Top

Published in:

Open Access 01-07-2019 | Computed Tomography | Computed Tomography

Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma

Authors: Lucian Beer, Michael Toepker, Ahmed Ba-Ssalamah, Christian Schestak, Anja Dutschke, Martin Schindl, Alexander Wressnegger, Helmut Ringl, Paul Apfaltrer

Published in: European Radiology | Issue 7/2019

Abstract

Objectives

The aim of this study was to assess the objective and subjective image characteristics of monoenergetic images (MEI[+]), using a noise-optimized algorithm at different kiloelectron volts (keV) compared to polyenergetic images (PEI), in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

This retrospective, institutional review board-approved study included 45 patients (18 male, 27 female; mean age 66 years; range, 42–96 years) with PDAC who had undergone a dual-energy CT (DECT) of the abdomen for staging. One standard polyenergetic image (PEI) and five MEI(+) images in 10-keV intervals, ranging from 40 to 80 keV, were reconstructed. Line-density profile analysis, as well as the contrast-to-noise ratio (CNR) of the tumor, the signal-to-noise ratio (SNR) of the regular pancreas parenchyma and the tumor, and the CNR of the three main peripancreatic vessels, was calculated. For subjective quality assessment, two readers independently assessed the images using a 5-point Likert scale. Reader reliability was evaluated using an intraclass correlation coefficient.

Results

Line-density profile analysis revealed the largest gradient in attenuation between PDAC and regular tissue in MEI(+) at 40 keV. Low-keV MEI(+)reconstructions at 40 and 50 keV increased CNR and SNR compared to PEI (40 keV: CNR 46.8 vs. 7.5; SNR_Pankreas 32.5 vs. 15.7; SNR_Lesion 13.5 vs. 8.6; p < 0.001). MEI(+) at 40 keV and 50 keV were consistently preferred by the observers (p < 0.05), showing a high intra-observer 0.937 (0.92–0.95) and inter-observer 0.911 (0.89–0.93) agreement.

Conclusion

MEI(+) reconstructions at 40 keV and 50 keV provide better objective and subjective image quality compared to conventional PEI of DECT in patients with PDAC.

Key Points

• Low-keV MEI(+) reconstructions at 40 and 50 keV increase tumor-to-pancreas contrast compared to PEI.

• Low-keV MEI(+) reconstructions improve objective and subjective image quality parameters compared to PEI.

• Dual-energy post-processing might be a valuable tool in the diagnostic workup of patients with PDAC.

Available only for authorised users

Arvold ND, Niemierko A, Mamon HJ, Fernandez-del Castillo C, Hong TS (2011) Pancreatic cancer tumor size on CT scan versus pathologic specimen: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys 80:1383–1390CrossRefPubMed

Somers I, Bipat S (2017) Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT. Eur Radiol 27:3408–3435CrossRefPubMedPubMedCentral

Koelblinger C, Ba-Ssalamah A, Goetzinger P et al (2011) Gadobenate dimeglumine–enhanced 3.0-T MR imaging versus multiphasic 64–detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology 259:757–766CrossRefPubMed

Jeon SK, Lee JM, Joo I et al (2018) Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT. Eur Radiol 28:3484–3493CrossRefPubMed

De Cecco CN, Caruso D, Schoepf UJ et al (2018) A noise-optimized virtual monoenergetic reconstruction algorithm improves the diagnostic accuracy of late hepatic arterial phase dual-energy CT for the detection of hypervascular liver lesions. Eur Radiol 28:3393–3404CrossRefPubMed

Euler A, Obmann MM, Szucs-Farkas Z et al (2018) Comparison of image quality and radiation dose between split-filter dual-energy images and single-energy images in single-source abdominal CT. Eur Radiol 28:3405–3412CrossRefPubMed

Kordbacheh H, Baliyan V, Singh P, Eisner BH, Sahani DV, Kambadakone AR (2018) Rapid kVp switching dual-energy CT in the assessment of urolithiasis in patients with large body habitus: preliminary observations on image quality and stone characterization. Abdom Radiol (NY). https://doi.org/10.1007/s00261-018-1808-5

Nagayama Y, Iyama A, Oda S et al (2018) Dual-layer dual-energy computed tomography for the assessment of hypovascular hepatic metastases: impact of closing k-edge on image quality and lesion detectability. Eur Radiol. https://doi.org/10.1007/s00330-018-5789-0

May MS, Wiesmueller M, Heiss R et al (2018) Comparison of dual- and single-source dual-energy CT in head and neck imaging. Eur Radiol. https://doi.org/10.1007/s00330-018-5762-y

10.

Frellesen C, Fessler F, Hardie AD et al (2015) Dual-energy CT of the pancreas: improved carcinoma-to-pancreas contrast with a noise-optimized monoenergetic reconstruction algorithm. Eur J Radiol 84:2052–2058CrossRefPubMed

11.

Sudarski S, Apfaltrer P, Nance JW et al (2013) Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol 82:e574–e581CrossRefPubMed

12.

Toepker M, Czerny C, Ringl H et al (2014) Can dual-energy CT improve the assessment of tumor margins in oral cancer? Oral Oncol 50:221–227CrossRefPubMed

13.

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 49:586–592CrossRefPubMed

14.

Albrecht MH, Scholtz J-E, Hüsers 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 26:1863–1870CrossRefPubMed

15.

Zhao L, Li F, Zhang Z et al (2018) Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: feasibility of using low-concentration contrast medium. Eur Radiol 28:4379–4388CrossRefPubMed

16.

Rassouli N, Chalian H, Rajiah P, Dhanantwari A, Landeras L (2017) Assessment of 70-keV virtual monoenergetic spectral images in abdominal CT imaging: a comparison study to conventional polychromatic 120-kVp images. Abdom Radiol (NY) 42:2579–2586CrossRef

17.

Bellini D, Gupta S, Ramirez-Giraldo JC et al (2017) Use of a noise optimized monoenergetic algorithm for patient-size independent selection of an optimal energy level during dual-energy CT of the pancreas. J Comput Assist Tomogr 41:39–47CrossRefPubMed

18.

Mangold S, Cannaó PM, Schoepf UJ et al (2016) Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study. Eur Radiol 26:1871–1878CrossRefPubMed

19.

Muenzel D, Lo GC, Yu HS et al (2017) Material density iodine images in dual-energy CT: detection and characterization of hypervascular liver lesions compared to magnetic resonance imaging. Eur J Radiol 95:300–306CrossRefPubMed

20.

Gordic S, Puippe GD, Krauss B et al (2016) Correlation between dual-energy and perfusion CT in patients with hepatocellular carcinoma. Radiology 280:78–87CrossRefPubMed

21.

McNamara MM, Little MD, Alexander LF, Van Carroll L, Beasley TM, Morgan DE (2015) Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas: complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT. Abdom Imaging 40:1230–1240CrossRefPubMed

22.

Parakh A, Patino M, Muenzel D, Kambadakone A, Sahani DV (2018) Role of rapid kV-switching dual-energy CT in assessment of post-surgical local recurrence of pancreatic adenocarcinoma. Abdom Radiol (NY) 43:497–504CrossRef

23.

George E, Wortman JR, Fulwadhva UP, Uyeda JW, Sodickson AD (2017) Dual energy CT applications in pancreatic pathologies. Br J Radiol 90:20170411CrossRefPubMedPubMedCentral

24.

Behrendt FF, Schmidt B, Plumhans C et al (2009) Image fusion in dual energy computed tomography: effect on contrast enhancement, signal-to-noise ratio and image quality in computed tomography angiography. Invest Radiol 44:1–6CrossRefPubMed

Title: Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma
Authors: Lucian Beer
Michael Toepker
Ahmed Ba-Ssalamah
Christian Schestak
Anja Dutschke
Martin Schindl
Alexander Wressnegger
Helmut Ringl
Paul Apfaltrer
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: European Radiology / Issue 7/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06116-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 7/2019

The best predictor of ischemic coronary stenosis: subtended myocardial volume, machine learning–based FFRCT, or high-risk plaque features?

A radiomics approach to predict lymph node metastasis and clinical outcome of intrahepatic cholangiocarcinoma

Deep learning for liver tumor diagnosis part I: development of a convolutional neural network classifier for multi-phasic MRI

An analysis of 11.3 million screening tests examining the association between recall and cancer detection rates in the English NHS breast cancer screening programme

Increased volumes of mildly elevated capillary transit time heterogeneity positively predict favorable outcome and negatively predict intracranial hemorrhage in acute ischemic stroke with large vessel occlusion

Normative volume measurements of the fetal intra-cranial compartments using 3D volume in utero MR imaging