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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(02): 085-093
DOI: 10.1055/s-0042-1742677
Original Article

Evaluation of Hypervascular Focal Liver Lesions Utilizing Virtual Monoenergetic Images from Third-Generation Dual-Source Dual-Energy Computed Tomography

Niyas Narappulan
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Venkatesh Kasi Arunachalam
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Ezhilmathi Alavandar
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Swathigha Selvaraja
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Rupa Renganathan
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Mathew Cherian
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
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Abstract

Objectives The purpose of our study was to evaluate the virtual monochromatic imaging in detecting hypervascular focal liver lesions in the late arterial phase with third-generation dual-source dual-energy computed tomography and to assess its image quality.

Materials and Methods In our study, 80 patients were included. Contrast-enhanced images in the late arterial phase (in the dual-energy mode) were acquired and were post-processed in Syngo, via workstation, using Monoenergetic + software. Five sets of images, one polychromatic energy image (corresponding to 120 kVp single-energy image) and four virtual monoenergetic image (VMI) sets at 40, 50, 60, and 70 keV levels, were generated. All these images were analyzed both objectively and subjectively. The attenuation values were measured, and the contrast-to-noise ratio (CNR) of liver and tumor were measured and compared objectively in each dataset. Image noise, image contrast, and diagnostic confidence for liver lesion detection were analyzed subjectively using a five-point scale system. Statistical analysis was performed using Kolmogorov–Smirnov, analysis of variance, and Kruskal–Wallis tests.

Results Among the VMI, maximum image noise was observed in the 40 keV image, with a gradual reduction in the image noise being noted with an increase in the VMI energy. The CNR of the hepatic parenchyma and the tumor gradually increased with a reduction in VMI energy from 70 to 40 keV. On subjective analysis, image contrast and image noise were observed to be more in low VMI datasets. In lesion detection, diagnostic confidence with an excellent confidence level was observed with a decrease in VMI energy.

Conclusion VMI datasets of 40 to 70 keV from third-generation dual-source DECT provide superior diagnostic accuracy for detecting hypervascular liver lesions. Considering the image noise and lesion detection rate among the VMI datasets, 60 keV VMI is the most helpful dataset for increased liver lesion detection with good image quality.

Keywords

third generation - dual source - dual energy - virtual monoenergetic image - hypervascular - liver


Publication History

Article published online:
18 February 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/)

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  • References

  • 1 Altenbernd J, Heusner TA, Ringelstein A, Ladd SC, Forsting M, Antoch G. Dual-energy-CT of hypervascular liver lesions in patients with HCC: investigation of image quality and sensitivity. Eur Radiol 2011; 21 (04) 738-743
    CrossrefPubMedGoogle Scholar
  • 2 Lv P, Lin XZ, Chen K, Gao J. Spectral CT in patients with small HCC: investigation of image quality and diagnostic accuracy. Eur Radiol 2012; 22 (10) 2117-2124
    CrossrefPubMedGoogle Scholar
  • 3 Mileto A, Nelson RC, Samei E. et al. Dual-energy MDCT in hypervascular liver tumors: effect of body size on selection of the optimal monochromatic energy level. AJR Am J Roentgenol 2014; 203 (06) 1257-1264
    CrossrefPubMedGoogle Scholar
  • 4 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
  • 5 Große Hokamp N, Höink AJ, Doerner J. et al. Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience. Abdom Radiol (NY) 2018; 43 (08) 2066-2074
    CrossrefPubMedGoogle Scholar
  • 6 Yeh BM, Shepherd JA, Wang ZJ, Teh HS, Hartman RP, Prevrhal S. Dual-energy and low-kVp CT in the abdomen. AJR Am J Roentgenol 2009; 193 (01) 47-54
    CrossrefPubMedGoogle Scholar
  • 7 Yamada Y, Jinzaki M, Tanami Y, Abe T, Kuribayashi S. Virtual monochromatic spectral imaging for the evaluation of hypovascular hepatic metastases: the optimal monochromatic level with fast kilovoltage switching dual-energy computed tomography. Invest Radiol 2012; 47 (05) 292-298
    CrossrefPubMedGoogle Scholar
  • 8 Sudarski S, Apfaltrer P, Nance Jr JW. et al. Objective and subjective image quality of liver parenchyma and hepatic metastases with virtual monoenergetic dual-source dual-energy CT reconstructions: an analysis in patients with gastrointestinal stromal tumor. Acad Radiol 2014; 21 (04) 514-522
    CrossrefPubMedGoogle Scholar
  • 9 Caruso D, De Cecco CN, Schoepf UJ. et al. Can dual-energy computed tomography improve visualization of hypoenhancing liver lesions in portal venous phase? Assessment of advanced image-based virtual monoenergetic images. Clin Imaging 2017; 41: 118-124
    CrossrefPubMedGoogle Scholar
  • 10 Husarik DB, Gordic S, Desbiolles L. et al. Advanced virtual monoenergetic computed tomography of hyperattenuating and hypoattenuating liver lesions: ex-vivo and patient experience in various body sizes. Invest Radiol 2015; 50 (10) 695-702
    CrossrefPubMedGoogle Scholar
  • 11 Nagayama Y, Nakaura T, Oda S. et al. Dual-layer DECT for multiphasic hepatic CT with 50 percent iodine load: a matched-pair comparison with a 120 kVp protocol. Eur Radiol 2018; 28 (04) 1719-1730
    CrossrefPubMedGoogle Scholar
  • 12 Sellerer T, Noël PB, Patino M. et al. Dual-energy CT: a phantom comparison of different platforms for abdominal imaging. Eur Radiol 2018; 28 (07) 2745-2755
    CrossrefPubMedGoogle Scholar
  • 13 De Cecco CN, Caruso D, Schoepf UJ. et al. A noise-optimized virtual monoenergetic reconstruction algorithm improves the diagnostic accuracy of late hepatic arterial phase dual-energy CT for the detection of hypervascular liver lesions. Eur Radiol 2018; 28 (08) 3393-3404
    CrossrefPubMedGoogle Scholar
  • 14 Robinson E, Babb J, Chandarana H, Macari M. Dual source dual energy MDCT: comparison of 80 kVp and weighted average 120 kVp data for conspicuity of hypo-vascular liver metastases. Invest Radiol 2010; 45 (07) 413-418
    CrossrefPubMedGoogle Scholar
  • 15 Kalisz K, Rassouli N, Dhanantwari A, Jordan D, Rajiah P. Noise characteristics of virtual monoenergetic images from a novel detector-based spectral CT scanner. Eur J Radiol 2018; 98: 118-125
    CrossrefPubMedGoogle Scholar
  • 16 Marin D, Ramirez-Giraldo JC, Gupta S. et al. Effect of a noise-optimized second-generation monoenergetic algorithm on image noise and conspicuity of hypervascular liver tumors: an in vitro and in vivo study. AJR Am J Roentgenol 2016; 206 (06) 1222-1232
    CrossrefPubMedGoogle Scholar
  • 17 Leng S, Yu L, Fletcher JG, McCollough CH. Maximizing iodine contrast-to-noise ratios in abdominal CT imaging through use of energy domain noise reduction and virtual monoenergetic dual-energy ct. Radiology 2015; 276 (02) 562-570
    CrossrefPubMedGoogle Scholar
  • 18 Yu Y, Lin X, Chen K. et al. Hepatocellular carcinoma and focal nodular hyperplasia of the liver: differentiation with CT spectral imaging. Eur Radiol 2013; 23 (06) 1660-1668
    CrossrefPubMedGoogle Scholar