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Virtual versus true non-contrast dual-energy CT imaging for the diagnosis of aortic intramural hematoma

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Abstract

Purpose

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.

Materials and methods

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.

Results

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%.

Conclusion

DL-DECT offers similar performances with VNC and TNC images for IMH diagnosis without compromise in diagnostic image quality.

Key Points

• 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.

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Abbreviations

AAS:

Acute aortic syndrome

CNR:

Contrast-to-noise ratio

CTA:

CT angiography

CTDIvol :

Volume CT dose index

DL-DECT:

Dual-layer dual-energy computed tomography

DLP:

Dose-length product

DS-DECT:

Dual-source dual-energy computed tomography

IMH:

Intramural hematoma

ROI:

Regions of interest

SD:

Standard deviations

TNC:

True non-contrast

VNC:

virtual non-contrast

WED:

Water-equivalent diameter

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Acknowledgments

We thank Pr. Emmanuel Coche, Dr. Begum Demirler, and Dr.Matteo Pozzi for helping with the clinical study.

Funding

This work has not received any funding.

Author information

Author notes

  1. Salim Si-Mohamed and Nicolas Dupuis contributed equally to this work.

Authors and Affiliations

  1. Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France

    Salim Si-Mohamed, Nicolas Dupuis, Valérie Tatard-Leitman, Matthias Dion, Philippe Douek & Loic Boussel

  2. Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France

    Salim Si-Mohamed, Nicolas Dupuis, Sara Boccalini, Matthias Dion, Philippe Douek & Loic Boussel

  3. Anatomy Lab, Rockefeller Faculty, Lyon Est, Lyon, France

    Nicolas Dupuis & Matthias Dion

  4. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital , Lausanne, Switzerland

    David Rotzinger

  5. CT Clinical Science, Best, Netherlands

    Alain Vlassenbroek

  6. CT Clinical Science, Philips, Suresnes, France

    Philippe Coulon

  7. Global Advanced Technologies, CT, Philips, Haifa, Israel

    Yoad Yagil & Nadav Shapira

Authors
  1. Salim Si-Mohamed
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Corresponding author

Correspondence to Salim Si-Mohamed.

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Guarantor

The scientific guarantor of this publication is Professor Loic Boussel.

Conflict of interest

Philippe Coulon, Yoad Yagil, and Nadav Shapira are employees of Philips Healthcare, the manufacturer of the scanner.

Statistics and biometry

Prof. Loic Boussel provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was not required.

Methodology

• Retrospective

• Observational

• Multicenter study

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Si-Mohamed, S., Dupuis, N., Tatard-Leitman, V. et al. Virtual versus true non-contrast dual-energy CT imaging for the diagnosis of aortic intramural hematoma. Eur Radiol 29, 6762–6771 (2019). https://doi.org/10.1007/s00330-019-06322-5

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  • DOI: https://doi.org/10.1007/s00330-019-06322-5

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