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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(02): 085-093
DOI: 10.1055/s-0042-1742677
Original Article

Evaluation of Hypervascular Focal Liver Lesions Utilizing Virtual Monoenergetic Images from Third-Generation Dual-Source Dual-Energy Computed Tomography

Niyas Narappulan
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Venkatesh Kasi Arunachalam
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Ezhilmathi Alavandar
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Swathigha Selvaraja
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Rupa Renganathan
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
,
Mathew Cherian
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
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Abstract

Objectives The purpose of our study was to evaluate the virtual monochromatic imaging in detecting hypervascular focal liver lesions in the late arterial phase with third-generation dual-source dual-energy computed tomography and to assess its image quality.

Materials and Methods In our study, 80 patients were included. Contrast-enhanced images in the late arterial phase (in the dual-energy mode) were acquired and were post-processed in Syngo, via workstation, using Monoenergetic + software. Five sets of images, one polychromatic energy image (corresponding to 120 kVp single-energy image) and four virtual monoenergetic image (VMI) sets at 40, 50, 60, and 70 keV levels, were generated. All these images were analyzed both objectively and subjectively. The attenuation values were measured, and the contrast-to-noise ratio (CNR) of liver and tumor were measured and compared objectively in each dataset. Image noise, image contrast, and diagnostic confidence for liver lesion detection were analyzed subjectively using a five-point scale system. Statistical analysis was performed using Kolmogorov–Smirnov, analysis of variance, and Kruskal–Wallis tests.

Results Among the VMI, maximum image noise was observed in the 40 keV image, with a gradual reduction in the image noise being noted with an increase in the VMI energy. The CNR of the hepatic parenchyma and the tumor gradually increased with a reduction in VMI energy from 70 to 40 keV. On subjective analysis, image contrast and image noise were observed to be more in low VMI datasets. In lesion detection, diagnostic confidence with an excellent confidence level was observed with a decrease in VMI energy.

Conclusion VMI datasets of 40 to 70 keV from third-generation dual-source DECT provide superior diagnostic accuracy for detecting hypervascular liver lesions. Considering the image noise and lesion detection rate among the VMI datasets, 60 keV VMI is the most helpful dataset for increased liver lesion detection with good image quality.

Keywords

third generation - dual source - dual energy - virtual monoenergetic image - hypervascular - liver


Publication History

Article published online:
18 February 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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