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Spinal dual-energy computed tomography: improved visualisation of spinal tumorous growth with a noise-optimised advanced monoenergetic post-processing algorithm

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

The aim of this study was to evaluate the effect of advanced monoenergetic post-processing (MEI+) on the visualisation of spinal growth in contrast-enhanced dual-energy CT (DE-CT).

Methods

Twenty-six oncologic patients (age, 61 ± 17 years) with spinal tumorous growth were included. Patients underwent contrast-enhanced dual-energy CT on a third-generation dual-source CT scanner. Image acquisition was in dual-energy mode (100/Sn150kV), and scans were initiated 90 s after contrast agent administration. Virtual monoenergertic images (MEI+) were reconstructed at four different kiloelectron volts (keV) levels (40, 60, 80, 100) and compared to the standard blended portal venous computed tomography (CTpv). Image quality was assessed qualitatively (conspicuity, delineation, sharpness, noise, confidence; two independent readers; 5-point Likert scale; 5 = excellent) and quantitatively by calculating signal-to-noise (SNR) and contrast-to-noise-ratios (CNR). For a subgroup of 10 patients with MR imaging within 4 months of the DE-CT, we compared the monoenergetic images to the MRIs qualitatively.

Results

Highest contrast of spinal growth was observed in MEI+ at 40 keV, with significant differences to CTpv and all other keV reconstructions (60, 80, 100; p < 0.01). Highest conspicuity, delineation and sharpness were observed in MEI+ at 40 keV, with significant differences to CTpv (p < 0.001). Similarly, MEI+ at 40 keV yielded highest diagnostic confidence (4.6 ± 0.6), also with significant differences to CTpv (3.45 ± 0.9, p < 0.001) and to high keV reconstructions (80, 100; p ≤ 0.001). Similarly, CNR calculations revealed highest scores for MEI+ at 40 keV followed by 60 keV and CTpv, with significant differences to high keV MEI+ reconstructions. Qualitative analysis scores peaked for MR images followed by the MEI+ 40-keV reconstructions.

Conclusion

MEI+ at low keV levels can significantly improve image quality and delineation of spinal growth in patients with portal-venous phase CT scans due to increased CNR and limited image noise.

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Abbreviations

MEI+:

Advanced monoenergetic post-processing

CTpv :

Blended portal venous computed tomography

CNR:

Contrast-to-noise-ratios

DE-CT:

Dual-energy CT

HU:

Hounsflied Unit

ROI:

Regions of interest [17]

rm-ANOVA:

Repeated-measures-ANOVA

SNR:

Signal-to-noise

SD:

Standard deviation

MEI, #5:

Virtual monoenergetic imaging

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Mareen Kraus, Jakob Weiss, Nadja Selo, Mike Notohamiprodjo, Fabian Bamberg, Konstantin Nikolaou & Ahmed E. Othman

  2. Siemens Healthcare GmbH, Erlangen, Germany

    Thomas Flohr

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  1. Mareen Kraus
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Correspondence to Ahmed E. Othman.

Ethics declarations

We declare that all human studies have been approved by the local ethics committee at the University Hospital Tübingen and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Due to the retrospective nature of this study, the ethics committee waived informed patient consent.

Conflict of interest

TF is an Employee of Siemens Healthcare GmbH.

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Kraus, M., Weiss, J., Selo, N. et al. Spinal dual-energy computed tomography: improved visualisation of spinal tumorous growth with a noise-optimised advanced monoenergetic post-processing algorithm. Neuroradiology 58, 1093–1102 (2016). https://doi.org/10.1007/s00234-016-1733-7

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