Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation

Doris Leithner; Julian L. Wichmann; Thomas J. Vogl; Jesko Trommer; Simon S. Martin; Jan Erik Scholtz; Boris Bodelle; Carlo N. De Cecco; Taylor Duguay; John W. Nance; U. Joseph Schoepf; Moritz H. Albrecht

doi:10.1097/RLI.0000000000000387

Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation

Doris Leithner, Julian L. Wichmann, Thomas J. Vogl, Jesko Trommer, Simon S. Martin, Jan Erik Scholtz, Boris Bodelle, Carlo N. De Cecco, Taylor Duguay, John W. Nance, U. Joseph Schoepf, Moritz H. Albrecht

Houston Methodist

Research output: Contribution to journal › Article › peer-review

62 Scopus citations

Abstract

Objectives: The aim of this study was to investigate the impact of virtual monoenergetic imaging (VMI+) and dual-energy computed tomography perfusion maps (DECT-PMs) on reader confidence and diagnostic accuracy in dual-energy computed tomography pulmonary angiography (DE-CTPA) studies with suboptimal contrast attenuation, compared with standard linearly blended reconstruction series. Materials and Methods: Dual-energy computed tomography pulmonary angiography examinations with suboptimal contrast attenuation of 68 patients with suspected pulmonary embolism (PE) were included in this institutional review board-approved retrospective study. Virtual monoenergetic imaging series at 40 keV, DECT-PM, and linearly blended images (M-0.6, 60% 90-kV spectrum) were reconstructed. Contrast-to-noise ratio and signal-to-noise ratio within the pulmonary trunk were calculated. Four independent radiologists assessed the presence of PE and their diagnostic confidence using 3 DE-CTPA reconstruction protocols: protocol 1, M-0.6 images; protocol 2, M-0.6 series and DECT-PM; and protocol 3, M-0.6, DECT-PM, and VMI+ series. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients showed central and 29 segmental PE. Greater contrast-to-noise ratio and signal-to-noise ratio values were measured in VMI+ series at 40 keV in comparison to M-0.6 images (P < 0.001). Diagnostic accuracy for segmental PE detection was as follows: protocol 1 (69.1%); protocol 2 (86.8%); and protocol 3 (92.6%). Protocol 3 resulted in a significantly greater area under the curve for diagnosing segmental PE (0.991, P ≤ 0.033), compared with protocol 1 and 2 (0.897 and 0.951, respectively), and provided the highest diagnostic confidence (P < 0.001). Conclusions: A reconstruction protocol including 40-keV VMI+ series and DECT-PM improves reader confidence and diagnostic accuracy for segmental PE detection compared with standard M-0.6 images in DE-CTPA with suboptimal contrast attenuation.

Original language	English (US)
Pages (from-to)	659-665
Number of pages	7
Journal	Investigative Radiology
Volume	52
Issue number	11
DOIs	https://doi.org/10.1097/RLI.0000000000000387
State	Published - Nov 1 2017

Keywords

computed tomography pulmonary angiography
diagnostic accuracy
dual-energy CT
pulmonary embolism
suboptimal contrast attenuation
virtual monoenergetic imaging

ASJC Scopus subject areas

General Medicine

Access to Document

10.1097/RLI.0000000000000387

Cite this

Leithner, D., Wichmann, J. L., Vogl, T. J., Trommer, J., Martin, S. S., Scholtz, J. E., Bodelle, B., De Cecco, C. N., Duguay, T., Nance, J. W., Schoepf, U. J., & Albrecht, M. H. (2017). Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation. Investigative Radiology, 52(11), 659-665. https://doi.org/10.1097/RLI.0000000000000387

Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation. / Leithner, Doris; Wichmann, Julian L.; Vogl, Thomas J. et al.
In: Investigative Radiology, Vol. 52, No. 11, 01.11.2017, p. 659-665.

Research output: Contribution to journal › Article › peer-review

Leithner, D, Wichmann, JL, Vogl, TJ, Trommer, J, Martin, SS, Scholtz, JE, Bodelle, B, De Cecco, CN, Duguay, T, Nance, JW, Schoepf, UJ & Albrecht, MH 2017, 'Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation', Investigative Radiology, vol. 52, no. 11, pp. 659-665. https://doi.org/10.1097/RLI.0000000000000387

@article{b783ffb9a94c4f32a910dcf156b4cf83,

title = "Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation",

abstract = "Objectives: The aim of this study was to investigate the impact of virtual monoenergetic imaging (VMI+) and dual-energy computed tomography perfusion maps (DECT-PMs) on reader confidence and diagnostic accuracy in dual-energy computed tomography pulmonary angiography (DE-CTPA) studies with suboptimal contrast attenuation, compared with standard linearly blended reconstruction series. Materials and Methods: Dual-energy computed tomography pulmonary angiography examinations with suboptimal contrast attenuation of 68 patients with suspected pulmonary embolism (PE) were included in this institutional review board-approved retrospective study. Virtual monoenergetic imaging series at 40 keV, DECT-PM, and linearly blended images (M-0.6, 60% 90-kV spectrum) were reconstructed. Contrast-to-noise ratio and signal-to-noise ratio within the pulmonary trunk were calculated. Four independent radiologists assessed the presence of PE and their diagnostic confidence using 3 DE-CTPA reconstruction protocols: protocol 1, M-0.6 images; protocol 2, M-0.6 series and DECT-PM; and protocol 3, M-0.6, DECT-PM, and VMI+ series. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients showed central and 29 segmental PE. Greater contrast-to-noise ratio and signal-to-noise ratio values were measured in VMI+ series at 40 keV in comparison to M-0.6 images (P < 0.001). Diagnostic accuracy for segmental PE detection was as follows: protocol 1 (69.1%); protocol 2 (86.8%); and protocol 3 (92.6%). Protocol 3 resulted in a significantly greater area under the curve for diagnosing segmental PE (0.991, P ≤ 0.033), compared with protocol 1 and 2 (0.897 and 0.951, respectively), and provided the highest diagnostic confidence (P < 0.001). Conclusions: A reconstruction protocol including 40-keV VMI+ series and DECT-PM improves reader confidence and diagnostic accuracy for segmental PE detection compared with standard M-0.6 images in DE-CTPA with suboptimal contrast attenuation.",

keywords = "computed tomography pulmonary angiography, diagnostic accuracy, dual-energy CT, pulmonary embolism, suboptimal contrast attenuation, virtual monoenergetic imaging",

author = "Doris Leithner and Wichmann, {Julian L.} and Vogl, {Thomas J.} and Jesko Trommer and Martin, {Simon S.} and Scholtz, {Jan Erik} and Boris Bodelle and {De Cecco}, {Carlo N.} and Taylor Duguay and Nance, {John W.} and Schoepf, {U. Joseph} and Albrecht, {Moritz H.}",

year = "2017",

month = nov,

day = "1",

doi = "10.1097/RLI.0000000000000387",

language = "English (US)",

volume = "52",

pages = "659--665",

journal = "Investigative Radiology",

issn = "0020-9996",

publisher = "Lippincott Williams and Wilkins",

number = "11",

}

TY - JOUR

T1 - Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation

AU - Leithner, Doris

AU - Wichmann, Julian L.

AU - Vogl, Thomas J.

AU - Trommer, Jesko

AU - Martin, Simon S.

AU - Scholtz, Jan Erik

AU - Bodelle, Boris

AU - De Cecco, Carlo N.

AU - Duguay, Taylor

AU - Nance, John W.

AU - Schoepf, U. Joseph

AU - Albrecht, Moritz H.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objectives: The aim of this study was to investigate the impact of virtual monoenergetic imaging (VMI+) and dual-energy computed tomography perfusion maps (DECT-PMs) on reader confidence and diagnostic accuracy in dual-energy computed tomography pulmonary angiography (DE-CTPA) studies with suboptimal contrast attenuation, compared with standard linearly blended reconstruction series. Materials and Methods: Dual-energy computed tomography pulmonary angiography examinations with suboptimal contrast attenuation of 68 patients with suspected pulmonary embolism (PE) were included in this institutional review board-approved retrospective study. Virtual monoenergetic imaging series at 40 keV, DECT-PM, and linearly blended images (M-0.6, 60% 90-kV spectrum) were reconstructed. Contrast-to-noise ratio and signal-to-noise ratio within the pulmonary trunk were calculated. Four independent radiologists assessed the presence of PE and their diagnostic confidence using 3 DE-CTPA reconstruction protocols: protocol 1, M-0.6 images; protocol 2, M-0.6 series and DECT-PM; and protocol 3, M-0.6, DECT-PM, and VMI+ series. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients showed central and 29 segmental PE. Greater contrast-to-noise ratio and signal-to-noise ratio values were measured in VMI+ series at 40 keV in comparison to M-0.6 images (P < 0.001). Diagnostic accuracy for segmental PE detection was as follows: protocol 1 (69.1%); protocol 2 (86.8%); and protocol 3 (92.6%). Protocol 3 resulted in a significantly greater area under the curve for diagnosing segmental PE (0.991, P ≤ 0.033), compared with protocol 1 and 2 (0.897 and 0.951, respectively), and provided the highest diagnostic confidence (P < 0.001). Conclusions: A reconstruction protocol including 40-keV VMI+ series and DECT-PM improves reader confidence and diagnostic accuracy for segmental PE detection compared with standard M-0.6 images in DE-CTPA with suboptimal contrast attenuation.

AB - Objectives: The aim of this study was to investigate the impact of virtual monoenergetic imaging (VMI+) and dual-energy computed tomography perfusion maps (DECT-PMs) on reader confidence and diagnostic accuracy in dual-energy computed tomography pulmonary angiography (DE-CTPA) studies with suboptimal contrast attenuation, compared with standard linearly blended reconstruction series. Materials and Methods: Dual-energy computed tomography pulmonary angiography examinations with suboptimal contrast attenuation of 68 patients with suspected pulmonary embolism (PE) were included in this institutional review board-approved retrospective study. Virtual monoenergetic imaging series at 40 keV, DECT-PM, and linearly blended images (M-0.6, 60% 90-kV spectrum) were reconstructed. Contrast-to-noise ratio and signal-to-noise ratio within the pulmonary trunk were calculated. Four independent radiologists assessed the presence of PE and their diagnostic confidence using 3 DE-CTPA reconstruction protocols: protocol 1, M-0.6 images; protocol 2, M-0.6 series and DECT-PM; and protocol 3, M-0.6, DECT-PM, and VMI+ series. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients showed central and 29 segmental PE. Greater contrast-to-noise ratio and signal-to-noise ratio values were measured in VMI+ series at 40 keV in comparison to M-0.6 images (P < 0.001). Diagnostic accuracy for segmental PE detection was as follows: protocol 1 (69.1%); protocol 2 (86.8%); and protocol 3 (92.6%). Protocol 3 resulted in a significantly greater area under the curve for diagnosing segmental PE (0.991, P ≤ 0.033), compared with protocol 1 and 2 (0.897 and 0.951, respectively), and provided the highest diagnostic confidence (P < 0.001). Conclusions: A reconstruction protocol including 40-keV VMI+ series and DECT-PM improves reader confidence and diagnostic accuracy for segmental PE detection compared with standard M-0.6 images in DE-CTPA with suboptimal contrast attenuation.

KW - computed tomography pulmonary angiography

KW - diagnostic accuracy

KW - dual-energy CT

KW - pulmonary embolism

KW - suboptimal contrast attenuation

KW - virtual monoenergetic imaging

UR - http://www.scopus.com/inward/record.url?scp=85019749506&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019749506&partnerID=8YFLogxK

U2 - 10.1097/RLI.0000000000000387

DO - 10.1097/RLI.0000000000000387

M3 - Article

C2 - 28542094

AN - SCOPUS:85019749506

SN - 0020-9996

VL - 52

SP - 659

EP - 665

JO - Investigative Radiology

JF - Investigative Radiology

IS - 11

ER -

Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography with Suboptimal Contrast Attenuation

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this