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Added value of 40 keV virtual monoenergetic images for diagnosing malignant pleural effusion on chest CT

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Abstract

Objective

This study aimed to evaluate the added value of 40 keV virtual mono-energetic images (VMIs) obtained from dual-layer detector CT (DLCT) for diagnosing malignant pleural effusion (MPE) in patients presenting with unilateral pleural effusion on chest CT.

Materials and methods

This retrospective study included 75 patients with unilateral pleural effusion who underwent contrast-enhanced chest CT scans using DLCT. Quantitative and qualitative assessments of the visibility of pleural thickening were conducted on both conventional 120 kVp images and 40 keV VMIs. Two independent radiologists reviewed chest CT scans with or without 40 keV VMIs to detect pleural nodules or nodular thickening for the diagnosis of MPE. Diagnostic performances were compared and independent predictors of MPE were identified through multivariate logistic regression analysis using CT and clinicopathologic findings.

Results

Pleural thickening associated with MPE demonstrated a higher contrast-to-noise ratio value and greater visual conspicuity in 40 keV VMIs compared to benign effusions (p < 0.05). For both readers, the use of 40 keV VMIs significantly improved (p < 0.05) the diagnostic performance in terms of sensitivity and area under the curve (AUC) for diagnosing MPE through the detection of pleural nodularity. Inter-observer agreements between the two readers were substantial for both 120 kVp images alone and the combined use of 40 keV VMIs. Initial cytology results and pleural nodularity at 40 keV were identified as independent predictors of MPE.

Conclusion

The use of 40 keV VMIs from DLCT can improve diagnostic performance of readers in detecting MPE among patients with unilateral pleural effusion.

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Authors and Affiliations

  1. Department of Radiology, Gyeongsang National University Changwon Hospital, 555 Samjeongja-dong, Seongsan-gu, Changwon, Republic of Korea

    Nahyeon Kim, Kyungsoo Bae & Kyung Nyeo Jeon

  2. Department of Radiology, Institute of Medical Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea

    Nahyeon Kim, Kyungsoo Bae & Kyung Nyeo Jeon

  3. Department of Internal Medicine, Institute of Medical Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea

    Ho Cheol Kim

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  1. Nahyeon Kim
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  2. Kyungsoo Bae
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Correspondence to Kyung Nyeo Jeon.

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Kim, N., Bae, K., Kim, H.C. et al. Added value of 40 keV virtual monoenergetic images for diagnosing malignant pleural effusion on chest CT. Jpn J Radiol (2024). https://doi.org/10.1007/s11604-024-01571-x

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