Single-energy CT Research Articles

An experimental study on the diagnostic advantage of dual-energy computed tomography over single-energy scan to evaluate the treatment effect following transcatheter arterial chemoembolization.

We assessed the diagnostic advantage of dual-energy computed tomography (DECT) over single-energy computed tomography (SECT) to evaluate lipiodol accumulation in target lesions following transcatheter arterial chemoembolization (TACE). TACE was performed in 10 rabbits in whom the VX2 tumor was implanted in their left liver lobes. The miriplatin-lipiodol mixture was injected into the common hepatic artery. All rabbits were sacrificed 2 days after TACE, and the liver was harvested. CT was performed using both single-energy and dual-energy scan modes. The specimen was stained with Oil Red O to evaluate lipiodol accumulation; this was considered the reference standard. Mutual information (MI) was used to evaluate the significance of radiological-pathological correlation. Estimated iodine content values on iodine material density images were compared with actual values obtained using mass spectroscopy. Mean MI values were 0.69, 0.32, 0.83, 0.72, 0.65, and 0.58 for single-energy scan; iodine density images; and virtual monoenergetic images for energy levels of 40, 60, 80, and 100 keV, respectively. The MI value of the monochromatic image (40 keV) was the highest among all sequences. However, this was not significant compared with the single-energy scan (p = 0.81). A significant correlation was observed between the estimated and actual values of iodine content (Pearson's product moment coefficient = 0.70, p = 0.023). More accurate and quantitative lipiodol evaluation in targeted tumors after TACE can be achieved by applying DECT rather than SECT.

A simulation framework for preclinical proton irradiation workflow

Objective.The integration of proton beamlines with x-ray imaging/irradiation platforms has opened up possibilities for image-guided Bragg peak irradiations in small animals. Such irradiations allow selective targeting of normal tissue substructures and tumours. However, their small size and location pose challenges in designing experiments. This work presents a simulation framework useful for optimizing beamlines, imaging protocols, and design of animal experiments. The usage of the framework is demonstrated, mainly focusing on the imaging part.Approach.The fastCAT toolkit was modified with Monte Carlo (MC)-calculated primary and scatter data of a small animal imager for the simulation of micro-CT scans. The simulated CT of a mini-calibration phantom from fastCAT was validated against a full MC TOPAS CT simulation. A realistic beam model of a preclinical proton facility was obtained from beam transport simulations to create irradiation plans in matRad. Simulated CT images of a digital mouse phantom were generated using single-energy CT (SECT) and dual-energy CT (DECT) protocols and their accuracy in proton stopping power ratio (SPR) estimation and their impact on calculated proton dose distributions in a mouse were evaluated.Main results.The CT numbers from fastCAT agree within 11 HU with TOPAS except for materials at the centre of the phantom. Discrepancies for central inserts are caused by beam hardening issues. The root mean square deviation in the SPR for the best SECT (90 kV/Cu) and DECT (50 kV/Al-90 kV/Al) protocols are 3.7% and 1.0%, respectively. Dose distributions calculated for SECT and DECT datasets revealed range shifts <0.1 mm, gamma pass rates (3%/0.1 mm) greater than 99%, and no substantial dosimetric differences for all structures. The outcomes suggest that SECT is sufficient for proton treatment planning in animals.Significance.The framework is a useful tool for the development of an optimized experimental configuration without using animals and beam time.

Image-based finite element model stiffness and vBMD by single and dual energy CT reconstruction kernel

Single-energy quantitative computed tomography (SEQCT) provides volumetric bone mineral density (vBMD) measures for bone analysis and input to image-based finite element models (FEMs). Dual-energy CT (DECT) improves vBMD by accounting for voxel-specific material variations utilizing scans at multiple x-ray energies. vBMD is also altered by reconstruction kernel that cannot be accounted for using calibration phantoms. This study compared vBMD and FEM stiffness derived from SEQCT and DECT images reconstructed with two common kernels. SEQCT and DECT images of cadaveric shoulders (n = 10) were collected using standard (STD) and boneplus (BONE) kernels. Hounsfield Units were converted to vBMD using specimen-specific calibrations. DECT STD and BONE images were generated using an established material decomposition method with 40 and 90 keV simulated monochromatic images. A proximal humerus bone section below the anatomic neck was used for vBMD analysis and FEM generation. FEMs were loaded to 1 % apparent strain for stiffness measurements.Between STD and BONE kernel images, average vBMD differed 0.9 mgK2HPO4/cc and 4.1 mg K2HPO4/cc, in SEQCT and DECT images, respectively. Significant differences occurred in DECT images (p = 0.001). BONE reconstructed images produced higher vBMD measures across both SEQCT and DECT images. The difference between STD and BONE in both SEQCT- and DECT-based FEMs persisted, with larger estimated stiffness in BONE models. For six of the models DECT-based had higher stiffness than SEQCT-based models using the same kernel, although these models differed between STD and BONE kernels. Differences in stiffness between STD and BONE derived models were similar across image types (DECT: 17.5 kN/mm; SEQCT: 19.0 kN/mm). Stiffness values were significantly different within SECT kernels and between SEQCT BONE and DECT STD models. This study shows important differences in vBMD and FEM stiffness that occur due to CT-based imaging parameters alone. These results indicate that consistent imaging parameters should be used for vBMD analysis and FEM input to avoid systematic measurement errors.

Assessment of photon-counting Computed Tomography for quantitative imaging in radiation therapy: PCCT for quantitative imaging in radiotherapy.

To test a first generation clinical PCCT scanner's capabilities to characterize materials in an anthropomorphic head phantom for radiation therapy purposes. A CIRS 731-HN head-and-neck phantom (CIRS/SunNuclear, Norfolk, USA) was scanned on a NAEOTOM Alpha photon-counting CT (PCCT) and a SOMATOM Definition AS+ with single-energy and dual-energy CT techniques (SECT and DECT, respectively), both scanners manufactured by Siemens (Siemens Healthineers, Forscheim, Germany). A method was developed to derive relative electron density (RED) and effective atomic number (EAN) from linear attenuation coefficients (LAC) of virtual mono-energetic images and applied for the PCCT and DECT data. For DECT, Siemens' syngo.via 'Rho/Z'-algorithm was also utilized. Proton stopping-power ratios (SPR) were calculated based on RED/EAN with the Bethe equation. For SECT, a stoichiometric calibration to SPR was used. Nine materials in the phantom were segmented, excluding border pixels. Distributions and root-mean-square deviations (RMSD) within the material regions were evaluated for LAC, RED/EAN and SPR, respectively. Two example ray-projections were also examined for LAC, SPR and water-equivalent thickness (WET), for illustrations of a more treatment-like scenario. There was a tendency towards narrower distributions for PCCT compared to both DECT methods for the investigated quantities, observed across all materials for RED only. Likewise the scored RMSDs showed overall superiority for PCCT with a few exceptions: for water-like materials, EAN and SPR were comparable between the modalities; for titanium the RED and SPR estimates were inferior for PCCT. The PCCT data gave the smallest deviations from theoretic along the more complex example ray profile whereas the more standard projection showed similar results between the modalities. This study shows promising results for tissue characterization in a human-like geometry for radiotherapy purposes using PCCT. The significance of improvements for clinical practice remains to be demonstrated.

Dual-Energy CT as a Well-Established CT Modality to Reduce Contrast Media Amount: A Systematic Review from the Computed Tomography Subspecialty Section of the Italian Society of Radiology.

Background: Our study aims to provide an overview of existing evidence regarding the image quality of dual-energy CT (DECT) employing reduced contrast media (CM) volumes, in comparison to single-energy CT (SECT) with standard CM loads. The advantages, indications, and possible applications of DECT were investigated from the perspective of providing better patient care, minimizing CM volume and managing CM shortage. Methods: In this systematic review (PRISMA methodology), PubMed and WOS were searched from January 2010 to January 2023 by two independent reviewers. The scan and CM characteristics, radiation dose, and results of quantitative (contrast to noise ratio, CNR, and signal to noise ratio, SNR) and qualitative assessment of image quality were collected. Sixty non-duplicated records eligible for full-text screening were examined. Results: Finally, 22 articles (1818 patients) were included. The average CM reduction with DECT ranged between 43.4 ± 11%. Despite the wide variability in CT scan protocols, no differences were found in radiation doses between DECT and SECT. Conclusions: DECT scanners allow the employment of lower CM volumes with equal or better image quality evaluated by quantitative and qualitative analyses and similar dose radiation compared to SECT. Using image reconstructions at low monochromatic energy levels, DECT increases iodine conspicuity and attenuation contributing to CM containment measures.

Image quality of virtual monochromatic and material density iodine images for evaluation of head and neck neoplasms using deep learning-based CT image reconstruction – A retrospective observational study

PurposeTo compare the quality of deep learning image reconstructed (DLIR) virtual monochromatic images (VMI) and material density (MD) iodine images from dual-energy computed tomography (DECT) for the evaluation of head and neck neoplasms with CT scans from a conventional single-energy protocol. MethodA total of 294 head and neck CT scans (98 VMIs operated at 60 keV, 102 MD iodine images, and 94 images from a 120 kVp single-energy CT (SECT) protocol) were retrospectively evaluated. VMIs and MD iodine images were generated using the Gemstone Spectral Imaging (GSI) mode using DLIR and metal artifact reduction (MAR) algorithms. SECT images were generated using adaptive statistical iterative reconstruction (ASIR-V). Images were scored by two independent readers on a 6-point Likert-type scale for overall image quality, vessel contrast, soft tissue contrast, noise texture, noise intensity, artifact reduction, and sharpness. ResultsSubjective overall image quality was rated as superior or excellent in 98 % of DLIR-based MD iodine images and VMIs, but only in 55 % of ASIR-V-based SECT images. For each individual quality criterion, image quality of VMIs and MD iodine images was rated as better than that of SECT images (p < 0.001 in each case). Noise texture and intensity were rated better in MD iodine images than in VMIs. ConclusionDECT using both DLIR and MAR for the generation of VMIs and MD iodine images resulted in higher subjective quality of oncologic head and neck images than ASIR-V-based SECT. Noise reduction and noise texture were best achieved with DLIR-based MD iodine images.

AAPM Task Group Report 299: Quality control in multi-energy computed tomography.

Multi-energy computed tomography (MECT) offers the opportunity for advanced visualization, detection, and quantification of select elements (e.g., iodine) or materials (e.g., fat) beyond the capability of standard single-energy computed tomography (CT). However, the use of MECT requires careful consideration as substantially different hardware and software approaches have been used by manufacturers, including different sets of user-selected or hidden parameters that affect the performance and radiation dose of MECT. Another important consideration when designing MECT protocols is appreciation of the specific tasks being performed; for instance, differentiating between two different materials or quantifying a specific element. For a given task, it is imperative to consider both the radiation dose and task-specific image quality requirements. Development of a quality control (QC) program is essential to ensure the accuracy and reproducibility of these MECT applications. Although standard QC procedures have been well established for conventional single-energy CT, the substantial differences between single-energy CT and MECT in terms of system implementations, imaging protocols, and clinical tasks warrant QC tests specific to MECT. This task group was therefore charged with developing a systematic QC program designed to meet the needs of MECT applications. In this report, we review the various MECT approaches that are commercially available, including information about hardware implementation, MECT image types, image reconstruction, and postprocessing techniques that are unique to MECT. We address the requirements for MECT phantoms, review representative commercial MECT phantoms, and offer guidance regarding homemade MECT phantoms. We discuss the development of MECT protocols, which must be designed carefully with proper consideration of MECT technology, imaging task, and radiation dose. We then outline specific recommended QC tests in terms of general image quality, radiation dose, differentiation and quantification tasks, and diagnostic and therapeutic applications.

First application of scintillator-based photon-counting computed tomography to rock samples: Preliminary results and prospects

Abstract Knowledge of the three-dimensional distribution of minerals in a rock sample is of fundamental importance to deciphering a sample’s properties and history. Attenuation-contrast X-ray computed tomography (X-ray CT) is widely used in the geosciences to determine the three-dimensional distributions of minerals or pores, or both. Photon counting CT (PC-CT) uses a novel energy-resolved X-ray detector that allows X-rays with a continuous energy spectrum to be detected separately within arbitrary energy ranges. Here we report the first results of applying laboratory-build PC-CT combined with multi-pixel photon counter (MPPC) to common minerals such as quartz and calcite. In the low-energy range, PC-CT produced higher contrast images than single-energy X-ray CT. Minerals were successfully identified from the relationships between the mean CT values for each energy window and the mean difference between pairs of energy windows. These results suggest that PC-CT can produce high-contrast images of minerals and may be able to distinguish mineral phases with different attenuation curves, even when their CT values are similar. We obtained CT images of minerals in a natural sedimentary rock sample, composed mainly of quartz and carbonate. Although the spatial resolution of the detector in this study was insufficient for the sample, the main carbonate veins were clearly visible as high carbonate-content areas in the PC-CT images. Given some prior knowledge of mineral phases from other methods, it may be possible to use PC-CT imaging to obtain further information about their chemical compositions.

A direct comparison of multi-energy x-ray and proton CT for imaging and relative stopping power estimation of plastic and ex-vivo phantoms

Objective.Proton therapy administers a highly conformal dose to the tumour region, necessitating accurate prediction of the patient's 3D map of proton relative stopping power (RSP) compared to water. This remains challenging due to inaccuracies inherent in single-energy computed tomography (SECT) calibration. Recent advancements in spectral x-ray CT (xCT) and proton CT (pCT) have shown improved RSP estimation compared to traditional SECT methods. This study aims to provide the first comparison of the imaging and RSP estimation performance among dual-energy CT (DECT) and photon-counting CT (PCCT) scanners, and a pCT system prototype.Approach.Two phantoms were scanned with the three systems for their performance characterisation: a plastic phantom, filled with water and containing four plastic inserts and a wood insert, and a heterogeneous biological phantom, containing a formalin-stabilised bovine specimen. RSP maps were generated by converting CT numbers to RSP using a calibration based on low- and high-energy xCT images, while pCT utilised a distance-driven filtered back projection algorithm for RSP reconstruction. Spatial resolution, noise, and RSP accuracy were compared across the resulting images.Main results.All three systems exhibited similar spatial resolution of around 0.54 lp/mm for the plastic phantom. The PCCT images were less noisy than the DECT images at the same dose level. The lowest mean absolute percentage error (MAPE) of RSP,(0.28±0.07)%, was obtained with the pCT system, compared to MAPE values of(0.51±0.08)%and(0.80±0.08)%for the DECT- and PCCT-based methods, respectively. For the biological phantom, the xCT-based methods resulted in higher RSP values in most of the voxels compared to pCT.Significance.The pCT system yielded the most accurate estimation of RSP values for the plastic materials, and was thus used to benchmark the xCT calibration performance on the biological phantom. This study underlined the potential benefits and constraints of utilising such a novelex-vivophantom for inter-centre surveys in future.

Dual-Split CT to Simulate Multiple Radiation Doses From a Single Scan-Liver Lesion Detection Compared With Dose-Matched Single-Energy CT.

The aim of this study was to evaluate the potential use of simulated radiation doses from a dual-split CT scan for dose optimization by comparing their lesion detectability to dose-matched single-energy CT acquisitions at different radiation dose levels using a mathematical model observer. An anthropomorphic abdominal phantom with liver lesions (5-10 mm, both hyperattenuating and hypoattenuating) was imaged using a third-generation dual-source CT in single-energy dual-source mode at 100 kVp and 3 radiation doses (5, 2.5, 1.25 mGy). The tube current was 67% for tube A and 33% for tube B. For each dose, 5 simulated radiation doses (100%, 67%, 55%, 45%, 39%, and 33%) were generated through linear image blending. The phantom was also imaged using traditional single-source single-energy mode at equivalent doses. Each setup was repeated 10 times. Image noise texture was evaluated by the average spatial frequency (fav) of the noise power spectrum. Liver lesion detection was measured by the area under the receiver operating curve (AUC), using a channelized Hotelling model observer with 10 dense Gaussian channels. Fav decreased at lower radiation doses and differed between simulated and single-energy images (eg, 0.16 mm-1 vs 0.14 mm-1 for simulated and single-energy images at 1.25 mGy), indicating slightly blotchier noise texture for dual-split CT. For hyperattenuating lesions, the mean AUC ranged between 0.92-0.99, 0.81-0.96, and 0.68-0.89 for single-energy, and between 0.91-0.99, 0.78-0.91, and 0.70-0.85 for dual-split at 5 mGy, 2.5 mGy, and 1.25 mGy, respectively. For hypoattenuating lesions, the AUC ranged between 0.90-0.98, 0.75-0.93, and 0.69-0.86 for the single-energy, and between 0.92-0.99, 0.76-0.87, and 0.67-0.81 for dual-split at 5 mGy, 2.5 mGy, and 1.25 mGy, respectively. AUC values were similar between both modes at 5 mGy, and slightly lower, albeit not significantly, for the dual-split mode at 2.5 and 1.25 mGy. Lesion detectability was comparable between multiple simulated radiation doses from a dual-split CT scan and dose-matched single-energy CT. Noise texture was slightly blotchier in the simulated images. Simulated doses using dual-split CT can be used to assess the impact of radiation dose reduction on lesion detectability without the need for repeated patient scans.

Dosimetric impact of stopping power for human bone porosity with dual-energy computed tomography in scanned carbon-ion therapy treatment planning

Few reports have documented how the accuracy of stopping power ratio (SPR) prediction for porous bone tissue affects the dose distribution of scanned carbon-ion beam therapy. The estimated SPR based on single-energy computed tomography (SECT) and dual-energy CT (DECT) were compared for the femur of a Rando phantom which simulates the porosity of human bone, NEOBONE which is the hydroxyapatite synthetic bone substitute, and soft tissue samples. Dose differences between SECT and DECT were evaluated for a scanned carbon-ion therapy treatment plan for the Rando phantom. The difference in the water equivalent length was measured to extract the SPR of the examined samples. The differences for SPR estimated from the DECT-SPR conversion were small with − 1.8% and − 3.3% for the Rando phantom femur and NEOBONE, respectively, whereas the differences for SECT-SPR were between 7.6 and 70.7%, illustrating a 1.5-mm shift of the range and a dose difference of 13.3% at maximum point in the evaluation of the dose distribution. This study demonstrated that the DECT-SPR conversion method better estimated the SPR of the porosity of bone tissues than SECT-SPR followed by the accurate range of the carbon-ion beams on carbon-ion dose calculations.

Feasibility of dose calculation for treatment plans using electron density maps from a novel dual-layer detector spectral CT simulator

BackgroundConventional single-energy CT can only provide a raw estimation of electron density (ED) for dose calculation by developing a calibration curve that simply maps the HU values to ED values through their correlations. Spectral CT, also known as dual-energy CT (DECT) or multi-energy CT, can generate a series of quantitative maps, such as ED maps. Using spectral CT for radiotherapy simulations can directly acquire ED information without developing specific calibration curves. The purpose of this study is to assess the feasibility of utilizing electron density (ED) maps generated by a novel dual-layer detector spectral CT simulator for dose calculation in radiotherapy treatment plans.Methods30 patients from head&neck, chest, and pelvic treatment sites were selected retrospectively, and all of them underwent spectral CT simulation. Treatment plans based on conventional CT images were transplanted to ED maps with the same structure set, including planning target volume (PTV) and organs at risk (OARs), and the dose distributions were then recalculated. The differences in dose and volume histogram (DVH) parameters of the PTV and OARs between the two types of plans were analyzed and compared. Besides, gamma analysis between these plans was performed by using MEPHYSTO Navigator software.ResultsIn terms of PTV, the homogeneity index (HI), gradient index (GI), D2%, D98%, and Dmean showed no significant difference between conventional plans and ED plans. For OARs, statistically significant differences were observed in parotids D50%, brainstem in head&neck plans, spinal cord in chest plans and rectum D50% in pelvic plans, whereas the variance remained minor. For the rest, the DVH parameters exhibited no significant difference between conventional plans and ED plans. All of the mean gamma passing rates (GPRs) of gamma analysis were higher than 90%.ConclusionCompared to conventional treatment plans relying on CT images, plans utilizing ED maps demonstrated similar dosimetric quality. However, the latter approach enables direct utilization in dose calculation without the requirements of establishing and selecting a specific Hounsfield unit (HU) to ED calibration curve, providing an advantage in clinical applications.

Misinterpretations about CT numbers, material decomposition, and elemental quantification.

Quantitative CT imaging, particularly iodine and calcium quantification, is an important CT-based biomarker. This study quantifies sources of errors in quantitative CT imaging in both single-energy and spectral CT. This work examines the theoretical relationship between CT numbers, linear attenuation coefficient, and material quantification. We derive four understandings: (1) CT numbers are not proportional with element mass in vivo, (2) CT numbers are proportional with element mass only when contained in a voxel of pure water, (3) iodine-water material decomposition is never accurate in vivo, and (4) for error-free material decomposition a voxel must only consist of the basis decomposition vectors. Misinterpretation-based errors are calculated using the National Institute of Standards and Technology (NIST) XCOM database for: tissue chemical compositions, clinical concentrations of hydroxyapatite (HAP), and iodine. Quantification errors are also demonstrated experimentally using phantoms. In single-energy CT, misinterpretation-induced errors for HAP density in adipose, muscle, lung, soft tissue, and blood ranged from 0-132%, i.e., a mass error of 0-749 mg/cm3. In spectral CT, errors with iodine in the same tissues resulted in a range of < 0.1-33% error, resulting in a mass error of < 0.1-1.2 mg/mL. Our work demonstrates material quantification is fundamentally limited when measured in vivo due to measurement conditions differing from assumed and the errors are at or above detection limits for bone mineral density (BMD) and spectral iodine quantification. To define CT-derived biomarkers, the errors we demonstrate should either be avoided or built into uncertainty bounds. Improving error bounds in quantitative CT biomarkers, specifically in iodine and BMD quantification, could lead to improvements in clinical care aspects based on quantitative CT. CT numbers are only proportional with element mass only when contained in a voxel of pure water, therefore iodine-water material decomposition is never accurate in vivo. Misinterpretation-induced errors ranged from 0-132% for HAP density and < 0.1-33% in spectral CT with iodine. For error-free material decomposition, a voxel must only consist of the basis decomposition vectors.

Technical note: A GPU-based shared Monte Carlo method for fast photon transport in multi-energy x-ray exposures.

The Monte Carlo (MC) method is an accurate technique for particle transport calculation due to the precise modeling of physical interactions. Nevertheless, the MC method still suffers from the problem of expensive computational cost, even with graphics processing unit (GPU) acceleration. Our previous works have investigated the acceleration strategies of photon transport simulation for single-energy CT. But for multi-energy CT, conventional individual simulation leads to unnecessary redundant calculation, consuming more time. This work proposes a novel GPU-based shared MC scheme (gSMC) to reduce unnecessary repeated simulations of similar photons between different spectra, thereby enhancing the efficiency of scatter estimation in multi-energy x-ray exposures. The shared MC method selects shared photons between different spectra using two strategies. Specifically, we introduce spectral region classification strategy to select photons with the same initial energy from different spectra, thus generating energy-shared photon groups. Subsequently, the multi-directional sampling strategy is utilized to select energy-and-direction-shared photons, which have the same initial direction, from energy-shared photon groups. Energy-and-direction-shared photons perform shared simulations, while others are simulated individually. Finally, all results are integrated to obtain scatter distribution estimations for different spectral cases. The efficiency and accuracy of the proposed gSMC are evaluated on the digital phantom and clinical case. The experimental results demonstrate that gSMC can speed up the simulation in the digital case by ∼37.8% and the one in the clinical case by ∼20.6%, while keeping the differences in total scatter results within 0.09%, compared to the conventional MC package, which performs an individual simulation. The proposed GPU-based shared MC simulation method can achieve fast photon transport calculation for multi-energy x-ray exposures.

Optimizing twin-beam dual-energy CT reconstruction: Quantitative consistency and stability assessment in reference to 120 kV: An observational study.

The split filter CT can filter X-ray beam. Theoretically, the split filter CT not only provides a good low-energy beam, but also provides a more robust CT value. The aim of this study was to compare conventional single-energy computed tomography (SECT) and twin-beam dual-energy (TBDE) CT regarding the quantitative consistency and stabilities of HU measurements at different abdominal organs. Forty-four patients were prospectively enrolled to randomly receive SECT and TBDE protocols at either body part of a thorax-abdominal examination. Their overlapping scan coverage was subjected to further image analysis. For TBDE scans, composed images(c-images) and virtual monoenergetic images (VMIs) at 60, 70, 80, and 90 kiloelectron volt (keV) were reconstructed. The attenuations were measured at 5 abdominal organs and compared between SECT and TBDE to characterize quantitative consistency by intraclass correlation coefficients (ICCs), whereas their standard deviations were used to assess the Hounsfield Unit (HU) stability. The c-images, 70 keV and 80 keV VMIs from TBDE provided consistent HU values (all ICCs > 0.8) with the SECT measurements; moreover, these TBDE images had superior HU stability over SECT images in all abdominal measurements except for fat tissue. The best HU stability can be achieved in 80 keV VMIs with the lowest noise level. The c-images and VMIs derived from TBDE can produce consistent values as SECT. The 80 keV images displayed better HU stability and a lower noise level across various abdominal organs.

Dual-energy CT applications on liver imaging: what radiologists and radiographers should know? A systematic review.

This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging. A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging. Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5mL/kg at 3-4mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6-80mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection. Our review recommends using 80/140 kVp tube voltage with 1.5mL/kg ICA at 3-4mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.

Diagnostic value of one-stop CT energy spectrum and perfusion for angiogenesis in colon and rectum cancer

ObjectiveEvaluation of the predictive value of one-stop energy spectrum and perfusion CT parameters for microvessel density (MVD) in colorectal cancer cancer foci.MethodsClinical and CT data of 82 patients with colorectal cancer confirmed by preoperative colonoscopy or surgical pathology in our hospital from September 2019 to November 2022 were collected and analyzed retrospectively. Energy spectrum CT images were measured using the Protocols general module of the GSI Viewer software of the GE AW 4.7 post-processing workstation to measure the CT values of the arterial and venous phase lesions and the neighboring normal intestinal wall in a single energy range of 40 kev∼140 kev, and the slopes of the energy spectrum curves (λ) were calculated between 40 kev-90 kev; Iodine concentration (IC), Water concentration (WC), Effective-Z (Eff-Z) and Normalized iodine concentration (NIC) were measured by placing a region of interest (ROI) on the iodine concentration map and water concentration map at the lesion and adjacent to the normal intestinal wall.Perfusion CT images were scanned continuously and dynamically using GSI Perfusion software and analyzed by applying CT Perfusion 4.0 software.Blood volume (BV), blood flow (BF), surface permeability (PS), time to peak (TTP), and mean transit time (MTT) were measured respectively in the lesion and adjacent normal colorectal wall. Based on the pathological findings, the tumors were divided into a low MVD group (MVD < 35/field of view, n = 52 cases) and a high MVD group (MVD ≥ 35/field of view, n = 30 cases) using a median of 35/field of view as the MVD grouping criterion. The collected data were statistically analyzed, the subjects’ operating characteristic curve (ROC) was plotted, and the area under curve (AUC), sensitivity, specificity, and Yoden index were calculated for the predicted efficacy of each parameter of the energy spectrum and perfusion CT and the combined parameters.ResultsThe CT values, IC, NIC, λ, Eff-Z of 40kev∼140kev single energy in the arterial and venous phase of colorectal cancer in the high MVD group were higher than those in the low MVD group, and the differences were all statistically significant (p < 0.05). The AUC of each single-energy CT value in the arterial phase from 40 kev to 120 kev for determining the high or low MVD of colorectal cancer was greater than 0.8, indicating that arterial stage has a good predictive value for high or low MVD in colorectal cancer; AUC for arterial IC, NIC and IC + NIC were all greater than 0.9, indicating that in arterial colorectal cancer, both single and combined parameters of spectral CT are highly effective in predicting the level of MVD. The AUC of 40 kev to 90 kev single-energy CT values in the intravenous phase was greater than 0.9, and its diagnostic efficacy was more representative; The AUC of IC and NIC in venous stage were greater than 0.8, which indicating that the IC and NIC energy spectrum parameters in venous stage colorectal cancer have a very good predictive value for the difference between high and low MVDs, with the greatest diagnostic efficacy in IC.The values of BV and BF in the high MVD group were higher than those in the low MVD group, and the differences were statistically significant (P < 0.05), and the AUC of BF, BV, and BV + BF were 0.991, 0.733, and 0.997, respectively, with the highest diagnostic efficacy for determining the level of MVD in colorectal cancer by BV + BF.ConclusionOne-stop CT energy spectrum and perfusion imaging technology can accurately reflect the MVD in living tumor tissues, which in turn reflects the tumor angiogenesis, and to a certain extent helps to determine the malignancy, invasion and metastasis of living colorectal cancer tumor tissues based on CT energy spectrum and perfusion parameters.

Real-time diagnosis of intracerebral hemorrhage by generating dual-energy CT from single-energy CT

Real-time diagnosis of intracerebral hemorrhage after thrombectomy is crucial for follow-up treatment. However, this is difficult to achieve with standard single-energy CT (SECT) due to similar CT values of blood and contrast agents under a single energy spectrum. In contrast, dual-energy CT (DECT) scanners employ two different energy spectra, which allows for real-time differentiation between hemorrhage and contrast extravasation based on energy-related attenuation characteristics. Unfortunately, DECT scanners are not as widely used as SECT scanners due to their high costs. To address this dilemma, in this paper, we generate pseudo DECT images from a SECT image for real-time diagnosis of hemorrhage. More specifically, we propose a SECT-to-DECT Transformer-based Generative Adversarial Network (SDTGAN), which is a 3D transformer-based multi-task learning framework equipped with a shared attention mechanism. In this way, SDTGAN can be guided to focus more on high-density areas (crucial for hemorrhage diagnosis) during the generation. Meanwhile, the introduced multi-task learning strategy and the shared attention mechanism also enable SDTGAN to model dependencies between interconnected generation tasks, improving generation performance while significantly reducing model parameters and computational complexity. In the experiments, we approximate real SECT images using mixed 120kV images from DECT data to address the issue of not being able to obtain the true paired DECT and SECT data. Extensive experiments demonstrate that SDTGAN can generate DECT images better than state-of-the-art methods. The code of our implementation is available at https://github.com/jiang-cw/SDTGAN.

Variation in Hounsfield unit calculated using dual-energy computed tomography: comparison of dual-layer, dual-source, and fast kilovoltage switching technique.

The purpose of the study is to investigate the variation in Hounsfield unit (HU) values calculated using dual-energy computed tomography (DECT) scanners. A tissue characterization phantom inserting 16 reference materials were scanned three times using DECT scanners [dual-layer CT (DLCT), dual-source CT (DSCT), and fast kilovoltage switching CT (FKSCT)] changing scanning conditions. The single-energy CT images (120 or 140 kVp), and virtual monochromatic images at 70keV (VMI70) and 140keV (VMI140) were reconstructed, and the HU values of each reference material were measured. The difference in HU values was larger when the phantom was scanned using the half dose with wrapping with rubber (strong beam-hardening effect) compared with the full dose without the rubber (reference condition), and the difference was larger as the electron density increased. For SECT, the difference in HU values against the reference condition measured by the DSCT (3.2 ± 5.0 HU) was significantly smaller (p < 0.05) than that using DLCT with 120 kVp (22.4 ± 23.8 HU), DLCT with 140 kVp (11.4 ± 12.8 HU), and FKSCT (13.4 ± 14.3 HU). The respective difference in HU values in the VMI70 and VMI140 measured using the DSCT (10.8 ± 17.1 and 3.5 ± 4.1 HU) and FKSCT (11.5 ± 21.8 and 5.5 ± 10.4 HU) were significantly smaller than those measured using the DLCT120 (23.1 ± 27.5 and 12.4 ± 9.4 HU) and DLCT140 (22.3 ± 28.6 and 13.1 ± 11.4 HU). The HU values and the susceptibility to beam-hardening effects varied widely depending on the DECT scanners.

Synthetic Low-Energy Monochromatic Image Generation in Single-Energy Computed Tomography System Using a Transformer-Based Deep Learning Model.

While dual-energy computed tomography (DECT) technology introduces energy-specific information in clinical practice, single-energy CT (SECT) is predominantly used, limiting the number of people who can benefit from DECT. This study proposed a novel method to generate synthetic low-energy virtual monochromatic images at 50keV (sVMI50keV) from SECT images using a transformer-based deep learning model, SwinUNETR. Data were obtained from 85 patients who underwent head and neck radiotherapy. Among these, the model was built using data from 70 patients for whom only DECT images were available. The remaining 15 patients, for whom both DECT and SECT images were available, were used to predict from the actual SECT images. We used the SwinUNETR model to generate sVMI50keV. The image quality was evaluated, and the results were compared with those of the convolutional neural network-based model, Unet. The mean absolute errors from the true VMI50keV were 36.5 ± 4.9 and 33.0 ± 4.4 Hounsfield units for Unet and SwinUNETR, respectively. SwinUNETR yielded smaller errors in tissue attenuation values compared with those of Unet. The contrast changes in sVMI50keV generated by SwinUNETR from SECT were closer to those of DECT-derived VMI50keV than the contrast changes in Unet-generated sVMI50keV. This study demonstrated the potential of transformer-based models for generating synthetic low-energy VMIs from SECT images, thereby improving the image quality of head and neck cancer imaging. It provides a practical and feasible solution to obtain low-energy VMIs from SECT data that can benefit a large number of facilities and patients without access to DECT technology.