Objectives: To assess the diagnostic performance and clinical efficacy of metal artefact reduction using monoenergetic imaging with dual-energy computed tomography (DECT). Materials: A total of 30 patients with 32 metal device regions were examined using the DECT protocol with 100 kVp and 140 kVp spectra. Specific post-processing software was used to generate optimised monoenergetic images and standard combined images by filtered back projection. Two independent observers subjectively graded the degree of artefact and diagnostic quality of the two sets of images on a five-point rating scale. The beamhardening artefact (mean density of the most pronounced streak 1 cm from the device) was compared between both groups. Qualitative assessment by type of device (internal or external device) was performed. Results: A total of 32 examinations with 19 internal, 10 external, and 3 internal + external implanted metal devices were performed. Monoenergetic imaging was rated superior for artefact reduction in 75% cases and for diagnostic quality in 78% cases, compared with standard combined imaging by filtered back projection (p < 0.001). The mean density of beam hardening artefacts improved from-725.22 HU in standard combined imaging to-519.02 HU using monoenergetic imaging (p = 0.025). The presence of an external metal device adversely affected the artefact reduction performance of monoenergetic imaging (p = 0.045), without significantly affecting diagnostic quality. Conclusion: Monoenergetic extrapolation using DECT can significantly reduce metal artefact and improve diagnostic quality compared with filtered back projection. Its performance was adversely affected by the presence of an external device.

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Primary pericardial lymphoma is rare in immunocompetent patients. Its symptoms are non-specific and may lead to a delayed diagnosis. Early detection and characterisation by computed tomography and positronemission tomography-computed tomography, and prompt intervention can result in a favourable prognosis. We report a case of primary pericardial lymphoma in an immunocompetent man who underwent chemotherapy and achieved complete resolution. Clinical, radiological, and pathological manifestations, and differential diagnoses are described.

a 47-year-old woman presented with peripheral upper and lower limb numbness and recurrent headaches, and a history of transient expressive dysphasia with spontaneous recovery 6 years previously. She also developed gradual cognitive impairment and bilateral sensorineural hearing loss after that. Extensive blood tests and imaging including echocardiogram were all unremarkable. Nerve conduction testing revealed demyelinating sensorimotor polyneuropathy of the lower limbs. Three months previously the patient was admitted with rapid deterioration in her physical and mental condition, as well as lower limb oedema. Chest radiograph showed new bilateral pleural effusions. Magnetic resonance imaging (MRI) brain studies revealed diffuse leptomeningeal enhancement mainly in the central skull base cisterns and bilateral posterior