Download PDF
CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(02): 127-134
DOI: 10.1055/s-0041-1740475
Review Article

Utility of Dual-Energy CT in Abdominal Interventions

Tara Prasad Tripathy
1   Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
,
Ranjan Patel 
1   Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
,
Karamvir Chandel
1   Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
,
Amar Mukund
1   Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Dual-energy computed tomography (DECT) is an emerging CT technique based on data acquisition at two different settings. Various postprocessing techniques generate different sets of images, each with unique advantages. With DECT, it is possible to obtain virtual unenhanced images from monochromatic reconstructions and attenuation maps of different elements, thereby improving the detection and characterization of a variety of lesions. Presently, DECT is widely used to evaluate pulmonary embolism, characterize abdominal masses, determine the composition of urinary calculi, and detect tophi in gout. CT angiography is an essential prerequisite for endovascular intervention. DECT allows a better quality of angiographic images with a lesser dose of contrast. Various postprocessing techniques in DECT also help in a better evaluation of response to locoregional therapy. Virtual noncontrast images and iodine map differentiate residual or recurrent tumors from intrinsically hyperdense materials. Superior metallic artifact reduction allows better evaluation of vascular injuries adjacent to bony fractured fragments or previously deployed embolization coils. In addition to metal artifacts reduction, virtual monochromatic spectral imaging could further mitigate metal artifacts during CT-guided biopsy, providing an improved depiction of lesions and safe and versatile access for long puncture pathways. This article reviews and illustrates the different applications of DECT in various abdominal interventions. Familiarity with the capabilities of DECT may help interventional radiologists to improve their practice and ameliorate patient care.

Keywords

dual-energy CT - abdominal interventions - transarterial chemoembolization - transjugular intrahepatic portosystemic shunt - CT-guided interventions

Note

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Authors' Contributions

T.P.T. and K.C. assisted in conceptualizing manuscript; R.P. in images and design of the work; A.M. supported in conceptualizing of the manuscript, manuscript editing, and drafting. All authors read and approved the final manuscript.




Publication History

Article published online:
24 January 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Millner MR, McDavid WD, Waggener RG, Dennis MJ, Payne WH, Sank VJ. Extraction of information from CT scans at different energies. Med Phys 1979; 6 (01) 70-71
    CrossrefPubMedGoogle Scholar
  • 2 Chiro GD, Brooks RA, Kessler RM. et al. Tissue signatures with dual-energy computed tomography. Radiology 1979; 131 (02) 521-523
    CrossrefPubMedGoogle Scholar
  • 3 Silva AC, Morse BG, Hara AK, Paden RG, Hongo N, Pavlicek W. Dual-energy (spectral) CT: applications in abdominal imaging. Radiographics 2011; 31 (04) 1031-1046 , discussion 1047–1050
    CrossrefPubMedGoogle Scholar
  • 4 Kalisz K, Halliburton S, Abbara S. et al. Update on cardiovascular applications of multienergy CT. Radiographics 2017; 37 (07) 1955-1974
    CrossrefPubMedGoogle Scholar
  • 5 Khanduri S, Goyal A, Singh B. et al. The utility of dual energy computed tomography in musculoskeletal imaging. J Clin Imaging Sci 2017; 7: 34
    CrossrefPubMedGoogle Scholar
  • 6 Lu GM, Wu SY, Yeh BM, Zhang LJ. Dual-energy computed tomography in pulmonary embolism. Br J Radiol 2010; 83 (992) 707-718
    CrossrefPubMedGoogle Scholar
  • 7 Curry III TS, Dowdey JE, Murry RC. Christensen's Physics of Diagnostic Radiology. 4th ed.. Philadelphia, PA: Lea & Febiger; 1990: 61-69
    Google Scholar
  • 8 May MS, Wiesmueller M, Heiss R. et al. Comparison of dual- and single-source dual-energy CT in head and neck imaging. Eur Radiol 2019; 29 (08) 4207-4214
    CrossrefPubMedGoogle Scholar
  • 9 Im AL, Lee YH, Bang DH, Yoon KH, Park SH. Dual energy CT in patients with acute abdomen; is it possible for virtual non-enhanced images to replace true non-enhanced images?. Emerg Radiol 2013; 20 (06) 475-483
    CrossrefPubMedGoogle Scholar
  • 10 Kikano EG, Rajdev M, Salem KZ. et al. Utility of iodine density perfusion maps from dual-energy spectral detector CT in evaluating cardiothoracic conditions: a primer for the radiologist. AJR Am J Roentgenol 2020; 214 (04) 775-785
    CrossrefPubMedGoogle Scholar
  • 11 Shuman WP, Green DE, Busey JM. et al. Dual-energy liver CT: effect of monochromatic imaging on lesion detection, conspicuity, and contrast-to-noise ratio of hypervascular lesions on late arterial phase. AJR Am J Roentgenol 2014; 203 (03) 601-606
    CrossrefPubMedGoogle Scholar
  • 12 Han SC, Chung YE, Lee YH, Park KK, Kim MJ, Kim KW. Metal artifact reduction software used with abdominopelvic dual-energy CT of patients with metal hip prostheses: assessment of image quality and clinical feasibility. AJR Am J Roentgenol 2014; 203 (04) 788-795
    CrossrefPubMedGoogle Scholar
  • 13 Johnson TR, Krauss B, Sedlmair M. et al. Material differentiation by dual energy CT: initial experience. Eur Radiol 2007; 17 (06) 1510-1517
    CrossrefPubMedGoogle Scholar
  • 14 Purysko AS, Primak AN, Baker ME. et al. Comparison of radiation dose and image quality from single-energy and dual-energy CT examinations in the same patients screened for hepatocellular carcinoma. Clin Radiol 2014; 69 (12) e538-e544
    CrossrefPubMedGoogle Scholar
  • 15 Lehti L, Söderberg M, Höglund P, Nyman U, Gottsäter A, Wassélius J. Reliability of virtual non-contrast computed tomography angiography: comparing it with the real deal. Acta Radiol Open 2018; 7 (7-8): 2058460118790115
    Google Scholar
  • 16 Zhang S, Levin DC, Halpern EJ, Fischman D, Savage M, Walinsky P. Accuracy of MDCT in assessing the degree of stenosis caused by calcified coronary artery plaques. AJR Am J Roentgenol 2008; 191 (06) 1676-1683
    CrossrefPubMedGoogle Scholar
  • 17 Schmid K, McSharry WO, Pameijer CH, Binette JP. Chemical and physicochemical studies on the mineral deposits of the human atherosclerotic aorta. Atherosclerosis 1980; 37 (02) 199-210
    CrossrefPubMedGoogle Scholar
  • 18 Uotani K, Watanabe Y, Higashi M. et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol 2009; 19 (08) 2060-2065
    CrossrefPubMedGoogle Scholar
  • 19 Barrett T, Bowden DJ, Shaida N. et al. Virtual unenhanced second generation dual-source CT of the liver: is it time to discard the conventional unenhanced phase?. Eur J Radiol 2012; 81 (07) 1438-1445
    CrossrefPubMedGoogle Scholar
  • 20 Lv P, Lin XZ, Li J, Li W, Chen K. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma: recently introduced spectral CT method. Radiology 2011; 259 (03) 720-729
    CrossrefPubMedGoogle Scholar
  • 21 Wang Q, Shi G, Qi X, Fan X, Wang L. Quantitative analysis of the dual-energy CT virtual spectral curve for focal liver lesions characterization. Eur J Radiol 2014; 83 (10) 1759-1764
    CrossrefPubMedGoogle Scholar
  • 22 Lee JA, Jeong WK, Kim Y. et al. Dual-energy CT to detect recurrent HCC after TACE: initial experience of color-coded iodine CT imaging. Eur J Radiol 2013; 82 (04) 569-576
    CrossrefPubMedGoogle Scholar
  • 23 Brockmann C, Scharf J, Nölte IS, Seiz M, Groden C, Brockmann MA. Dual-energy CT after peri-interventional subarachnoid haemorrhage: a feasibility study. Clin Neuroradiol 2010; 20 (04) 231-235
    CrossrefPubMedGoogle Scholar
  • 24 Ferda J, Novák M, Mírka H. et al. The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography. Eur Radiol 2009; 19 (10) 2518-2522
    CrossrefPubMedGoogle Scholar
  • 25 Gupta R, Phan CM, Leidecker C. et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology 2010; 257 (01) 205-211
    CrossrefPubMedGoogle Scholar
  • 26 Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008; 28 (06) 1603-1616
    CrossrefPubMedGoogle Scholar
  • 27 Wortman JR, Uyeda JW, Fulwadhva UP, Sodickson AD. Dual-energy CT for abdominal and pelvic trauma. Radiographics 2018; 38 (02) 586-602
    CrossrefPubMedGoogle Scholar
  • 28 Golzarian J, Dussaussois L, Abada HT. et al. Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 1998; 171 (02) 329-331
    CrossrefPubMedGoogle Scholar
  • 29 Iezzi R, Cotroneo AR, Filippone A. et al. Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection?. Radiology 2006; 241 (03) 915-921
    CrossrefPubMedGoogle Scholar
  • 30 Macari M, Chandarana H, Schmidt B, Lee J, Lamparello P, Babb J. Abdominal aortic aneurysm: can the arterial phase at CT evaluation after endovascular repair be eliminated to reduce radiation dose?. Radiology 2006; 241 (03) 908-914
    CrossrefPubMedGoogle Scholar
  • 31 Stavropoulos SW, Charagundla SR. Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 2007; 243 (03) 641-655
    CrossrefPubMedGoogle Scholar
  • 32 Chandarana H, Godoy MC, Vlahos I. et al. Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms–initial observations. Radiology 2008; 249 (02) 692-700
    CrossrefPubMedGoogle Scholar
  • 33 Stolzmann P, Frauenfelder T, Pfammatter T. et al. Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT. Radiology 2008; 249 (02) 682-691
    CrossrefPubMedGoogle Scholar
  • 34 Maturen KE, Kleaveland PA, Kaza RK. et al. Aortic endograft surveillance: use of fast-switch kVp dual-energy computed tomography with virtual noncontrast imaging. J Comput Assist Tomogr 2011; 35 (06) 742-746
    CrossrefPubMedGoogle Scholar
  • 35 Mangold S, De Cecco CN, Schoepf UJ. et al. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography. Eur Radiol 2016; 26 (12) 4380-4389
    CrossrefPubMedGoogle Scholar
  • 36 Almutairi A, Al Safran Z, AlZaabi SA, Sun Z. Dual energy CT angiography in peripheral arterial stents: optimal scanning protocols with regard to image quality and radiation dose. Quant Imaging Med Surg 2017; 7 (05) 520-531
    CrossrefPubMedGoogle Scholar
  • 37 Mangold S, Cannaó PM, Schoepf UJ. et al. Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study. Eur Radiol 2016; 26 (06) 1871-1878
    CrossrefPubMedGoogle Scholar
  • 38 Do TD, Heim J, Melzig C. et al. Virtual monochromatic spectral imaging versus linearly blended dual-energy and single-energy imaging during CT-guided biopsy needle positioning: optimization of keV settings and impact on image quality. PLoS One 2020; 15 (02) e0228578
    CrossrefPubMedGoogle Scholar
  • 39 Otrakji A, Digumarthy SR, Lo Gullo R, Flores EJ, Shepard JA, Kalra MK. Dual-energy CT: spectrum of thoracic abnormalities. Radiographics 2016; 36 (01) 38-52
    CrossrefPubMedGoogle Scholar