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Photon-counting CT urogram: optimal acquisition potential (kV) determination for virtual noncontrast creation

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

Abstract

Purpose

To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus 120 kV.

Methods

A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A p < .05 indicated statistical significance.

Results

63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all p > .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (− 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (p = .04). Diagnostic confidence for urinary calculi was 4.6 [1.1] at 140 kV and 4.1 [1.4] at 120 kV (p = .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (p < .001).

Conclusion

PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients.

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA

    Bari Dane, Daniel Freedman, Luke Ginocchio, Paul Smereka & Alec Megibow

  2. Department of Biostatistics, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA

    Kun Qian

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  1. Bari Dane
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Correspondence to Bari Dane.

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Conflict of interest

Bari Dane received Speaker honorarium from Siemens Healthineers. Daniel Freedman: None. Kun Qian: None. Luke Ginocchio: None. Paul Smereka: None. Alec Megibow is a Consultant for Bracco Diagnostics. Daniel Freedman controlled the data and Kun Qian analyzed the data.

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This study was institutional review board approved and Health Insurance Portability and Accountability Act compliant.

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Dane, B., Freedman, D., Qian, K. et al. Photon-counting CT urogram: optimal acquisition potential (kV) determination for virtual noncontrast creation. Abdom Radiol 49, 868–874 (2024). https://doi.org/10.1007/s00261-023-04113-7

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  • DOI: https://doi.org/10.1007/s00261-023-04113-7

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