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Research ArticlePatient Safety

Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT

R.P. Reimer, D. Flatten, T. Lichtenstein, D. Zopfs, V. Neuhaus, C. Kabbasch, D. Maintz, J. Borggrefe and N. Große Hokamp
American Journal of Neuroradiology October 2019, 40 (10) 1617-1623; DOI: https://doi.org/10.3174/ajnr.A6220
R.P. Reimer
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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  • ORCID record for R.P. Reimer
D. Flatten
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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  • ORCID record for D. Flatten
T. Lichtenstein
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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D. Zopfs
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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V. Neuhaus
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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C. Kabbasch
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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D. Maintz
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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J. Borggrefe
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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N. Große Hokamp
aFrom the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Article Figures & Data

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    Fig 1.

    ROI placement in the cortical gray and juxtacortical white matter, in the thalamic parenchyma and posterior limb of the internal capsule, in the caudate nucleus (orange ROIs), in an extraocular muscle (red ROI), and in the medulla oblongata (blue ROI) on an axial plane showing the basal ganglia (A), the orbital cavity (B), and the posterior fossa (C).

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    Fig 2.

    Image noise in extraocular muscle in CI compared with 65-keV virtual monoenergetic images regarding different radiation dose protocols. Significant differences are indicated. The asterisk indicates P = .02; double asterisks, P = .004; triple asterisks, P < .001).

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    Fig 3.

    The CNR of gray-white matter differentiation in CI compared with 65-keV virtual monoenergetic images regarding different radiation dose protocols. Significant differences are indicated (asterisk, P = .04; double asterisks, P = .02; triple asterisks, P < .001).

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    Fig 4.

    Examples of improved image quality in 65-keV virtual monoenergetic images acquired with a CTDIvol with 55 mGy (A), 49.8 mGy (B), and 44.7 mGy (C) compared with CI, respectively (D–F).

Tables

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    Table 1:

    Radiation dose

    Tube Current–Time Product (mAs)320290260
    DLP (mGy × cm)a1014.9 ± 56.9937.7 ± 40.2837.7 ± 45.6
        Radiation dose reduction−7.6%−17.5%
    CTDIvol (mGy)5549.844.7
        Radiation dose reduction−9.5%−18.7%
    • Note:—DLP indicates dose-length product.

    • ↵a Results are means ± SDs.

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    Table 2:

    Quantitative results of attenuation, noise, and CNRa

    CTDIvol (mGy)CIVMI65keV
    5549.844.75549.844.7
    Attenuation
        GM34.0 ± 1.433.4 ± 1.534.1 ± 1.734.6 ± 1.334.2 ± 1.235.1 ± 1.5
        WM26.5 ± 1.226.1 ± 1.527.0 ± 1.626.4 ± 1.126.0 ± 1.327.1 ± 1.4
        Thalamus33.6 ± 1.533.2 ± 1.634.4 ± 1.934.4 ± 1.433.9 ± 1.435.5 ± 1.8
        Posterior limb26.5 ± 2.226.3 ± 2.026.6 ± 2.226.1 ± 1.426.0 ± 1.726.6 ± 2.0
        Caudate nucleus34.5 ± 4.435.2 ± 2.135.4 ± 2.335.7 ± 1.535.8 ± 1.836.3 ± 2.1
        Extraocular muscle32.8 ± 5.631.1 ± 6.433.2 ± 8.131.9 ± 5.630.8 ± 6.235.4 ± 9.9
        Medulla oblongata31.5 ± 4.332.0 ± 4.534.6 ± 4.931.1 ± 3.331.0 ± 3.033.9 ± 3.7
    Noise
        GM4.5 ± 0.84.6 ± 0.74.8 ± 0.83.1 ± 0.63.1 ± 0.53.2 ± 0.5
        WM4.5 ± 0.74.8 ± 0.84.9 ± 0.73.0 ± 0.53.2 ± 0.53.3 ± 0.6
        Thalamus5.8 ± 0.86.0 ± 1.06.1 ± 1.14.0 ± 0.74.2 ± 0.84.3 ± 0.9
        Posterior limb5.2 ± 1.05.5 ± 1.15.6 ± 1.33.6 ± 0.83.7 ± 0.93.9 ± 1.0
        Caudate nucleus5.4 ± 1.15.6 ± 1.25.6 ± 0.83.7 ± 0.93.8 ± 0.83.8 ± 0.6
        Extraocular muscle5.3 ± 1.45.6 ± 1.66.1 ± 2.13.6 ± 1.13.7 ± 1.34.2 ± 1.6
        Medulla oblongata6.1 ± 1.26.4 ± 1.26.7 ± 1.44.4 ± 1.04.6 ± 0.94.7 ± 0.9
    GM-WM CNR2.5 ± 0.52.4 ± 0.52.3 ± 0.53.4 ± 0.53.3 ± 0.53.2 ± 0.5
    • ↵a Results are means ± SDs.

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    Table 3:

    Qualitative results of subjective image parametersa

    CTDIvol (mGy)CIVMI65keV
    5549.844.75549.844.7
    GWMA3 (3–3)3 (3–3)3 (3–3)5 (5–5)5 (5–5)5 (4–5)
    CMAS3 (3–3)3 (3–3)3 (3–4)5 (5–5)5 (5–5)5 (5–5)
    CMAI3 (3–3)3 (3–3)3 (2–3)5 (5–5)5 (5–5)4 (4–5)
    SSA4 (4–5)4 (4–4)4 (4–5)4 (4–5)4 (4–5)4 (4–5)
    Noise3 (3–3)2 (2–3)3 (3–3)4 (4–4)4 (4–4)4 (4–4)
    Artifacts3 (3–4)3 (2–3)3 (2–3)4 (4–5)4 (4–5)4 (4–4)
    • Note:—GWMA indicates assessment of gray-white matter differentiation of the basal ganglia; CMAS, assessment of corticomedullary differentiation supratentorially; CMAI, assessment of corticomedullary differentiation infratentorially; SSA, assessment of subcalvarial space.

    • ↵a Results are medians (quartiles).

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American Journal of Neuroradiology: 40 (10)
American Journal of Neuroradiology
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R.P. Reimer, D. Flatten, T. Lichtenstein, D. Zopfs, V. Neuhaus, C. Kabbasch, D. Maintz, J. Borggrefe, N. Große Hokamp
Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT
American Journal of Neuroradiology Oct 2019, 40 (10) 1617-1623; DOI: 10.3174/ajnr.A6220

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Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT
R.P. Reimer, D. Flatten, T. Lichtenstein, D. Zopfs, V. Neuhaus, C. Kabbasch, D. Maintz, J. Borggrefe, N. Große Hokamp
American Journal of Neuroradiology Oct 2019, 40 (10) 1617-1623; DOI: 10.3174/ajnr.A6220
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