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Becker J, Feitelson LM, Risch F, Canalini L, Kaufmann D, Wudy R, Jehs B, Haerting M, Wollny C, Scheurig-Muenkler C, Kroencke T, Schwarz F, Decker JA, Bette S. Spectral Differentiation of Hyperdense Non-Vascular and Vascular Renal Lesions Without Solid Components in Contrast-Enhanced Photon-Counting Detector CT Scans-A Pilot Study. Diagnostics (Basel) 2025; 15:79. [PMID: 39795607 PMCID: PMC11719968 DOI: 10.3390/diagnostics15010079] [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: 11/18/2024] [Revised: 12/18/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Introduction: The number of incidental renal lesions identified in CT scans of the abdomen is increasing. Objective: The aim of this study was to determine whether hyperdense renal lesions without solid components in a portal venous CT scan can be clearly classified as vascular or non-vascular by material decomposition into iodine and water. Methods: This retrospective single-center study included 26 patients (mean age 72 years ± 9; 16 male) with 42 hyperdense renal lesions (>20 HU) in a contrast-enhanced Photon-Counting Detector CT scan (PCD-CT) between May and December 2022. Spectral decomposition into virtual non-contrast (VNC) images and iodine quantification maps was performed, and HU values were quantified within the lesions. Further imaging and histopathological reports served as reference standards. Results: Mean VNC values were 55.7 (±24.2) HU for non-vascular and 32.2 (±11.1) HU for vascular renal lesions. Mean values in the iodine maps were 5.7 (±7.8) HU for non-vascular and 33.3 (±19.0) HU for vascular renal lesions. Using a threshold of >20.3 HU in iodine maps, a total of 7/8 (87.5%) vascular lesions were correctly identified. Conclusion: This proof-of-principle study suggests that the routine use of spectral information acquired in PCD-CT scans might be able to reduce the necessary workup for hyperdense renal lesions without solid components. Further studies with larger patient cohorts are necessary to validate the results of this study and to determine the usefulness of this method in clinical routine.
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Affiliation(s)
- Judith Becker
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Laura-Marie Feitelson
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Franka Risch
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Luca Canalini
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - David Kaufmann
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Ramona Wudy
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Bertram Jehs
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Mark Haerting
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Claudia Wollny
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Christian Scheurig-Muenkler
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Thomas Kroencke
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159 Augsburg, Germany
| | - Florian Schwarz
- Centre for Diagnostic Imaging and Interventional Therapy, Donau-Isar-Klinikum, Perlasberger Straße 41, 94469 Deggendorf, Germany;
| | - Josua A. Decker
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
| | - Stefanie Bette
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.B.); (L.-M.F.); (F.R.); (L.C.); (D.K.); (R.W.); (B.J.); (M.H.); (C.W.); (C.S.-M.); (J.A.D.); (S.B.)
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Jensen CT, Wong VK, Likhari GS, Daoud TE, Ahmad M, Bassett R, Pasyar S, Virarkar MK, Roman-Colon AM, Liu X. Dual-energy CT for differentiation of hypodense liver lesions in pancreatic adenocarcinoma. Eur Radiol 2024:10.1007/s00330-024-11291-5. [PMID: 39699673 DOI: 10.1007/s00330-024-11291-5] [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: 09/13/2024] [Revised: 10/21/2024] [Accepted: 11/14/2024] [Indexed: 12/20/2024]
Abstract
OBJECTIVE To assess the accuracy of CT spectral HU curve assessment of hypodense liver lesions. METHODS In this retrospective HIPAA-compliant study (January 2016 through May 2023), patients with biopsy-proven pancreatic adenocarcinoma and a biopsied indeterminate liver lesion underwent a DECT abdominal CT scan. Spectral HU curves were provided for each hypodense liver lesion, and slopes were calculated. Lesion Hounsfield units, iodine concentration and virtual enhancement were recorded. The Wilcoxon rank sum test was used to compare malignant and benign lesions. Optimal cutoff points were estimated using ROC curves and Youden's Index. RESULTS Thirty-six patients (19 men, 17 women) with a mean age of 63 years ± 9 (standard deviation), a mean height of 170.9 cm ± 9.5, a mean weight of 69.8 kg ± 14.5, and a body mass index of 23.9 kg/m2 ± 3.5. Reference standard assessment identified 92 liver lesions (50 metastases, 24 cysts, 13 abscesses, 3 regions of inflammation, 2 hemangiomas) with a mean size of 1.1 cm ± 0.5. The mean interval between the CT and liver lesion biopsy was 24 days. A diagnosis of benign versus malignant was determined based on optimal cutoffs: spectral curve slope of 1.36, iodine concentration of 6.47 (100 µg/cm3), and enhancement of 10.25. The receiver operating curves (ROC) for diagnosis using spectral curve slope, iodine concentration, and virtual enhancement resulted in an area under the curve (AUC) of 0.948, 0.946, and 0.937, respectively. CONCLUSION Spectral HU curves and iodine concentration of well-defined hypodense liver lesions are highly accurate in the diagnosis of benign versus malignant lesions. KEY POINTS Question Limited evidence exists for spectral imaging diagnosis of liver lesions-can DECT accurately differentiate between benign and metastatic hypodense liver lesions? Findings Ninety-two hypodense liver lesions evaluated using HU keV curve slope, iodine concentration, and virtual enhancement resulted in accurate benign versus metastatic differentiation. Clinical relevance Hypodense liver lesions are a challenging issue at staging, often requiring further imaging, follow-up, and/or biopsy. The additional information from multi-energy CT can be useful to differentiate between benign and malignant lesions, thereby reducing the need for costly additional evaluation.
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Affiliation(s)
- Corey T Jensen
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Vincenzo K Wong
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gauruv S Likhari
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taher E Daoud
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Moiz Ahmad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Pasyar
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - Xinming Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Tal Tamir H, Stav D, Hadad Y, Kessner R. Thyroid nodule characterization using Spectral Detector Computed Tomography (SDCT) in comparison to ultrasound. Eur J Radiol 2024; 170:111213. [PMID: 38006615 DOI: 10.1016/j.ejrad.2023.111213] [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: 08/07/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To characterize thyroid nodules seen on Spectral Detector computed tomography (SDCT) in respect to their Thyroid Imaging Reporting and Data System (TI-RADS) category on Ultrasound (US). METHODS We included patients that underwent US examination for the evaluation of thyroid nodules and contrast-enhanced SDCT examination of the neck/thorax, between the years 2018-2020. The SDCT and US were performed within 6 months of each other. Only patients with a visible thyroid nodule on SDCT were included. Attenuation measurements of the nodules in Hounsfield units (HU) were performed on the conventional CT images, virtual non-contrast (VNC) images and virtual monoenergetic images of 40 keV and 100 keV. The Iodine concentration, spectral slope and enhancement estimation results of the nodules were measured. We compared the spectral results between two groups of nodules, according to the US report: TI-RADS 2-3 and TI-RADS 4-5 groups. RESULTS Thirty-eight nodules were included in the study, 22 nodules in the TI-RADS 2-3 group and 16 in the TI-RADS 4-5 group. The nodules of the TI-RADS 4-5 group had significantly higher Iodine concentration measurement, 4.6 ± 1.8 mg/ml, compared to 2.3 ± 1.2 mg/ml in the TI-RADS 2-3 group; significantly higher estimated enhancement, 3.9 ± 1.5, compared to 2.2 ± 0.7; and significantly higher calculated spectral slope, 5.6 ± 2.2 compared to 2.9 ± 1.5 (p < 0.001). CONCLUSION Spectral results of SDCT may assist in differentiating intermediate-high risk (TI-RADS 4-5) from low risk (TI-RADS 2-3) thyroid nodules. ADVANCES IN KNOWLEDGE SDCT offers additional information for the characterization of thyroid nodules.
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Affiliation(s)
- Hila Tal Tamir
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Department of Diagnostic Imaging, Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Dana Stav
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Department of Diagnostic Imaging, Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Yitzhac Hadad
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Department of Diagnostic Imaging, Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Rivka Kessner
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Department of Diagnostic Imaging, Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel.
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Xu Y, Li Y, Li S, Xue S, Liu J. Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation. Insights Imaging 2023; 14:51. [PMID: 36977956 PMCID: PMC10050608 DOI: 10.1186/s13244-023-01393-x] [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: 10/21/2022] [Accepted: 02/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Liver cirrhosis-acute decompensation (LC-AD) has rapid short-term disease progression and difficult early risk stratification. The purpose is to develop and validate a model based on dual-energy CT quantification of extracellular liver volume (ECVIC-liver) for predicting the occurrence of acute-on-chronic liver failure (ACLF) within 90 days in patients with hepatitis B (HBV) LC-AD. METHODS The retrospective study included patients with HBV LC-AD who underwent dual-energy CT scans of the liver from January 2018 to March 2022 and were randomized to training group (215 patients) and validation group (92 patients). The primary outcome was the need for readmission within 90 days due to ACLF. Based on the training group data, independent risk factors for disease progression in clinical and dual-energy CT parameters were identified and modeled by logistic regression analysis. Based on the training and validation groups data, receiver operating characteristic (ROC) curves, calibration curves, and decision analysis curves (DCA) were used to verify the discrimination, calibration, and clinical validity of the nomogram. RESULTS Chronic liver failure consortium-acute decompensation score (CLIF-C ADs) (p = 0.008) and ECVIC-liver (p < 0.001) were independent risk factors for ACLF within 90 days. The AUC of the model combined ECVIC-liver and CLIF-C ADs were 0.893 and 0.838 in the training and validation groups, respectively. The calibration curves show good agreement between predicted and actual risks. The DCA indicates that the model has good clinical application. CONCLUSION The model combined ECVIC-liver and CLIF-C ADs can early predict the occurrence of ACLF within 90 days in HBV LC-AD patients.
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Affiliation(s)
- Yuan Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yufeng Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shouxiao Xue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.
- Second Clinical School, Lanzhou University, Lanzhou, China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China.
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Ma Y, Li S, Huang G, Huang X, Zhou Q, Wang W, Wang J, Zhao F, Li Z, Chen X, Zhu B, Zhou J. Role of iodine density value on dual-energy CT for detection of high tumor cell proportion region in lung cancer during CT-guided transthoracic biopsy. Eur J Radiol 2023; 160:110689. [PMID: 36669332 DOI: 10.1016/j.ejrad.2023.110689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to identify regions with at least 20% tumor cell content in lung cancer tumors by using spectral parameters from dual-layer spectral detector computed tomography (SDCT) to design the puncture path for transthoracic lung biopsy (TTLB). MATERIALS AND METHODS This prospective study recruited patients with suspected lung cancer. Forty-one patients were enrolled to identify the high tumor cell proportion region (HTPR) and then another 15 patients to validate the accuracy of the HTPR. In each of the 41 patients, the suspected regions with high or low tumor cell proportions were punctured according to local iodine density (IoD) values for separate biopsies. The tumor cell proportions of 82 specimens were assessed and classified into high and low tumor cell proportions based on the threshold value of 20 %. The performance of spectral parameters was analyzed to distinguish the HTPR (tumor cell proportion ≥ 20 %) from the low tumor cell proportion region (LTPR). The cutoff value of optimal spectral parameter was used to prospectively guide the biopsy of the HTPR in 15 cases for further validation, and then the accuracy was calculated. RESULTS The AUC values of spectral parameters were all higher than those of CTconventional in identifying the HTPR (all P < 0.05). The IoD with a cutoff value of 0.59 mg/mL in arterial phase (AP) yielded good performance (specificity: 97.10 %) in identifying the HTPR. It was applied to 15 cases for validation, and the accuracy rate was 100 %. CONCLUSION Spectral CT parameters can be used to identify regions with at least 20% tumor cell content in lung cancer for biopsies.
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Affiliation(s)
- Yaqiong Ma
- Second Clinical School, Lanzhou University, 730030 Lanzhou, China; Department of Radiology, Gansu Provincial Hospital, 730030 Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, China
| | - Shenglin Li
- Second Clinical School, Lanzhou University, 730030 Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Xiaoyu Huang
- Second Clinical School, Lanzhou University, 730030 Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, China
| | - Qing Zhou
- Second Clinical School, Lanzhou University, 730030 Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, China
| | - Wenna Wang
- Department of Radiology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Jinsui Wang
- Department of Pathology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Fenghui Zhao
- Department of Pathology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Zhenjun Li
- Department of Pathology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, Shanghai, 200070, Shanghai, China
| | - Bingyin Zhu
- Department of Radiology, Gansu Provincial Hospital, 730030 Lanzhou, China
| | - Junlin Zhou
- Second Clinical School, Lanzhou University, 730030 Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, China; Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, China.
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Cao J, Lennartz S, Pisuchpen N, Mroueh N, Kongboonvijit S, Parakh A, Sahani DV, Kambadakone A. Renal Lesion Characterization by Dual-Layer Dual-Energy CT: Comparison of Virtual and True Unenhanced Images. AJR Am J Roentgenol 2022; 219:614-623. [PMID: 35441533 DOI: 10.2214/ajr.21.27272] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND. Prior studies have provided mixed results for the ability to replace true unenhanced (TUE) images with virtual unenhanced (VUE) images when characterizing renal lesions by dual-energy CT (DECT). Detector-based dual-layer DECT (dlDECT) systems may optimize performance of VUE images for this purpose. OBJECTIVE. The purpose of this article was to compare dual-phase dlDECT examinations evaluated using VUE and TUE images in differentiating cystic and solid renal masses. METHODS. This retrospective study included 110 patients (mean age, 64.3 ± 11.8 years; 46 women, 64 men) who underwent renal-mass protocol dlDECT between July 2018 and February 2022. TUE, VUE, and nephrographic phase image sets were reconstructed. Lesions were diagnosed as solid masses by histopathology or MRI. Lesions were diagnosed as cysts by composite criteria reflecting findings from MRI, ultrasound, and the TUE and nephrographic phase images of the dlDECT examinations. One radiologist measured lesions' attenuation on all dlDECT image sets. Lesion characterization was compared between use of VUE and TUE images, including when considering enhancement of 20 HU or greater to indicate presence of a solid mass. RESULTS. The analysis included 219 lesions (33 solid masses; 186 cysts [132 simple, 20 septate, 34 hyperattenuating]). TUE and VUE attenuation were significantly different for solid masses (33.4 ± 7.1 HU vs 35.4 ± 8.6 HU, p = .002), simple cysts (10.8 ± 5.6 HU vs 7.1 ± 8.1 HU, p < .001), and hyperattenuating cysts (56.3 ± 21.0 HU vs 47.6 ± 16.3 HU, p < .001), but not septate cysts (13.6 ± 8.1 HU vs 14.0 ± 6.8 HU, p = .79). Frequency of enhancement 20 HU or greater when using TUE and VUE images was 90.9% and 90.9% in solid masses, 0.0% and 9.1% in simple cysts, 15.0% and 10.0% in septate cysts, and 11.8% and 38.2% in hyperattenuating cysts. All solid lesions were concordant in terms of enhancement 20 HU or greater when using TUE and VUE images. Twelve simple cysts and nine hyperattenuating cysts showed enhancement of 20 HU or greater when using VUE but not TUE images. CONCLUSION. Use of VUE images reliably detected enhancement in solid masses. However, VUE images underestimated attenuation of simple and hyperattenuating cysts, leading to false-positive findings of enhancement by such lesions. CLINICAL IMPACT. The findings do not support replacement of TUE acquisitions with VUE images when characterizing renal lesions by dlDECT.
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Affiliation(s)
- Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
| | - Simon Lennartz
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nisanard Pisuchpen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nayla Mroueh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
| | - Sasiprang Kongboonvijit
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
| | | | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114-2696
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Lennartz S, Hokamp NG, Kambadakone A. Dual-Energy CT of the Abdomen: Radiology In Training. Radiology 2022; 305:19-27. [PMID: 35727149 DOI: 10.1148/radiol.212914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 61-year-old man with an esophageal cancer diagnosis underwent staging dual-energy CT of the chest and abdomen in the portal venous phase after contrast media administration. Aside from the primary tumor and suspicious local lymph nodes, CT revealed hypoattenuating ambiguous liver lesions, an incidental right adrenal nodule, and a right renal lesion with soft-tissue attenuation. In addition, advanced atherosclerosis of the abdominal aorta and its major branches was noted. This article provides a case-based review of dual-energy CT technologies and their applications in the abdomen. The clinical utility of virtual monoenergetic images, virtual unenhanced images, and iodine maps is discussed.
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Affiliation(s)
- Simon Lennartz
- From the Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany (S.L., N.G.H.); and Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Mass (A.K.)
| | - Nils Große Hokamp
- From the Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany (S.L., N.G.H.); and Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Mass (A.K.)
| | - Avinash Kambadakone
- From the Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany (S.L., N.G.H.); and Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Mass (A.K.)
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Gehling K, Mokry T, Do TD, Giesel FL, Dietrich S, Haberkorn U, Kauczor HU, Weber TF. Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity. ROFO-FORTSCHR RONTG 2022; 194:747-754. [PMID: 35211927 DOI: 10.1055/a-1735-3477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients with malignant lymphoma, disease activity is recommended to be assessed by FDG-PET/CT and the Deauville five-point scale (5-PS). The purpose of this study was to explore the potential of iodine concentration measured in contrast-enhanced dual-layer spectral detector CT (SDCT) as an alternative surrogate parameter for lymphoma disease activity by investigating its correlation with maximum standardized uptake values (SUVmax) and 5-PS. MATERIALS AND METHODS 25 patients were retrospectively analyzed. Contrast-enhanced SDCT and FDG-PET/CT were performed in the same treatment interval within at most 3 months. CT attenuation values (AV), absolute iodine concentrations (aIC), and normalized iodine concentrations (nIC) of lymphoma lesions were correlated with SUVmax using Spearman's rank correlation coefficient. The performance of aIC and nIC to detect lymphoma activity (defined as 5-PS > 3) was determined using ROC curves. RESULTS 60 lesions were analyzed, and 31 lesions were considered active. AV, aIC, and nIC all correlated significantly with SUVmax. The strongest correlation (Spearman ρ = 0.71; p < 0.001) and highest area under the ROC curve (AUROC) for detecting lymphoma activity were observed for nIC normalized to inferior vena cava enhancement (AUROC = 0.866). The latter provided sensitivity, specificity, and diagnostic accuracy of 87 %, 75 %, and 80 %, respectively, at a threshold of 0.20. ROC analysis for AV (AUROC = 0.834) and aIC (AUROC = 0.853) yielded similar results. CONCLUSION In malignant lymphomas, there is a significant correlation between metabolic activity as assessed by FDG-PET/CT and iodine concentration as assessed by SDCT. Iodine concentration shows promising diagnostic performance for detecting lymphoma activity and may represent a potential imaging biomarker. KEY POINTS · Iodine concentration correlates significantly with SUVmax in lymphoma patients. · Iodine concentration may represent a potential imaging biomarker for detecting lymphoma activity. · Normalization of iodine concentration improves diagnostic performance of iodine concentration. CITATION FORMAT · Gehling K, Mokry T, Do TD et al. Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1735-3477.
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Affiliation(s)
- Kim Gehling
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,German Cancer Research Center (DKFZ) Division of Radiology, Heidelberg, Germany
| | - Thuy Duong Do
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany.,Department of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Sascha Dietrich
- Clinic for Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Thiravit S, Brunnquell C, Cai LM, Flemon M, Mileto A. Use of dual-energy CT for renal mass assessment. Eur Radiol 2020; 31:3721-3733. [PMID: 33210200 DOI: 10.1007/s00330-020-07426-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
Although dual-energy CT (DECT) may prove useful in a variety of abdominal imaging tasks, renal mass evaluation represents the area where this technology can be most impactful in abdominal imaging compared to routinely performed contrast-enhanced-only single-energy CT exams. DECT post-processing techniques, such as creation of virtual unenhanced and iodine density images, can help in the characterization of incidentally discovered renal masses that would otherwise remain indeterminate based on post-contrast imaging only. The purpose of this article is to review the use of DECT for renal mass assessment, including its benefits and existing limitations. KEY POINTS: • If DECT is selected as the scanning mode for most common abdominal protocols, many incidentally found renal masses can be fully triaged within the same exam. • Virtual unenhanced and iodine density DECT images can provide additional information when renal masses are discovered in the post-contrast-only setting. • For renal mass evaluation, virtual unenhanced and iodine density DECT images should be interpreted side-by-side to troubleshoot pitfalls that can potentially lead to erroneous interpretation.
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Affiliation(s)
- Shanigarn Thiravit
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.,Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Christina Brunnquell
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Larry M Cai
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Mena Flemon
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Achille Mileto
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.
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10
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Zopfs D, Lennartz S, Zaeske C, Merkt M, Laukamp KR, Reimer RP, Maintz D, Borggrefe J, Grosse Hokamp N. Phantomless assessment of volumetric bone mineral density using virtual non-contrast images from spectral detector computed tomography. Br J Radiol 2020; 93:20190992. [PMID: 32101453 DOI: 10.1259/bjr.20190992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate phantomless assessment of volumetric bone mineral density (vBMD) based on virtual non-contrast images of arterial (VNCa) and venous phase (VNCv) derived from spectral detector CT in comparison to true non-contrast (TNC) images and adjusted venous phase conventional images (CIV(adjusted)). METHODS 104 consecutive patients who underwent triphasic spectral detector CT between January 2018 and April 2019 were retrospectively included. TNC, VNCa, VNCv and venous phase images (CIV) were reconstructed. vBMD was obtained by two radiologists using an FDA/CE-cleared software. Average vBMD of the first three lumbar vertebrae was determined in each reconstruction; vBMD of CIV was adjusted for contrast enhancement as suggested earlier. RESULTS vBMD values obtained from CIV(adjusted) are comparable to vBMD values derived from TNC images (91.79 ± 36.52 vs 90.16 ± 41.71 mg/cm3, p = 1.00); however, vBMD values derived from VNCa and VNCv (42.20 ± 22.50 and 41.98 ± 23.3 mg/cm3 respectively) were significantly lower as compared to vBMD values from TNC and CIV(adjusted) (all p ≤ 0.01). CONCLUSION Spectral detector CT-derived virtual non-contrast images systematically underestimate vBMD and therefore should not be used without appropriate adjustments. Adjusted venous phase images provide reliable results and may be utilized for an opportunistic BMD screening in CT examinations. ADVANCES IN KNOWLEDGE Adjustments of venous phase images facilitate opportunistic assessment of vBMD, while spectral detector CT-derived VNC images systematically underestimate vBMD.
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Affiliation(s)
- David Zopfs
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Simon Lennartz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA
| | - Charlotte Zaeske
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Martin Merkt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Robert Peter Reimer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Jan Borggrefe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Nils Grosse Hokamp
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
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