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Obesity-Related Pitfalls of Virtual versus True Non-Contrast Imaging—An Intraindividual Comparison in 253 Oncologic Patients
oleh: Henner Huflage, Andreas Steven Kunz, Robin Hendel, Johannes Kraft, Stefan Weick, Gary Razinskas, Stephanie Tina Sauer, Lenhard Pennig, Thorsten Alexander Bley, Jan-Peter Grunz
Format: | Article |
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Diterbitkan: | MDPI AG 2023-04-01 |
Deskripsi
Objectives: Dual-source dual-energy CT (DECT) facilitates reconstruction of virtual non-contrast images from contrast-enhanced scans within a limited field of view. This study evaluates the replacement of true non-contrast acquisition with virtual non-contrast reconstructions and investigates the limitations of dual-source DECT in obese patients. Materials and Methods: A total of 253 oncologic patients (153 women; age 64.5 ± 16.2 years; BMI 26.6 ± 5.1 kg/m<sup>2</sup>) received both multi-phase single-energy CT (SECT) and DECT in sequential staging examinations with a third-generation dual-source scanner. Patients were allocated to one of three BMI clusters: non-obese: <25 kg/m<sup>2</sup> (<i>n</i> = 110), pre-obese: 25–29.9 kg/m<sup>2</sup> (<i>n</i> = 73), and obese: >30 kg/m<sup>2</sup> (<i>n</i> = 70). Radiation dose and image quality were compared for each scan. DECT examinations were evaluated regarding liver coverage within the dual-energy field of view. Results: While arterial contrast phases in DECT were associated with a higher CTDI<sub>vol</sub> than in SECT (11.1 vs. 8.1 mGy; <i>p</i> < 0.001), replacement of true with virtual non-contrast imaging resulted in a considerably lower overall dose-length product (312.6 vs. 475.3 mGy·cm; <i>p</i> < 0.001). The proportion of DLP variance predictable from patient BMI was substantial in DECT (R<sup>2</sup> = 0.738) and SECT (R<sup>2</sup> = 0.620); however, DLP of SECT showed a stronger increase in obese patients (<i>p</i> < 0.001). Incomplete coverage of the liver within the dual-energy field of view was most common in the obese subgroup (17.1%) compared with non-obese (0%) and pre-obese patients (4.1%). Conclusion: DECT facilitates a 30.8% dose reduction over SECT in abdominal oncologic staging examinations. Employing dual-source scanner architecture, the risk for incomplete liver coverage increases in obese patients.