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Dual-energy CT in the obese: a preliminary retrospective review to evaluate quality and feasibility of the single-source dual-detector implementation

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the feasibility of performing dual-energy CT with a single-source spectral detector system in obese patients.

Materials and methods

Retrospective, IRB-approved review of 28 patients weighing ≥ 270 lbs (122 kg) who underwent CT of the abdomen on a single-source spectral detector system was performed. Two blinded, independent radiologists rated relative preference between conventional CT images taken at 120 kVp (CCT120) and monoenergetic 70 keV equivalent (MonoE70) as well as iodine map image quality in the spleen, pancreas, kidneys, and liver. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between conventional CT and MonoE70 images and correlated with body habitus markers of weight, height, and abdominal diameter.

Results

MonoE70 images were preferred by radiologists 100% of the time (1-sample t test, p < 0.0001) over conventional CCT120 images. Noise was significantly lower; SNR and CNR were significantly higher in MonoE70 images than in CCT120 images (paired t tests, p < 0.0001). Mean iodine map rating (scale 1–5) was 4.54 ± 0.58, denoting near homogenous and complete iodine mapping through the spleen, pancreas, kidneys, and liver for the majority of patients. Body habitus markers were not significantly correlated with image preference score; noise; MonoE70 SNR; MonoE70 CNR; change in noise, SNR, or CNR from CCT120 to MonoE70, or iodine map quality; ordinal and linear regression, p = 0.2547, p = 0.6837, p =  0.1888, p = 0.5489, p = 0.9830, p = 0.8849, p = 0.8741, p = 0.1522, respectively.

Conclusion

The single-source spectral detector implementation of dual-energy CT provides viable, high-quality imaging for obese patients.

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Abbreviations

CCT120:

Conventional CT images taken at 120 kVp

CNR:

Contrast-to-noise ratio

DECT:

Dual-energy CT

MonoE70:

Virtual monoenergetic 70 keV equivalent dual-energy images

SNR:

Signal-to-noise ratio

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Author information

Authors and Affiliations

  1. Department of Radiology, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA

    Noah E. Atwi, David L. Smith, Raman Danrad & Aran M. Toshav

  2. School of Medicine, LSU Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA

    Carson D. Flores

  3. Philips Healthcare, 595 Miner Road, Highland Heights, OH, 44143, USA

    Ekta Dharaiya

  4. Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Avinash Kambadakone

Authors
  1. Noah E. Atwi
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  2. David L. Smith
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  3. Carson D. Flores
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  4. Ekta Dharaiya
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  5. Raman Danrad
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  6. Avinash Kambadakone
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  7. Aran M. Toshav
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Corresponding author

Correspondence to Aran M. Toshav.

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Funding

None.

Conflicts of interest

Author ED is an employee of Philips Healthcare, which developed the DECT implementation used in this study. Author AT is a member of the Philips Healthcare speaker’s bureau. Data were analyzed and controlled by author NA; no data were analyzed or controlled by the authors ED or AT. LSU Health Sciences Center Department of Radiology has a research agreement with Philips Healthcare; however, no funding was provided for this project.

IRB statement

A retrospective imaging review with waiver of informed consent was approved by the institutional review board. The study was compliant with the Health Insurance Portability and Accountability Act.

Summary statement

Dual-energy CT acquisition in obese patients is often limited due to effects of photon starvation, which has hindered its clinical application; this study provides evidence that single-source spectral detector implementations of DECT are not susceptible to this limitation.

Implications for patient care

No habitus threshold should keep a patient from undergoing imaging of the abdomen on a single-source, spectral detector implementation of DECT if it would provide an advantage to patient care.

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Atwi, N.E., Smith, D.L., Flores, C.D. et al. Dual-energy CT in the obese: a preliminary retrospective review to evaluate quality and feasibility of the single-source dual-detector implementation. Abdom Radiol 44, 783–789 (2019). https://doi.org/10.1007/s00261-018-1774-y

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  • DOI: https://doi.org/10.1007/s00261-018-1774-y

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