Postablation assessment of hepatocellular carcinoma using dual-energy CT: Comparison of half versus standard iodine contrast medium

This retrospective study was aimed to evaluate the reduced iodine load on image quality and diagnostic performance in multiphasic hepatic CT using a novel monoenergetic reconstruction algorithm (nMERA) in assessment of local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Ninety patients who underwent CT 1 month after RFA of HCC. Forty-five patients had multiphasic hepatic dual-energy CT with a half-reduced contrast medium (HRCM) of 277.5 mg I/kg. The nMERA (40-70-keV) images were reconstructed in each phase. Another 45 patients received a standard contrast medium (SCM) of 555 mg I/kg, and the images were reconstructed as a simulated 120-kVp images. Primary outcome was accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) in assessment of local tumor progression. Additional advanced assessments included the image noise, attenuation value, contrast-to-noise ratio (CNR), and subjective image quality between the groups. The accuracy, sensitivity and specificity of nMERA HRCM images were 95.7%, 100% and 93.9% for 40 keV, 95.7%, 85.7% and 100% for 50 keV, 83.0%, 42.8% and 100% for 60 keV, and 83.0%, 42.9% and 100% for 70 keV. The AUROC was 0.99, 0.99, 0.94, and 0.93 for 40-70 keV nMERA HRCM images, respectively. Compared with simulated 120-kVp SCM images, nMERA HRCM images demonstrated comparable noise at 70-keV (P < 0.05), and comparable CNR at 40- and 50-keV (P < 0.05). nMERA DECT enables the contrast medium to be reduced to up to 50% in multiphasic hepatic CT while preserving diagnostic accuracy.