Effect of acquisition techniques, latest kernels, and advanced monoenergetic post-processing for stent visualization with third-generation dual-source CT.

PURPOSE The purpose of this study is to systematically evaluate the effect of tube voltage, current kernels, and monoenergetic post-processing on stent visualization. METHODS A 6 mm chrome-cobalt peripheral stent was placed in a dedicated phantom and scanned with the available tube voltage settings of a third-generation dual-source scanner in single-energy (SE) and dual-energy (DE) mode. Images were reconstructed using the latest convolution kernels and monoenergetic reconstructions (40-190 keV) for DE. The sharpness of stent struts (S), struts width (SW), contrast-to-noise-ratios (CNR), and pseudoenhancement (PE) between the vessel with and without stent were analyzed using an in-house built automatic analysis tool. Measurements were standardized through calculated z-scores. Z-scores were combined for stent (SQ), luminal (LQ), and overall depiction quality (OQ) by adding S and SW, CNR and SW and PE, and S and SW and CNR and PE. Two readers rated overall stent depiction on a 5-point Likert-scale. Agreement was calculated using linear-weighted kappa. Correlations were calculated using Spearman correlation coefficient. RESULTS Maximum values of S and CNR were 169.1 HU/pixel for [DE; 100/ Sn 150 kV; Qr59; 40 keV] and 50.0 for [SE; 70 kV; Bv36]. Minimum values of SW and PE were 2.615 mm for [DE; 80 to 90/ Sn 150 kV; Qr59; 140 to 190 keV] and 0.12 HU for [DE; 80/ Sn 150 kV; Qr36; 190 keV]. Best combined z-scores of SQ, LQ, and OQ were 4.53 for [DE; 100/ Sn 150 kV; Qr 59; 40 keV], 1.23 for [DE; 100/ Sn 150 kV; Qr59; 140 keV] and 2.95 for [DE; 90/ Sn 150 kV; Qr59; 50 keV]. Best OQ of SE was ranked third with 2.89 for [SE; 90 kV; Bv59]. Subjective agreement was excellent (kappa=0.86; P < .001) and correlated well with OQ (rs=0.94, P < .001). CONCLUSION Combining DE computed tomography (CT) acquisition with the latest kernels and monoenergetic post-processing allows for improved stent visualization as compared with SECT. The best overall results were obtained for monoenergetic reconstructions with 50 keV from DECT 90/Sn 150 kV acquisitions using kernel Qr59.