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04.06.2018 | Computed Tomography

Impact of dual-energy CT post-processing to differentiate venous thrombosis from iodine flux artefacts

verfasst von: Jakob Weiss, Christoph Schabel, Ahmed E. Othman, Georg Bier, Konstantin Nikolaou, Fabian Bamberg, Malte N. Bongers

Erschienen in: European Radiology | Ausgabe 12/2018

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Abstract

Objectives

To investigate the accuracy of dual-energy (DE) CT-based iodine maps (IM) and noise-optimised monoenergetic extrapolations (MEI+) at 40 keV for the detection and differentiation of venous thrombosis (VT) from iodine flux artefacts (IFA) in comparison to portal-venous phase CT (CT_PV).

Methods

Ninety-nine patients were enrolled in this study. In all patients, VT or IFA was suspected on contrast-enhanced CT and confirmed by follow-up CT or colour-coded ultrasound. All examinations were performed on a third-generation dual-source CT system in DE mode during portal-venous phase. CT_PV, IM and 40-keV MEI+ were reconstructed and independently evaluated by two radiologists for the presence/absence of VT and/or IFA. Diagnostic confidence was rated on a three-point scale (3 = high confidence). Quantitative parameters were obtained by calculating contrast-to-noise ratios (CNRs), iodine content and thrombus volume. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC) of CNR.

Results

Diagnostic confidence was significantly higher for IM and MEI+ [both 3 (2-3)] compared to CT_PV [2 (1-3); p ≤ 0.03]. ROC analysis revealed significantly higher AUC values and increased sensitivity for IM and MEI+ (AUC = 88%/sensitivity = 79.1% and 86%/73.1%) than for CT_PV (75%/61.2%; p ≤ 0.01). Thrombus volume was significantly higher in MEI+ than in IM and CT_PV (p < 0.001). CNR of thrombosis was significantly higher in IM [11.5 (8.5-14.5), p < 0.001) and MEI+ [10.9 (8.8-15.5), p < 0.001] than in CT_PV [8.2 (5.8-11.4)]. Iodine quantification revealed significantly lower results in VT than in IFA [0.55 mg/ml (0.23-0.90) and 1.81 (1.60-2.12) mg/ml; p < 0.001].

Conclusions

IM and MEI+ 40 keV showed significantly higher diagnostic confidence and accuracy for the detection and differentiation of VT from IFA in comparison to CT_PV.

Key Points

• Iodine maps and noise-optimised monoenergetic extrapolations at 40 keV increase diagnostic confidence and accuracy for the detection and differentiation of venous thrombosis from iodine flux artefacts.

• Dual-energy post-processing can significantly increase contrast-to-noise ratio and the sensitivity for the diagnosis of venous thrombosis

• Iodine load in venous thrombosis is significantly lower than in iodine flux artefacts

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Titel: Impact of dual-energy CT post-processing to differentiate venous thrombosis from iodine flux artefacts
verfasst von: Jakob Weiss
Christoph Schabel
Ahmed E. Othman
Georg Bier
Konstantin Nikolaou
Fabian Bamberg
Malte N. Bongers
Publikationsdatum: 04.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 12/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5534-8

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Impact of dual-energy CT post-processing to differentiate venous thrombosis from iodine flux artefacts