Monoenergetic CT Research Articles

Development of a dual-energy computed tomography quality control program: Characterization of scanner response and definition of relevant parameters for a fast-kVp switching dual-energy computed tomography system.

A prototype QC phantom system and analysis process were developed to characterize the spectral capabilities of a fast kV-switching dual-energy computed tomography (DECT) scanner. This work addresses the current lack of quantitative oversight for this technology, with the goal of identifying relevant scan parameters and test metrics instrumental to the development of a dual-energy quality control (DEQC). A prototype elliptical phantom (effective diameter: 35 cm) was designed with multiple material inserts for DECT imaging. Inserts included tissue equivalent and material rods (including iodine and calcium at varying concentrations). The phantom was scanned on a fast kV-switching DECT system using 16 dual-energy acquisitions (CTDIvol range: 10.3-62 mGy) with varying pitch, rotation time, and tube current. The circular head phantom (22 cm diameter) was scanned using a similar protocol (12 acquisitions; CTDIvol range: 36.7-132.6 mGy). All acquisitions were reconstructed at 50, 70, 110, and 140 keV and using a water-iodine material basis pair. The images were evaluated for iodine quantification accuracy, stability of monoenergetic reconstruction CT number, noise, and positional constancy. Variance component analysis was used to identify technique parameters that drove deviations in test metrics. Variances were compared to thresholds derived from manufacturer tolerances to determine technique parameters that had a nominally significant effect on test metrics. Iodine quantification error was largely unaffected by any of the technique parameters investigated. Monoenergetic HU stability was found to be affected by mAs, with a threshold under which spectral separation was unsuccessful, diminishing the utility of DECT imaging. Noise was found to be affected by CTDIvol in the DEQC body phantom, and CTDIvol and mA in the DEQC head phantom. Positional constancy was found to be affected by mAs in the DEQC body phantom and mA in the DEQC head phantom. A streamlined scan protocol was developed to further investigate the effects of CTDIvol and rotation time while limiting data collection to the DEQC body phantom. Further data collection will be pursued to determine baseline values and statistically based failure thresholds for the validation of long-term DECT scanner performance.

Low kV versus dual-energy virtual monoenergetic CT imaging for proven liver lesions: what are the advantages and trade-offs in conspicuity and image quality? A pilot study.

Single-energy low tube potential (SE-LTP) and dual-energy virtual monoenergetic (DE-VM) CT images both increase the conspicuity of hepatic lesions by increasing iodine signal. Our purpose was to compare the conspicuity of proven liver lesions, artifacts, and radiologist preferences in dose-matched SE-LTP and DE-VM images. Thirty-one patients with 72 proven liver lesions (21 benign, 51 malignant) underwent full-dose contrast-enhanced dual-energy CT (DECT). Half-dose images were obtained using single tube reconstruction of the dual-source SE-LTP projection data (80 or 100kV), and by inserting noise into dual-energy projection data, with DE-VM images reconstructed from 40 to 70keV. Three blinded gastrointestinal radiologists evaluated half-dose SE-LTP and DE-VM images, ranking and grading liver lesion conspicuity and diagnostic confidence (4-point scale) on a per-lesion basis. Image quality (noise, artifacts, sharpness) was evaluated, and overall image preference was ranked on per-patient basis. Lesion-to-liver contrast-to-noise ratio (CNR) was compared between techniques. Mean lesion size was 1.5±1.2cm. Across the readers, the mean conspicuity ratings for 40, 45, and 50keV half-dose DE-VM images were superior compared to other half-dose image sets (p<0.0001). Per-lesion diagnostic confidence was similar between half-dose SE-LTP compared to half-dose DE-VM images (p≥0.05; 1.19 vs. 1.24-1.32). However, SE-LTP images had less noise and artifacts and were sharper compared to DE-VM images less than 70keV (p<0.05). On a per-patient basis, radiologists preferred SE-LTP images the most and preferred 40-50keV the least (p<0.0001). Lesion CNR was also higher in SE-LTP images than DE-VM images (p<0.01). For the same applied dose level, liver lesions were more conspicuous using DE-VM compared to SE-LTP; however, SE-LTP images were preferred more than any single DE-VM energy level, likely due to lower noise and artifacts.

Noise-Optimized Virtual Monoenergetic Dual-Energy CT Improves Diagnostic Accuracy for the Detection of Active Arterial Bleeding of the Abdomen

PurposeTo evaluate diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique for detection of active arterial abdominal bleeding on dual-energy (DE) CT angiography compared with standard image reconstruction. Materials and MethodsDE CT angiography data sets of 71 patients (46 men; age 63.6 y ± 13.3) with suspected arterial bleeding of the abdomen or pelvis were reconstructed with standard linearly blended (F_0.5), VMI+, and traditional virtual monoenergetic imaging (VMI) algorithms in 10-keV increments from 40 to 100 keV. Attenuation measurements were performed in the descending aorta, area of hemorrhage, and feeding artery to calculate contrast-to-noise ratios (CNRs) in patients with active arterial bleeding. Based on quantitative image quality results, the best series for each reconstruction technique were chosen to analyze the diagnostic performance of 3 blinded radiologists. ResultsDE CT angiography showed acute arterial bleeding in 36 patients. Mean CNR was superior in 40-keV VMI+ compared with VMI series (all P < .001), which showed highest CNRs in 70-keV VMI and F_0.5 (21.6 ± 7.9, 12.9 ± 4.7, and 10.4 ± 3.6) images. Area under the curve analysis for detection of arterial bleeding showed significantly superior (P < .001) results for 40-keV VMI+ (0.963) compared with 70-keV VMI (0.775) and F_0.5 (0.817) series. ConclusionsDiagnostic accuracy in patients with active arterial bleeding of the abdomen can be significantly improved using VMI+ reconstructions at 40 keV compared with standard linearly blended and traditional VMI series in DE CT angiography.

Endoleaks after endovascular aortic aneurysm repair: Improved detection with noise-optimized virtual monoenergetic dual-energy CT

PurposeTo assess image quality and diagnostic performance of a noise-optimized algorithm to reconstruct virtual monoenergetic images (VMI+) for the detection of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) using dual-energy CT angiography (DE-CTA). Materials and methodsSeventy-five patients (42 men; 66.2±11.7years) underwent DE-CTA following EVAR. Arterial phase images were acquired in dual-energy mode for the reconstruction of standard linearly-blended M_0.5, VMI+ and traditional monoenergetic images (VMI) at 40–100keV in 10-keV intervals. Contrast-to-noise ratios (CNR) were calculated for the area of leakage in patients with endoleaks. Diagnostic accuracy for endoleak detection was evaluated by three blinded radiologists using the objectively best series for each reconstruction technique. ResultsThirty-four out of 75 patients showed endoleaks. Quantitative image parameters were highest at 40-keV VMI+ (CNR, 21.3±11.1), compared to M_0.5 (CNR, 10.9±5.5) and all VMI series that showed highest values at 70keV (CNR, 13.5±6.6; all P<0.001). ROC analysis for endoleak detection revealed an area under the curve (AUC) of 0.992 for 40-keV VMI+ series, which was significantly higher (P≤0.039) compared to 70-keV VMI (0.914) and M_0.5 series (0.916). ConclusionsNoise-optimized VMI+ series at 40keV improve diagnostic accuracy for the detection and rule-out of endoleaks after EVAR.

Advanced image-based virtual monoenergetic dual-energy CT angiography of the abdomen: optimization of kiloelectron volt settings to improve image contrast.

To compare quantitative image quality parameters in abdominal dual-energy computed tomography angiography (DE-CTA) using an advanced image-based (Mono+) reconstruction algorithm for virtual monoenergetic imaging and standard DE-CTA. Fifty-five patients (36 men; mean age, 64.2 ± 12.7years) who underwent abdominal DE-CTA were retrospectively included. Mono + images were reconstructed at 40, 50, 60, 70, 80, 90 and 100keV levels and as standard linearly blended M_0.6 images (60% 100kV, 40% 140kV). The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the common hepatic (CHA), splenic (SA), superior mesenteric (SMA) and left renal arteries (LRA) were objectively measured. Mono+ DE-CTA series showed a statistically superior CNR for 40, 50, 60, 70 and 80keV (P < 0.031) compared to M_0.6 images for all investigated arteries except SMA at 80keV (P = 0.08). CNR at 40keV revealed a mean relative increase of 287.7% compared to linearly blended images among all assessed arteries (P < 0.001). SNR of Mono+ images was consistently significantly higher at 40, 50, 60 and 70keV compared to M_0.6 for CHA and SA (P < 0.009). Compared to linearly blended images, Mono+ reconstructions at low keV levels of abdominal DE-CTA datasets significantly improve quantitative image quality. • Mono+ combines increased attenuation with reduced image noise compared to standard DE-CTA. • Mono+ shows superior contrast-to-noise ratios at low keV compared to linearly-blended images. • Contrast-to-noise ratio in monoenergetic DE-CTA peaks at 40keV. • Mono+ reconstructions significantly improve quantitative image quality at low keV levels.

Value of monoenergetic dual-energy CT (DECT) for artefact reduction from metallic orthopedic implants in post-mortem studies.

The aim of this ex vivo study was to assess the performance of monoenergetic dual-energy CT (DECT) reconstructions to reduce metal artefacts in bodies with orthopedic devices in comparison with standard single-energy CT (SECT) examinations in forensic imaging. Forensic and clinical impacts of this study are also discussed. Thirty metallic implants in 20 consecutive cadavers with metallic implants underwent both SECT and DECT with a clinically suitable scanning protocol. Extrapolated monoenergetic DECT images at 64, 69, 88, 105, 120, and 130keV and individually adjusted monoenergy for optimized image quality (OPTkeV) were generated. Image quality of the seven monoenergetic images and of the corresponding SECT image was assessed qualitatively and quantitatively by visual rating and measurements of attenuation changes induced by streak artefact. Qualitative and quantitative analyses showed statistically significant differences between monoenergetic DECT extrapolated images and SECT, with improvements in diagnostic assessment in monoenergetic DECT at higher monoenergies. The mean value of OPTkeV was 137.6 ± 4.9 with a range of 130 to 148keV. This study demonstrates that monoenergetic DECT images extrapolated at high energy levels significantly reduce metallic artefacts from orthopedic implants and improve image quality compared to SECT examination in forensic imaging.

Evaluation of monoenergetic imaging to reduce metallic instrumentation artifacts in computed tomography of the cervical spine.

Monoenergetic imaging with dual-energy CT has been proposed to reduce metallic artifacts in comparison with conventional polychromatic CT. The purpose of this study is to systematically evaluate and define the optimal dual-energy CT imaging parameters for specific cervical spinal implant alloy compositions. Spinal fixation rods of cobalt-chromium or titanium alloy inserted into the cervical spine section of an Alderson Rando anthropomorphic phantom were imaged ex vivo with fast-kilovoltage switching CT at 80 and 140 peak kV. The collimation width and field of view were varied between 20 and 40 mm and medium to large, respectively. Extrapolated monoenergetic images were generated at 70, 90, 110, and 130 kiloelectron volts (keV). The standard deviation of voxel intensities along a circular line profile around the spine was used as an index of the magnitude of metallic artifact. The metallic artifact was more conspicuous around the fixation rods made of cobalt-chromium than those of titanium alloy. The magnitude of metallic artifact seen with titanium fixation rods was minimized at monoenergies of 90 keV and higher, using a collimation width of 20 mm and large field of view. The magnitude of metallic artifact with cobalt-chromium fixation rods was minimized at monoenergies of 110 keV and higher; collimation width or field of view had no effect. Optimization of acquisition settings used with monoenergetic CT studies might yield reduced metallic artifacts.

Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels

To evaluate optimal monoenergetic dual-energy computed tomography (DECT) settings for artefact reduction of posterior spinal fusion implants of various vendors and spine levels. Posterior spinal fusion implants of five vendors for cervical, thoracic and lumbar spine were examined ex vivo with single-energy (SE) CT (120 kVp) and DECT (140/100 kVp). Extrapolated monoenergetic DECT images at 64, 69, 88, 105keV and individually adjusted monoenergy for optimised image quality (OPTkeV) were generated. Two independent radiologists assessed quantitative and qualitative image parameters for each device and spine level. Inter-reader agreements of quantitative and qualitative parameters were high (ICC = 0.81-1.00, κ = 0.54-0.77). HU values of spinal fusion implants were significantly different among vendors (P < 0.001), spine levels (P < 0.01) and among SECT, monoenergetic DECT of 64, 69, 88, 105keV and OPTkeV (P < 0.01). Image quality was significantly (P < 0.001) different between datasets and improved with higher monoenergies of DECT compared with SECT (V = 0.58, P < 0.001). Artefacts decreased significantly (V = 0.51, P < 0.001) at higher monoenergies. OPTkeV values ranged from 123-141keV. OPTkeV according to vendor and spine level are presented herein. Monoenergetic DECT provides significantly better image quality and less metallic artefacts from implants than SECT. Use of individual keV values for vendor and spine level is recommended. • Artefacts pose problems for CT following posterior spinal fusion implants. • CT images are interpreted better with monoenergetic extrapolation using dual-energy (DE) CT. • DECT extrapolation improves image quality and reduces metallic artefacts over SECT. • There were considerable differences in monoenergy values among vendors and spine levels. • Use of individualised monoenergy values is indicated for different metallic hardware devices.

An algorithm for noise suppression in dual energy CT material density images

Dual-energy material density images obtained by prereconstruction-basis material decomposition techniques offer specific tissue information, but they exhibit relatively high pixel noise. It is shown that noise in the material density images is negatively correlated and that this can be exploited for noise reduction in the two-basis material density images. The algorithm minimizes noise-related differences between pixels and their local mean values, with the constraint that monoenergetic CT values, which can be calculated from the density images, remain unchanged. Applied to the material density images, a noise reduction by factors of 2 to 5 is achieved. While quantitative results for regions of interest remain unchanged, edge effects can occur in the processed images. To suppress these, locally adaptive algorithms are presented and discussed. Results are documented by both phantom measurements and clinical examples.