Single source dual energy CT: What is the optimal monochromatic energy level for the analysis of the lung parenchyma?

Abstract

ObjectiveTo determine the optimal monochromatic energy level for lung parenchyma analysis in spectral CT. MethodsAll 50 examinations (58% men, 64.8±16yo) from an IRB-approved prospective study on single-source dual energy chest CT were retrospectively included and analyzed.Monochromatic images in lung window reconstructed every 5keV from 40 to 140keV were independently assessed by two chest radiologists. Based on the overall image quality and the depiction/conspicuity of parenchymal lesions, each reader had to designate for every patient the keV level providing the best diagnostic and image quality. Results72% of the examinations exhibited parenchymal lesions.Reader 1 picked the 55keV monochromatic reconstruction in 52% of cases, 50 in 30% and 60 in 18%. Reader 2 chose 50keV in 52% cases, 55 in 40%, 60 in 6% and 40 in 2%. The 50 and 55keV levels were chosen by at least one reader in 64% and 76% of all patients, respectively.Merging 50 and 55keV into one category results in an optimal setting selected by reader 1 in 82% of patients and by reader 2 in 92%, with a 74% concomitant agreement. ConclusionThe best image quality for lung parenchyma in spectral CT is obtained with the 50–55keV monochromatic reconstructions.