Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions

what are the advantages and trade-offs in conspicuity and image quality? A pilot study

G. Jay Hanson, Gregory J. Michalak, Robert Childs, Brian McCollough, Anil N. Kurup, David M. Hough, Judson M. Frye, Jeff L. Fidler, Sudhakar K Venkatesh, Shuai Leng, Lifeng Yu, Ahmed F. Halaweish, W. Scott Harmsen, Cynthia H McCollough, Joel Garland Fletcher

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images. Methods: Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100 kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70 keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques. Results: Mean lesion size was 1.5 ± 1.2 cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50 keV half-dose DE-VM images were superior compared to other half-dose image sets (p < 0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p ≥ 0.05; 1.19 vs. 1.24–1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70 keV (p < 0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40–50 keV the least (p < 0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p < 0.01). Conclusion: For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Oct 5 2017

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Noise
Artifacts
Liver
Iodine
Radiologists

Keywords

  • Artifacts
  • Dual-energy CT
  • Image quality
  • Liver
  • Radiation dosage
  • Virtual monoenergetic imaging

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions : what are the advantages and trade-offs in conspicuity and image quality? A pilot study. / Hanson, G. Jay; Michalak, Gregory J.; Childs, Robert; McCollough, Brian; Kurup, Anil N.; Hough, David M.; Frye, Judson M.; Fidler, Jeff L.; Venkatesh, Sudhakar K; Leng, Shuai; Yu, Lifeng; Halaweish, Ahmed F.; Harmsen, W. Scott; McCollough, Cynthia H; Fletcher, Joel Garland.

In: Abdominal Radiology, 05.10.2017, p. 1-9.

Research output: Contribution to journalArticle

Hanson, G. Jay ; Michalak, Gregory J. ; Childs, Robert ; McCollough, Brian ; Kurup, Anil N. ; Hough, David M. ; Frye, Judson M. ; Fidler, Jeff L. ; Venkatesh, Sudhakar K ; Leng, Shuai ; Yu, Lifeng ; Halaweish, Ahmed F. ; Harmsen, W. Scott ; McCollough, Cynthia H ; Fletcher, Joel Garland. / Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions : what are the advantages and trade-offs in conspicuity and image quality? A pilot study. In: Abdominal Radiology. 2017 ; pp. 1-9.
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abstract = "Purpose: Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images. Methods: Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100 kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70 keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques. Results: Mean lesion size was 1.5 ± 1.2 cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50 keV half-dose DE-VM images were superior compared to other half-dose image sets (p < 0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p ≥ 0.05; 1.19 vs. 1.24–1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70 keV (p < 0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40–50 keV the least (p < 0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p < 0.01). Conclusion: For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.",
keywords = "Artifacts, Dual-energy CT, Image quality, Liver, Radiation dosage, Virtual monoenergetic imaging",
author = "Hanson, {G. Jay} and Michalak, {Gregory J.} and Robert Childs and Brian McCollough and Kurup, {Anil N.} and Hough, {David M.} and Frye, {Judson M.} and Fidler, {Jeff L.} and Venkatesh, {Sudhakar K} and Shuai Leng and Lifeng Yu and Halaweish, {Ahmed F.} and Harmsen, {W. Scott} and McCollough, {Cynthia H} and Fletcher, {Joel Garland}",
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T1 - Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions

T2 - what are the advantages and trade-offs in conspicuity and image quality? A pilot study

AU - Hanson, G. Jay

AU - Michalak, Gregory J.

AU - Childs, Robert

AU - McCollough, Brian

AU - Kurup, Anil N.

AU - Hough, David M.

AU - Frye, Judson M.

AU - Fidler, Jeff L.

AU - Venkatesh, Sudhakar K

AU - Leng, Shuai

AU - Yu, Lifeng

AU - Halaweish, Ahmed F.

AU - Harmsen, W. Scott

AU - McCollough, Cynthia H

AU - Fletcher, Joel Garland

PY - 2017/10/5

Y1 - 2017/10/5

N2 - Purpose: Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images. Methods: Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100 kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70 keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques. Results: Mean lesion size was 1.5 ± 1.2 cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50 keV half-dose DE-VM images were superior compared to other half-dose image sets (p < 0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p ≥ 0.05; 1.19 vs. 1.24–1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70 keV (p < 0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40–50 keV the least (p < 0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p < 0.01). Conclusion: For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.

AB - Purpose: Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images. Methods: Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100 kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70 keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques. Results: Mean lesion size was 1.5 ± 1.2 cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50 keV half-dose DE-VM images were superior compared to other half-dose image sets (p < 0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p ≥ 0.05; 1.19 vs. 1.24–1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70 keV (p < 0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40–50 keV the least (p < 0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p < 0.01). Conclusion: For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.

KW - Artifacts

KW - Dual-energy CT

KW - Image quality

KW - Liver

KW - Radiation dosage

KW - Virtual monoenergetic imaging

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