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Lin DC, Tsai PS, Lin TL, Huang WH, Liu YP, Wu TH, Shih CT. Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study. BMC Cardiovasc Disord 2025; 25:268. [PMID: 40197259 PMCID: PMC11977887 DOI: 10.1186/s12872-025-04695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients. METHODS Between January 2018 and December 2020, 108 subjects diagnosed of PAD were enrolled (mean age of 64.1 ± 13.5 years) and utilized dual-energy computed tomography (DECT) with material decomposition to measure the vessel volume, muscle volume, fat volume, and cortical-bone volume in lower extremity respectively. The association between each leg composition and developing complications or morbidities in PAD patients was analyzed over a two-year follow-up. RESULTS Fontaine stage 3 and 4 had lower muscle mass compared to stages 1 and 2. More severe vascular stenosis was associated with lower muscle, fat, and cortical-bone volume. Patients with severe Fontaine stages (3 and 4) and lower-leg vascular stenosis had a higher risk of developing infection or inflammation (OR 45.5, 95% CI: 13.5-166.7, and OR 11.7, 95% CI: 2.8-50, P < 0.05) and amputation (OR 18.2, 95% CI: 2.2-142.8, and OR 10.7, 95% CI: 1.11-100, P < 0.05). Lower thigh cortical-bone volume was associated with an increased risk of falls resulting in fractures (OR: 1.39, 95% CI: 1.13-2.19, P < 0.01). Thigh cortical-bone volume below 64.5 cm3 was identified as the cut-off value to predict fall-related fractures, with a sensitivity of 100% and specificity of 92%. CONCLUSIONS This study demonstrates the potential of DECT with material decomposition to assess lower extremity composition and its relevance in predicting complications and morbidities in PAD patients. Severe vascular stenosis may contribute to muscle wasting and subsequent complications, while lower thigh cortical-bone mass may serve as a predictor of fall-related fractures.
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Affiliation(s)
- Dao-Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Pei-Shan Tsai
- Department of Radiology, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, Taipei City, Taiwan
| | - Tzu-Lin Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Wen-Hui Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, Taipei City, Taiwan
| | - Yu-Peng Liu
- Nursing and Management, Mackay Junior College of Medicine, Taipei City, Taiwan
- Department of Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Cheng-Ting Shih
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City, Taiwan.
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Kazimierczak W, Kazimierczak N, Wilamowska J, Wojtowicz O, Nowak E, Serafin Z. Enhanced visualization in endoleak detection through iterative and AI-noise optimized spectral reconstructions. Sci Rep 2024; 14:3845. [PMID: 38360941 PMCID: PMC10869818 DOI: 10.1038/s41598-024-54502-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
To assess the image quality parameters of dual-energy computed tomography angiography (DECTA) 40-, and 60 keV virtual monoenergetic images (VMIs) combined with deep learning-based image reconstruction model (DLM) and iterative reconstructions (IR). CT scans of 28 post EVAR patients were enrolled. The 60 s delayed phase of DECTA was evaluated. Objective [noise, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR)] and subjective (overall image quality and endoleak conspicuity - 3 blinded readers assessment) image quality analyses were performed. The following reconstructions were evaluated: VMI 40, 60 keV VMI; IR VMI 40, 60 keV; DLM VMI 40, 60 keV. The noise level of the DLM VMI images was approximately 50% lower than that of VMI reconstruction. The highest CNR and SNR values were measured in VMI DLM images. The mean CNR in endoleak in 40 keV was accounted for as 1.83 ± 1.2; 2.07 ± 2.02; 3.6 ± 3.26 in VMI, VMI IR, and VMI DLM, respectively. The DLM algorithm significantly reduced noise and increased lesion conspicuity, resulting in higher objective and subjective image quality compared to other reconstruction techniques. The application of DLM algorithms to low-energy VMIs significantly enhances the diagnostic value of DECTA in evaluating endoleaks. DLM reconstructions surpass traditional VMIs and IR in terms of image quality.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland.
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland.
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland.
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Justyna Wilamowska
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Olaf Wojtowicz
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Ewa Nowak
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
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Zeng Y, Geng D, Zhang J. Noise-optimized virtual monoenergetic imaging technology of the third-generation dual-source computed tomography and its clinical applications. Quant Imaging Med Surg 2021; 11:4627-4643. [PMID: 34737929 DOI: 10.21037/qims-20-1196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
The third-generation dual-source computed tomography (DSCT) is among the most advanced imaging methods. It employs noise-optimized virtual monoenergetic imaging (VMI+) technology. It uses the frequency-split method to extract high-contrast image information from low-energy images and low-noise information from images reconstructed at an optimal energy level, combining them to obtain the final image with improved quality. This review is the first to summarize the results of clinical studies that primarily and recently evaluated the VMI+ technique based on tumor, blood vessel, and other lesion classification. We aim to assist radiologists in quickly selecting the appropriate energy level when performing image reconstruction for superior image quality in clinical work and providing several ideas for future scientific research of the VMI+ technique. Presently, VMI+ reconstruction is mostly used for images of various tumors or blood vessels, including coronary plaques, coronary stents, deep vein thromboses, pulmonary embolisms (PEs), active arterial hemorrhages, and endoleaks after endovascular aneurysm repair. In addition, VMI+ has been used for imaging children's heads, liver lesions, pancreatic lacerations, and reducing metal artifacts. Regarding the reconstruction at the optimal energy level, the VMI+ technique yielded a higher image quality than the pre-optimized virtual monoenergetic imaging (VMI) technique and single-energy CT. Moreover, either low concentrations of contrast medium or low iodine injection rates can be applied before VMI+ reconstruction at a low-energy level to reduce contrast agent-related kidney injury risk. After reconstructing an image at the optimal energy level, both the image's window width and level can also be adjusted to improve the image effect's reach and diagnosis suitability. To improve image quality and lesion-imaging clarity and reduce the use of contrast agents, VMI+ reconstruction technology has been applied clinically, in which the selection of energy level is the key to the whole reconstruction process. Our review summarizes these optimal levels for radiologists' reference and suggests new ideas for the direction of future VMI+ research.
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Affiliation(s)
- Yanwei Zeng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
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Hamid S, Nasir MU, So A, Andrews G, Nicolaou S, Qamar SR. Clinical Applications of Dual-Energy CT. Korean J Radiol 2021; 22:970-982. [PMID: 33856133 PMCID: PMC8154785 DOI: 10.3348/kjr.2020.0996] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 01/05/2023] Open
Abstract
Dual-energy CT (DECT) provides insights into the material properties of tissues and can differentiate between tissues with similar attenuation on conventional single-energy imaging. In the conventional CT scanner, differences in the X-ray attenuation between adjacent structures are dependent on the atomic number of the materials involved, whereas in DECT, the difference in the attenuation is dependent on both the atomic number and electron density. The basic principle of DECT is to obtain two datasets with different X-ray energy levels from the same anatomic region and material decomposition based on attenuation differences at different energy levels. In this article, we discuss the clinical applications of DECT and its potential robust improvements in performance and postprocessing capabilities.
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Affiliation(s)
- Saira Hamid
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada.
| | - Muhammad Umer Nasir
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron So
- Department of Medical Biophyics, Schulich School of Medicine and Dentistry Western University London, Ontario, Canada
| | - Gordon Andrews
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Sadia Raheez Qamar
- Department of Medical Imaging, Sunnybrook Hospital, University of Toronto, Toronto, Canada
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D'Angelo T, Lenga L, Arendt CT, Bucher AM, Peterke JL, Caruso D, Mazziotti S, Ascenti G, Blandino A, Othman AE, Martin SS, Albrecht MH, Bodelle B, Vogl TJ, Wichmann JL. Carotid and cerebrovascular dual-energy computed tomography angiography: Optimization of window settings for virtual monoenergetic imaging reconstruction. Eur J Radiol 2020; 130:109166. [PMID: 32693314 DOI: 10.1016/j.ejrad.2020.109166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 04/25/2020] [Accepted: 07/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Dedicated post-processing of dual-energy computed tomography angiography (DE-CTA) datasets has been shown to allow for increased vascular contrast. The goal of our study was to define optimal window settings for displaying virtual monoenergetic images (VMI) reconstructed from dual-energy carotid and cerebrovascular DE-CTA. METHODS Fifty-seven patients who underwent clinically-indicated carotid and cerebrovascular third-generation dual-source DE-CTA were retrospectively evaluated. Standard linearly-blended (M_0.6), 70-keV traditional VMI (M70), and 40-keV noise-optimized VMI (M40+) reconstructions were analyzed. For M70 and M40+ datasets, the subjectively best window setting (width and level, B-W/L) was independently determined by two observers and subsequently related with aortic arch attenuation to calculate optimized values (O-W/L) using linear regression. Subjective evaluation of image quality (IQ) between W/L settings were assessed by two additional readers. Repeated measures analysis of variance were performed to compare W/L settings and IQ indices between M_0.6, M70, and M40 + . RESULTS B-W/L and O-W/L for M70 were 580/210 and 560/200, and for M40+ were 1630/570 and 1560/550, respectively, higher than standard DE-CTA W/L settings (450/100). Highest subjective scores were observed for M40+ regarding overall IQ (all p < 0.001). CONCLUSION Application of O-W/L settings is mandatory to optimize subjective IQ of VMI reconstructions of DE-CTA.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Andreas M Bucher
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julia L Peterke
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncological and Pathological Sciences, "La Sapienza'' University Hospital, Latina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Ahmed E Othman
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tübingen, Tübingen, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Albrecht MH, Vogl TJ, Martin SS, Nance JW, Duguay TM, Wichmann JL, De Cecco CN, Varga-Szemes A, van Assen M, Tesche C, Schoepf UJ. Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT. Radiology 2019; 293:260-271. [DOI: 10.1148/radiol.2019182297] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Iuga AI, Doerner J, Siedek F, Haneder S, Byrtus J, Luetkens JA, Maintz D, Hickethier T. Computed tomography pulmonary angiograms using a novel dual-layer spectral detector: Adjusted window settings are essential for diagnostic image quality. Medicine (Baltimore) 2019; 98:e16606. [PMID: 31415352 PMCID: PMC6831234 DOI: 10.1097/md.0000000000016606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine optimal window settings for conventional polyenergetic and virtual monoenergetic images derived from computed tomography pulmonary angiogram (CTPA) examinations of a novel dual-layer spectral detector computed tomography system (DLCT). METHODS Monoenergetic (40 keV) and polyenergetic images of 50 CTPA examinations were calculated and the best individual window width and level (W/L) values were manually assessed. Optimized values were obtained afterwards based on regression analysis. Diameters of standardized pulmonary artery segments and subjective image quality parameters were evaluated and compared. RESULTS Attenuation and contrast-to-noise values were higher in monoenergetic than in polyenergetic images (P≤.001). Averaged best individual W/L for polyenergetic and monoenergetic were 1020/170 and 2070/480 HU, respectively.All adjusted W/L-settings varied significantly compared to standard settings (700/100 HU) and obtained higher subjective image quality scores. A systematic overestimation of artery diameters for standard window settings in monoenergetic images was observed. CONCLUSIONS Appropriate W/L-settings are required to assess polyenergetic and monoenergetic CTPA images of a novel DLCT. W/L-settings of 1020/170 HU and 2070/480 HU were found to be the best averaged values for polyenergetic and monoenergetic CTPA images, respectively.
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Affiliation(s)
- Andra-Iza Iuga
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Jonas Doerner
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Florian Siedek
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Jonathan Byrtus
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Julian A. Luetkens
- Institute of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Tilman Hickethier
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
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Variation of degree of stenosis quantification using different energy level with dual energy CT scanner. Neuroradiology 2018; 61:285-291. [PMID: 30554271 DOI: 10.1007/s00234-018-2142-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the variation in the quantification of the carotid degree of stenosis (DoS) with a dual energy computed tomography (CT), using different energy levels during the image reconstruction. METHODS In this retrospective study, 53 subjects (37 males; mean age 67 ± 11 years; age range 47-83 years) studied with a multi-energy CT scanner were included. Datasets were reconstructed on a dedicated workstation and from the CT raw data multiple datasets were generated at the following monochromatic energy levels: 66, 70, 77, and 86 kilo-electronvolt (keV). Two radiologists independently performed all measurements for quantification of the degree of stenosis. Wilcoxon test was used to test the differences between the Hounsifield unit (HU) values in the plaques at different keV. RESULTS The Wilcoxon analysis showed a statistically significant difference (p = 0.001) in the DoS assessment among the different keVs selected. The Bland-Altman analysis showed that the DoS difference had a linear relation with the keV difference (the bigger is the difference in keV, the bigger is the variation in DoS) and that for different keVs, the difference in DoS is reduced with its increase. CONCLUSION A standardization in the use of the energy level during the image reconstruction should be considered.
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Virtual Monoenergetic Images From a Novel Dual-Layer Spectral Detector Computed Tomography Scanner in Portal Venous Phase: Adjusted Window Settings Depending on Assessment Focus Are Essential for Image Interpretation. J Comput Assist Tomogr 2018; 42:350-356. [PMID: 29369944 DOI: 10.1097/rct.0000000000000711] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to determine optimal window settings for conventional polyenergetic (PolyE) and virtual monoenergetic images (MonoE) derived from abdominal portal venous phase computed tomography (CT) examinations on a novel dual-layer spectral-detector CT (SDCT). METHODS From 50 patients, SDCT data sets MonoE at 40 kiloelectron volt as well as PolyE were reconstructed and best individual window width and level values manually were assessed separately for evaluation of abdominal arteries as well as for liver lesions. Via regression analysis, optimized individual values were mathematically calculated. Subjective image quality parameters, vessel, and liver lesion diameters were measured to determine influences of different W/L settings. RESULTS Attenuation and contrast-to-noise values were significantly higher in MonoE compared with PolyE. Compared with standard settings, almost all adjusted W/L settings varied significantly and yielded higher subjective scoring. No differences were found between manually adjusted and mathematically calculated W/L settings. CONCLUSIONS PolyE and MonoE from abdominal portal venous phase SDCT examinations require appropriate W/L settings depending on reconstruction technique and assessment focus.
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Zhao L, Li F, Zhang Z, Zhang Z, Jiang Y, Wang X, Gu J, Li D. Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: Feasibility of using low-concentration contrast medium. Eur Radiol 2018; 28:4379-4388. [PMID: 29654560 DOI: 10.1007/s00330-018-5407-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/13/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the feasibility of low-concentration contrast media (LC-CM) in cerebral and cervical dual-energy CT angiography (DE-CTA) using an advanced monoenergetic (Mono+) reconstruction technique. METHODS Sixty-five consecutive patients prospectively selected to undergo cerebral and cervical DE-CTA were randomised into two groups: 32 patients (63.7 ± 9.7 years) in the high-concentration contrast medium (HC-CM) group with iopromide 370 and 33 patients (60.7 ± 10.8 years) in the low-concentration contrast medium (LC-CM) group with iodixanol 270. Traditional monoenergetic (Mono) and Mono+ images from 40 to 100 keV levels (at 10-keV intervals) and the standard mixed (Mixed, 120 kVp equivalent) images were reconstructed. Subjective image quality parameters included the contrast-to-noise ratio (CNR) and objective image quality parameters were evaluated and compared between the two groups. RESULTS The 40-keV Mono+ images in the LC-CM group showed comparable objective CNR (common carotid arteries: 83.7 ± 24.5 vs. 78.1 ± 23.2; internal carotid arteries: 82.2 ± 26.8 vs. 76.8 ± 24.1; middle cerebral arteries: 72.5 ± 24.6 vs. 70.6 ± 19.2; all p > 0.05) and subjective image scores (3.95 ± 0.19 vs. 3.83 ± 0.35; p > 0.05) compared with Mixed images in the HC-CM group. CONCLUSION The Mono+ reconstruction technique could reduce the concentration of iodinated CM in the diagnosis of cerebral and cervical angiography. KEY POINTS • Mono+ shows decreased noise and superior CNR compared with Mono. • The 40-keV Mono+ images show the highest CNR in the LC-CM group. • The Mono+ reconstruction technique could reduce the concentration of iodinated CM.
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Affiliation(s)
- Lu Zhao
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Zewei Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Zhang Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinyu Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jun Gu
- Siemens Healthineers, Beijing, 100102, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Saba L, di Martino M, Siotto P, Anzidei M, Argiolas GM, Porcu M, Suri JS, Wintermark M. Radiation dose and image quality of computed tomography of the supra-aortic arteries: A comparison between single-source and dual-source CT Scanners. J Neuroradiol 2018; 45:136-141. [DOI: 10.1016/j.neurad.2017.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/08/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
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12
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Zopfs D, Lennartz S, Laukamp K, Große Hokamp N, Mpotsaris A, Maintz D, Borggrefe J, Neuhaus V. Improved depiction of atherosclerotic carotid artery stenosis in virtual monoenergetic reconstructions of venous phase dual-layer computed tomography in comparison to polyenergetic reconstructions. Eur J Radiol 2018; 100:36-42. [DOI: 10.1016/j.ejrad.2018.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/24/2017] [Accepted: 01/06/2018] [Indexed: 11/27/2022]
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13
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Improved Opacification of a Suboptimally Enhanced Pulmonary Artery in Chest CT: Experience Using a Dual-Layer Detector Spectral CT. AJR Am J Roentgenol 2018; 210:734-741. [PMID: 29446668 DOI: 10.2214/ajr.17.18537] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the quality of virtual monoenergetic imaging (VMI) from dual-layer detector spectral CT and the effect of virtual monoenergetic images obtained at low energies on the detection of pulmonary embolism (PE) in patients with a suboptimally enhanced pulmonary artery on chest CT. MATERIALS AND METHODS Of 1552 consecutive chest CT examinations performed with dual-layer detector spectral CT using a routine protocol with a tube voltage of 120 kVp, 79 examinations with suboptimal enhancement of the pulmonary artery (i.e., mean attenuation of pulmonary artery ≤ 180 HU) were included. The mean attenuation of the pulmonary artery, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of virtual monoenergetic images obtained at 40-200 keV were compared with those of the conventional 120-kVp images. The virtual monoenergetic images with the best CNR were compared with the 120-kVp images with regard to subjective image quality and diagnostic accuracy for detecting PE. RESULTS Sufficient attenuation of the pulmonary artery (> 180 HU) was obtained using VMI for 78 of the 79 examinations. The noise levels of the virtual monoenergetic images were gradually increased with decreasing energy level (i.e., kiloelectron volt setting). The CNR and SNR of virtual monoenergetic images at 40-65 keV were significantly higher (both, p < 0.001) than the CNR and SNR of the 120-kVp images. The CNR was the highest at 40 keV for all cases. Diagnostic accuracy for detecting PE was significantly higher for 40-keV images (reader 1: AUC = 0.992, p = 0.033; reader 2: AUC = 0.986, p = 0.043) than for 120-kVp images (reader 1, AUC = 0.911; reader 2, AUC = 0.933). The subjective quality was not different between these two images. CONCLUSION In chest CT examinations in which the pulmonary artery is suboptimally enhanced, obtaining virtual monoenergetic images at a low energy setting using dual-layer detector spectral CT allows sufficient attenuation of the pulmonary artery to be achieved while preserving image quality and increasing diagnostic performance for detecting PE.
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Leithner D, Mahmoudi S, Wichmann JL, Martin SS, Lenga L, Albrecht MH, Booz C, Arendt CT, Beeres M, D'Angelo T, Bodelle B, Vogl TJ, Scholtz JE. Evaluation of virtual monoenergetic imaging algorithms for dual-energy carotid and intracerebral CT angiography: Effects on image quality, artefacts and diagnostic performance for the detection of stenosis. Eur J Radiol 2018; 99:111-117. [DOI: 10.1016/j.ejrad.2017.12.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/01/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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Neuhaus V, Große Hokamp N, Abdullayev N, Maus V, Kabbasch C, Mpotsaris A, Maintz D, Borggrefe J. Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck. Eur Radiol 2017; 28:1102-1110. [DOI: 10.1007/s00330-017-5081-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 02/01/2023]
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Improvement of Image Quality in Unenhanced Dual-Layer CT of the Head Using Virtual Monoenergetic Images Compared With Polyenergetic Single-Energy CT. Invest Radiol 2017; 52:470-476. [DOI: 10.1097/rli.0000000000000367] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Detecting Intracranial Hemorrhage Using Automatic Tube Current Modulation With Advanced Modeled Iterative Reconstruction in Unenhanced Head Single- and Dual-Energy Dual-Source CT. AJR Am J Roentgenol 2017; 208:1089-1096. [DOI: 10.2214/ajr.16.17171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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