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Virtual monochromatic spectral attenuation curve analysis for evaluation of incidentally detected small renal lesions using rapid kilovoltage-switching dual-energy computed tomography

  • Kidneys, Ureters, Bladder, Retroperitoneum
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether the spectral attenuation curve on a rapid kilovoltage-switching dual-energy computed tomography (DECT) scan can distinguish enhancing from nonenhancing incidental small (1–4 cm) renal lesions compared with conventional single-energy attenuation changes.

Methods

This retrospective study enrolled 46 patients with 78 renal lesions (24 enhancing; 54 nonenhancing) who underwent DECT with DE mode performed during the portovenous or nephrographic phase. Final diagnosis of enhancing and nonenhancing masses was confirmed by pathology or imaging following the established criteria. Virtual monochromatic images (VMI) were reconstructed, and the slopes between the VMI dataset at 40–70 keV (Slope HU40–70), 40–100 keV (Slope HU40–100), and 40–140 keV (Slope HU40–140) were measured. Visual assessment of the curve pattern was recorded. Diagnostic accuracies were calculated with a cross-validated Mann–Whitney U test, and correlations of quantitative spectral parameters and intraclass correlation coefficient (ICC) were calculated using Spearman’s rho correlation.

Results

All quantitative and qualitative spectral analysis parameters significantly differentiated the enhancing and nonenhancing lesions (P < 0.001). The optimal slope thresholds calculated by cross-validation for Slope HU40–70, Slope HU40–100, and Slope HU40–140 were 3.0, 1.8 and 1.2, respectively for reader 1 and 3.0, 1.9 and 1.15, respectively for reader 2. Using a slope threshold at all datasets yielded a high diagnostic accuracy of 96 for reader 1 and 95 for reader 2. Using a ∆HU threshold of 20 HU yielded an accuracy of 100. Visual analysis of the curve pattern also yielded high accuracy of 94.

Conclusions

The spectral attenuation curve on rapid kilovoltage-switching DECT gives excellent diagnostic accuracy differentiating between incidental enhancing and nonenhancing renal lesions. This benefit of DECT will be most helpful when the true unenhanced phase is not performed.

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Acknowledgements

Ms. Nerisa Thornsri, Siriraj Medical Research Centre (for collaboration in the mathematics and statistical analyses) and Mr. David Park (for English-language editing).

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Adisa Moleesaide, Arjin Maneegarn, Rathachai Kaewlai & Shanigarn Thiravit

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  1. Adisa Moleesaide
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  2. Arjin Maneegarn
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  4. Shanigarn Thiravit
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Correspondence to Shanigarn Thiravit.

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Moleesaide, A., Maneegarn, A., Kaewlai, R. et al. Virtual monochromatic spectral attenuation curve analysis for evaluation of incidentally detected small renal lesions using rapid kilovoltage-switching dual-energy computed tomography. Abdom Radiol 47, 3817–3827 (2022). https://doi.org/10.1007/s00261-022-03634-x

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  • DOI: https://doi.org/10.1007/s00261-022-03634-x

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