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Improvements of diagnostic accuracy and visualization of vertebral metastasis using multi-level virtual non-calcium reconstructions from dual-layer spectral detector computed tomography

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate feasibility and diagnostic performance of multi-level calcium suppression in spectral detector computed tomography (SDCT) for assessment of bone metastasis.

Materials and methods

Retrospective IRB-approved study on 21 patients who underwent SDCT (120 kV, reference mAs 116) and MRI. Thoracic and lumbar vertebrae (n = 357) were included and categorized as normal (n = 133) or metastatic (n = 203) based on MRI (STIR, T1w, ±contrast). The multi-level virtual non-calcium (VNCa) algorithm computes dynamic soft tissue/calcium pairs allowing for computation of different suppression index levels to address inter-individual variance of prevalent calcium composition weights. We computed images with low, medium, and high calcium suppression indices and compared them with conventional images (VNCa_low/med/high and conventional images (CI)). For quantitative image analysis, regions of interest were placed in normal and metastatic bone. Two readers reviewed the datasets independently in multiple sessions. They determined the presence of vertebral metastases on a per vertebra basis using a binary scale. Statistic assessment was performed using ANOVA with Tukey HSD, Student’s T test, and ROC analysis.

Results

Attenuation of both normal and metastatic bone was lower in VNCa images than that in conventional images (e.g., CI/VNCa_low, − 46.3 to 238.8 HU/343.3–60.2 HU; p ≤ 0.05). VNCa_low+med improved separation of normal and metastatic bone in ROC analysis (AUC, CI/VNCa_low/VNCa_med = 0.74/0.95/0.98; p ≤ 0.05). In subjective analysis, both sensitivity and specificity were clearly improved in VNCa_low as compared with CI (0.85/0.84 versus 0.78/0.82). Readers showed a good inter-rater reliability (kappa = 0.65).

Conclusions

Multi-level VNCa reconstructed from SDCT improve quantitative separation of normal and metastatic bone and subjective determination of bone metastases when using low to intermediate calcium suppression indices.

Key Points

• Spectral detector CT allows for multi-level calcium suppression in CT images and low and medium calcium suppression indices improved separation of normal and metastatic bone.

• Thus, multi-level calcium suppression allows to optimize image contrast in regard to dedicated pathologies.

• Low-level virtual non-calcium images (index 25–50) improved diagnostic performance regarding detection of metastasis.

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Abbreviations

CI:

Conventional images

CNR:

Contrast-to-noise ratio

DECT:

Dual-energy computed tomography

DSCT:

Dual-source computed tomography

MRI:

Magnetic resonance imaging

PACS:

Picture archiving and communication system

ROC:

Receiver operating characteristic

SBI:

Spectral base image

SDCT:

Spectral detector computed tomography

VNCa:

Virtual non-calcium images

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Funding

Part of this study have been funded under a research agreement between (i) University Hospitals Cleveland Medical Center/Case Western Reserve University and Philips Healthcare and (ii) University Hospital Cologne and Philips Healthcare.

Author information

Author notes

  1. N. Abdullayev and N. Große Hokamp contributed equally to this work.

Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany

    N. Abdullayev, N. Große Hokamp, S. Lennartz, J. A. Holz, V. Neuhaus, D. Maintz, B. Krug & J. Borggrefe

  2. Department of Radiology, Case Western Reserve University, Cleveland, OH, USA

    N. Große Hokamp

  3. Department of Radiology, University Hospitals Medical Center, Cleveland, OH, USA

    N. Große Hokamp

  4. Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    N. Große Hokamp

  5. Philips Clinical Science CT, Haifa, Israel

    Z. Romman

  6. Philips Clinical Science CT, Hamburg, Germany

    G. Pahn

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  1. N. Abdullayev
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Corresponding author

Correspondence to N. Große Hokamp.

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Guarantor

The scientific guarantor of this publication is PD Dr. med. Jan Borggrefe.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: NGH, DM, JB are on the speakers bureau of Philips Healthcare. ZR, GP are employees of Philips Healthcare.

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One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Abdullayev, N., Große Hokamp, N., Lennartz, S. et al. Improvements of diagnostic accuracy and visualization of vertebral metastasis using multi-level virtual non-calcium reconstructions from dual-layer spectral detector computed tomography. Eur Radiol 29, 5941–5949 (2019). https://doi.org/10.1007/s00330-019-06233-5

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