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• The algorithm developed was applied prospectively in patients to check its validity. • The present study was divided into ex vivo and in vivo experiments. • Non-invasive characterization of calcium renal stones is quite useful in selecting suitable treatment modality. • This study introduces the concept of DECT based characterization of materials using effective atomic number (Z eff) and electron density(ρ e) Non-invasive DECT based characterization of renal stones using their effective atomic number (Z eff) and the electron density (ρe) in patients. This paper aims to develop a method for in-vivo characterization of renal stone. Differentiation of renal stones in-vivo especially sub types of calcium stones have very important advantage for better judgement of treatment modality. 50 extracted renal stones were scanned ex-vivo using dual energy CT scanner. A method was developed to characterize these renal stones using effective atomic number and electron density obtained from dual energy CT data. The method and formulation developed in ex-vivo experiments was applied in in-vivo study of 50 randomly selected patients of renal stones who underwent dual energy CT scan. The developed method was able to characterize Calcium Oxalate Monohydrate (COM) and the combination of COM and Calcium Oxalate Dihydrate (COD) stones non-invasively in patients with a sensitivity of 81% and 83%respectively. The method was also capable of differentiating Uric, Cystine and mixed stones with the sensitivity of 100, 100 and 85.71% respectively. The developed dual energy CT based method was capable of differentiating sub types of calcium stones which is not differentiable on single energy or dual energy CT images. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate the material decomposition (MD) techniques in rapid kVp switching dual-energy CT (rsDECT) for quantifying liver fat content in rats with nonalcoholic fatty liver.Materials and Methods: Fifty male Sprague-Dawley (SD) rats were divided into study group (n=37) and control group (n = 13) and underwent rsDECT examination at different intervals. All the data analysis was performed using AW4.7 workstation. The fat contents under the traditional fat(water), fat(blood), and fat(muscle) material decomposition (MD) images and the fat volume fraction (FVF) from the liver fat maps generated using multi-material decomposition (MMD) technique were measured. The pathological grades (grade 0, 1, 2 and 3) of fatty liver were determined after euthanasia. The measurement differences among different grades and the correlation of measurements with different grades was analyzed using ANOVA and Spearman correlation, respectively. A receiver operating characteristics (ROC) curve was used to analyze the diagnostic efficacies of fat contents and FVF.Results: There were statistically significant differences in FVF and fat contents under fat(water), fat(blood), fat(muscle) based MD images among different grades. These values correlated well with the pathological grades (R-value: 0.90, 0.75, 0.79, 0.80, all p <0.001), with FVF having the highest correlation. The area-under-the-curve in ROC of using FVF was the highest, with the cut-off value of 0.92 for sensitivity of 89.2% and specificity of 100%.Conclusion: The rsDECT MD techniques could quantitatively evaluate the fat content of fatty liver in rat, with the FVF from MMD having the highest correlation with pathological grades. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To compare dual energy CT (DECT) quantitative metrics and radiomics for differentiating benign and malignant pancreatic lesions on contrast enhanced abdomen CT.Materials and Methods: Our study included 103 patients who underwent contrast-enhanced DECT for assessing focal pancreatic lesions at one of the two hospitals (Site A: age 68 ± 12 yrs; malignant = 41, benign = 18; Site B: age 46 ± 2 yrs; malignant = 23, benign = 21). All malignant lesions had histologic confirmation, and benign lesions were stable on follow up CT (>12 months) or had characteristic benign features on MRI. Arterial-phase, low- and high-kV DICOM images were processed with the DECT Tumor Analysis (DETA) to obtain DECT quantitative metrics such as HU, iodine and water content from a region of interest (ROI) over focal pancreatic lesions. Separately, we obtained DECT radiomics from the same ROI. Data were analyzed with multiple logistic regression and receiver operating characteristics to generate area under the curve (AUC) for best predictive variables.Results: DECT quantitative metrics and radiomics had AUCs of 0.98-0.99 at site A and 0.89-0.94 at site B data for classifying benign and malignant pancreatic lesions. There was no significant difference in the AUCs and accuracies of DECT quantitative metrics and radiomics from lesion rims and volumes among patients at both sites (p > 0.05). Supervised learning-based model with data from the two sites demonstrated best AUCs of 0.94 (DECT radiomics) and 0.90 (DECT quantitative metrics) for characterizing pancreatic lesions as benign or malignant.Conclusion: Compared to complex DECT radiomics, quantitative DECT information provide a simpler but accurate method of differentiating benign and malignant pancreatic lesions. [ABSTRACT FROM AUTHOR]

Radiologists play a key role in the management of trauma patients. With the improvement of computed tomography (CT), radiologist makes an important contribution to the timely diagnosis of trauma-related findings and the choice of the most suitable treatment, improving patient outcomes. It is important to select the most appropriate imaging technique, which in the trauma patient is CT, and especially the most appropriate CT protocol, to correctly characterize trauma injuries. Currently, there is no agreement on what the optimal protocol is, acquisition times and number of contrast enhanced phases are not standardized. This is a review of the most recent literature on optimizing the CT protocol in polytrauma, with the intent of giving a useful tool for radiologists in the management of trauma patients. [ABSTRACT FROM AUTHOR]

• A simulation-based method was proposed to predict stopping power ratio (SPR). • The practical error in SPR was evaluated using an ICRP110 human phantom. • kV-MV dual-energy CT can provide more accurate predictions than kV-kV dual-energy CT. Purpose: This study aims to estimate the proton stopping power ratio (SPR) by using 80–120 kV and 120 kV–6 MV dual-energy CT (DECT) in a fully simulation-based approach for proton therapy dose calculations. Methods: Based on a virtual CT system, a two-step approach is applied to obtain the reference attenuation coefficient for image reconstruction. The effective atomic number (EAN) and electron density ratio (EDR) are estimated from two CT scans. The SPR is estimated using a calibration based on known materials to obtain a piecewise linear relationship between the EAN and the logarithm of the mean excitation energy, ln I m . The calibration phantoms are constructed from reference tissue materials taken from ICRU Report 44. Our approach is evaluated through using the ICRP110 human phantom. The respective influences of noise and beam hardening effects are studied. Results: With the beam hardening correction applied, the results of 120 kV–6 MV DECT are comparable to those of 80–120 kV DECT in predicting the EAN, but the former demonstrated a clear improvement in predicting the EDR and SPR. The 120 kV–6 MV DECT is able to predict the SPR within an accuracy of 10% for lung tissue and 5% for pelvis tissue, thereby outperforming the 80–120 kV DECT. Conclusions: The 120 kV–6 MV DECT is less sensitive to noise but more susceptible to beam hardening effects. By applying beam hardening correction, the 120 kV–6 MV DECT can predict the SPR more accurately than the 80–120 kV DECT. To utilize our DECT approach most effectively, high-quality reconstructed images are required. [ABSTRACT FROM AUTHOR]

• In-plane spatial resolution degrades at a lower image contrast. • In-plane spatial resolution degrades with increasing focal spot size. • Image noise increases in high resolution mode. • Noise texture is altered among standard, high resolution and dual energy modes. • Detectability degrades with increasing focal spot size. To assess the task-based performance of images obtained under different focal spot size and acquisition mode on a dual-energy CT scanner. Axial CT image series of the Catphan phantom were obtained using a tube focus at different sizes. Acquisitions were performed in standard single-energy, high resolution (HR) and dual-energy modes. Images were reconstructed using conventional and high definition (HD) kernels. Task-based transfer function at the 50% level (TTF 50%) for teflon, delrin, low density polyethylene (LDPE) and acrylic, as well as image noise and noise texture, were assessed across all focal spots and acquisition modes using Noise Power Spectrum (NPS) analysis. A non-prewhitening mathematical observer model was used to calculate detectability index (d NPW ′). TTF 50% degraded with increasing focal spot size. TTF 50% ranged from 0.67 mm−1 for teflon to 0.25 mm−1 for acrylic. For standard kernel, image noise and NPS-determined average spatial frequency were 8.3 HU and 0.29 mm−1, respectively in single-energy, 12.0 HU and 0.37 mm−1 in HR, and 7.9 HU and 0.26 mm−1 in dual-energy mode. For standard kernel, d NPW ′ was 61 in single-energy and HR mode and reduced to 56 in dual-energy mode. The task-based image quality assessment metrics have shown that spatial resolution is higher for higher image contrast materials and detectability is higher in the standard single-energy mode compared to HR and dual-energy mode. The results of the current study provide CT operators the required knowledge to characterize their CT system towards the optimization of its clinical performance. [ABSTRACT FROM AUTHOR]

• A dual source CT (DSCT) is a CT system with two x-ray tubes and two detectors at an angle of approximately 90°. • DSCT provides temporal resolution of approximately a quarter of the gantry rotation time. • Clinically robust imaging of the heart and the coronary arteries at high and variable heart rates has been demonstrated. • DSCT enables high-pitch scanning and dual energy CT at improved spectral separation by filtration of the high-kV beam. • DSCT has to cope with some challenges, among them cross-scattered radiation. This article describes the technical principles and clinical applications of dual source CT. A dual source CT (DSCT) is a CT system with two x-ray tubes and two detectors at an angle of approximately 90°. Both measurement systems acquire CT scan data simultaneously at the same anatomical level of the patient (same z-position). DSCT provides temporal resolution of approximately a quarter of the gantry rotation time for cardiac, cardio-thoracic and pediatric imaging. Successful imaging of the heart and the coronary arteries at high and variable heart rates has been demonstrated. DSCT systems can be operated at twice the spiral pitch of single source CT systems (up to pitch 3.2). The resulting high table speed is beneficial for pediatric applications and fast CT angiographic scans, e. g. of the aorta or the extremities. Operating both X-ray tubes at different tube potential (kV) enables the acquisition of dual energy data and the corresponding applications such as monoenergetic imaging and computation of material maps. Spectral separation can be improved by different filtration of the X-ray beams of both X-ray tubes. As a downside, DSCT systems have to cope with some challenges, among them the limited size of the second measurement system, and cross-scattered radiation. [ABSTRACT FROM AUTHOR]

• An overall improvement in image quality was obtained for the 70 keV PMR. • iMAR method provided best reduction of metal artefacts observed on CT. • Combining the 70 keV PMR with the iMAR bring benefits for CT use in RT. To evaluate the use of pseudo-monoenergetic reconstructions (PMR) from dual-energy computed tomography, combined with the iterative metal artefact reduction (iMAR) method. Pseudo-monoenergetic CT images were obtained using the dual-energy mode on the Siemens Somatom Definition AS scanner. A range of PMR combinations (70–130 keV) were used with and without iMAR. A Virtual Water™ phantom was used for quantitative assessment of error in the presence of high density materials: titanium, alloys 330 and 600. The absolute values of CT number differences (AD) and normalised standard deviations (NSD) were calculated for different phantom positions. Image quality was assessed using an anthropomorphic pelvic phantom with an embedded hip prosthesis. Image quality was scored blindly by five observers. AD and NSD values revealed differences in CT number errors between tested sets. AD and NSD were reduced in the vicinity of metal for images with iMAR (p < 0.001 for AD/NSD). For ROIs away from metal, with and without iMAR, 70 keV PMR and pCT AD values were lower than for the other reconstructions (p = 0.039). Similarly, iMAR NSD values measured away from metal were lower for 130 keV and 70 keV PMR (p = 0.002). Image quality scores were higher for 70 keV and 130 keV PMR with iMAR (p = 0.034). The use of 70 keV PMR with iMAR allows for significant metal artefact reduction and low CT number errors observed in the vicinity of dense materials. It is therefore an attractive alternative to high keV imaging when imaging patients with metallic implants, especially in the context of radiotherapy planning. [ABSTRACT FROM AUTHOR]

• Measurement of %Stenosis in single energy cardiac CT is considerably overestimated. • Dual energy cardiac CT provides images that are less affected by cardiac motion. • The detail reconstruction kernel provides a more accurate assessment of %Stenosis. • Effective dose in dual energy cardiac CT is lower than in routine gated acquisition. To investigate the effects of heart beat rate (bpm), vessel angulation and acquisition protocol on the estimation accuracy of calcified stenosis using a dual-energy CT scanner. A thorax semi-anthropomorphic phantom coupled with a motion simulator and a vessel phantom representing a 50% coronary artery calcified stenosis, were used. Electrocardiograph (ECG)-synchronized acquisitions were performed at different bpms. Acquisitions were performed using A, B, and C single-energy and D dual-energy protocols. Protocol A was prospective ECG-triggered axial and protocols B and C were retrospective single- and two-segment reconstruction ECG-gated helical acquisitions. Protocol D was prospective ECG-triggered axial acquisition. The vessel phantom was placed at two angulations relative to z-axis. Images were reconstructed using all available kernels with iterative reconstruction. Stenosis-percentage was estimated using the CT vendor's vessel analysis tool. Effective dose (ED) was estimated using the dose-length product method. In protocols A, B, and C, measured Stenosis-percentage increased with bpm. Stenosis-percentage estimate ranged from 56.8% at 40 bpm to 62.6% at 100 bpm. In protocol D, Stenosis-percentage ranged from 59.3% at 40 bpm to 54.8% at 80 bpm. Stenosis-percentage was overestimated on respect to the nominal value in most kernels. The detail kernel exhibited the highest accuracy. Stenosis-percentage was not affected by the vessel angulation. ED for protocols A, B, C, and D was 2.4 mSv, 5.1 mSv, 5.5 mSv, and 2.8 mSv, respectively. Use of the dual-energy cardiac CT examination protocol along with the detail kernel is recommended for a more accurate assessment of Stenosis-percentage. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To define an optimal monoenergetic extrapolation (ME) in dual-energy computed tomography (DECT) for metal artifact reduction (MAR) including different body regions and orthopedic implants.Material and Methods: DECT scans were acquired with dual-source CT (SOMATOM Force, Siemens, Germany) at tube voltage A 80-100 kV/B Sn150 kV from 39 patients (mean 54.1 ± 20.7 years, 23 male vs. 16 female) with orthopedic implants ranging from wires to joint implants. Scans were assembled in four groups based on scan regions and volume. Single- and weighted-energy images at a ratio of 0.3 and MEs at 100, 130, 160, and 190 keV were produced using vendor-specific postprocessing software (Syngo.Via, Siemens, Germany). Artifact degree was assessed quantitatively by metal-induced Hounsfield unit changes in relation to reference tissues. Visibility of screw-bone interface, hardware integrity, adjacent bone, and soft tissues were visually rated on a four-point Likert scale (0, none; 3, strong artifacts with nondiagnostic quality). Optimal energy was visually determined by side-by-side comparisons. Artifact degree was statistically compared between regions and energies.Results: Metal-induced attenuation changes were most severe in large scan volume groups for all energies. Reference tissue attenuation outside metal artifacts was not affected by ME (p = 0.57). Independent of region, ME at 130-190 keV quantitatively performed significantly better for MAR than the remainder. ME 130 keV showed the highest frequency (54%) in optimal energy ratings based on qualitative image criteria.Conclusion: DECT significantly reduces image artifacts in patients with orthopedic hardware and prospective choice of ME at 130 keV may suit best for optimal MAR, independent of region or implant. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To investigate the value of using rapid kVp switching dual energy computed tomography (rsDECT) for the multi-parameter analysis of the heterogeneity of fatty liver in rat.Materials and Methods: Twenty-four male rats were randomly divided into experimental (n = 16) and control (n = 8) groups. Four rats in the experimental group and two in the control group were examined by rsDECT every 3 weeks starting from week 8. The liver fat contents (LFC) of the left and right liver lobes were measured on the fat(water)-based material decomposition images to calculate fat content and CT value of liver and spleen were measured on the 70keV monochromatic images to calculate the liver-to-spleen CT value ratio [(L/S)70 keV] and difference at 70keV[(L-S)70 keV], and the spectral curve slopes of the left and right liver lobes (Slope-L, Slope-R). Measurements were evaluated statistically.Results: The statistical analysis showed that the (L/S)70 keV, (L-S)70 keV, Slope and LFC in the different fatty liver groups were all significantly different (p < 0.05). Pearson correlation analysis results showed that the rsDECT results of the left and right liver lobes correlated with the fat percentage from pathological analysis (p < 0.05), with the left liver lobe having better correlation. Paired t-tests showed that the fat percentage of the left liver lobe was significantly higher than that of the right one, while (L/S)70 keV, and (L-S)70 keV were significantly lower. Diagnostic analysis using ROC curve showed that the areas under the curves with parameters of the left liver lobe were also greater than those of the right liver lobe.Conclusion: rsDECT multi-parameter imaging could quantitatively evaluate the heterogeneity of fat deposition in the liver, providing valuable information for the accurate and effective assessment of the heterogeneity of fatty liver. [ABSTRACT FROM AUTHOR]

Abstract ObjectiveTo assess the feasibility of dual energy CT (DECT) to derive myocardial extracellular volume (ECV) and detect myocardial ECV differences without a non-contrast acquisition, compared to single energy CT (SECT). MethodsSubjects (n = 35) with focal fibrosis (n = 17), diffuse fibrosis (n = 10), and controls (n = 9) underwent non-contrast and delayed acquisitions to calculate SECT-ECV. DECT-ECV was calculated using the delayed acquisition and the derived virtual non-contrast images. In the control and diffuse fibrotic groups, the entire myocardium of the left ventricle was used to calculate ECV. Two ROIs were placed in the focal fibrotic group, one in normal and one in fibrotic myocardium. ResultsMedian ECV was 33.4% (IQR, 30.1–37.4) using SECT and 34.9% (IQR, 31.2–39.2) using DECT (p = 0.401). For both techniques, focal and diffuse fibrosis had significantly higher ECV values (all p < 0.021) than normal myocardium. There was no systematic bias between DECT and SECT (p = 0.348). SECT had a higher radiation dose (1.1 mSv difference) than DECT (p < 0.001). ConclusionECV can be measured using a DECT approach with only a delayed acquisition. The DECT approach provides similar results at a lower radiation dose compared to SECT. [ABSTRACT FROM AUTHOR]

Purpose In this study non-calcified plaque composition is evaluated by Dual Energy CT (DECT). Energy Dispersive X-ray Spectroscopy (EDS) has been used to study the Plaque composition. An attempt has been made to explain the DECT results with EDS analysis. Methods Thirty-two ex-vivo human cadaver coronary artery samples were scanned by DECT and data was evaluated to calculate their effective atomic number and electron density (Z eff & ρ e ) by inversion method. Result of DECT was compared with pathology to assess their differentiating capability. The EDS study was used to explain DECT outcome. Results DECT study was able to differentiate vulnerable plaque from stable with 87% accuracy (area under the curve (AUC):0.85 [95% confidence interval {CI}:0.73–0.98}] and Kappa Coefficient (KC):0.75 with respect to pathology. EDS revealed significant compositional difference in vulnerable and stable plaque at p < .05. The weight percentage of higher atomic number elements like F, Na, Mg, S, Si, P, Cl, K and Ca was found to be slightly more in vulnerable plaques as compared to a stable plaque. EDS also revealed a significantly increased weight percentage of nitrogen in stable plaques. Conclusions The EDS results were able to explain the outcomes of DECT study. This study conclusively explains the physics of DECT as a tool to assess the nature of non-calcified plaques as vulnerable and stable. The method proposed in this study allows for differentiation between vulnerable and stable plaque using DECT. [ABSTRACT FROM AUTHOR]

The purpose of this study was to obtain the fraction by weight of the elemental composition and mass density of a humanoid tissue phantom that includes lung tissue, soft tissue, and bone tissue, by using dual energy computed tomography (DECT). The fraction by weight and the mass density for tissue-equivalent materials were calculated by means of a least-squares method with a linear attenuation coefficient, using monochromatic photon energies of 10–140 keV, as obtained from DECT. The accuracy of calculated values for the fractions by weight of H (hydrogen), C (carbon), N (nitrogen), and O (oxygen) as verified by comparing the values with those that were analyzed using the combustion technique. The fraction by weight for other elements was confirmed by comparing with the analyzed values by means of energy dispersive photon spectroscopy. The calculated mass densities for each tissue were compared with those that were obtained by dividing the weight by volume. The calculated values of the fraction by weight that were obtained by means of DECT had differences of 1.9%, 9.2%, 6.6%, 7.8%, 0.8%, and 0.2% at a maximum for H, C, N, O, P (phosphorus), and Ca (calcium), respectively, from the reference values analyzed by the combustion technique and energy dispersive photon spectroscopy. The difference in the mass density for tissue was 0.011 g/cm 3 at a maximum. This study demonstrated the fraction by weight and the mass density of the humanoid tissue-equivalent materials that were calculated by means of DECT were expected high accuracy. [ABSTRACT FROM AUTHOR]

Objectives Late contrast enhancement visualizes myocardial infarction, but the contrast to noise ratio (CNR) is low using conventional CT. The aim of this study was to determine if spectral CT can improve imaging of myocardial infarction. Materials and Methods A canine model of myocardial infarction was produced in 8 animals (90-min occlusion, reperfusion). Later, imaging was performed after contrast injection using CT at 90 kVp/150 kVpSn. The following reconstructions were evaluated: Single energy 90 kVp, mixed, iodine map, multiple monoenergetic conventional and monoenergetic noise optimized reconstructions. Regions of interest were measured in infarct and remote regions to calculate contrast to noise ratio (CNR) and Bhattacharya distance (a metric of the differentiation between regions). Blinded assessment of image quality was performed. The same reconstruction methods were applied to CT scans of four patients with known infarcts. Results For animal studies, the highest CNR for infarct vs. myocardium was achieved in the lowest keV (40 keV) VMo images (CNR 4.42, IQR 3.64–5.53), which was superior to 90 kVp, mixed and iodine map (p = 0.008, p = 0.002, p < 0.001, respectively). Compared to 90 kVp and iodine map, the 40 keV VMo reconstructions showed significantly higher histogram separation (p = 0.042 and p < 0.0001, respectively). The VMo reconstructions showed the highest rate of excellent quality scores. A similar pattern was seen in human studies, with CNRs for infarct maximized at the lowest keV optimized reconstruction (CNR 4.44, IQR 2.86–5.94). Conclusions Dual energy in conjunction with noise-optimized monoenergetic post-processing improves CNR of myocardial infarct delineation by approximately 20–25%. [ABSTRACT FROM AUTHOR]

Background To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. Methods 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA. Diagnostic performance for identifying patients at risk of dying was evaluated using ROC analysis. All-cause mortality was assessed via the hospital electronic medical records and/or consultation of the patient or the patient's primary care physician via phone call interviews. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve (AUC) were determined for PDvol (volume of perfusion defects/total lung volume), transverse right ventricular to left ventricular diameter ratios (RV/LV) and for the combination of both tests. Results Mortality was 38% within the investigated time period of 6 months. Patients who died had significantly higher PDvol (PDvol 28 ± 13% vs. 19 ± 12%, p < 0.001) and a non-significant difference in transverse RV/LV ratio (1.14 ± 0.37 vs. 1.06 ± 0.22, p = 0.159). The AUC was 0.71 for PDvol, 0.53 for RV/LV ratio, and 0.67 for the combination of PDvol and RV/LV ratio. PDvol remained a significant predictor after correcting for age. Conclusions In the absence of thromboembolic clots, PDvol at DE-CTA appears to be predictive for all cause mortality. [ABSTRACT FROM AUTHOR]

Introduction Many studies aimed at validating the application of Dual Energy Computed Tomography (DECT) in clinical practice where conventional CT is not exhaustive. An example is given by bone marrow oedema detection, in which DECT based on water/calcium (W/Ca) decomposition was applied. In this paper a new DECT approach, based on water/cortical bone (W/CB) decomposition, was investigated. Materials and methods Eight patients suffering from marrow oedema were scanned with MRI and DECT. Two-materials density decomposition was performed in ROIs corresponding to normal bone marrow and oedema. These regions were drawn on DECT images using MRI informations. Both W/Ca and W/CB were considered as material basis. Scatter plots of W/Ca and W/CB concentrations were made for each ROI in order to evaluate if oedema could be distinguished from normal bone marrow. Thresholds were defined on the scatter plots in order to produce DECT images where oedema regions were highlighted through color maps. The agreement between these images and MR was scored by two expert radiologists. Results For all the patients, the best scores were obtained using W/CB density decomposition. Conclusions In all cases, DECT color map images based on W/CB decomposition showed better agreement with MR in bone marrow oedema identification with respect to W/Ca decomposition. This result encourages further studies in order to evaluate if DECT based on W/CB decomposition could be an alternative technique to MR, which would be important when short scanning duration is relevant, as in the case of aged or traumatic patients. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Medizinische Physik is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Medizinische Physik is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and purpose Postoperative imaging of cochlear implant needs to provide detailed information on the position of individual electrodes; the aim of this study was to evaluate visualization of individual electrodes and measurement of the electrode–modiolus distance (EMD) using dual energy CT (DECT) – with low radiation dose using virtual monochromatic spectral (VMS) imaging comparing the images quality and radiation dose with those by using multidetector CT (MDCT). Materials and methods 25 pediatric patients who underwent cochlear implantation were imaged using DECT (15 patients) and MDCT (10 patients), and the image quality and radiation dose of DECT were compared to those of MDCT. Measurement of EMD was done for 5 electrodes and the results were correlated with neural response telemetry (NRT) and behavioural mapping levels. Results A statistically significant difference between the radiation dose of DECT and MDCT was confirmed ( p = 0.002) without a statistically significant difference in images quality (weighted K = −0.129 and PABAK = 0.533). Statistically significant correlations were found between EMD and NRT threshold, T (threshold) and C (maximum comfortable) levels with p = <0.01. Conclusion DECT accurately detects the electrode position with low radiation dose which helps in CI fitting. [ABSTRACT FROM AUTHOR]

Rationale and Objectives To evaluate the benefits of dual-energy computed tomography (CT) colonography (DECTC) as a preoperative staging tool in patients with clinically suspected colorectal cancer (CRC). Materials and Methods Twenty-two patients with colorectal neoplasia underwent preoperative abdominal DECTC on a dual-source scanner (SOMATOM Definition Flash; Siemens) operated at tube potentials of Sn140/100 kVp. Scans were evaluated for local tumor stage and the presence of synchronous intracolonic and extracolonic findings using dual-energy color-coded images. An enhancement ≥25 Hounsfield units (HU) was defined to indicate malignancy. Patients' effective doses were calculated. Results Preoperative DECTC allowed for complete bowel evaluation in all patients, including subjects with stenosing CRC. DECTC revealed 22 carcinomas (mean enhancement, 47 ± 12 HU). In total, 22 synchronous intracolonic lesions were detected, including 19 adenomas (mean enhancement, 51 ± 19 HU). Benign structures showed enhancement <25 HU. Comparing DECTC to histopathology, 95% carcinomas and 71% synchronous lesions proximal to stenosing CRC could be verified. Mean estimated effective dose was 13.0 ± 5.2 mSv. Conclusions Preoperative DECTC can be used as an accurate and dose-efficient primary-staging examination. Especially after incomplete optical colonoscopy, virtual colonoscopy enables full preoperative colonic assessment on the same day. Dual-energy CT enables distinction between neoplasia and non-neoplastic findings within and outside the colon. Therefore, DECTC can be regarded as a promising “one-stop” staging examination in patients with clinically suspected CRC. [ABSTRACT FROM AUTHOR]

Background There is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy. Objective Evaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography (DECT) vs a standard iodinated contrast volume coronary CT angiography protocol (SCCTA). Methods A total of 102 consecutive patients were randomized to SCCTA (n = 53) or DECT with rapid kVp switching (n = 49). Eighty milliliters and 35 mL of iodinated contrast were administered in the SCCTA and DECT cohorts, respectively. Two readers measured signal and noise in the coronary arteries; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A 5-point signal/noise Likert scale was used to evaluate image quality; scores of <3 were nondiagnostic. Agreement was assessed through kappa analyses. Results Demographics and radiation dose were not significantly different; there was no difference in CNR between both cohorts (P = .95). A significant difference in SNR between the groups (P = .02) lost significance (P = .13) when adjusted for body mass index. The median Likert score was inferior for DECT for reader 1 (3.6 ± 0.6 vs 4.3 ± 0.6; P < .001) but not reader 2 (4.1 ± 0.6 vs 4.3 ± 0.5; P = .06). Agreement in diagnostic interpretability in the DECT and SCCTA groups was 91% (95% confidence interval, 86%-100%) and 96% (95% confidence interval, 90%-100%), respectively. Conclusion DECT resulted in inferior image quality scores but demonstrated comparable SNR, CNR, and rate of diagnostic interpretability without a radiation dose penalty while allowing for >50% reduction in contrast volume compared with SCCTA. [ABSTRACT FROM AUTHOR]

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Purpose: To compare the linear blending image with the nonlinear moidal blending image using dual energy CT for the evaluation of the viable portion of hepatocelluJar carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Materials and Methods: One-hundred and twenty three HCC patients incompletely treated after TACE were enrolled in this study. The dual energy mode (80 kVp and Sn140 kVp) was only applied in the late arterial phase scanning. A paired t-test was used to compare the lesion-to-liver contrast-to-noise ratio (CNR) and the image noise between the two blending images. Lesion conspicuity, image sharpness, image noise and the overall image quality between the two blending images were compared using the Wilcoxon matched-pair signed-ranks test. Results: The lesion-to-liver CNR was significantly higher on the moidal blending image (5.6 ± 3.2) than on the linear blending image (2.7 ± 1.6) (p < 0.001). The image noise was significantly lower on the moidal blending image (10.9 ± 3.5) than on the linear blending image (17.5 ± 5.5) (p <0.001). The lesion conspicuity and overall image quality were significantly better on the moidal blending image for both reviewers (p < 0.001). However, with respect to image sharpness, the linear blending image was significantly better for both reviewers (p < 0.01). Conclusion: The nonlinear moidal blending image of dual energy CT showed an increased lesion-to-liver CNR, decreased noise and improved overall image quality for the evaluation of the viable portion of HCC after TACE. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The aim of this study was to measure the radiation dose of dual-energy and single-energy multidetector computed tomographic (CT) imaging using adult liver, renal, and aortic imaging protocols. Materials and Methods: Dual-energy CT (DECT) imaging was performed on a conventional 64-detector CT scanner using a software upgrade (Volume Dual Energy) at tube voltages of 140 and 80 kVp (with tube currents of 385 and 675 mA, respectively), with a 0.8-second gantry revolution time in axial mode. Parameters for single-energy CT (SECT) imaging were a tube voltage of 140 kVp, a tube current of 385 mA, a 0.5-second gantry revolution time, helical mode, and pitch of 1.375:1. The volume CT dose index (CTDIvol) value displayed on the console for each scan was recorded. Organ doses were measured using metal oxide semiconductor field-effect transistor technology. Effective dose was calculated as the sum of 20 organ doses multiplied by a weighting factor found in International Commission on Radiological Protection Publication 60. Radiation dose saving with virtual noncontrast imaging reconstruction was also determined. Results: The CTDIvol values were 49.4 mGy for DECT imaging and 16.2 mGy for SECT imaging. Effective dose ranged from 22.5 to 36.4 mSv for DECT imaging and from 9.4 to 13.8 mSv for SECT imaging. Virtual noncontrast imaging reconstruction reduced the total effective dose of multiphase DECT imaging by 19% to 28%. Conclusion: Using the current Volume Dual Energy software, radiation doses with DECT imaging were higher than those with SECT imaging. Substantial radiation dose savings are possible with DECT imaging if virtual noncontrast imaging reconstruction replaces precontrast imaging. [Copyright &y& Elsevier]