Abstract
ObjectivesTo compare the true non-enhanced (TNE) and virtual non-enhanced (VNE) data sets in patients who underwent gastric preoperative dual-energy CT (DECT) and to evaluate potential radiation dose reduction by omitting a TNE scan.MethodsA total of 74 patients underwent gastric DECT. The mean CT values, length, image quality and effective radiation doses for VNE and TNE images were compared.ResultsThere was no statistical difference in maximal thickness of gastric tumors and maximal diameter of enlarged lymph nodes among the TNE and VNE images (P>0.05). The mean CT value differences between TNE and VNE were statistically significant for all tissue types, except for aorta attenuation measurements (P<0.05), but the absolute differences were under 10 HU. Lower noise was found for VNE images than TNE images (P<0.01). Image quality of VNE was diagnostic but lower than that of TNE (P<0.01). The dose reduction achieved by omitting the TNE acquisition was 21.40±4.44%.ConclusionVNE scan may potentially replace TNE as part of a multi-phase gastric preoperative staging imaging protocol with consequent saving in radiation dose.
Highlights
Multi-detector computed tomography (MDCT) is one of the most widely used diagnostic tools for pre-operative staging of patients with gastric cancer
TNE true non-enhanced CT, VNE images derived from the arterial (VNEA) virtual non-enhanced (VNE) data acquired at the arterial phase, VNEP VNE data acquired at the portal venous phase, LN lymph node, stomach normal stomach wall. doi:10.1371/journal.pone.0112295.t001
CT value and noise Sixty-three gastric tumors in 63 patients and 112 enlarged lymph nodes in 20 patients were detected on enhanced Dual-energy Computed Tomography (DECT) images
Summary
Multi-detector computed tomography (MDCT) is one of the most widely used diagnostic tools for pre-operative staging of patients with gastric cancer. The clinical practice for detection and staging of gastric masses using CT required a baseline TNE scan immediately followed by a contrast enhanced acquisition, as it depended on the diffuse enhancement and thickening of the lesion [1,2] These three standard phases of scan normally derive a large amount of radiation dose which could be harmful to patients either in preoperative staging or in follow up. Based on two synchronous CT acquisitions at the same time, this technology allows the differentiation and identification of materials with different X-ray absorptions on low and high tube voltage [4] This technique can differentiate attenuation of materials with large atomic numbers such as iodine-based contrast agents. The generation of VNE and iodine map distribution emphasized the local blood supply for lesion identification, and allowed to avoid a TNE, which could save dose for the patient, who might benefit during both preoperative staging and oncological follow-up
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