Initial Clinical Experience of Virtual Monoenergetic Imaging Improves Stent Visualization in Lower Extremity Run-Off CT Angiography by Dual-Layer Spectral Detector CT

Abstract

Virtual monoenergetic imaging (VMI) may improve stent visualization in lower extremity run-off computed tomography angiography. The purpose of this study was to evaluate the image quality (IQ) of stents and to determine the optimal kiloelectron volt (keV) level of VMI images for stent evaluation compared to conventional CT images. This study included 32 patients with prior stent placement who underwent run-off computed tomography angiography on a dual-layer spectral detector CT scanner. Thirteen image series were evaluated for each stent, including conventional CT and 12 VMI datasets from 40 keV to 150 keV obtained in 10-keV intervals. Attenuation, SD, contrast-to-noise ratio, and signal-to-noise ratio of the native vessel and the vessel with a stent were evaluated. The diameter of the stent was measured in all 13 image series. The IQ was evaluated by two readers using a five-point scale (1 = poor IQ, 5 = excellent IQ). A total of 39 stents in 29 patients were evaluated. Compared to conventional CT, attenuation of the native vessel and the vessel with a stent was higher at 40-60 keV, and the SD was equal or lower at 50-150 keV. Based on the attenuation and SD of VMI images, the contrast-to-noise ratio and signal-to-noise ratio were higher at 40-70 keV, among which the highest ratios were obtained at 40 keV. The stent diameter was equal or larger at 60-150 keV, and the lowest stent diameter underestimation occurred at 100 keV. The IQ was equal or higher, ranging from 60 to 100 keV in comparison with conventional CT, and the highest IQ score occurred at 90 keV. This quantitative and qualitative assessment of VMI images and conventional images indicated that IQ improvement and more accurate stent lumen evaluation on lower extremity run-off CT angiography can be achieved by dual-layer spectral detector CT.