Dual-energy CT Imaging Research Articles

Dual-energy spectral CT imaging of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children.

Pulmonary embolism (PE) associated with Mycoplasma pneumoniae pneumonia (MPP) in children has already attracted more attention. CT pulmonary angiography (CTPA) has been the preferred method for diagnosing PE, but it has some limitations, especially for children. Dual-energy spectral CT has been used in diagnosing PE in adults. To evaluate the application of dual-energy spectral CT in diagnosing PE in children with MPP. Eighty-three children with MPP and highly suspected PE, underwent CTPA with spectral imaging mode, 25 children were diagnosis with PE. Noise, clot-to-artery contrast-to-noise ratio, image quality and diagnosis confidence were calculated and assessed on nine monochromatic image sets (40 to 80keV). CTPA images were observed for the presence, localization and embolic degrees of PE. Clots were divided into intra- and extra-consolidation clots. For extra-consolidation clots, iodine concentration (IC) of perfusion defects and normal lung, perfusion defects of four children before and after the treatment were measured and compared. For intra-consolidation clots, IC of consolidation areas with clots and consolidation areas without clot were measured and compared. The optimal energy level for detecting PE in children was 55keV. 116 clots (29 extra-consolidations) were found, IC of defect regions was 0.69 ± 0.28mg/mL (extra-consolidations) and 0.90 ± 0.23mg/mL (intra-consolidations), both significantly lower than the 2.76 ± 0.45mg/mL in normal lungs and 10.25 ± 1.76mg/mL in consolidations without clots (P < 0.001). Significant difference was found in the presence or absence of perfusion defects between occlusive clots and nonocclusive clots (P < 0.001). IC of the perfusion defects significantly increased after treatment (P < 0.001). In dual-energy spectral CTPA, 55keV images optimize PE detection for children, and MD images quantify pulmonary blood flow of PE, and may help to detect small clots and quantify embolic degrees.

Dual-Energy Computed Tomography Imaging in Early-Stage Hepatocellular Carcinoma: A Preliminary Study.

Background This study aims to evaluate the application of dual-energy computed tomography (DECT) for multiparameter quantitative measurement in early-stage hepatocellular carcinoma (HCC). Methods The study retrospectively enrolled 30 patients with early-stage HCC and 43 patients with early-stage HCC who received radiofrequency ablation (RFA) and underwent abdomen enhanced CT scans in GSI mode. The GSI viewer was used for image display and data analysis. The regions of interest (ROIs) were delineated in the arterial phase and the venous phase. The optimal single energy value, CT values on different energy levels (40 keV, 70 keV, 100 keV, and 140 keV), the optimal energy level, the slope of the spectral attenuation curve, the effective atomic number (Zeff), iodine concentration (IC), water concentration (WC), normalized iodine concentration (NIC), and normalized water concentration (NWC) are measured and quantitatively analyzed. Results The CT values of early-stage HCC at different single energy levels in dual phases were significantly different, and the single energy values were negatively correlated with the CT values. In the arterial phase and the venous phase, the optimal energy values for the best contrast-to-noise ratio were (68.34 ± 3.20) keV and (70.14 ± 2.01) keV, respectively. The slope of the spectral attenuation curve showed a downward trend at 40 keV, 70 keV, 100 keV, and 140 keV, but there was no statistically significant difference (P > 0.05). Zeff was positively correlated with IC and standardized IC, but has no significant correlation with WC and NWC in dual phases. Conclusion DECT imaging contains multiparameter information and has different application values for early-stage HCC, and it is necessary to select the parameters reasonably for personalized and comprehensive evaluation.

Improving Generalization Capability of Multiorgan Segmentation Models Using Dual-Energy CT

Multiorgan segmentation in computed tomography (CT) images is essential for a variety of clinical applications. Due to variations in acquisition protocols, clinical data differ in terms of soft-tissue contrast, noise, and artifacts. Devising automatic multiorgan segmentation approaches, which are generalized to data acquired using different CT protocols, are challenging and essential when conducting any multicenter/scanner analyses. In this study, we investigate the use of dual-energy CT (DECT) images to train a fully convolutional segmentation network which is generalized to CT images acquired using different protocols (i.e., at different energy levels and using a variety of reconstruction kernels) from different CT scanners. Furthermore, a novel image fusion approach in the frequency domain is proposed and compared to state-of-the-art fusion approaches, in terms of the segmentation quality achieved by the network. Overall, the experiments indicate that the generalization capability of the segmentation network is improved using DECT image fusion. The proposed fusion method outperforms all single-energy CT approaches. It provided a significant improvement in segmentation accuracy, ranging from 16.0% to 23.35% with <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p \leq 0.03$ </tex-math></inline-formula> . Furthermore, two image fusion methods statistically significantly improve segmentation quality in the abdominal organs compared to simply using all available DECT data.

One half-scan dual-energy CT imaging using the Dual-domain Dual-way Estimated Network (DoDa-Net) model.

Compared with single-energy computed tomography (CT), dual-energy CT (DECT) can distinguish materials better. However, most DECT reconstruction theories require two full-scan projection datasets of different energies, and this requirement is hard to meet, especially for cases where a physical blockage disables a full circular rotation. Thus, it is critical to relax the requirements of data acquisition to promote the application of DECT. A flexible one half-scan DECT scheme is proposed, which acquires two projection datasets on two-quarter arcs (one for each energy). The limited-angle problem of the one half-scan DECT scheme can be solved by a reconstruction method. Thus, a dual-domain dual-way estimation network called DoDa-Net is proposed by utilizing the ability of deep learning in non-linear mapping. Specifically, the dual-way mapping Generative Adversarial Network (DM-GAN) was first designed to mine the relationship between two different energy projection data. Two half-scan projection datasets were obtained, the data of which was twice that of the original projection dataset. Furthermore, the data transformation from the projection domain to the image domain was realized by the total variation (TV)-based method. In addition, the image processing network (Im-Net) was employed to optimize the image domain data. The proposed method was applied to a digital phantom and real anthropomorphic head phantom data to verify its effectiveness. The reconstruction results of the real data are encouraging and prove the proposed method's ability to suppress noise while preserving image details. Also, the experiments conducted on simulated data show that the proposed method obtains the closest results to the ground truth among the comparison methods. For low- and high-energy reconstruction, the peak signal-to-noise ratio (PSNR) of the proposed method is as high as 40.3899 and 40.5573 dB, while the PSNR of other methods is lower than 36.5200 dB. Compared with FBP, TV, and other GAN-based methods, the proposed method reduces root mean square error (RMSE) by, respectively, 0.0124, 0.0037, and 0.0016 for low-energy reconstruction, and 0.0102, 0.0028, and 0.0015 for high-energy reconstruction. The developed DoDa-Net model for the proposed one half-scan DECT scheme consists of two stages. In stage one, DM-GAN is used to realize the dual map of projection data. In stage two, the TV-based method is employed to transform the data from the projection domain to the image domain. Furthermore, the reconstructed image is processed by the Im-Net. According to the experimental results of qualitative and quantitative evaluation, the proposed method has advantages in detail preservation, indicating the potential of the proposed method in one half-scan DECT reconstruction.

Optimization of dual energy computed tomography post-processing to reduce lower limb artifacts in gout.

In gout, several types of dual-energy computed tomography (DECT) artifacts have been described (nail bed, skin, beam hardening, submillimeter and vascular artifacts), which can lead to overdiagnosis. The objective of this study was to determine the optimal DECT settings for post processing in order to reduce the frequency of some common artifacts in patients with suspected gout. Seventy-seven patients hospitalized for suspected gout (feet/ankles and/or knees) who received a DECT imaging were included (final diagnosis of 43 gout and 34 other rheumatic disorders). Different post-processing settings were evaluated using Syngovia software: nine settings (R1 to R9) were evaluated with a combination of different ratio (1.28, 1.36 and 1.55) and attenuation coefficient (120, 150, 170 HU). Among the nine settings tested, the R2 setting (170 HU, ratio =1.28) significantly reduced the presence of knee and foot/ankle artifacts compared to the standard R1 setting (85% and 94% decrease in beam hardening and clumpy artifacts in the ankle and foot, respectively (P<0.001); a decrease of 71%, 60% and 88% respectively of meniscal beam hardening, beam hardening and submillimeter artifacts in the knee (P<0.001). Compared to standard settings, the use of R2 settings decreased sensitivity [0.79 (95% CI: 0.65, 0.88) versus 0.90 (95% CI: 0.78, 0.96)] and increased specificity [0.86 (95% CI: 0.71, 0.93) versus 0.63 (95% CI: 0.47, 0.77)] (P<0.001). Settings using an attenuation coefficient to 120 HU and/or a ratio to 1.55 were all associated with a significant increasing of artifacts, especially clumpy and beam hardening artifacts. Applying a ratio of 1.28 and a minimum attenuation of 170 HU in DECT post-processing eliminates the majority of artifacts located in the lower limbs, particularly clumpy artifacts and beam hardening.

DIRECT-Net: A unified mutual-domain material decomposition network for quantitative dual-energy CT imaging.

The purpose of this paper is to present an end-to-end deep convolutional neural network to improve the dual-energy CT (DECT) material decompositionperformance. In this study, we proposes a unified mutual-domain (sinogram domain and CT domain) material decomposition network (DIRECT-Net) for DECT imaging. By design, the DIRECT-Net has immediate access to mutual-domain data, and utilizes stacked convolution neural network layers for noise reduction and material decomposition. The training data are numerically generated following the fundamental DECT imaging physics. Numerical simulation of the XCAT digital phantom, experiments of a biological specimen, a calcium chloride phantom and an iodine solution phantom are carried out to evaluate the performance of DIRECT-Net. Comparisons are performed with different DECT decompositionalgorithms. Results demonstrate that the proposed DIRECT-Net can generate water and bone basis images with less artifacts compared to the other decomposition methods. Additionally, the quantification errors of the calcium chloride (75-375 mg/cm3 ) and the iodine (2-20 mg/cm3 ) are less than 4%. An end-to-end material decomposition network is proposed for quantitative DECT imaging. The qualitative and quantitative results demonstrate that this new DIRECT-Net has promising benefits in improving the DECT imagequality.

Tumorous tissue characterization using integrated 18F-FDG PET/dual-energy CT in lung cancer: Combining iodine enhancement and glycolytic activity

Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has become the method of choice for tumor staging in lung cancer patients with improved diagnostic accuracy for the evaluation of lymph node involvement and distant metastasis. Due to its spectral capabilities, dual-energy CT (DECT) employs a material decomposition algorithm enabling precise quantification of iodine concentrations in distinct tissues. This technique enhances the characterization of tumor blood supply and has demonstrated promising results for the assessment of therapy response in patients with lung cancer.Several studies have demonstrated that DECT provides additional value to the PET-based evaluation of glycolytic activity, especially for the evaluation of therapy response and follow-up of patients with lung cancer. The combination of PET and DECT in a single scanner system enables the simultaneous assessment of glycolytic activity and iodine enhancement, offering further insight to the characterization of tumorous tissues. Recently a new approach of a novel integrated PET/DECT was investigated in a pilot study on patients with non-small cell lung cancer (NSCLC). The study showed a moderate correlation between PET-based standard uptake values (SUV) and DECT-based iodine densities in the evaluation of lung tumorous tissue but with limited assessment of lymph nodes.The following review on tumorous tissue characterization using PET and DECT imaging describes the strengths and limitations of this novel technique.

Bowel Peristalsis Artifact on Dual-Energy CT: In Vitro Study on the Influence of Different Dual-Energy CT Platforms and Enteric Contrast Agents.

BACKGROUND. The value of dual-energy CT (DECT) for bowel wall assessment is increasingly recognized. Although technical improvements reduce peristalsis artifact in conventional CT, the effects of peristalsis on DECT image reconstructions remain poorly studied. OBJECTIVE. The purpose of this study was to evaluate the influence of different DECT scanners and enteric contrast agents on the severity of bowel peristalsis artifact in vitro. METHODS. To simulate bowel peristalsis, a 3-cm-diameter corrugated hollow tube representing the bowel was oscillated constantly in the z-axis within a larger water-filled cylinder. The bowel was serially filled with air, water, and iodinated or experimental dark contrast material and scanned on four different DECT platforms (spectral detector, rapid peak kilovoltage switching, split filter, and dual source) to reconstruct 120-kVp-like and iodine images. Two readers rated each image reconstruction for artifact severity from 0 (none) to 3 (severe) and recorded the degree to which iodine images depicted bowel wall hyperattenuation on 120-kVp-like images as artifactual. Artifact severity scores were compared by ANOVA with Bonferroni correction. RESULTS. Interrater agreement on artifact scores was excellent (intraclass correlation coefficient, 0.82 [95% CI, 0.79-0.84]). For 120-kVp-like images, mean peristalsis artifact scores were lower (all p < .001) for split-filter (1.47) and dual-source (1.86) scanners than for spectral-detector (2.58) and rapid-kilovoltage-switching (2.74) scanners. Compared with those on 120-kVp images, peristalsis artifacts on iodine images were less severe for spectral-detector (score, 1.03; p < .001) and rapid-kilovoltage-switching (2.09; p < .001) systems but more severe for dual-source (2.77; p < .001) and split-filter (2.62; p < .001) systems. Peristalsis artifact was rated less severe with experimental dark bowel contrast medium (score, 1.79) than with other bowel contrast agents (all p < .001). Iodine images helped identify bowel wall hyperattenuation as artifactual in 94.7% of reviewed cases for spectral-detector and 40.7% of cases for rapid-kilovoltage-switching scanners. CONCLUSION. For spectral-detector and rapid-kilovoltage-switching DECT, iodine images minimize peristalsis artifact, but for dual-source and split-filter DECT, mixed 120-kVp-like images are preferred. Compared with iodinated contrast material and water, experimental dark bowel contrast material reduces peristalsis artifact. CLINICAL IMPACT. Knowledge of the preferred images for reducing peristalsis artifact can lessen the effect of peristalsis on clinical DECT interpretation. Dark enteric contrast agents, when they become clinically available, may further reduce the effects of peristalsis.

Dual-energy x-ray computed tomography study based on CsI:Tl and LYSO:Ce scintillator combination

Dual-energy computed tomography (CT) provides a better material classification capability than traditional CT. A scintillator is an essential component that determines the optical resolution, detective quantum efficiency, and energy separation of the dual-layer dual-energy CT system. In this paper, we propose a new dual-layer scintillator combination composed of CsI:Tl and LYSO:Ce for dual-energy CT imaging. The x-ray attenuation physical process of CsI:Tl and LYSO:Ce combination is simulated on Geant4. The energy distribution and luminescence of different thicknesses of the scintillator combination are investigated by simulation experiments. Then, the optimal thicknesses of the combination are designed based on simulation results. Furthermore, a dual-layer dual-energy CT system using the scintillator combination is built, and practical dual-energy imaging experiments are implemented in the system. Simulation results indicate that the CsI:Tl and LYSO:Ce combination can effectively realize dual-energy detection. The optimal thickness is 100 μm for CsI:Tl and 500 μm for LYSO:Ce. Practical experiments show that the dual-energy CT system using the CsI:Tl and LYSO:Ce combination has low noise. Materials of the metal mixture sample and the igneous rock sample are correctly separated using the dual-energy data obtained by the CsI:Tl and LYSO:Ce combination. Therefore, the CsI:Tl and LYSO:Ce combination is expected to be used in dual-energy CT imaging studies of complex materials, such as metals, bones, and rocks.

Dual-energy CT-based radiomics nomogram in predicting histological differentiation of head and neck squamous carcinoma: a multicenter study.

To develop and validate a dual-energy CT (DECT)-based radiomics nomogram from multicenter trials for predicting the histological differentiation of head and neck squamous cell carcinoma (HNSCC). A total of 178 patients (112 in the training and 66 in the validation cohorts) from eight institutions with histologically proven HNSCCs were included in this retrospective study. Radiomics-signature models were constructed from features extracted from virtual monoenergetic images (VMI) and iodine-based material decomposition images (IMDI), reconstructed from venous-phase DECT images. Clinical factors were also assessed to build a clinical model. Multivariate logistic regression analysis was used to develop a nomogram combining the radiomics signature models and clinical model for predicting poorly differentiated HNSCC and moderately well-differentiated HNSCC. The predictive performance of the clinical model, radiomics signature models, and nomogram was compared. The calibration degree of the nomogram was also assessed. The tumor location, VMI-signature, and IMDI-signature were associated with the degree of HNSCC differentiation, and areas under the ROC curves (AUCs) were 0.729, 0.890, and 0.833 in the training cohort and 0.627, 0.859, and 0.843 in the validation cohort, respectively. The nomogram incorporating tumor location and two radiomics-signature models yielded the best performance in training (AUC = 0.987) and validation (AUC = 0.968) cohorts with a good calibration degree. The nomogram that integrated the DECT-based radiomics-signature models and tumor location showed good performance in predicting histological differentiation degree of HNSCC, providing a novel combination for predicting HNSCC differentiation.

A phantom study using dual-energy spectral computed tomography imaging: Comparison of image quality between two adaptive statistical iterative reconstruction (ASiR, ASiR-V) algorithms for evaluating ground-glass nodules of the lung.

To assess the image quality of the two adaptive statistical iterative reconstruction (ASiR and ASiR-V) algorithms for evaluating ground-glass nodules (GGNs) of the lung. The chest phantom with ground-glass simulated pulmonary nodules was scanned by dual-energy spectral computed tomography (CT) using gemstone spectral imaging mode. The image was reconstructed with ASiR and ASiR-V from 0 (FBP) to 90% blending percentages, respectively. The average noise and signal-to-noise ratio (SNR) of reconstruction images were calculated. The data were statistically analyzed. Compared with FBP, as the percentage of ASiR and ASiR-V increased from 10 to 90%, image noise reduced by 3.7%-45.2% and 14.1%-73.8%, respectively, and the SNR increased accordingly. There was significantly higher SNR value of ASiR-V images as the percentages of IR increased to 50% or greater, compared to those of ASiR. Subjective image quality scores of ASiR and ASiR-V improved significantly as percentage increased from 10 to 80% for ASiR and ASiR-V (peaked at 60% for both of them). Both ASiR and ASiR-V can reduce the image noise and improve the objective image quality for presenting pulmonary nodules on dual-energy spectral CT imaging compared with FBP. ASiR-V provided further image quality improvement than ASiR, and both ASiR and ASiR-V 60% had the highest image quality score.

Dual Energy Computed Tomography for Diagnosis and Monitoring Attempted Medical Management of a Large Urate Urolith in a Desert Tortoise (Gopherus agassizii)

An estimated 29-year-old male, desert tortoise ( Gopherus agassizii ) under professional care presented for endoscopic liver biopsies as part of a diagnostic work-up for recurrent, profound anemia and hypoalbuminemia. Suspected cystoliths were identified during endoscopy but were not visible on contemporary radiographs. Dual-energy computed tomography (DECT) imaging confirmed the presence of a large urate urolith filling the majority of the bladder. Due to the recent clinical illness, the tortoise was considered a poor surgical candidate. Medical management consisting of urinary alkalinization with potassium citrate, vibration therapy, and daily warm water soaks was elected. Following institution of medical therapies, the tortoise began passing pieces of urate stone that were 0.25-2.0cm in diameter during daily soaks. A recheck DECT scan at two months indicated the urolith was approximately 1/3 the initial size, suggesting medical therapy was effectively treating the urolith. Unfortunately, after five months of medical therapy, the stone had increased in size again on the follow-up DECT scan. This case report suggests that medical management may be a potential option for large urate cystoliths in desert tortoises, though more research is needed to further refine effective therapeutics for such cases. The use of dual-energy CT imaging was essential in this case as it enabled confirmation of stone presence, identification of urolith composition, and monitoring of response to therapy.

Individual aspects in eldery patients with fragility fractures

Due to our ageing population, the number of elderly patients who are treated in the emergency department due to low-energy trauma (e.g., tripping) continues to rise. These minor accidents often result in fragility fractures classically located in the proximal humerus, distal radius, spine, pelvis, and near the hip joint. Pre-existing conditions, polypharmacy, and general frailty increase the risk of fragility fractures in this patient population. Geriatric trauma fractures and especially insufficiency fractures of the posterior pelvic ring are often difficult to diagnose by plain X‑ray. Therefore, in geriatric trauma patients, cross-sectional imaging, e.g., computed tomography (CT), dual-energy CT (DECT), or magnetic resonance imaging (MRI), should be considered early for reliable evaluation of asuspected fracture. This also allows for the identification of older fractures. Particularly in cognitively impaired elderly patients, difficult examination conditions or an unclear fall event, cross-sectional imaging is often indicated. However, this may also involve risks, e.g., use of contrast medium in patients with impaired renal function, so that each case must be considered individually. Furthermore, the diagnosis and treatment of osteoporosis, which is an underlying disease that leads to fragility fractures, is of particular importance. In the diagnostic workup, measurement of bone density using dual energy X‑ray absorptiometry (DXA) is the standard method according to guidelines. In specific situations, high-resolution peripheral quantitative CT (HR-pQCT) may also be used. Due to the special challenges of correctly detecting fragility fractures and being able to quickly initiate adequate therapy, good cooperation between radiologists and trauma surgeons is necessary.

Advanced CT techniques for hepatic microwave ablation zone monitoring and follow-up.

To evaluate utility of advanced CT techniques including HighlY constrained back-projection and dual-energy CT for intra- and post-procedure hepatic microwave ablation zone monitoring. 8 hepatic microwave ablations were performed in 4 adult swine (5min/65W). Low-dose routine CECT and dual-energy CT images were obtained every 1min during ablation. Images were reconstructed ± HYPR. Image quality and dose metrics were collected. 21 MWA were performed in 4 adult swine. Immediate post-procedure CECT was performed in the arterial, portal venous, and delayed phases using both routine and DECT imaging with full-dose weight-based IV contrast dosing. An additional 16 MWA were subsequently performed in 2 adult swine. Immediate post-procedure CT was performed with half-dose IV contrast using routine and DECT. 12 patients (10M/2F, mean age 62.4 yrs) with 14 hepatic tumors (4 HCC, 10 metastatic lesions) treated with MWA were prospectively imaged with DECT 1month post-procedure. 120kV equivalent images were compared to DECT [51keV, iodine material density]. Image quality and dose metrics were collected. Gas created during MWA led to high CNR in all intraprocedural CT datasets. Optimal CNRs were noted at 4min with CNR 6.7, 15.5,15.9, and 21.5 on LD-CECT, LD-CECT + HYPR, DECT, and DECT + HYPR, respectively (p < 0.001). Image quality scores at 4min were 1.8, 2.8, 2.4, and 3, respectively (p < 0.001). Mean radiation dose (CTDIvol) was eightfold higher for the DECT series. For swine, post-procedural DECT images (IMD/51keV) showed improved CNR compared to routine CT at all time points with full and with reduced dose contrast (CNR 4.6, 3.2, and 1.5, respectively, at half-contrast dose, p < 0.001). For human subjects, the 51keV and IMD images showed higher CNRs (5.8, 4.8 vs 4.0, p < 0.001) and SNRs (3.7, 5.9 vs 2.8). Ablation zone sharpness was improved with DECT (routine 3.0 ± 0.7, DECT 3.5 ± 0.5). Diagnostic confidence was higher with DECT (routine 2.3 ± 0.9, DECT 2.6 ± 0.8). Mean DLP for DECT was 905.7 ± 606mGy-cm, CTDIvol 37.5 ± 21.2mGy, and effective dose 13.6 ± 9.1mSv, slightly higher than conventional CT series. Advanced CT techniques can improve CT image quality in peri-procedural hepatic microwave ablation zone evaluation.

Impact of dual-energy 50-keV virtual monoenergetic images on radiologist confidence in detection of key imaging findings of small hepatocellular carcinomas using multiphase liver CT.

Dual-energy virtual monoenergetic images can increase iodine signal, potentially increasing the conspicuity of hepatic masses. To determine if dual-energy 50-keV virtual monoenergetic images improve visualization of key imaging findings or diagnostic confidence for small (≤2 cm) hepatocellular carcinomas (HCC) at multiphase, contrast-enhanced liver computed tomography (CT). Patients with chronic liver disease underwent multiphase dual-energy CT imaging for HCC, with late arterial and delayed phase dual-energy 50-keV images reconstructed. Two non-reader subspecialized gastrointestinal (GI) radiologists established the reference standard, determining the location and diagnosis of all hepatic lesions using predetermined criteria. Three GI radiologists interpreted mixed kV CT images without or with dual-energy 50-keV images. Radiologists identified potential HCCs and rated their confidence (0-100 scales) in imaging findings of arterial enhancement, enhancing capsule, tumor washout, and LI-RADS 5 (2018) category. In total, 45 patients (14 women; mean age = 59.5 ± 10.9 years) with chronic liver disease were included. Of them, 19 patients had 25 HCCs ≤2 cm (mean size = 1.5 ± 0.4 cm). There were 17 LI-RADS 3 and 4 lesions and 19 benign lesions. Reader confidence in imaging findings of arterial enhancement, enhancing capsule, and non-peripheral washout significantly increased with dual-energy images (P ≤ 0.022). Overall confidence in HCC diagnosis increased significantly with dual-energy 50-keV images (52.4 vs. 68.8; P = 0.001). Dual-energy images demonstrated a slight but significant decrease in overall image quality. Radiologist confidence in key imaging features of small HCCs and confidence in imaging diagnosis increases with use of dual-energy 50-keV images at multiphase, contrast-enhanced liver CT.

Dual-energy CT imaging over non-overlapping, orthogonal arcs of limited-angular ranges.

Interest exists in dual-energy computed tomography (DECT) imaging with scanning arcs of limited-angular ranges (LARs) for reducing scan time and radiation dose, and for enabling scan configurations of C-arm CT that can avoid possible collision between the rotating X-ray tube/detector and the imaged subject. In this work, we investigate image reconstruction for a type of configurations of practical DECT interest, referred to as the two-orthogonal-arc configuration, in which low- and high-kVp data are collected over two non-overlapping arcs of equal LAR α, ranging from 30° to 90°, separated by 90°. The configuration can readily be implemented, e.g., on CT with dual sources separated by 90° or with the slow-kVp-switching technique. The directional-total-variation (DTV) algorithm developed previously for image reconstruction in conventional, single-energy CT is tailored to enable image reconstruction in DECT with two-orthogonal-arc configurations. Performing visual inspection and quantitative analysis of monochromatic images obtained and effective atomic numbers estimated, we observe that the monochromatic images of the DTV algorithm from LAR data are with substantially reduced LAR artifacts, which are observed otherwise in those of existing algorithms, and thus visually correlate reasonably well, in terms of metrics PCC and nMI, with their reference images obtained from full-angular-range data. In addition, effective atomic numbers estimated from LAR data of DECT with two-orthogonal-arc configurations are in reasonable agreement, with relative errors up to ∼ 10%, with those estimated from full-angular-range data in DECT. The results acquired in the work may yield insights into the design of LAR configurations of practical dual-energy application relevance in diagnostic CT or C-arm CT imaging.

Learning-based synthetic dual energy CT imaging from single energy CT for stopping power ratio calculation in proton radiation therapy.

Dual energy CT (DECT) has been shown to estimate stopping power ratio (SPR) map with a higher accuracy than conventional single energy CT (SECT) by obtaining the energy dependence of photon interactions. This work presents a learning-based method to synthesize DECT images from SECT image for proton radiotherapy. The proposed method uses a residual attention generative adversarial network. Residual blocks with attention gates were used to force the model to focus on the difference between DECT images and SECT images. To evaluate the accuracy of the method, we retrospectively investigated 70 head-and-neck cancer patients whose DECT and SECT scans were acquired simultaneously. The model was trained to generate both a high and low energy DECT image based on a SECT image. The generated synthetic low and high DECT images were evaluated against the true DECT images using leave-one-out cross-validation. To evaluate our method in the context of a practical application, we generated SPR maps from synthetic DECT (sDECT) using a dual-energy based stoichiometric method and compared the SPR maps to those generated from DECT. A dosimetric comparison for dose obtained from DECT was performed against that derived from sDECT. The mean of mean absolute error, peak signal-to-noise ratio and normalized cross-correlation for the synthetic high and low energy CT images was 36.9 HU, 29.3 dB, 0.96 and 35.8 HU, 29.2 dB, and 0.96, respectively. The corresponding SPR maps generated from synthetic DECT showed an average normalized mean square deviation of about 1% with reduced noise level and artifacts than those from original DECT. Dose-volume histogram (DVH) metrics for the clinical target volume agree within 1% between the DECT and sDECT calculated dose. Our method synthesized accurate DECT images and showed a potential feasibility for proton SPR map generation. This study investigated a learning-based method to synthesize DECT images from SECT image for proton radiotherapy.

Quantitative lung perfusion blood volume using dual energy CT-based effective atomic number (Zeff ) imaging.

Iodine material images (aka iodine basis images) generated from dual energy computed tomography (DECT) have been used to assess potential perfusion defects in the pulmonary parenchyma. However, iodine material images do not provide the needed absolute quantification of the pulmonary blood pool, as materials with effective atomic numbers (Zeff ) different from those of basis materials may also contribute to iodine material images, thus confounding the quantification of perfusion defects. (i) To demonstrate the limitations of iodine material images in pulmonary perfusion defect quantification and (ii) to develop and validate a new quantitative biomarker using effective atomic numbers derived from DECT images. The quantitative relationship between the perfusion blood volume (PBV) in pulmonary parenchyma and the effective atomic number (Zeff ) spatial distribution was studied to show that the desired quantitative PBV maps are determined by the spatial maps of Zeff as , where a, b, and β are three constants. Namely, quantitative is determined by Zeff images instead of the iodine basis images. Perfusion maps were generated for four human subjects to demonstrate the differences between conventional iodine material image-based PBV (PBViodine ) derived from two-material decompositions and the proposed method. Among patients with pulmonary emboli, the proposed maps clearly show the perfusion defects while the PBViodine maps do not. Additionally, when there are no perfusion defects present in the derived PBV maps, no pulmonary emboli were diagnosed by an experienced thoracic radiologist. Effective atomic number-based quantitative PBV maps provide the needed sensitive and specific biomarker to quantify pulmonary perfusion defects.

The role of dual energy computed tomography in the differentiation of acute gout flares and acute calcium pyrophosphate crystal arthritis

ObjectivesTo analyse the diagnostic impact of dual energy computed tomography (DECT) in acute gout flares and acute calcium pyrophosphate (CPP) crystal arthritis when compared to the gold standard of arthrocentesis with compensated polarised light microscopy. Microscopy results were also compared to musculoskeletal ultrasound (MUS), conventional radiographs, and the suspected clinical diagnosis (SCD).MethodsThirty-six patients with a suspected gout flare (n = 24) or acute CPP crystal arthritis (n = 11, n = 1 suffered from neither) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed DECT images for signs of monosodium urate crystals or calcium pyrophosphate deposition.ResultsSensitivity of DECT for gout was 63% (95% CI 0.41–0.81) with a specificity of 92% (0.41–0.81) while sensitivity and specificity for acute CPP arthritis were 55% (0.23–0.83) and 92% (0.74–0.99), respectively. MUS had the highest sensitivity of all imaging modalities with 92% (0.73–0.99) and a specificity of 83% (0.52–0.98) for gout, while sensitivity and specificity for acute CPP crystal arthritis were 91% (0.59–1.00) and 92% (0.74–0.99), respectively.ConclusionDECT is an adequate non-invasive diagnostic tool for acute gout flares but might have a lower sensitivity than described by previous studies. Both MUS and SCD had higher sensitivities than DECT for acute gout flares and acute CPP crystal arthritis.Key Points• DECT offers a lower sensitivity for acute gout flares than previously described.• DECT sensitivity for acute CPP crystal arthritis is less than the already validated ultrasound.

Dual-energy CT in pulmonary vascular disease.

Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.