Improved Conspicuity of Abdominal Lesions with Single-Source Dual-Energy MDCT Hadassah Hebrew University Medical Center Jerusalem, Israel Ruth Eliahou MD, Jacob Sosna, MD AFIIM 2008
1972 – First single slice CT 2005 – Single-Source Dual-Energy MDCT
3 KV Intensity Pre-patient Beam filtration Low-Energy X-ray radiation High-Energy X-ray radiation Spectrum Decomposition Principle: Photons in the x ray beam of the CT scanner have different energies
X-Rays SCINT2 SCINT1 E1 E2 64 detectors PHILIPS Brilliance CT Prototype 32 detectors for low energy 32 detectors for high energy Dual-Energy CT
low energy image high energy image combined image Each scan creates 3 types of images:
Every pixel has 2 HU values – for high & low energy -986/ / / / / / /147
Dual-Energy CT main advantages: Separation Contrast
A separation line can be calculated each material has a different separation line
Materials Separation 1. Iodine 2, Oil 3. 20% oil 5. Calcium 4. Barium 6. Gadolinium 7. Cis Platinum 8. Water 1. Iodine Avg: 319 2, Oil Avg: % oil Avg: Calcium Avg Barium Avg Gadolinium Avg Cis Platinum Avg Water Avg 1.3
Dual-Energy CT main advantages: Separation Contrast
CT density of tissues is the result of interactions between x-ray photons and tissues: Compton scattering Photoelectric effect Dual-Energy Imaging At Low Voltage: Photoelectric effect is increased Compton scattering is decreased Contrast is improved higher attenuation readings of iodine are obtained
Purpose To quantitatively and qualitatively evaluate lesion conspicuity & Contrast to Noise ratio of abdominal lesions with DECT.
Materials and Methods A prospective study (9 / 2006 – 2 / 2008) Each patient signed an informed consent All studies were clinically indicated Study population: 23 patients Average age 58 years (range 36-86)
Materials and Methods CT parameters 2-3mm slice thickness mm increment 140 kVp mAs 100 cc of nonionic contrast cc/sec Regions-of-interest (ROI) were drawn on the lesion evaluated and the adjacent organ
Contrast-to-Noise Ratio CNR was defined as the difference in attenuation between the lesion and the organ, divided by the air SD for both the low-energy and regular CT images (for fixed ROI)
HU lesion – HU organ SD air CNR =
Lesion Contrast Qualitative Assessment Low energy and regular CT images were visually compared using the same window Lesion conspicuity was graded on a predetermined scale No difference = 0 Significant change = 3
Results 37 lesions 27 solid 10 cystic Organs 14 kidney 12 liver 5 ovary 4 lymph nodes 2 fluid collections
Results Improved CNR was noted for both lesion types Solid lesion CNR 2.11 (SD=0.4) with low energy 1.76 (SD=0.26) for regular CT (p<0.01) Cystic lesion CNR 8.24 (SD=0.64) with low energy 7.58 (SD=0.46) for regular CT (p<0.03)
Results On visual inspection Low energy 2.1 for conspicuity & lesion-to-organ contrast, solid lesions 2.4 for cystic lesions Regular CT 1.8 for conspicuity & lesion-to-organ contrast, solid lesions 2.05 for cystic lesions
Results CombinedLow Energy
Results CombinedLow Energy
So, If better lesion conspicuity Why not scan with low kV all the time ? Noisy image, Data may be lost!
Conclusions Improved conspicuity of solid and cystic abdominal and pelvic lesions on low energy images obtained using single-source dual-energy MDCT May enable earlier detection of small lesions and improved diagnosis of neoplastic processes
Work in Progress Digital Subtraction (electronic cleansing) of tagged stool in computed tomographic colonography based on the Dual energy imaging separation capabilities
Our CTC Study: Aim: To compare prep- less dual energy CTC with OC for evaluation of colorectal polyps Hypothesis: Dual Energy prep- less CTC can: reliably detect polyps ≥ 10 mm Superior digital cleansing
Study design: 100 high risk patients Will be referred by gastroenterologists to research fellow for preparation guidelines CTC will be performed and analyzed 3 wks later, OC with video taping will be performed with segmental unblinding as a gold standard