Extra-abdominal dual-energy CT applications: a comprehensive overview
- 42 Downloads
Unlike conventional computed tomography, dual-energy computed tomography is a relatively novel technique that exploits ionizing radiations at different energy levels. The separate radiation sets can be achieved through different technologies, such as dual source, dual layers or rapid switching voltage. Body tissue molecules vary for their specific atomic numbers and electron density, and the interaction with different sets of radiations results in different attenuations, allowing to their final distinction. In particular, iodine recognition and quantification have led to important information about intravenous contrast medium delivery within the body. Over the years, useful post-processing algorithms have also been validated for improving tissue characterization. For instance, contrast resolution improvement and metal artifact reduction can be obtained through virtual monoenergetic images, dose reduction by virtual non-contrast reconstructions and iodine distribution highlighting through iodine overlay maps. Beyond the evaluation of the abdominal organs, dual-energy computed tomography has also been successfully employed in other anatomical districts. Although lung perfusion is one of the most investigated, this evaluation has been extended to narrowly fields of application, such as musculoskeletal, head and neck, vascular and cardiac. The potential pool of information provided by dual-energy technology is already wide and not completely explored, yet. Therefore, its performance continues to raise increasing interest from both radiologists and clinicians.
KeywordsDual-energy CT Iodine overlay Virtual monoenergetic imaging Virtual non-calcium Bone removal
The authors declare that they received no funding.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 11.Megibow AJ, Kambadakone A, Ananthakrishnan L (2018) Dual-energy computed tomography: image acquisition, processing, and workflow. Radiol Clin North Am 56(507–520):4Google Scholar
- 13.Rajiah P, Halliburton S (2015) Technical aspects of DECT with dual layer detectors. In: Carrascosa P, Cury R, García M, Leipsic J (eds) Dual-energy CT in cardiovascular imaging. Springer, ChamGoogle Scholar
- 15.Apel A, Fletcher JG, Fidler JL, Hough DM, Yu L, Guimaraes LS, Bellemann ME, McCollough CH, Holmes DR 3rd, Eusemann CD (2011) Pilot multi-reader study demonstrating potential for dose reduction in dual energy hepatic CT using non-linear blending of mixed kV image datasets. Eur Radiol 21:644–652PubMedCrossRefPubMedCentralGoogle Scholar
- 16.Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol 49:586–592PubMedCrossRefPubMedCentralGoogle Scholar
- 18.D’Angelo T, Bucher AM, Lenga L, Arendt CT, Peterke JL, Caruso D, Mazziotti S, Blandino A, Ascenti G, Othman AE, Martin SS, Leithner D, Vogl TJ, Wichmann JL (2018) Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography. Eur Radiol 28:1393–1401PubMedCrossRefPubMedCentralGoogle Scholar
- 21.Masy M, Giordano J, Petyt G, Hossein-Foucher C, Duhamel A, Kyheng M, De Groote P, Fertin M, Lamblin N, Bervar JF, Remy J, Remy-Jardin M (2018) Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 28(12):5100–5110PubMedCrossRefPubMedCentralGoogle Scholar
- 26.Yuan R, Shuman WP, Earls JP, Hague CJ, Mumtaz HA, Scott-Moncrieff A, Ellis JD, Mayo JR, Leipsic JA (2012) Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography—a prospective randomized trial. Radiology 262:290–297PubMedCrossRefPubMedCentralGoogle Scholar
- 28.Leithner D, Wichmann JL, Vogl TJ, Trommer J, Martin SS, Scholtz JE, Bodelle B, De Cecco CN, Duguay T, Nance JW Jr, Schoepf UJ, Albrecht MH (2017) Virtual monoenergetic imaging and iodine perfusion maps improve diagnostic accuracy of dual-energy computed tomography pulmonary angiography with suboptimal contrast attenuation. Invest Radiol 52:659–665PubMedCrossRefPubMedCentralGoogle Scholar
- 34.Schmid-Bindert G, Henzler T, Chu TQ, Meyer M, Nance JW Jr, Schoepf UJ, Dinter DJ, Apfaltrer P, Krissak R, Manegold C, Schoenberg SO, Fink C (2012) Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT? Eur Radiol 22:93–103PubMedCrossRefPubMedCentralGoogle Scholar
- 35.Ito R, Iwano S, Shimamoto H, Umakoshi H, Kawaguchi K, Ito S, Kato K, Naganawa S (2017) A comparative analysis of dual-phase dual-energy CT and FDG-PET/CT for the prediction of histopathological invasiveness of non-small cell lung cancer. Eur J Radiol 95:186–191PubMedCrossRefPubMedCentralGoogle Scholar
- 41.Rizzo S, Radice D, Femia M, De Marco P, Origgi D, Preda L, Barberis M, Vigorito R, Mauri G, Mauro A, Bellomi M (2018) Metastatic and non-metastatic lymph nodes: quantification and different distribution of iodine uptake assessed by dual-energy CT. Eur Radiol 28:760–769PubMedCrossRefPubMedCentralGoogle Scholar
- 44.Glazebrook KN, Doerge S, Leng S, Drees TA, Hunt KN, Zingula SN, Pruthi S, Geske JR, Carter RE, McCollough CH, Fletcher JG (2019) Ability of dual-energy ct to detect silicone gel breast implant rupture and nodal silicone spread. AJR Am J Roentgenol 212:933–942PubMedCrossRefPubMedCentralGoogle Scholar
- 45.Volterrani L, Gentili F, Fausto A et al (2019) Dual-energy computed tomography for locoregional staging of breast cancer; preliminary results. AJR Am J Roentgenol (in press)Google Scholar
- 46.Albrecht MH, De Cecco CN, Schoepf UJ, Spandorfer A, Eid M, De Santis D, Varga-Szemes A, van Assen M, von Knebel-Doeberitz PL, Tesche C, Puntmann VO, Nagel E, Vogl TJ, Nance JW (2018) Dual-energy CT of the heart current and future status. Eur J Radiol 105:110–118PubMedCrossRefPubMedCentralGoogle Scholar
- 48.Rubinshtein R, Miller TD, Williamson EE, Kirsch J, Gibbons RJ, Primak AN, McCollough CH, Araoz PA (2009) Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard. Heart Br Card Soc 95:1419–1422CrossRefGoogle Scholar
- 49.Carrascosa PM, Deviggiano A, Capunay C, Campisi R, López de Munain M, Vallejos J, Tajer C, Rodriguez-Granillo GA (2015) Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease. Eur J Radiol 84:637–642PubMedCrossRefPubMedCentralGoogle Scholar
- 50.Nakahara T, Toyama T, Jinzaki M, Seki R, Saito Y, Higuchi T, Yamada M, Arai M, Tsushima Y, Kuribayashi S, Kurabayashi M (2017) Quantitative analysis of iodine image of dual-energy computed tomography at rest: comparison with 99mTc-tetrofosmin stress-rest single-photon emission computed tomography myocardial perfusion imaging as the reference standard. J Thorac Imaging 2:97–104Google Scholar
- 51.Arnoldi E, Lee YS, Ruzsics B, Weininger M, Spears JR, Rowley CP, Chiaramida SA, Costello P, Reiser MF, Schoepf UJ (2011) CT detection of myocardial blood volume deficits: dual-energy CT compared with single-energy CT spectra. J Cardiovasc Comput Tomogr 5:421–429PubMedCrossRefPubMedCentralGoogle Scholar
- 53.Mangold S, Cannaó PM, Schoepf UJ, Wichmann JL, Canstein C, Fuller SR, Muscogiuri G, Varga-Szemes A, Nikolaou K, De Cecco CN (2016) Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study. Eur Radiol 26:1871–1878PubMedCrossRefPubMedCentralGoogle Scholar
- 54.Hickethier T, Baeßler B, Kroeger JR, Doerner J, Pahn G, Maintz D, Michels G, Bunck AC (2017) Monoenergetic reconstructions for imaging of coronary artery stents using spectral detector CT: in-vitro experience and comparison to conventional images. J Cardiovasc Comput Tomogr 11:33–39PubMedCrossRefPubMedCentralGoogle Scholar
- 57.Ascenti G, Mazziotti S, Lamberto S, Bottari A, Caloggero S, Racchiusa S, Mileto A, Scribano E (2011) Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay. AJR Am J Roentgenol 196:1408–1414PubMedCrossRefPubMedCentralGoogle Scholar
- 58.Martin SS, Wichmann JL, Weyer H, Scholtz JE, Leithner D, Spandorfer A, Bodelle B, Jacobi V, Vogl TJ, Albrecht MH (2017) Endoleaks after endovascular aortic aneurysm repair: improved detection with noise-optimized virtual monoenergetic dual-energy CT. Eur J Radiol 94:125–132PubMedCrossRefPubMedCentralGoogle Scholar
- 61.Tawfik AM, Bodelle B, Vogl TJ (2015) Dual energy CT in head and neck tumors. In: De Cecco C, Laghi A, Schoepf U, Meinel F (eds) Dual energy CT in oncology. Springer, ChamGoogle Scholar
- 65.Albrecht MH, Scholtz JE, Kraft J, Bauer RW, Kaup M, Dewes P, Bucher AM, Burck I, Wagenblast J, Lehnert T, Kerl JM, Vogl TJ, Wichmann JL (2015) Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer. Eur Radiol 25:2493PubMedCrossRefPubMedCentralGoogle Scholar
- 66.Yamauchi H, Buehler M, Goodsitt MM, Keshavarzi N, Srinivasan A (2016) Dual-energy CT-based differentiation of benign posttreatment changes from primary or recurrent malignancy of the head and neck: comparison of spectral hounsfield units at 40 and 70 keV and iodine concentration. AJR Am J Roentgenol 206:580–587PubMedCrossRefPubMedCentralGoogle Scholar
- 68.Forghani R, Levental Gupta R, Lam S, Dadfar N, Curtin HD (2015) Different spectral hounsfield unit curve and high-energy virtual monochromatic image characteristics of squamous cell carcinoma compared with nonossified thyroid cartilage. AJNR Am J Neuroradiol 36:1194–1200PubMedCrossRefPubMedCentralGoogle Scholar
- 71.Magarelli N, De Santis V, Marziali G, Menghi A, Burrofato A, Pedone L, Del Prete D, Iezzi R, de Waure C, D’andrea M, Leone A, Colosimo C (2018) Application and advantages of monoenergetic reconstruction images for the reduction of metallic artifacts using dual-energy CT in knee and hip prostheses. Radiol Med 123:593–600PubMedCrossRefPubMedCentralGoogle Scholar
- 78.Biondi M, Vanzi E, De Otto G, Banci Buonamici F, Belmonte GM, Mazzoni LN, Guasti A, Carbone SF, Mazzei MA, La Penna A, Foderà E, Guerreri D, Maiolino A, Volterrani L (2016) Water/cortical bone decomposition: a new approach in dual energy CT imaging for bone marrow oedema detection. A feasibility study. Phys Med 32:1712–1716PubMedCrossRefPubMedCentralGoogle Scholar