Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Abstract

Objective To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. Materials and Methods This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff ) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. Results Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion : 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images ( p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI ( p = 0.022, p = 0.033, respectively). Conclusion Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

Diagnostic value of dual-energy CT and clinicopathological and imaging feature analysis of mixed endometrial stromal and smooth muscle tumors with intracardiac extension

“…Regarding the visualization effect of the dual-energy dataset on the early vascular invasion of MESSMT, we found that lesion visualization with 40 keV reconstruction images is better than other VMIs, while color-coded ID and Zeff reconstructed images also achieve satisfactory performance. This finding is similar to previous research results ( 8 , 9 , 25 ). Based on objective assessment of the image quality, higher CNR corresponds to lower keV because higher CT attenuation of the vein lesions leads to higher contrast to the background.…”

“…Virtual monoenergetic images derived from DECT have been shown to improve soft tissue contrast and increase the conspicuity of solid organ lesions ( 24 ). Color-coded iodine density and Z effective reconstruction images have also been proven to perform well in the subjective assessment of lesions since the human eye is more sensitive to color than to grayscale ( 25 ). Regarding the visualization effect of the dual-energy dataset on the early vascular invasion of MESSMT, we found that lesion visualization with 40 keV reconstruction images is better than other VMIs, while color-coded ID and Zeff reconstructed images also achieve satisfactory performance.…”

Evaluation of optimal monoenergetic images acquired by dual-energy CT in the diagnosis of T staging of thoracic esophageal cancer

“…Dual-energy CT can obtain multiparameter images such as substance separation, virtual single energy, effective atomic number, and energy spectrum curve, which can qualitatively and quantitatively provide more valuable information for the differential diagnosis of lesions, determination of pathological types and aggressiveness of cancers, and prediction of efficacy of neoadjuvant therapy [ 18 , 23 – 25 ]. However, the multiparameters of DECT are rarely used for esophageal cancer staging.…”

Initial Investigation of Clinical Value of Noise-Optimized Virtual Monoenergetic Images Derived From Dual-Energy Computed Tomography Angiography in Preoperative Perforator Planning of Anterolateral Thigh Flap Transplantation

“…For each thigh, visualization of the branch order of the descending branches of the lateral circumflex femoral artery was assessed with a 5-point scale: 5, excellent (fourth-order or higher-order branches); 4, superior (third-order branches); 3, diagnostic (second-order branches); 2, suboptimal (main- or first-order branches); and 1, poor (vessels not seen) 14 . For each thigh, the image quality was scored as follows: 5, sharp anatomical structure and satisfactory details; 4, less clear anatomical structure and details; 3, decreased confidence in details but the anatomical structure is still relatively clear; 2, poor details and anatomical structure difficult to make out; and 1, unacceptable anatomical structure and details 15 . For each cutaneous perforator, the vascular network continuity of the perforator was assessed on a 3-point scale: 2, well continuous, the course of the perforators and their source arteries could be identified easily; 1, discontinuous, but the course of the perforators and their source arteries could be identified through the upper and lower slices; 0, discontinuous, and the course of perforators and their source arteries could not be identified.…”