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European Radiology
Published in: European Radiology 12/2018

01-12-2018 | Computed Tomography

Impact of dual-energy CT post-processing to differentiate venous thrombosis from iodine flux artefacts

Authors: Jakob Weiss, Christoph Schabel, Ahmed E. Othman, Georg Bier, Konstantin Nikolaou, Fabian Bamberg, Malte N. Bongers

Published in: European Radiology | Issue 12/2018

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Abstract

Objectives

To investigate the accuracy of dual-energy (DE) CT-based iodine maps (IM) and noise-optimised monoenergetic extrapolations (MEI+) at 40 keV for the detection and differentiation of venous thrombosis (VT) from iodine flux artefacts (IFA) in comparison to portal-venous phase CT (CTPV).

Methods

Ninety-nine patients were enrolled in this study. In all patients, VT or IFA was suspected on contrast-enhanced CT and confirmed by follow-up CT or colour-coded ultrasound. All examinations were performed on a third-generation dual-source CT system in DE mode during portal-venous phase. CTPV, IM and 40-keV MEI+ were reconstructed and independently evaluated by two radiologists for the presence/absence of VT and/or IFA. Diagnostic confidence was rated on a three-point scale (3 = high confidence). Quantitative parameters were obtained by calculating contrast-to-noise ratios (CNRs), iodine content and thrombus volume. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC) of CNR.

Results

Diagnostic confidence was significantly higher for IM and MEI+ [both 3 (2-3)] compared to CTPV [2 (1-3); p ≤ 0.03]. ROC analysis revealed significantly higher AUC values and increased sensitivity for IM and MEI+ (AUC = 88%/sensitivity = 79.1% and 86%/73.1%) than for CTPV (75%/61.2%; p ≤ 0.01). Thrombus volume was significantly higher in MEI+ than in IM and CTPV (p < 0.001). CNR of thrombosis was significantly higher in IM [11.5 (8.5-14.5), p < 0.001) and MEI+ [10.9 (8.8-15.5), p < 0.001] than in CTPV [8.2 (5.8-11.4)]. Iodine quantification revealed significantly lower results in VT than in IFA [0.55 mg/ml (0.23-0.90) and 1.81 (1.60-2.12) mg/ml; p < 0.001].

Conclusions

IM and MEI+ 40 keV showed significantly higher diagnostic confidence and accuracy for the detection and differentiation of VT from IFA in comparison to CTPV.

Key Points

• Iodine maps and noise-optimised monoenergetic extrapolations at 40 keV increase diagnostic confidence and accuracy for the detection and differentiation of venous thrombosis from iodine flux artefacts.
• Dual-energy post-processing can significantly increase contrast-to-noise ratio and the sensitivity for the diagnosis of venous thrombosis
• Iodine load in venous thrombosis is significantly lower than in iodine flux artefacts
Literature
1.
2.
Liebman HA, O'Connell C (2016) Incidental venous thromboembolic events in cancer patients: what we know in 2016. Thromb Res 140(Suppl 1):S18–S20CrossRef
3.
Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K (2016) Trousseau's syndrome: cancer-associated thrombosis. Jpn J Clin Oncol 46:204–208CrossRef
4.
Di Nisio M, Ferrante N, De Tursi M et al (2010) Incidental venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Thromb Haemost 104:1049-1054CrossRef
5.
Ageno W, Squizzato A, Togna A et al (2012) Incidental diagnosis of a deep vein thrombosis in consecutive patients undergoing a computed tomography scan of the abdomen: a retrospective cohort study. J Thromb Haemost 10:158–160CrossRef
6.
Bongers MN, Schabel C, Krauss B et al (2015) Noise-optimized virtual monoenergetic images and iodine maps for the detection of venous thrombosis in second-generation dual-energy CT (DECT): an ex vivo phantom study. Eur Radiol 25:1655–1664CrossRef
7.
Karande GY, Hedgire SS, Sanchez Y et al (2016) Advanced imaging in acute and chronic deep vein thrombosis. Cardiovasc Diagn Ther 6:493–507CrossRef
8.
Huisman MV, Klok FA (2013) Diagnostic management of acute deep vein thrombosis and pulmonary embolism. J Thromb Haemost 11:412–422CrossRef
9.
Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol 49:586–592CrossRef
10.
Chandarana H, Megibow AJ, Cohen BA et al (2011) Iodine quantification with dual-energy CT: phantom study and preliminary experience with renal masses. AJR Am J Roentgenol 196:W693–W700CrossRef
11.
Qian LJ, Zhu J, Zhuang ZG et al (2012) Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study. Eur Radiol 22:2178–2185CrossRef
12.
Ascenti G, Sofia C, Mazziotti S et al (2016) Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma. Clin Radiol 71:938.e931–938.e939CrossRef
13.
Wichmann JL, Gillott MR, De Cecco CN et al (2016) Dual-energy computed tomography angiography of the lower extremity runoff: impact of noise-optimized virtual monochromatic imaging on image quality and diagnostic accuracy. Invest Radiol 51:139-146CrossRef
14.
Albrecht MH, Scholtz JE, Husers K et al (2016) Advanced image-based virtual monoenergetic dual-energy CT angiography of the abdomen: optimization of kiloelectron volt settings to improve image contrast. Eur Radiol 26:1863–1870CrossRef
15.
Albrecht MH, Trommer J, Wichmann JL et al (2016) Comprehensive comparison of virtual monoenergetic and linearly blended reconstruction techniques in third-generation dual-source dual-energy computed tomography angiography of the thorax and abdomen. Invest Radiol 51:582–590CrossRef
16.
Weiss J, Notohamiprodjo M, Bongers M et al (2016) Effect of noise-optimized monoenergetic postprocessing on diagnostic accuracy for detecting incidental pulmonary embolism in portal-venous phase dual-energy computed tomography. Invest Radiol 52:142–147
17.
Schabel C, Bongers M, Sedlmair M et al (2014) Assessment of the hepatic veins in poor contrast conditions using dual energy CT: evaluation of a novel monoenergetic extrapolation software algorithm. Rofo 186:591–597CrossRef
18.
Stiegler H, Arbogast H, Nees S, Halder A, Grau A, Riess H (1989) Thrombectomy, lysis, or heparin treatment: concurrent therapies of deep vein thrombosis: therapy and experimental studies. Semin Thromb Hemost 15:250–258CrossRef
19.
Kistner RL, Sparkuhl MD (1979) Surgery in acute and chronic venous disease. Surgery 85:31–43PubMed
20.
Mori H, Hayashi K, Uetani M, Matsuoka Y, Iwao M, Maeda H (1987) High-attenuation recent thrombus of the portal vein: CT demonstration and clinical significance. Radiology 163:353–356CrossRef
21.
Paluch L, Nawrocka-Laskus E, Dabrowska A, Popiela T, Walecki J (2017) Ultrasound elastography for determination of the age of venous thrombi. evaluation of thrombus evolution in patients after sclerotherapy. Pol J Radiol 82:88–91CrossRef
22.
Lim KE, Hsu WC, Hsu YY, Chu PH, Ng CJ (2004) Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients. Clin Imaging 28:439–444CrossRef
23.
Nakaura T, Awai K, Oda S et al (2011) A low-kilovolt (peak) high-tube current technique improves venous enhancement and reduces the radiation dose at indirect multidetector-row CT venography: initial experience. J Comput Assist Tomogr 35:141–147CrossRef
24.
Fujikawa A, Matsuoka S, Kuramochi K et al (2011) Vascular enhancement and image quality of CT venography: comparison of standard and low kilovoltage settings. AJR Am J Roentgenol 197:838–843CrossRef
25.
Loud PA, Katz DS, Bruce DA, Klippenstein DL, Grossman ZD (2001) Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography. Radiology 219:498–502CrossRef
26.
Begemann PG, Bonacker M, Kemper J et al (2003) Evaluation of the deep venous system in patients with suspected pulmonary embolism with multi-detector CT: a prospective study in comparison to Doppler sonography. J Comput Assist Tomogr 27:399–409CrossRef
27.
Oda S, Utsunomiya D, Awai K et al (2011) Indirect computed tomography venography with a low-tube-voltage technique: reduction in the radiation and contrast material dose—a prospective randomized study. J Comput Assist Tomogr 35:631–636CrossRef
28.
Cho ES, Chung JJ, Kim S, Kim JH, Yu JS, Yoon CS (2013) CT venography for deep vein thrombosis using a low tube voltage (100 kVp) setting could increase venous enhancement and reduce the amount of administered iodine. Korean J Radiol 14:183–193CrossRef
Metadata
Title
Impact of dual-energy CT post-processing to differentiate venous thrombosis from iodine flux artefacts
Authors
Jakob Weiss
Christoph Schabel
Ahmed E. Othman
Georg Bier
Konstantin Nikolaou
Fabian Bamberg
Malte N. Bongers
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5534-8

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