Virtual monoenergetic imaging in rapid kVp-switching dual-energy CT (DECT) of the abdomen: impact on CT texture analysis.

Abstract

To study the impact of keV levels of virtual monoenergetic images generated from rapid kVp-switching dual-energy CT (rsDECT) on CT texture analysis (CTTA). This study included 30 consecutive patients (59.3±12years; range 34-77years; 17M:13F) who underwent portal venous phase abdominal CT on a rsDECT scanner. Axial 5-mm monoenergetic images at 5 energy levels (40/50/60/70/80keV) were created and CTTA of liver was performed. CTTA comprised a filtration-histogram technique with different spatial scale filter (SSF) values (0-6). CTTA quantification at each SSF value included histogram-based statistical parameters such as mean intensity, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. The values were compared using repeated measures ANOVA. Among the different CTTA metrics, mean intensity (at SSF>0), skewness, and kurtosis did not show variability whereas entropy, MPP, and SD varied with different keV levels. There was no change in skewness and kurtosis values for all 6 filters (p>0.05). Mean intensity showed no change for filters 2-6 (p>0.05). Mean intensity at SSF=0 i.e., mean attenuations were 91.2±2.9, 108.7±3.6, 136.1±4.7, 179.8±6.9, and 250.5±10.1 HU for 80, 70, 60, 50, and 40keV images, respectively demonstrating significant variability (decrease) with increasing keV levels (p<0.001). Entropy, MPP, and SD values showed a statistically significant decrease with increasing keV of monoenergetic images on all 6 filters (p<0.001). The energy levels of monoenergetic images have variable impact on the different CTTA parameters, with no significant change in skewness, kurtosis, and filtered mean intensity whereas significant decrease in mean attenuation, entropy, MPP, and SD values with increasing energy levels.