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Wang M, Chen H, Ma Y, Bai R, Gao S, Yang L, Guo W, Zhang C, Kang C, Lan Y, Sun Y, Zhang Y, Xiao X, Hou Y. Dual-layer spectral-detector CT for detecting liver steatosis by using proton density fat fraction as reference. Insights Imaging 2024; 15:210. [PMID: 39145877 PMCID: PMC11327236 DOI: 10.1186/s13244-024-01716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/15/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of liver dual-layer spectral-detector CT (SDCT) derived parameters of liver parenchyma for grading steatosis with reference to magnetic resonance imaging-based proton density fat fraction (MRI-PDFF). METHODS Altogether, 320 consecutive subjects who underwent MRI-PDFF and liver SDCT examinations were recruited and prospectively enrolled from four Chinese hospital centers. Participants were classified into normal (n = 152), mild steatosis (n = 110), and moderate/severe(mod/sev) steatosis (n = 58) groups based on MRI-PDFF. SDCT liver parameters were evaluated using conventional polychromatic CT images (CTpoly), virtual mono-energetic images at 40 keV (CT40kev), the slope of the spectral attenuation curve (λ), the effective atomic number (Zeff), and liver to spleen attenuation ratio (L/S ratio). Linearity between SDCT liver parameters and MRI-PDFF was examined using Spearman correlation. Cutoff values for SDCT liver parameters in determining steatosis grades were identified using the area under the receiver-operating characteristic curve analyses. RESULTS SDCT liver parameters demonstrated a strong correlation with PDFF, particularly Zeff (rs = -0.856; p < 0.001). Zeff achieved an area under the curve (AUC) of 0.930 for detecting the presence of steatosis with a sensitivity of 89.4%, a specificity of 82.4%, and an AUC of 0.983 for detecting mod/sev steatosis with a sensitivity of 93.1%, a specificity of 93.5%, the corresponding cutoff values were 7.12 and 6.94, respectively. Zeff also exhibited good diagnostic performance for liver steatosis grading in subgroups, independent of body mass index. CONCLUSION SDCT liver parameters, particularly Zeff, exhibit excellent diagnostic accuracy for grading steatosis. CRITICAL RELEVANCE STATEMENT Dual-layer SDCT parameter, Zeff, as a more convenient and accurate imaging biomarker may serve as an alternative indicator for MRI-based proton density fat fraction, exploring the stage and prognosis of liver steatosis, and even metabolic risk assessment. KEY POINTS Liver biopsy is the standard for grading liver steatosis, but is limited by its invasive nature. The diagnostic performance of liver steatosis using SDCT-Zeff outperforms conventional CT parameters. SDCT-Zeff accurately and noninvasively assessed the grade of liver steatosis.
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Affiliation(s)
- Min Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Hongyu Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Ruobing Bai
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Sizhe Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Linlin Yang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Wenli Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Cong Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Chengjun Kang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yu Lan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yanqiu Sun
- Department of Radiology, Qinghai Provincial People's Hospital, Qinghai, P.R. China
| | - Yonggao Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Xigang Xiao
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
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Hu N, Yan G, Tang M, Wu Y, Song F, Xia X, Chan LWC, Lei P. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp 2023; 7:72. [PMID: 37985560 PMCID: PMC10661153 DOI: 10.1186/s41747-023-00387-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023] Open
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD), previously called metabolic nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide. The multi-factorial nature of MAFLD severity is delineated through an intricate composite analysis of the grade of activity in concert with the stage of fibrosis. Despite the preeminence of liver biopsy as the diagnostic and staging reference standard, its invasive nature, pronounced interobserver variability, and potential for deleterious effects (encompassing pain, infection, and even fatality) underscore the need for viable alternatives. We reviewed computed tomography (CT)-based methods for hepatic steatosis quantification (liver-to-spleen ratio; single-energy "quantitative" CT; dual-energy CT; deep learning-based methods; photon-counting CT) and hepatic fibrosis staging (morphology-based CT methods; contrast-enhanced CT biomarkers; dedicated postprocessing methods including liver surface nodularity, liver segmental volume ratio, texture analysis, deep learning methods, and radiomics). For dual-energy and photon-counting CT, the role of virtual non-contrast images and material decomposition is illustrated. For contrast-enhanced CT, normalized iodine concentration and extracellular volume fraction are explained. The applicability and salience of these approaches for clinical diagnosis and quantification of MAFLD are discussed.Relevance statementCT offers a variety of methods for the assessment of metabolic dysfunction-associated fatty liver disease by quantifying steatosis and staging fibrosis.Key points• MAFLD is the most prevalent chronic liver disease worldwide and is rapidly increasing.• Both hardware and software CT advances with high potential for MAFLD assessment have been observed in the last two decades.• Effective estimate of liver steatosis and staging of liver fibrosis can be possible through CT.
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Affiliation(s)
- Na Hu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Gang Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fasong Song
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xing Xia
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lawrence Wing-Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Borges AP, Antunes C, Caseiro-Alves F. Spectral CT: Current Liver Applications. Diagnostics (Basel) 2023; 13:diagnostics13101673. [PMID: 37238163 DOI: 10.3390/diagnostics13101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Using two different energy levels, dual-energy computed tomography (DECT) allows for material differentiation, improves image quality and iodine conspicuity, and allows researchers the opportunity to determine iodine contrast and radiation dose reduction. Several commercialized platforms with different acquisition techniques are constantly being improved. Furthermore, DECT clinical applications and advantages are continually being reported in a wide range of diseases. We aimed to review the current applications of and challenges in using DECT in the treatment of liver diseases. The greater contrast provided by low-energy reconstructed images and the capability of iodine quantification have been mostly valuable for lesion detection and characterization, accurate staging, treatment response assessment, and thrombi characterization. Material decomposition techniques allow for the non-invasive quantification of fat/iron deposition and fibrosis. Reduced image quality with larger body sizes, cross-vendor and scanner variability, and long reconstruction time are among the limitations of DECT. Promising techniques for improving image quality with lower radiation dose include the deep learning imaging reconstruction method and novel spectral photon-counting computed tomography.
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Affiliation(s)
- Ana P Borges
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Célia Antunes
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Filipe Caseiro-Alves
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
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Detection of fatty liver using virtual non-contrast dual-energy CT. Abdom Radiol (NY) 2022; 47:2046-2056. [PMID: 35306577 PMCID: PMC9107401 DOI: 10.1007/s00261-022-03482-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Determine whether liver attenuation measured on dual-energy CT (DECT) virtual non-contrast examinations predicts the presence of fatty liver. METHODS Single-institution retrospective review from 2016 to 2020 found patients with DECT and proton density fat fraction MRI (MRI PDFF) within 30 days. MRI PDFF was the reference standard for determining hepatic steatosis. Attenuation measurements from VNC and mixed 120 kVp-like images were compared to MRI PDFF in the right and left lobes. Performance of VNC was compared to measurement of the liver-spleen attenuation difference (LSAD). RESULTS 128 patients were included (69 men, 59 women) with mean age 51.6 years (range 14-98 years). > 90% of patients received CT and MRI in the emergency department or as inpatients. Median interval between DECT and MRI PDFF was 2 days (range 0-28 days). Prevalence of fatty liver using the reference standard (MRI PDFF > 6%) was 24%. Pearson correlation coefficient between VNC and MRI- DFF was -0.64 (right) and -0.68 (left, both p < 0.0001). For LSAD, correlation was - 0.43 in both lobes (p < 0.0001). Considering MRI PDFF > 6% as diagnostic of steatosis, area under the receiver operator characteristic curve (AUC) was 0.834 and 0.872 in the right and left hepatic lobes, with an optimal threshold of 54.8 HU (right) and 52.5 HU (left), yielding sensitivity/specificity of 57%/93.9% (right) and 67.9%/90% (left). For LSAD, AUC was 0.808 (right) and 0.767 (left) with optimal sensitivity/specificity of 93.3%/57.1% (right) and 78.6%/68% (left). CONCLUSION Attenuation measured at VNC CT was moderately correlated with liver fat content and had > 90% specificity for diagnosis of fatty liver.
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Marri UK, Madhusudhan KS. Dual-Energy Computed Tomography in Diffuse Liver Diseases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1742432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an advancement in the field of CT, where images are acquired at two energies. Materials are identified and quantified based on their attenuation pattern at two different energy beams using various material decomposition algorithms. With its ability to identify and quantify materials such as fat, calcium, iron, and iodine, DECT adds great value to conventional CT and has innumerable applications in body imaging. Continuous technological advances in CT scanner hardware, material decomposition algorithms, and image reconstruction software have led to considerable growth of these applications. Among all organs, the liver is the most widely investigated by DECT, and DECT has shown promising results in most liver applications. In this article, we aim to provide an overview of the role of DECT in the assessment of diffuse liver diseases, mainly the deposition of fat, fibrosis, and iron and review the most relevant literature.
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Affiliation(s)
- Uday Kumar Marri
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Chatzaraki V, Born C, Kubik-Huch RA, Froehlich JM, Thali MJ, Niemann T. Influence of Radiation Dose and Reconstruction Kernel on Fat Fraction Analysis in Dual-energy CT: A Phantom Study. In Vivo 2021; 35:3147-3155. [PMID: 34697145 DOI: 10.21873/invivo.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The quantitative evaluation of fat tissue, mainly for the determination of liver steatosis, is possible by using dual-energy computed tomography. Different photon energy acquisitions allow for estimation of attenuation coefficients. The effect of variation in radiation doses and reconstruction kernels on fat fraction estimation was investigated. MATERIALS AND METHODS A six-probe-phantom with fat concentrations of 0%, 20%, 40%, 60%, 80%, and 100% were scanned in Sn140/100 kV with radiation doses ranging between 20 and 200 mAs before and after calibration. Images were reconstructed using iterative kernels (I26,Q30,I70). RESULTS Fat fractions measured in dual-energy computed tomography (DECT) were consistent with the 20%-stepwise varying actual concentrations. Variation in radiation dose resulted in 3.1% variation of fat fraction. Softer reconstruction kernel (I26) underestimated the fat fraction (-9.1%), while quantitative (Q30) and sharper kernel (I70) overestimated fat fraction (10,8% and 13,1, respectively). CONCLUSION The fat fraction in DECT approaches the actual fat concentration when calibrated to the reconstruction kerneö. Variation of radiation dose caused an acceptable 3% variation.
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Affiliation(s)
| | - Corinna Born
- Hospital Pharmacy, Kantonsspital Baden, Baden, Switzerland
| | | | | | - Michael J Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland;
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Adam SZ, Rabinowich A, Kessner R, Blachar A. Spectral CT of the abdomen: Where are we now? Insights Imaging 2021; 12:138. [PMID: 34580788 PMCID: PMC8476679 DOI: 10.1186/s13244-021-01082-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.
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Affiliation(s)
- Sharon Z Adam
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviad Rabinowich
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arye Blachar
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Computed Tomography Techniques, Protocols, Advancements, and Future Directions in Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:305-320. [PMID: 34243919 DOI: 10.1016/j.mric.2021.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Computed tomography (CT) is often performed as the initial imaging study for the workup of patients with known or suspected liver disease. Our article reviews liver CT techniques and protocols in clinical practice along with updates on relevant CT advances, including wide-detector CT, radiation dose optimization, and multienergy scanning, that have already shown clinical impact. Particular emphasis is placed on optimizing the late arterial phase of enhancement, which is critical to evaluation of hepatocellular carcinoma. We also discuss emerging techniques that may soon influence clinical care.
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Takumi K, Nagano H, Harasawa T, Tabata K, Tokunaga T, Yoshiura T. Pulmonary hamartoma: Feasibility of dual-energy CT detection of intranodular fat. Radiol Case Rep 2021; 16:1032-1036. [PMID: 33680271 PMCID: PMC7917450 DOI: 10.1016/j.radcr.2021.01.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022] Open
Abstract
We have reported 2 cases of pulmonary hamartoma focusing on detecting intranodular fat, which is one of CT features suggestive of pulmonary hamartoma, using dual-energy CT analyses. For patient 1, a 73-year-old man was pointed out to have a nodular opacity on chest radiograph of pretreatment workup for retinal detachment. In patient 2, a 66-year-old woman with uterine carcinoma admitted for preoperative assessment. Both patients underwent dual-energy CT examination and the pulmonary lesions exhibited a downward-sloping curve at lower X-ray energies on attenuation curve of virtual monochromatic images, which suggested fatty tissue. Dual-energy CT analysis can help diagnose pulmonary hamartoma with detection of intralesional fatty tissue.
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Affiliation(s)
- Koji Takumi
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan,Corresponding author.
| | - Hiroaki Nagano
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Tomohiro Harasawa
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Kazuhiro Tabata
- Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Takuya Tokunaga
- General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Takashi Yoshiura
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
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Dual-energy CT in diffuse liver disease: is there a role? Abdom Radiol (NY) 2020; 45:3413-3424. [PMID: 32772121 DOI: 10.1007/s00261-020-02702-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/19/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy CT (DECT) can be defined as the use of two different energy levels to identify and quantify material composition. Since its inception, DECT has benefited from remarkable improvements in hardware and clinical applications. DECT enables accurate identification and quantification of multiple materials, including fat, iron, and iodine. As a consequence, multiple studies have investigated the potential role of DECT in the assessment of diffuse liver diseases. While this role is evolving, this article aims to review the most relevant literature on use of DECT for assessment of diffuse liver diseases. Moreover, the basic concepts on DECT techniques, types of image reconstruction, and DECT-dedicated software will be described, focusing on the areas that are most relevant for the evaluation of diffuse liver diseases. Also, we will review the evidence of added value of DECT in detection and assessment of hepatocellular carcinoma which is a known risk in patients with diffuse liver disease.
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Molwitz I, Leiderer M, Özden C, Yamamura J. Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review. ROFO-FORTSCHR RONTG 2020; 192:1137-1153. [DOI: 10.1055/a-1212-6017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background With dual-energy computed tomography (DECT) it is possible to quantify certain elements and tissues by their specific attenuation, which is dependent on the X-ray spectrum. This systematic review provides an overview of the suitability of DECT for fat quantification in clinical diagnostics compared to established methods, such as histology, magnetic resonance imaging (MRI) and single-energy computed tomography (SECT).
Method Following a systematic literature search, studies which validated DECT fat quantification by other modalities were included. The methodological heterogeneity of all included studies was processed. The study results are presented and discussed according to the target organ and specifically for each modality of comparison.
Results Heterogeneity of the study methodology was high. The DECT data was generated by sequential CT scans, fast-kVp-switching DECT, or dual-source DECT. All included studies focused on the suitability of DECT for the diagnosis of hepatic steatosis and for the determination of the bone marrow fat percentage and the influence of bone marrow fat on the measurement of bone mineral density. Fat quantification in the liver and bone marrow by DECT showed valid results compared to histology, MRI chemical shift relaxometry, magnetic resonance spectroscopy, and SECT. For determination of hepatic steatosis in contrast-enhanced CT images, DECT was clearly superior to SECT. The measurement of bone marrow fat percentage via DECT enabled the bone mineral density quantification more reliably.
Conclusion DECT is an overall valid method for fat quantification in the liver and bone marrow. In contrast to SECT, it is especially advantageous to diagnose hepatic steatosis in contrast-enhanced CT examinations. In the bone marrow DECT fat quantification allows more valid quantification of bone mineral density than conventional methods. Complementary studies concerning DECT fat quantification by split-filter DECT or dual-layer spectral CT and further studies on other organ systems should be conducted.
Key points:
Citation Format
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Affiliation(s)
- Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Leiderer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cao Q, Shang S, Han X, Cao D, Zhao L. Evaluation on Heterogeneity of Fatty Liver in Rats: A Multiparameter Quantitative Analysis by Dual Energy CT. Acad Radiol 2019; 26:e47-e55. [PMID: 30041922 DOI: 10.1016/j.acra.2018.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/27/2018] [Accepted: 05/27/2018] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the value of using rapid kVp switching dual energy computed tomography (rsDECT) for the multi-parameter analysis of the heterogeneity of fatty liver in rat. MATERIALS AND METHODS Twenty-four male rats were randomly divided into experimental (n = 16) and control (n = 8) groups. Four rats in the experimental group and two in the control group were examined by rsDECT every 3 weeks starting from week 8. The liver fat contents (LFC) of the left and right liver lobes were measured on the fat(water)-based material decomposition images to calculate fat content and CT value of liver and spleen were measured on the 70keV monochromatic images to calculate the liver-to-spleen CT value ratio [(L/S)70 keV] and difference at 70keV[(L-S)70 keV], and the spectral curve slopes of the left and right liver lobes (Slope-L, Slope-R). Measurements were evaluated statistically. RESULTS The statistical analysis showed that the (L/S)70 keV, (L-S)70 keV, Slope and LFC in the different fatty liver groups were all significantly different (p < 0.05). Pearson correlation analysis results showed that the rsDECT results of the left and right liver lobes correlated with the fat percentage from pathological analysis (p < 0.05), with the left liver lobe having better correlation. Paired t-tests showed that the fat percentage of the left liver lobe was significantly higher than that of the right one, while (L/S)70 keV, and (L-S)70 keV were significantly lower. Diagnostic analysis using ROC curve showed that the areas under the curves with parameters of the left liver lobe were also greater than those of the right liver lobe. CONCLUSION rsDECT multi-parameter imaging could quantitatively evaluate the heterogeneity of fat deposition in the liver, providing valuable information for the accurate and effective assessment of the heterogeneity of fatty liver.
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Parakh A, Baliyan V, Sahani DV. Dual-Energy CT in Focal and Diffuse Liver Disease. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Patino M, Prochowski A, Agrawal MD, Simeone FJ, Gupta R, Hahn PF, Sahani DV. Material Separation Using Dual-Energy CT: Current and Emerging Applications. Radiographics 2017; 36:1087-105. [PMID: 27399237 DOI: 10.1148/rg.2016150220] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dual-energy (DE) computed tomography (CT) offers the opportunity to generate material-specific images on the basis of the atomic number Z and the unique mass attenuation coefficient of a particular material at different x-ray energies. Material-specific images provide qualitative and quantitative information about tissue composition and contrast media distribution. The most significant contribution of DE CT-based material characterization comes from the capability to assess iodine distribution through the creation of an image that exclusively shows iodine. These iodine-specific images increase tissue contrast and amplify subtle differences in attenuation between normal and abnormal tissues, improving lesion detection and characterization in the abdomen. In addition, DE CT enables computational removal of iodine influence from a CT image, generating virtual noncontrast images. Several additional materials, including calcium, fat, and uric acid, can be separated, permitting imaging assessment of metabolic imbalances, elemental deficiencies, and abnormal deposition of materials within tissues. The ability to obtain material-specific images from a single, contrast-enhanced CT acquisition can complement the anatomic knowledge with functional information, and may be used to reduce the radiation dose by decreasing the number of phases in a multiphasic CT examination. DE CT also enables generation of energy-specific and virtual monochromatic images. Clinical applications of DE CT leverage both material-specific images and virtual monochromatic images to expand the current role of CT and overcome several limitations of single-energy CT. (©)RSNA, 2016.
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Affiliation(s)
- Manuel Patino
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Andrea Prochowski
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Mukta D Agrawal
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Frank J Simeone
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Rajiv Gupta
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Peter F Hahn
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Dushyant V Sahani
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
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15
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 4: Abdominal and Pelvic Applications. J Comput Assist Tomogr 2017; 41:8-14. [PMID: 27824670 DOI: 10.1097/rct.0000000000000546] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This is the fourth of a series of 4 white papers that represent expert consensus documents developed by the Society of Computed Body Tomography and Magnetic Resonance through its task force on dual-energy computed tomography. This article, part 4, discusses DECT for abdominal and pelvic applications and, at the end of each, will offer our consensus opinions on the current clinical utility of the application and opportunities for further research.
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Arai T, Misawa M, Arai M, Shinozaki M, Sakamoto K, Yajima Y, Nozaki Y, Tajima T, Sato M, Hinoshita F. Accuracy analysis of intrahepatic fat density measurements using dual-energy computed tomography: Validation using a test phantom. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:403-415. [PMID: 27911350 DOI: 10.3233/xst-16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Currently, no standardized method for measuring intrahepatic fat density via conventional computed tomography (CT) exists. OBJECTIVE We aim to quantify intrahepatic fat density via material decomposition analysis using rapid kilovolt peak-switching dual-energy (RSDE) CT. METHODS Homogenized porcine liver and fat (lard) were mixed in various ratios to produce phantoms for fat density verification. The actual fat density was measured on the basis of the phantom volume and weight, and these measurements were used as reference densities. The fat and liver mass attenuation coefficients, which were used as the material basis pairs, were employed in the material decomposition analysis. Then, the measured fat density of each phantom was compared with the reference densities. RESULTS For fat content differences exceeding 2%, the measured fat density for the phantoms became statistically significant (p < 0.01). The correlation between the reference densities and RSDE-measured fat densities was reasonably high (R > 0.9997); this indicates the validity of this analysis method. CONCLUSIONS Intrahepatic fat density can be measured using the mass attenuation coefficients of fat and liver in a material decomposition analysis. Given the knowledge of the accuracy and the limitations found in this study, our method can quantitatively evaluate fat density.
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Affiliation(s)
- Tomohiro Arai
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
- Graduate Division of Health Sciences, Graduate School of Komazawa University, Komazawa, Setagaya-ku, Tokyo, Japan
| | - Masaki Misawa
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Namiki, Tsukuba, Ibaraki, Japan
| | - Miki Arai
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Masafumi Shinozaki
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Kayo Sakamoto
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Yoshinobu Yajima
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Yuichi Nozaki
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Tsuyoshi Tajima
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
| | - Masanori Sato
- Graduate Division of Health Sciences, Graduate School of Komazawa University, Komazawa, Setagaya-ku, Tokyo, Japan
| | - Fumihiko Hinoshita
- Department of Radiology, Center Hospital of the National Center to Global Health and Medicine, Tokyo, Japan
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Kim S, Shuman WP. Clinical Applications of Dual-Energy Computed Tomography in the Liver. Semin Roentgenol 2016; 51:284-291. [PMID: 27743564 DOI: 10.1053/j.ro.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sooah Kim
- Department of Radiology, University of Washington, Seattle, WA.
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Abstract
Conventional imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR), play an important role in the diagnosis and management of patients with nonalcoholic fatty liver disease (NAFLD) by allowing noninvasive diagnosis of hepatic steatosis. However, conventional imaging modalities are limited as biomarkers of NAFLD for various reasons. Multi-parametric quantitative MRI techniques overcome many of the shortcomings of conventional imaging and allow comprehensive and objective evaluation of NAFLD. MRI can provide unconfounded biomarkers of hepatic fat, iron, and fibrosis in a single examination-a virtual biopsy has become a clinical reality. In this article, we will review the utility and limitation of conventional US, CT, and MR imaging for the diagnosis NAFLD. Recent advances in imaging biomarkers of NAFLD are also discussed with an emphasis in multi-parametric quantitative MRI.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Scott B Reeder
- Department of Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Takeshi Yokoo
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
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Itaya S, Matsui T, Kamiyama T, Yoshino H. [Evaluation of Fat Quantification in the Liver Using Dual Energy CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1084-1090. [PMID: 27867167 DOI: 10.6009/jjrt.2016_jsrt_72.11.1084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND PURPOSE Recently, the number of patients with nonalcoholic fatty liver disease (NAFLD) has been increasing, and some of them progresses to cirrhosis and hepatocellular carcinoma. Dual energy CT allows the discrimination of substance using monochromatic image (MI), and steatosis exhibit specifically the CT value of each energy level. The purpose is to evaluate the fat quantification in the liver using spectral HU curve and CT value compare to a conventional image diagnosis. METHODS Dual energy CT and liver biopsy were performed in 54 patients between October 2014 and April 2016. The CT value of 40 keV MI was measured by spectral HU curve setting 3 points ROI on the right and left liver. The CT value of 40 keV MI was compared with steatosis area and the NAFLD activity score (NAS). Additionally, steatosis area was compared with the conventional CT value scan and hepatorenal echo contrast value. RESULTS AND DISCUSSION The CT value of 40 keV MI exhibited a negative correlation for the stenosis area (R2=0.619), and NAS (R2=0.147). Steatosis area exhibited correlation for the conventional CT value (R2=0.407), and hepatorenal echo contrast (R2=0.135). This study suggests that the evaluation of the fat quantification in the liver using the spectral HU curve and CT value improved in comparison to the conventional image diagnosis.
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Affiliation(s)
- Shunsuke Itaya
- Department of Medical Radiation Technology, Teine-Keijinkai Hospital
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20
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Abstract
Although conceived of in the 1970s, practical use of dual-energy CT in the clinical setting did not come to fruition until 2006, and since that time an ever expanding exploration of the technology has been underway. This article will discuss technical aspects of the two commercially available CT scanners, review the recent literature, and provide an organ-based description of abdominal dual-energy CT applications for the practicing radiologist.
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22
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Li JH, Tsai CY, Huang HM. Assessment of hepatic fatty infiltration using dual-energy computed tomography: a phantom study. Physiol Meas 2014; 35:597-606. [DOI: 10.1088/0967-3334/35/4/597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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