Martin Simon S, Wichmann Julian L, Scholtz Jan-Erik, Leithner Doris, D'Angelo Tommaso, Weyer Hendrik, Booz Christian, Lenga Lukas, Vogl Thomas J, Albrecht Moritz H
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany.
J Vasc Interv Radiol. 2017 Sep;28(9):1257-1266. doi: 10.1016/j.jvir.2017.06.011. Epub 2017 Jul 19.
To evaluate diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique for detection of active arterial abdominal bleeding on dual-energy (DE) CT angiography compared with standard image reconstruction.
DE CT angiography data sets of 71 patients (46 men; age 63.6 y ± 13.3) with suspected arterial bleeding of the abdomen or pelvis were reconstructed with standard linearly blended (F_0.5), VMI+, and traditional virtual monoenergetic imaging (VMI) algorithms in 10-keV increments from 40 to 100 keV. Attenuation measurements were performed in the descending aorta, area of hemorrhage, and feeding artery to calculate contrast-to-noise ratios (CNRs) in patients with active arterial bleeding. Based on quantitative image quality results, the best series for each reconstruction technique were chosen to analyze the diagnostic performance of 3 blinded radiologists.
DE CT angiography showed acute arterial bleeding in 36 patients. Mean CNR was superior in 40-keV VMI+ compared with VMI series (all P < .001), which showed highest CNRs in 70-keV VMI and F_0.5 (21.6 ± 7.9, 12.9 ± 4.7, and 10.4 ± 3.6) images. Area under the curve analysis for detection of arterial bleeding showed significantly superior (P < .001) results for 40-keV VMI+ (0.963) compared with 70-keV VMI (0.775) and F_0.5 (0.817) series.
Diagnostic accuracy in patients with active arterial bleeding of the abdomen can be significantly improved using VMI+ reconstructions at 40 keV compared with standard linearly blended and traditional VMI series in DE CT angiography.
与标准图像重建相比，评估噪声优化的虚拟单能量成像（VMI+）重建技术在双能量（DE）CT血管造影中检测腹部动脉活动性出血的诊断准确性。
对71例（46例男性；年龄63.6岁±13.3岁）疑似腹部或盆腔动脉出血患者的DE CT血管造影数据集，采用标准线性混合（F_0.5）、VMI+和传统虚拟单能量成像（VMI）算法，以10 keV为增量，从40 keV到100 keV进行重建。对活动性动脉出血患者的降主动脉、出血区域和供血动脉进行衰减测量，以计算对比噪声比（CNR）。基于定量图像质量结果，选择每种重建技术的最佳序列，分析3名盲法放射科医生的诊断性能。
DE CT血管造影显示36例患者有急性动脉出血。40 keV的VMI+序列的平均CNR优于VMI序列（所有P < 0.001），后者在70 keV的VMI和F_0.5图像中显示出最高的CNR（分别为21.6±7.9、12.9±4.7和10.4±3.6）。检测动脉出血的曲线下面积分析显示，40 keV的VMI+序列（0.963）的结果明显优于70 keV的VMI序列（0.775）和F_0.5序列（0.817）（P < 0.001）。
在DE CT血管造影中，与标准线性混合和传统VMI序列相比，使用40 keV的VMI+重建可显著提高腹部动脉活动性出血患者的诊断准确性。
