Value of spectral detector computed tomography to differentiate infected from noninfected thoracoabominal fluid collections. Issue 145 (December 2021)

• Record Type: Journal Article
• Authors: Reimer, Robert Peter; Gertz, Roman Johannes; Pennig, Lenhard; Henze, Jörn; Celik, Erkan; Lennartz, Simon; Maintz, David; Zopfs, David; Große Hokamp, Nils
• Is Part Of: European journal of radiology. Issue 145(2021)
• Publication Date: 2021-12
• Subjects: AUC area under the curve -- CI conventional images -- CNR contrast-to-noise ratio -- CT computed tomography -- DECT dual-energy computed tomography -- HU Hounsfield units -- ICC intra-class correlation coefficient -- ROC receiver operating characteristics -- ROI region of interest -- SD standard deviation -- SDCT spectral detector computed tomography -- VMI virtual monoenergetic images -- VNC virtual non-contrast images; Tomography X-ray computed -- Fluid collections -- Differential diagnosis -- Infection; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.110037
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Purpose: To investigate the diagnostic value of spectral detector CT (SDCT)-derived virtual non-contrast (VNC), virtual monoenergetic images (VMI) and iodine overlays (IO) for distinguishing infected from noninfected fluid collections (FC) in the chest or abdomen. Method: This retrospective study included 58 patients with venous phase SDCT with 77 FC. For all included FC, microbiological analysis of aspirated fluid served as reference. For quantitative analysis, wall thickness was measured, and (ROI)-based analysis performed within the fluid, the FC's wall (if any) and the aorta. Two radiologists qualitatively evaluated visibility of wall enhancement, diagnostic confidence regarding infection of fluid collection, confidence of CT-guided drainage catheter placement and visibility of anatomical landmarks in conventional images (CI) and VNC, VMI40keV, IO. Results: Wall thickness significantly differed between infected (n = 46) and noninfected (n = 31) FC (3.5 ± 1.8 mm vs. 1.4 ± 1.8 mm, AUC = 0.81; p < 0.05). Fluid attenuation and wall enhancement was significantly higher in infected as compared to noninfected FC in all reconstructions (p < 0.05, respectively). Highest AUC regarding A) attenuation in fluid was yielded in CI and VMI70, 80keV (0.75); B) wall enhancement in CI (0.88) followed by iodine concentration (0.86). Contrast-to-noise ratio of wall vs. fluid was highest in VMI40keV (p < 0.05). All assessed qualitative parameters received significantly higher ratings when using spectral reconstructions vs. CI (p for all <0.05), except for visibility of wall enhancement. Conclusion: Spectral reconstructions improve the assessment of infected from noninfected thoracoabdominal fluid collections and depiction of wall enhancement. Diagnostic performance of the quantitative measurements in spectral reconstructions were comparable with measurements in conventional images.