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European Radiology
Published in: European Radiology 6/2021

Open Access 01-06-2021 | Computed Tomography | Computed Tomography

Evaluating anemia using contrast-enhanced spectral detector CT of the chest in a large cohort of 522 patients

Authors: D. Zopfs, M. Rinneburger, D. Pinto dos Santos, R. P. Reimer, K. R. Laukamp, D. Maintz, S. Lennartz, N. Große Hokamp

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

The blood of patients with anemia demonstrates distinctly lower attenuation in unenhanced CT images. However, the frequent usage of intravenous contrast hampers evaluation of anemia. Spectral detector computed tomography (SDCT) allows for reconstruction of virtual non-contrast images (VNC) from contrast-enhanced data (CE). The purpose of this study was to evaluate whether VNC allow for prediction of anemia.

Methods

Five hundred twenty-two patients with CE-SDCT of the chest and accessible serum hemoglobin (HbS) were retrospectively included. Patients were assigned to three groups (severe anemia, moderate/mild anemia, and healthy) based on recent lab tests (≤ 7 days) for HbS following gender and the WHO definition of anemia. CT attenuation was determined using two ROI in the left ventricular lumen and one ROI in the descending thoracic aorta. ROI were placed on CE and copied to VNC. ANOVA, linear regression, and receiver operating characteristics were used for statistic evaluation.

Results

Average HbS was 11.6 ± 2.4 g/dl. Attenuation on VNC showed significant differences between healthy patients, patients with mild/moderate anemia, and severely anemic patients (all p ≤ 0.05). Applying cutoffs of 39.2/37.6 HU and 33.6/32.7 HU allowed to differentiate between healthy, mild/moderately, and severely anemic men/women (AUC 0.857/0.833 and 0.879/0.932). A linear relationship between HbS and attenuation on VNC was established (r2 = 0.54, HbS = − 0.875 + 0.329 × HU).

Conclusions

An approximation of HbS and presence of anemia can be conducted based on simple attenuation measurements in contrast-enhanced SDCT examinations enabled by VNC imaging.

Key Points

• While the attenuation of blood is a previously described biomarker for anemia in non-contrast images, virtual non-contrast images from spectral detector CT circumvent this limitation and allow for diagnosis of anemia in contrast-enhanced scans.
• Attenuation of blood in virtual non-contrast images derived from spectral detector CT shows a moderate correlation to serum hemoglobin levels.
• Presence of anemia be estimated in virtual non-contrast images using proposed cutoffs of 39.2 HU and 37.6 HU for men and women, respectively, to differentiate between healthy and anemic patients.
Appendix
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Metadata
Title
Evaluating anemia using contrast-enhanced spectral detector CT of the chest in a large cohort of 522 patients
Authors
D. Zopfs
M. Rinneburger
D. Pinto dos Santos
R. P. Reimer
K. R. Laukamp
D. Maintz
S. Lennartz
N. Große Hokamp
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07497-y

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