Abstract
PurposeDetecting bladder cancer (BC) in routine CT images is important but is sometimes difficult when cancer is small. We evaluated the ability of 40-keV advanced monoenergetic images to depict BC.Materials and methodsFifty-two patients with a median age of 74 years (range 45–92) who were diagnosed as BC with transurethral resection or cystectomy, were included. They were examined with contrast-enhanced dual-energy CT (DE-CT) and advanced virtual monoenergetic images (40 keV) were reconstructed. For evaluating depictability of BC on 40-keV or virtual-120-kVp images, the difference in CT number between the cancer and bladder wall (BC–BW value) were calculated. We also subjectively assessed depictability of BC in virtual-120-kVp and 40-keV images using a 4-grade Likert scale (3: clear, 0: not visualized).ResultsIn 42 of 52 patients, BC–BW values could be calculated because BC was detected on CT images. The mean BC–BW value at 40 keV was significantly higher than that of virtual 120 kVp [80.5 ± 54 (SD) vs. 11.4 ± 12.5 HU, P < 0.01]. Average scores of subjective evaluations in the virtual-120-kVp and 40-keV images were 1.7 ± 1.2 and 2.1 ± 1.2, respectively (P < 0.001).ConclusionThe advanced monoenergetic reconstruction technique reconstructed using DE-CT image is useful to depict BC.
Highlights
Every year, 27 million bladder cancer (BC) patients are diagnosed worldwide [1]
CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration [7]
We evaluated the detectability of 40-kilo electron volt (keV) monoenergetic images (100 s) for BC
Summary
27 million bladder cancer (BC) patients are diagnosed worldwide [1]. Gross hematuria is the most common symptom of BC and patients with gross hematuria are four times more likely to have malignancy than those with microhematuria. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration [7]. Small BCs are sometimes hard to be depicted by conventional routine CE-CT scanned at 120 peak kilo electron volt (kVp) [during the nephrogenic phase (80–100 s)] due to lower enhancement. There have been some trials to detect bladder tumors in the portal phase image (60–80 s delay scan), with reports of detection rate higher than that of excretory phase [10, 11]. Only a few reports are available for the nephrographic phase image (80–100 s), since small BCs are sometimes hard to be depicted due to lower enhancement [12]. We evaluated the detectability of 40-keV monoenergetic images (100 s) for BC
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