Comparison of dual- and single-source dual-energy CT in head and neck imaging



The aim of this study was to compare image quality of single-source dual-energy CT (SS-DECT) with third-generation dual-source dual-energy CT (DS-DECT) in head and neck cancer.

Materials and methods

One hundred two patients with histologically proven head and neck cancer were prospectively randomized to undergo radiation dose-matched SS-DECT (n = 51, 120 kV, split-filter technique, 384 ref. mAs) or DS-DECT (n = 51, 80/Sn150 kV, tube A 100/tube B 67 ref. mAs). Inline default images (DI) and virtual monoenergetic images (VMI) for two different low energies (40 and 60 keV) were reconstructed. Objective image quality was evaluated as dose-normalized contrast to noise ratio (CNRD), and subjective image quality was rated on a 5-point Likert scale.


In both groups, highest CNRD values for vessel and tumor attenuation were obtained at 40 keV. DS-DECT was significantly better than SS-DECT regarding vessel and tumor attenuation. Overall subjective image quality in the SS-DECT group was highest on the DI followed by 40 keV and 60 keV. In the DS-DECT group, subjective image quality was highest at 40 keV followed by 60 keV and the DI. Forty kiloelectron volts and 60 keV were significantly better in the DS-DECT compared to the SS-DECT group (both p < 0.01).


In split-filter SS-DECT as well as in DS-DECT, highest overall image quality in head and neck imaging can be obtained with a combination of DI and low keV reconstructions. DS-DECT is superior to split-filter SS-DECT in terms of subjective image quality and vessel and tumor attenuation.

Key Points

• Image quality was diagnostic with both dual-energy techniques; however, the dual-source technique delivered significantly better results.

• Highest overall image quality in head and neck imaging can be obtained with a combination of default images and low keV reconstructions with both dual-energy techniques.

• The results of this study may have relevance for the decision-making process regarding replacement of CT scanners and focused patient examination considering image quality and subsequent therapeutic decision-making.

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Fig. 1
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Fig. 3



Mean attenuation


Contrast to noise ratio


Default image


Dose-length product


Dual-source dual-energy CT


Effective radiation dose


Hounsfield units


Energy levels


Image noise


Single-source dual-energy CT


Regions of interest


Virtual monoenergetic images


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The authors state that this work has not received any funding.

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Corresponding author

Correspondence to Wolfgang Wuest.

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The scientific guarantor of this publication is Wolfgang Wuest.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Rafael Heiss, Marco Wiesmueller, Michael Uder, Matthias Stefan May, and Wolfgang Wuest are members of Siemens Healthcare GmbH speakers’ bureau.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• cross-sectional study

• performed at one institution

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May, M.S., Wiesmueller, M., Heiss, R. et al. Comparison of dual- and single-source dual-energy CT in head and neck imaging. Eur Radiol 29, 4207–4214 (2019).

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  • Diagnostic imaging
  • Head and neck neoplasms
  • Image enhancement