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Rapid kVp-switching DECT portal venous phase abdominal CT scans in patients with large body habitus: image quality considerations

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Abstract

Purpose

To assess the diagnostic image quality and material decomposition characteristics of portal venous phase abdominal CT scans performed on rapid kVp-switching DECT (rsDECT) in patients with large body habitus.

Methods

We retrospectively included consecutive patients with large body habitus (≥ 90 kg) undergoing portal venous phase abdominal CT scans on rsDECT scanners between Sep 2014 and March 2018. Qualitative and quantitative assessment of the DECT data sets [65 keV monoenergetic, material density iodine (MD-I) and material density water (MD-W) images] was performed for determination of image quality (IQ) and image noise. Correlation of qualitative assessment scores with weight, BMI and patients’ diameter were calculated using Pearson correlation test. Optimal thresholds were calculated using AUC and Youden index to define most appropriate size cut off, below which the IQ of material density images is largely acceptable.

Results

The 65 keV monoenergetic images were of diagnostic quality (diagnostic acceptability, DA ≥ 3) in 97.8% of patients (n = 91/93). However, there was significant IQ degradation of MD-I images in 20.4% (n = 19/93, DA < 3) of patients. Similarly, there was significant degradation (DA < 3) of MD-W images in 26.9% (25/92). Clinically significant artifacts (PA ≥ 3/4) were seen in 31% (n = 29/93) and 32.3% (30/93) of MD-I and MD-W images respectively. Optimal threshold for diagnostic acceptability of MD-I images were 110 kg for weight and 33.5 kg/m2 for BMI.

Conclusion

Rapid kVp-switching DECT provides diagnostically acceptable monoenergetic images for patients with large body habitus (≥ 90 kg). There is degradation of IQ in the material density specific images particularly in patients weighing > 110 kg and with BMI > 33.5 kg/m2, due to higher number of artifacts.

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Abbreviations

MD-I:

Material density iodine

MD-W:

Material density water

IQ:

Image quality

DA:

Diagnostic acceptability

BMI:

Body mass index

PA:

Presence of artifacts

SAN:

Subjective analysis of image noise

TD:

Transverse diameter

DEFOV:

Dual energy field of view

ASIR:

Adaptive statistical iterative reconstruction

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    Vinit Baliyan, Hamed Kordbacheh, Ali Pourvaziri, Jessica Serrao, Evita Joseph & Avinash Kambadakone

  2. Department of Radiology, University of Washington, Seattle, WA, USA

    Dushyant V. Sahani

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  1. Vinit Baliyan
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  2. Hamed Kordbacheh
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Correspondence to Avinash Kambadakone.

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The authors declared that they have no conflict of interest. Avinash Kambadakone, MD, FRCR has following disclosures: Research Grant – Philips; Research Grant – GE Healthcare.

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Vinit Baliyan and Hamed Kordbacheh are co-first authors.

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Baliyan, V., Kordbacheh, H., Pourvaziri, A. et al. Rapid kVp-switching DECT portal venous phase abdominal CT scans in patients with large body habitus: image quality considerations. Abdom Radiol 45, 2902–2909 (2020). https://doi.org/10.1007/s00261-020-02416-7

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