C omputed tomography (CT) colonography is a noninvasive method for colorectal carcinoma screening and was shown to be highly sensitive for colorectal cancer and polyp detection in previous studies (1-4). The major problem for diagnostic and screening CT colonography is differentiation of tumor and polyps from stool. Therefore, several methods are used for this purpose such as prone and supine imaging (looking for movement of stool), use of laxatives (to clear stool from colon), barium tagging (to mark stools with barium) and density measurements (5). However, some patients can refuse or cannot tolerate bowel preparation leading to cancellation of CT colonography examinations. For patients who do not tolerate bowel preparation, laxative-free or reduced preparation protocols have been developed. Dual-energy computed tomography (DECT) is becoming increasingly used for body computed tomography (CT) applications (6-8). The major advantage of DECT is its ability to obtain iodine map and virtual noncontrast (VNC) images in a single CT study by acquiring two datasets with different kilovolts. On contrast-enhanced single-energy CT images, the density of a measured area is equal to basal density of the area plus the density increment due to iodine uptake. DECT allows measurement of basal density and the degree of iodine uptake on VNC and iodine map images, respectively, without acquiring unenhanced CT images (9). Pilot studies reported utility of DECT principle for diagnostic CT colonography and electronic cleansing after barium tagging for CT colonography (5, 10, 11). Recent studies showed that colorectal cancer can be detected without bowel preparation by DECT (12)
A B D O M I N A L I MAG I N G O R I G I N A L A R T I C L E
PURPOSEWe aimed to determine dual-energy computed tomography (DECT) characteristics of colorectal cancer and investigate effectiveness of DECT method in differentiating tumor from stool in patients with colorectal cancer.
METHODSFifty consecutive patients with colorectal tumors were enrolled. Staging was performed by DECT (80-140 kV) using dual-source CT after rectal air insufflation and without bowel preparation. Both visual and quantitative analyses were performed at 80 kV and 140 kV, on iodine map and virtual noncontrast (VNC) images.
RESULTSAll colorectal tumors had homogeneous pattern on iodine map. Stools demonstrated heterogeneous pattern in 86% (43/50) and homogeneous pattern in 14% (7/50) on iodine maps and were less visible on VNC images. Median density of tumors was 54 HU (18-100 HU) on iodine map and 28 HU (11-56 HU) on VNC images. Median density of stool was 36.5 HU (8-165 HU) on iodine map and -135.5 HU (-438 HU to -13 HU) on VNC images. The density of stools was significantly lower than tumors on both iodine map and VNC images (P < 0.001). The cutoff point of density measurement on VNC images was -1 HU with area under the curve of 1 and a sensitivity and specificity of 100%.
CONCLUSIONDensity or visual analysis of iodine map and VNC DECT images allow accurate differentiation of tumor ...