European Radiology

, Volume 29, Issue 1, pp 153–160 | Cite as

Improved display of cervical intervertebral discs on water (iodine) images: incidental findings from single-source dual-energy CT angiography of head and neck arteries

  • Qingxia Wu
  • Dapeng Shi
  • Tianming Cheng
  • Hongming Liu
  • Niuniu Hu
  • Xiaowan Chang
  • Ying Guo
  • Meiyun WangEmail author
Computed Tomography



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.

Key Points

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.


Intervertebral disc Dual-energy scanned projection radiography Computed tomography angiography Image quality enhancement Magnetic resonance imaging 



Adaptive statistical iterative reconstruction V


Contrast-to-noise ratio


Computed tomography angiography


Dual-energy computed tomography


Dose-length product


Fast spin echo


Gemstone spectral imaging




Head and neck computed tomography angiography


Intervertebral disc


Material decomposition


Region of interest


Scan field of view


Signal-to-noise ratio



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.

Informed consent

Written informed consent was obtained from all the patients prior to study inclusion.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic study/observational

• performed at one institution

Supplementary material

330_2018_5603_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Qingxia Wu
    • 1
  • Dapeng Shi
    • 1
  • Tianming Cheng
    • 1
  • Hongming Liu
    • 1
  • Niuniu Hu
    • 1
  • Xiaowan Chang
    • 2
  • Ying Guo
    • 1
  • Meiyun Wang
    • 1
    Email author
  1. 1.Department of RadiologyHenan Provincial People’s HospitalZhengzhouChina
  2. 2.Department of Operation and ManagementHenan Provincial People’s HospitalZhengzhouChina

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