Dual-Energy CT for Patients Suspected of Having Liver Iron Overload: Can Virtual Iron Content Imaging Accurately Quantify Liver Iron Content?

Abstract

Hepatic VIC showed significant correlation with R2* and MR-measured LIC (r = 0.885 and 0.871, respectively; P < .0001). To differentiate among different LIC thresholds of 1.8, 3.2, 7.0, and 15.0 mg of iron per gram of dry tissue, the corresponding optimal cutoff values for VIC were 2.50, 5.13, 8.93, and 17.97 HU, respectively. At a LIC threshold of 7.0 mg of iron per gram of dry tissue or higher, 100% sensitivity (15 of 15 patients) and 100% specificity (19 of 19 patients) were obtained for VIC. There was no significant difference between VIC and R2* (area under the ROC curve, 0.964 vs 0.993, respectively; P = .299) in grading LIC levels at a LIC threshold of 3.2 mg of iron per gram of dry tissue or higher. Conclusion Hepatic VIC is a potential index for accurately evaluating and grading clinically significant liver iron accumulation, with a diagnostic performance similar to that of MR imaging.

Dual-Energy CT: New Horizon in Medical Imaging

“…Liver iron overload may be quantified by using an iron-specific three-material decomposition algorithm with similar diagnostic performance to MRI (22) and, therefore, it may be used as an alternative method when MRI is not available or contraindicated.…”

Diagnosis and Management of Genetic Iron Overload Disorders

“…Fortunately, more recent sequences designed to independently measure both liver fat and iron can be used to overcome this limitation. There are some data to suggest that dual energy computed tomography (CT) may also be able to quantitatively measure iron concentration, 28 but such techniques are not clinically widespread at this time.…”

Focal Liver Lesions

“…17.1). In recent years, dual-energy and spectral CT technique has emerged, where the utilization of dual-source or polychromatic X-ray beams and the differential attenuation of such beams of different energies in tissues are applied to improve the detection of hypervascular hepatocellular carcinomas [14] or for the quantification of hepatic iron content [15]. However, dual-energy CT technology is still not widely employed in clinical practice despite potential merits, in part because of the post-processing time required to generate the appropriate images.…”