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- Title
Virtual versus true non-contrast dual-energy CT imaging for the diagnosis of aortic intramural hematoma.
- Authors
Si-Mohamed, Salim; Dupuis, Nicolas; Tatard-Leitman, Valérie; Rotzinger, David; Boccalini, Sara; Dion, Matthias; Vlassenbroek, Alain; Coulon, Philippe; Yagil, Yoad; Shapira, Nadav; Douek, Philippe; Boussel, Loic
- Abstract
<bold>Purpose: </bold>To assess whether virtual non-contrast (VNC) images derived from contrast dual-layer dual-energy computed tomography (DL-DECT) images could replace true non-contrast (TNC) images for aortic intramural hematoma (IMH) diagnosis in acute aortic syndrome (AAS) imaging protocols by performing quantitative as well as qualitative phantom and clinical studies.<bold>Materials and Methods: </bold>Patients with confirmed IMH were included retrospectively in two centers. For in vitro imaging, a custom-made phantom of IMH was placed in a semi-anthropomorphic thorax phantom (QRM GmbH) and imaged on a DL-DECT at 120 kVp under various conditions of patient size, radiation exposure, and reconstruction modes. For in vivo imaging, 21 patients (70 ± 13 years) who underwent AAS imaging protocols at 120 kVp were included. In both studies, contrast-to-noise ratio (CNR) between hematoma and lumen was compared using a paired t test. Diagnostic confidence (1 = non-diagnostic, 4 = exemplary) for VNC and TNC images was rated by two radiologists and compared. Effective radiation doses for each acquisition were calculated.<bold>Results: </bold>In both the phantom and clinical studies, we observed that the CNRs were similar between the VNC and TNC images. Moreover, both methods allowed differentiating the hyper-attenuation within the hematoma from the blood. Finally, we obtained equivalent high diagnostic confidence with both VNC and TNC images (VNC = 3.2 ± 0.7, TNC = 3.1 ± 0.7; p = 0.3). Finally, by suppressing TNC acquisition and using VNC, the mean effective dose reduction would be 40%.<bold>Conclusion: </bold>DL-DECT offers similar performances with VNC and TNC images for IMH diagnosis without compromise in diagnostic image quality.<bold>Key Points: </bold>• Dual-layer dual-energy CT enables virtual non-contrast imaging from a contrast-enhanced acquisition. • Virtual non-contrast imaging with dual-layer dual-energy CT reduces the number of acquisitions and radiation exposure in acute aortic syndrome imaging protocol. • Dual-layer dual-energy CT has the potential to become a suitable imaging tool for acute aortic syndrome.
- Subjects
IN vitro studies; RESEARCH; RESEARCH evaluation; RESEARCH methodology; RETROSPECTIVE studies; EVALUATION research; DIAGNOSTIC imaging; COMPARATIVE studies; AORTIC intramural hematoma; COMPUTED tomography; IMAGING phantoms; SENSITIVITY &; specificity (Statistics); ALGORITHMS
- Publication
European Radiology, 2019, Vol 29, Issue 7, pN.PAG
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06322-5