Comparison of image quality and radiation doses between rapid kV-switching and dual-source DECT techniques in the chest. Issue 119 (October 2019) - Singh, Ramandeep
Highlights: Radiation doses and monoenergetic images from SS-DECT and DS-DECT are similar. Material decomposition images from SS-DECT and DS-DECT are substantially different. Suboptimal material decomposition on SS-DECT generates artifactual heterogeneity. Artifactual heterogeneity on SS-DECT confounds evaluation of perfusion defects. Radiologists need to be aware of this limitation when reporting SS-DECT MDI images. Abstract: Purpose: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques. Materials and methods: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ± 14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-switching (SS-DECT) and dual source (DS-DECT) techniques per standard of care departmental protocols. Reconstructed images from both scanners had identical section thickness and section interval for virtual monoenergetic and material decomposition iodine (MDI) images. Two thoracic radiologists independently evaluated all DECT for findings, quality of images, perfusion defects (MDI), and presence of artifacts. Radiation dose descriptor, size-specific dose estimates (SSDE), was recorded. Data were analyzed with Wilcoxon Signed Rank and Cohen's Kappa tests. Results: There were no significant differences in patient weight or SSDE for the two DECT techniques (p > 0.06). Both radiologists reported no difference in lesion and artifact evaluation on the virtual monoenergetic images from either technique (p > 0.05). However, SS-DECT (in 63–71/97 patients) had substantial artifactual heterogeneity in pulmonary perfusion on MDI images compared to none on DS-DECT (p < 0.001). Conclusion: Despite identical patients and associated radiation doses, there were substantial differences in material decomposition iodine images generated from SS-DECT and DS-DECT techniques. Pulmonary heterogeneity on MDI images from SS-DECT leads to artifactual areas of low perfusion and can confound interpretation of true pulmonary perfusion.