Skip to main content
SpringerLink
Log in

Quantitative attenuation accuracy of virtual non-enhanced imaging compared to that of true non-enhanced imaging on dual-source dual-energy CT

  • Technical
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the quantitative attenuation and reliability of virtual non-contrast (VNC) images of the abdomen acquired from multiphasic scans with a dual-energy computed tomography (DECT) system and compare it with that of true non-enhanced images (TNC) on second- (Flash) and third- (Force) generation DECT scanners.

Methods

This retrospective study was approved by the institutional review board and included 123 patients with pancreatic cancer who had undergone routine clinical multiphasic DECT examinations at our institution using Flash and Force scanners between March and August 2017. VNC images of the abdomen were reconstructed from late arterial phase images. For every patient, regions-of-interest were defined in the aorta, fluid-containing structures (gallbladder, pleural effusion, and renal cysts > 10 mm), paravertebral muscles, subcutaneous fat, spleen, pancreas, renal cortex, and liver (eight locations) on TNC and VNC images. The mean attenuation of VNC was compared with TNC by organ for each CT scanner using an equivalence test and the Bland–Altman plot. The mean attenuations for TNC or VNC were compared between the Force and Flash CT scanners using a two-sample t test.

Results

The VNC attenuation of organs on the Force scanner was lower than was that on the Flash, and the mean attenuation difference in different organs on the Force was closer to 0. The estimated means of TNC and VNC were equivalent for an equivalence margin of 10 on the Force scanner.

Conclusion

VNC images in DECT are a promising alternative to TNC images. In clinical scenarios in which non-enhanced CT images are required but are not available for accurate diagnosis, VNC images can potentially serve as an alternative to TNC images without the radiation exposure risks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. https://stats.oecd.org.

  2. Alvarez RE, Macovski A (1976) Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 21 (5):733–744

    Article  CAS  Google Scholar 

  3. Mileto A, Marin D, Alfaro-Cordoba M, Ramirez-Giraldo JC, Eusemann CD, Scribano E, Blandino A, Mazziotti S, Ascenti G (2014) Iodine quantification to distinguish clear cell from papillary renal cell carcinoma at dual-energy multidetector CT: a multireader diagnostic performance study. Radiology 273 (3):813–820. https://doi.org/10.1148/radiol.14140171

    Article  PubMed  Google Scholar 

  4. Manoharan D, Sharma S, Das CJ, Kumar R, Singh G, Kumar P (2018) Single-Acquisition Triple-Bolus Dual-Energy CT Protocol for Comprehensive Evaluation of Renal Masses: A Single-Center Randomized Noninferiority Trial. AJR Am J Roentgenol 211 (1):W22–W32. https://doi.org/10.2214/ajr.17.18786

    Article  PubMed  Google Scholar 

  5. Kim SH, Kim CS, Kim MJ, Cho JY, Cho SH (2016) Differentiation of Clear Cell Renal Cell Carcinoma From Other Subtypes and Fat-Poor Angiomyolipoma by Use of Quantitative Enhancement Measurement During Three-Phase MDCT. AJR Am J Roentgenol 206 (1):W21–28. https://doi.org/10.2214/ajr.15.14666

    Article  PubMed  Google Scholar 

  6. Mileto A, Marin D, Ramirez-Giraldo JC, Scribano E, Krauss B, Mazziotti S, Ascenti G (2014) Accuracy of contrast-enhanced dual-energy MDCT for the assessment of iodine uptake in renal lesions. AJR American journal of roentgenology 202 (5):W466–474. https://doi.org/10.2214/ajr.13.11450

    Article  PubMed  Google Scholar 

  7. Chandarana H, Megibow AJ, Cohen BA, Srinivasan R, Kim D, Leidecker C, Macari M (2011) Iodine quantification with dual-energy CT: phantom study and preliminary experience with renal masses. AJR American journal of roentgenology 196 (6):W693–700. https://doi.org/10.2214/ajr.10.5541

    Article  PubMed  Google Scholar 

  8. Frellesen C, Azadegan M, Martin SS, Otani K, D’Angelo T, Booz C, Eichler K, Panahi B, Kaup M, Bauer RW, Vogl TJ, Wichmann JL (2018) Dual-Energy Computed Tomography-Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures: Diagnostic Accuracy and Characterization in Oncological Patients Undergoing Routine Staging Computed Tomography. Invest Radiol 53 (7):409–416. https://doi.org/10.1097/rli.0000000000000458

    Article  PubMed  Google Scholar 

  9. Graser A, Johnson TR, Bader M, Staehler M, Haseke N, Nikolaou K, Reiser MF, Stief CG, Becker CR (2008) Dual energy CT characterization of urinary calculi: initial in vitro and clinical experience. Invest Radiol 43 (2):112–119. https://doi.org/10.1097/rli.0b013e318157a144

    Article  PubMed  Google Scholar 

  10. Takahashi N, Vrtiska TJ, Kawashima A, Hartman RP, Primak AN, Fletcher JG, McCollough CH (2010) Detectability of urinary stones on virtual nonenhanced images generated at pyelographic-phase dual-energy CT. Radiology 256 (1):184–190. https://doi.org/10.1148/radiol.10091411

    Article  PubMed  PubMed Central  Google Scholar 

  11. Phan CM, Yoo AJ, Hirsch JA, Nogueira RG, Gupta R (2012) Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol 33 (6):1088–1094. https://doi.org/10.3174/ajnr.a2909

    Article  CAS  PubMed  Google Scholar 

  12. De Cecco CN, Muscogiuri G, Schoepf UJ, Caruso D, Wichmann JL, Cannaò PM, Canstein C, Fuller SR, Snider L, Varga-Szemes A, Hardie A (2016) Virtual unenhanced imaging of the liver with third-generation dual-source dual-energy CT and advanced modeled iterative reconstruction. Eur J Radiol 85 (7):1257–1264. https://doi.org/10.1016/j.ejrad.2016.04.012

    Article  PubMed  Google Scholar 

  13. De Cecco CN, Darnell A, Macías N, Ayuso JR, Rodríguez S, Rimola J, Pagés M, García-Criado Á, Rengo M, Laghi A, Ayuso C (2013) Virtual Unenhanced Images of the Abdomen With Second-Generation Dual-Source Dual-Energy Computed Tomography: Image Quality and Liver Lesion Detection. Invest Radiol 48 (1):1–9. https://doi.org/10.1097/rli.0b013e31826e7902

    Article  PubMed  Google Scholar 

  14. Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158 (1):1–10. https://doi.org/10.1148/radiology.158.1.3510019

    Article  CAS  PubMed  Google Scholar 

  15. Sauter AP, Kopp FK, Munzel D, Dangelmaier J, Renz M, Renger B, Braren R, Fingerle AA, Rummeny EJ, Noel PB (2018) Accuracy of iodine quantification in dual-layer spectral CT: Influence of iterative reconstruction, patient habitus and tube parameters. Eur J Radiol 102:83–88. https://doi.org/10.1016/j.ejrad.2018.03.009

    Article  PubMed  Google Scholar 

  16. Sauter AP, Muenzel D, Dangelmaier J, Braren R, Pfeiffer F, Rummeny EJ, Noel PB, Fingerle AA (2018) Dual-layer spectral computed tomography: Virtual non-contrast in comparison to true non-contrast images. Eur J Radiol 104:108–114. https://doi.org/10.1016/j.ejrad.2018.05.007

    Article  PubMed  Google Scholar 

  17. Ananthakrishnan L, Rajiah P, Ahn R, Rassouli N, Xi Y, Soesbe TC, Lewis MA, Lenkinski RE, Leyendecker JR, Abbara S (2017) Spectral detector CT-derived virtual non-contrast images: comparison of attenuation values with unenhanced CT. Abdom Radiol (NY) 42 (3):702–709. https://doi.org/10.1007/s00261-016-1036-9

    Article  Google Scholar 

  18. Toepker M, Moritz T, Krauss B, Weber M, Euller G, Mang T, Wolf F, Herold CJ, Ringl H (2012) Virtual non-contrast in second-generation, dual-energy computed tomography: Reliability of attenuation values. Eur J Radiol 81 (3):e398–e405. https://doi.org/10.1016/j.ejrad.2011.12.011

    Article  PubMed  Google Scholar 

  19. Kaufmann SMD, Sauter AMD, Spira DMD, Gatidis SMD, Ketelsen DMD, Heuschmid MMD, Claussen CDMD, Thomas CMD (2013) Tin-filter Enhanced Dual-Energy-CT. Acad Radiol 20 (5):596–603. https://doi.org/10.1016/j.acra.2013.01.010

    Article  PubMed  Google Scholar 

  20. Barrett T, Bowden DJ, Shaida N, Godfrey EM, Taylor A, Lomas DJ, Shaw AS (2011) Virtual unenhanced second generation dual-source CT of the liver: Is it time to discard the conventional unenhanced phase? Eur J Radiol 81 (7):1438–1445. https://doi.org/10.1016/j.ejrad.2011.03.042

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

Special thanks to the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center for their help in editing the manuscript.

Author information

Authors and Affiliations

  1. Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1437, Houston, TX, 77030, USA

    Sanaz Javadi, Priya Bhosale, Corey T. Jensen, Ott Le & Eric P. Tamm

  2. Department of Internal Medicine, Weiss Memorial Hospital, Affiliate of the University of Illinois, Chicago, Chicago, IL, USA

    Sherif Elsherif

  3. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rick R. Layman & Megan C. Jacobsen

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sun Jia

  5. Department of Bioengineering, The University of California, Berkeley, CA, USA

    Rajan J. Parikh

Authors
  1. Sanaz Javadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sherif Elsherif
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Priya Bhosale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Corey T. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rick R. Layman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Megan C. Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ott Le
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sun Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rajan J. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eric P. Tamm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanaz Javadi.

Ethics declarations

Conflict of interest

Rick Layman has received Siemens Healthineers and USDA SBIR grant.

Informed Consent

Institutional review board authorization was obtained. Formal consent was waived for this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Javadi, S., Elsherif, S., Bhosale, P. et al. Quantitative attenuation accuracy of virtual non-enhanced imaging compared to that of true non-enhanced imaging on dual-source dual-energy CT. Abdom Radiol 45, 1100–1109 (2020). https://doi.org/10.1007/s00261-020-02415-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02415-8

Keywords

Search

Navigation