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European Radiology
Published in: European Radiology 6/2018

01-06-2018 | Gastrointestinal

Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease

Authors: Sang Min Lee, Se Hyung Kim, Su Joa Ahn, Hyo-Jin Kang, Ji Hee Kang, Joon Koo Han

Published in: European Radiology | Issue 6/2018

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Abstract

Objectives

To determine the optimal keV on dual-layer, dual-energy CT enterography (dlDE-CTE) and to investigate the added value of virtual monoenergetic images (VMIs) for the diagnosis of active Crohn’s disease (CD).

Methods

We collected 76 patients (including 45 CD patients) who underwent dlDE-CTE. CD was diagnosed using ileocolonoscopy. Conventional polychromatic images (PCI) were reconstructed using an iterative reconstruction algorithm at 120 kVp, and VMI at 40 keV (VMI40), 55 keV (VMI55), and 70 keV (VMI70). Contrast-to-noise ratio (CNR) was compared using Kruskal-Wallis test. Three radiologists independently reviewed PCI and subsequently combined PCI and the optimized VMI for the diagnosis of active CD using a 5-point scale. Multi-reader multi-case receiver operating characteristic analysis was performed.

Results

Mean ± standard deviation of CNRs for both normal (13.6±6.5, 6.1±3.2, 2.0±2.1, 1.9±1.6; P<0.001) and abnormal (9.4±7.3, 6.5±4.8, 4.9±3.1, 3.7±2.3; P<0.001) bowels were significantly greatest on VMI40, followed by VMI55, VMI70, and PCI. When VMI40 were added to PCI, overall area-under-the-curve of the three radiologists was significantly improved from 0.891 to 0.951 for diagnosing active CD (P=0.009).

Conclusions

The lowest monoenergetic images (VMI40) provided the best CNR on dlDE-CTE. Furthermore, the diagnostic performance for diagnosing active CD can be significantly improved with the addition of VMI40.

Key Points

• CNR for both normal and abnormal bowel walls is greatest on VMI 40 .
• Subjective image quality on VMI 40 is better than those on PCI.
• When VMI 40 images are added to PCI, radiologists’ diagnostic performance can be improved.
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Metadata
Title
Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease
Authors
Sang Min Lee
Se Hyung Kim
Su Joa Ahn
Hyo-Jin Kang
Ji Hee Kang
Joon Koo Han
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5215-z

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