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Open Access 01-05-2021 | Magnetic Resonance Imaging | Hepatobiliary-Pancreas

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

Authors: R. P. Reimer, N. Große Hokamp, A. Fehrmann Efferoth, A. Krauskopf, D. Zopfs, J. R. Kröger, T. Persigehl, D. Maintz, A. C. Bunck

Published in: European Radiology | Issue 5/2021

Abstract

Objectives

To investigate whether the increased soft tissue contrast of virtual monoenergetic images (VMIs) obtained from a spectral detector computed tomography (SDCT) system improves washout assessment of arterially hyper-enhancing liver lesions.

Methods

Fifty-nine arterially hyper-enhancing lesions in 31 patients (age 65 ± 9 years, M/W 20/11) were included in this IRB-approved study. All patients underwent multi-phase SDCT for HCC screening. MRI, CEUS or biopsy within 3 months served as standard of reference to classify lesions as LiRADS 3 or 4/5. VMIs and conventional images (CIs) were reconstructed. Visual analysis was performed on 40, 60, and 80 kiloelectronvolt (keV) and CIs by 3 radiologists. Presence and visibility of washout were assessed; image quality and confidence of washout evaluation were evaluated on 5-point Likert scales. Signal-to-noise ratio (SNR), lesion-to-liver contrast-to-noise ratio (CNR) (|HU_lesion–HU_liver|/SD_liver) and washout (|HU_lesion–HU_liver|) were calculated. Statistical assessment was performed using ANOVA and Wilcoxon test.

Results

On subjective lesion analysis, the highest level of diagnostic confidence and highest sensitivity for the detection of lesion washout were found for 40-keV VMIs (40 keV vs. CI, 81.3 vs. 71.3%). Image quality parameters were significantly better in low-kiloelectronvolt VMIs than in CIs (p < 0.05; e.g. SNR_liver: 40 keV vs. CIs, 12.5 ± 4.1 vs. 5.6 ± 1.6). In LiRADS 4/5 lesions, CNR and quantitative washout values were significantly higher in 40-keV VMIs compared to CIs (p < 0.05; e.g. CNR and washout in 40 keV vs. CIs, 2.3 ± 1.6 vs. 0.8 ± 0.5 and 29.0 ± 19.1 vs. 12.9 ± 6.9 HU, respectively).

Conclusion

By increasing lesion contrast, low-kiloelectronvolt VMIs obtained from SDCT improve washout assessment of hyper-enhancing liver lesions with respect to washout visibility and diagnostic confidence.

Key Points

• Low-kiloelectronvolt virtual monoenergetic images from spectral detector CT facilitate washout assessment in arterially hyper-enhancing liver lesions.

• Image quality and quantitative washout parameters as well as subjective washout visibility and diagnostic confidence benefit from low-kiloelectronvolt virtual monoenergetic images.

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Title: Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions
Authors: R. P. Reimer
N. Große Hokamp
A. Fehrmann Efferoth
A. Krauskopf
D. Zopfs
J. R. Kröger
T. Persigehl
D. Maintz
A. C. Bunck
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Computed Tomography
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: European Radiology / Issue 5/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07379-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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