to improve contrast conspicuity and to lower radiation dose with a 16-MDCT: a phantom and human study. J Comput Assist Tomogr. 2006;30(3):391–7.CrossRefGoogle Scholar
  5. 5.
    Coursey CA, Nelson RC, Boll DT, et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics. 2010;30(4):1037–55.CrossRefGoogle Scholar
  6. 6.
    Machida H, Tanaka I, Fukui R, et al. Dual-energy spectral CT: various clinical vascular applications. Radiographics. 2016;36(4):1215–32.CrossRefGoogle Scholar
  7. 7.
    Beeres M, Trommer J, Frellesen C, et al. Evaluation of different keV-settings in dual-energy CT angiography of the aorta using advanced image-based virtual monoenergetic imaging. Int J Cardiovasc Imaging. 2016;32(1):137–44.CrossRefGoogle Scholar
  8. 8.
    Boos J, Fang J, Heidinger BH, Raptopoulos V, Brook OR. Dual energy CT angiography: pros and cons of dual-energy metal artifact reduction algorithm in patients after endovascular aortic repair. Abdom Radiol (NY). 2017;42(3):749–58.CrossRefGoogle Scholar
  9. 9.
    Chandarana H, Godoy MC, Vlahos I, et al. Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms–initial observations. Radiology. 2008;249(2):692–700.CrossRefGoogle Scholar
  10. 10.
    Flors L, Leiva-Salinas C, Norton PT, Patrie JT, Hagspiel KD. Endoleak detection after endovascular repair of thoracic aortic aneurysm using dual-source dual-energy CT: suitable scanning protocols and potential radiation dose reduction. AJR Am J Roentgenol. 2013;200(2):451–60.CrossRefGoogle Scholar
  11. 11.
    Flors L, Leiva-Salinas C, Norton PT, Patrie JT, Hagspiel KD. Imaging follow-up of endovascular repair of type B aortic dissection with dual-source, dual-energy CT and late delayed-phase scans. J Vasc Interv Radiol. 2014;25(3):435–42.CrossRefGoogle Scholar
  12. 12.
    Maturen KE, Kaza RK, Liu PS, Quint LE, Khalatbari SH, Platt JF. “Sweet spot” for endoleak detection: optimizing contrast to noise using low keV reconstructions from fast-switch kVp dual-energy CT. J Comput Assist Tomogr. 2012;36(1):83–7.CrossRefGoogle Scholar
  13. 13.
    Numburi UD, Schoenhagen P, Flamm SD, et al. Feasibility of dual-energy CT in the arterial phase: imaging after endovascular aortic repair. AJR Am J Roentgenol. 2010;195(2):486–93.CrossRefGoogle Scholar
  14. 14.
    Sommer WH, Graser A, Becker CR, et al. Image quality of virtual noncontrast images derived from dual-energy CT angiography after endovascular aneurysm repair. J Vasc Interv Radiol. 2010;21(3):315–21.CrossRefGoogle Scholar
  15. 15.
    Stolzmann P, Frauenfelder T, Pfammatter T, et al. Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT. Radiology. 2008;249(2):682–91.CrossRefGoogle Scholar
  16. 16.
    De Cecco CN, Schoepf UJ, Steinbach L, et al. White paper of the society of computed body tomography and magnetic resonance on dual-energy CT, part 3: vascular, cardiac, pulmonary, and musculoskeletal applications. J Comput Assist Tomogr. 2017;41(1):1–7.CrossRefGoogle Scholar
  17. 17.
    Albrecht MH, Scholtz JE, Husers K, et al. Advanced image-based virtual monoenergetic dual-energy CT angiography of the abdomen: optimization of kiloelectron volt settings to improve image contrast. Eur Radiol. 2016;26(6):1863–70.CrossRefGoogle Scholar
  18. 18.
    Pinho DF, Kulkarni NM, Krishnaraj A, Kalva SP, Sahani DV. Initial experience with single-source dual-energy CT abdominal angiography and comparison with single-energy CT angiography: image quality, enhancement, diagnosis and radiation dose. Eur Radiol. 2013;23(2):351–9.CrossRefGoogle Scholar
  19. 19.
    Yin XP, Zuo ZW, Xu YJ, et al. The optimal monochromatic spectral computed tomographic imaging plus adaptive statistical iterative reconstruction algorithm can improve the superior mesenteric vessel image quality. Eur J Radiol. 2017;89:47–53.CrossRefGoogle Scholar
  20. 20.
    Sudarski S, Apfaltrer P, Nance JW Jr, et al. Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol. 2013;82(10):e574–81.CrossRefGoogle Scholar
  21. 21.
    Wichmann JL, Gillott MR, De Cecco CN, et al. Dual-energy computed tomography angiography of the lower extremity runoff: impact of noise-optimized virtual monochromatic imaging on image quality and diagnostic accuracy. Invest Radiol. 2016;51(2):139–46.CrossRefGoogle Scholar
  22. 22.
    Lee J, Park CH, Oh CS, Han K, Kim TH. Coronary computed tomographic angiography at 80 kVp and knowledge-based iterative model reconstruction is non-inferior to that at 100 kVp with iterative reconstruction. PLoS ONE. 2016;11(9):e0163410.CrossRefGoogle Scholar
  23. 23.
    The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2–4):1–332.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Anish A. Patel
    • 1
    Email author
  • Patrick D. Sutphin
    • 1
  • Yin Xi
    • 1
  • Suhny Abbara
    • 1
  • Sanjeeva P. Kalva
    • 1
  1. 1.Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations