MO‐AB‐BRA‐04: Correct Identification of Low‐Attenuation Intracranial Hemorrhage and Calcification Using Dual‐Energy Computed Tomography in a Phantom System

Abstract

Purpose:Intracranial hemorrhage and calcification with Single‐Energy CT (SECT) attenuation below 100HU cannot be reliably identified using currently clinically available means. Calcification is typically benign but hemorrhage can carry a risk of intracranial bleeding and contraindicate use of anticoagulant therapies. A biologically‐relevant phantom was used to investigate identification of unknown intracranial lesions using dual‐energy CT (DECT) as a verification of prior lesion differentiation results.Methods:Prior phantom work investigating calcification and hemorrhage differentiation resulted in 3D‐DECT raw data (water density, calcium density, 68keV) for a range of DECT protocol variations: image thicknesses (1.25, 2.5, 3.75, 5mm), CTDIvol (36.7 to 132.6mGy) and reconstruction algorithms (Soft, Standard, Detail). Acquisition‐specific raw data were used to create a plane of optimal differentiation based on the geometric bisector of 3D‐linear regression of the two lesion distributions. Verification hemorrhage and calcification lesions, ranging in size from 0.5 to 1.5cm, were created at varying attenuation from 50 to 100HU. Lesions were inserted into a biologically‐relevant brain phantom and scanned using SECT (3.75mm images, Standard, 67mGy) and a range of DECT protocols (3.75mm images, Standard, [67, 105.6, 132.6mGy]). 3D‐DECT data were collected and blinded for analysis. The 3D‐DECT distribution of the lesion was then compared to the acquisition‐matched geometric bisector plane and the mean lesion value's position relative to the plane, indicating lesion identity, and the percentage of voxels on the identified side of the plane, indicating identification confidence, were derived.Results:98% of the 120 lesions investigated were identified correctly as hemorrhage or calcification. 74% were identified with greater than 80% confidence. Increases in CTDIvol and lesion diameter were associated with increased identification confidence.Conclusion:Intracranial lesions of unknown etiology were identified with 80% confidence for 74% of lesions investigated. These phantom data suggest that the identification of intracranial lesions below 100HU is clinically feasible using DECT.This research was conducted at the MD Anderson Center for Advanced Biomedical Imaging in‐part with equipment support from General Electric Healthcare