Evaluation of virtual monoenergetic imaging algorithms for dual-energy carotid and intracerebral CT angiography: Effects on image quality, artefacts and diagnostic performance for the detection of stenosis. Issue 99 (February 2018)

• Record Type: Journal Article
• Authors: Leithner, Doris; Mahmoudi, Scherwin; Wichmann, Julian L.; Martin, Simon S.; Lenga, Lukas; Albrecht, Moritz H.; Booz, Christian; Arendt, Christophe T.; Beeres, Martin; D'Angelo, Tommaso; Bodelle, Boris; Vogl, Thomas J.; Scholtz, Jan-Erik
• Is Part Of: European journal of radiology. Issue 99(2018)
• Page Start: 111
• Page End: 117
• Publication Date: 2018-02
• Subjects: BA basilar artery -- CCA common carotid artery -- CNR contrast-to-noise ratio -- DECT dual-energy CT -- DE-CTA dual-energy CTA -- ICA internal carotid artery -- MCA middle cerebral artery -- SNR signal-to-noise ratio -- VMI virtual monoenergetic imaging -- VMI+ noise-optimized virtual monoenergetic imaging; Dual-energy CT angiography -- Virtual monoenergetic imaging -- Carotid arteries -- Carotis stenosis -- Diagnostic performance; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2017.12.024
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: VMI+ improve quantitative image quality in supraaortic CTA. VMI and VMI+ provide increased suitability for artery evaluation. VMI and VMI+ show excellent accordance for the assessment of carotid stenosis. Abstract: Purpose: To investigate the impact of traditional (VMI) and noise-optimized virtual monoenergetic imaging (VMI+) algorithms on quantitative and qualitative image quality, and the assessment of stenosis in carotid and intracranial dual-energy CTA (DE-CTA). Materials and methods: DE-CTA studies of 40 patients performed on a third-generation 192-slice dual-source CT scanner were included in this retrospective study. 120-kVp image-equivalent linearly-blended, VMI and VMI+ series were reconstructed. Quantitative analysis included evaluation of contrast-to-noise ratios (CNR) of the aorta, common carotid artery, internal carotid artery, middle cerebral artery, and basilar artery. VMI and VMI+ with highest CNR, and linearly-blended series were rated qualitatively. Three radiologists assessed artefacts and suitability for evaluation at shoulder height, carotid bifurcation, siphon, and intracranial using 5-point Likert scales. Detection and grading of stenosis were performed at carotid bifurcation and siphon. Results: Highest CNR values were observed for 40-keV VMI+ compared to 65-keV VMI and linearly-blended images ( P < 0.001). Artefacts were low in all qualitatively assessed series with excellent suitability for supraaortic artery evaluation at shoulder and bifurcation height. Suitability was significantly higher in VMI+ and VMI compared to linearly-blended images for intracranial and ICA assessment ( P < 0.002). VMI and VMI+ showed excellent accordance for detection and grading of stenosis at carotid bifurcation and siphon with no differences in diagnostic performance. Conclusion: 40-keV VMI+ showed improved quantitative image quality compared to 65-keV VMI and linearly-blended series in supraaortic DE-CTA. VMI and VMI+ provided increased suitability for carotid and intracranial artery evaluation with excellent assessment of stenosis, but did not translate into increased diagnostic performance.