Improved display of cervical intervertebral discs on water (iodine) images: incidental findings from single-source dual-energy CT angiography of head and neck arteries
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To (a) assess the diagnostic performance of material decomposition (MD) water (iodine) images for the evaluation of cervical intervertebral discs (IVDs) in patients who underwent dual-energy head and neck CT angiography (HNCTA) compared with 70-keV images and (b) to explore the correlation of water concentration with the T2 relaxation time of IVDs.
Materials and methods
Twenty-four consecutive patients who underwent dual-energy HNCTA and cervical spine MRI were studied. The diagnostic performance of water (iodine), 70-keV and MR images for IVD bulge and herniation was assessed. A subjective image score for each image set was recorded. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of IVDs to the cervical spinal cord were compared between water (iodine) and 70-keV images. Disc water concentration as measured on water (iodine) images was correlated with T2 relaxation time.
IVD evaluations for bulge and herniation did not differ significantly among the three image sets (pairwise comparisons; all p > 0.05). SNR and CNR were significantly improved on water (iodine) images compared with those on 70-keV images (p < 0.001). Although water (iodine) images showed higher image quality scores when evaluating IVDs compared with 70-keV images, the difference is not significant (all adjusted p > 0.05). IVD water concentration exhibited no correlation with relative T2 relaxation time (all p > 0.05).
Water (iodine) images facilitated analysis of cervical IVDs by providing higher SNR and CNR compared with 70-keV images. The disc water concentration measured on water (iodine) images exhibited no correlation with relative T2 relaxation time.
• There was no significant difference in cervical IVD evaluations for bulge and herniation among water (iodine) images, 70-keV images and MR images.
• Water (iodine) images provided higher objective and subjective image quality than 70-keV images, though the difference of subjective evaluation was not statistically significant.
• The disc water concentration exhibited no correlation with relative T2 relaxation time, which reflects the inferiority of the water (iodine) images in evaluating disc water content compared with T2 maps.
KeywordsIntervertebral disc Dual-energy scanned projection radiography Computed tomography angiography Image quality enhancement Magnetic resonance imaging
Adaptive statistical iterative reconstruction V
Computed tomography angiography
Dual-energy computed tomography
Fast spin echo
Gemstone spectral imaging
Head and neck computed tomography angiography
Region of interest
Scan field of view
This study has received funding by the National Key R&D Program of China (YS2017YFGH000397), National Natural Science Foundation of China (81641168, 31470047, 81720108021, 81271565), Henan Province Scientific and Technological Innovation Talents Project (164200510014), Henan Province Scientific and Technological Cooperation Project (152106000014) and Key Project of Henan Medical Science and Technology Project (201501011).
Compliance with ethical standards
The scientific guarantor of this publication is Meiyun Wang.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors, Xiaowan Chang, has significant statistical expertise.
Written informed consent was obtained from all the patients prior to study inclusion.
Institutional review board approval was obtained.
• diagnostic study/observational
• performed at one institution
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