Yoshida Ryuya, Nagayama Yasunori, Esaki Takumi, Matsumoto Taiga, Tamura Yoshitaka, Ishiuchi Soichiro, Inoue Taihei, Sakabe Daisuke, Igarashi Yasuaki, Kidoh Masafumi, Oda Seitaro, Nakaura Takeshi, Kiyosue Hiro, Hirai Toshinori
Department of Diagnostic Radiology, Kumamoto University, Kumamoto, Japan.
Central Radiology, Kumamoto University Hospital, Kumamoto, Japan.
Abdom Radiol (NY). 2025 Aug 18. doi: 10.1007/s00261-025-05165-7.
To investigate whether virtual-monoenergetic images (VMI) from dual-layer spectral-detector computed tomography (DLCT) improve right adrenal vein (RAV) assessment before adrenal venous sampling (AVS), and portal-venous-phase (PVP) images alone can replace conventional multiphase CT combining late-arterial phase (LAP) and PVP.
Sixty-three patients with primary aldosteronism who underwent LAP and PVP DLCT before AVS were retrospectively analyzed. Conventional polyenergetic-images (PEI) and VMI at 40-70 keV (VMI) were reconstructed. Image noise and contrast-to-noise ratio (CNR) of RAV were quantified. VMI with the highest CNR was predefined as the best-VMI. Two radiologists evaluated four image series (PEI and best-VMI at LAP and PVP) separately for RAV visibility, accessory hepatic vein (AHV) assessability, and image noise using five-point scales (1 = worst, 5 = best). RAV detection and AHV assessability rates were compared among image series.
In both enhancement phases, VMI showed lower image noise and VMI higher CNR than PEI (all p < 0.05), with VMI providing the highest CNR and being designated as the best VMI. Compared to PEI at LAP, CNR was lower with PEI at PVP but higher with VMI at PVP (both, p < 0.001). In subjective analysis, VMI showed better scores than PEI for image noise (LAP: 4.0 ± 0.5 vs. 2.4 ± 0.6; PVP: 4.0 ± 0.6 vs. 2.5 ± 0.5) and RAV visibility (LAP: 4.5 ± 0.8 vs. 3.5 ± 0.8; PVP: 3.7 ± 1.0 vs. 2.6 ± 0.9) (all p < 0.001). With PEI, the RAV detection rate was lower at PVP than at LAP (54.8% vs. 89.7%, p < 0.001). Use of VMI at PVP achieved the same detection rate as PEI at LAP (89.7%, p = 1.0) and higher AHV assessability rate than PEI at PVP (96.8% vs. 80.2%, p < 0.001).
DLCT-VMI improved RAV assessments before AVS. Using VMI for PVP provided RAV depiction equivalent to PEI at LAP and superior AHV assessability to PEI at PVP, suggesting its potential as a surrogate for dedicated multiphase CT.
探讨双层光谱探测器计算机断层扫描（DLCT）的虚拟单能量图像（VMI）在肾上腺静脉采样（AVS）前对右肾上腺静脉（RAV）评估的改善情况，以及仅门静脉期（PVP）图像能否替代结合了动脉晚期（LAP）和PVP的传统多期CT。
回顾性分析63例原发性醛固酮增多症患者，这些患者在AVS前接受了LAP和PVP的DLCT检查。重建了传统的多能量图像（PEI）和40 - 70 keV的VMI。对RAV的图像噪声和对比噪声比（CNR）进行量化。将具有最高CNR的VMI预定义为最佳VMI。两名放射科医生分别使用五点量表（1 =最差，5 =最佳）对四个图像系列（LAP和PVP时的PEI和最佳VMI）进行评估，评估内容包括RAV的可见性、副肝静脉（AHV）的可评估性和图像噪声。比较各图像系列之间的RAV检测率和AHV可评估率。
在两个增强期，VMI均显示出比PEI更低的图像噪声和更高的CNR（所有p < 0.05），VMI具有最高的CNR并被指定为最佳VMI。与LAP时的PEI相比，PVP时的PEI的CNR较低，但PVP时的VMI的CNR较高（两者，p < 0.001）。在主观分析中，VMI在图像噪声（LAP：4.0 ± 0.5 vs. 2.4 ± 0.6；PVP：4.0 ± 0.6 vs. 2.5 ± 0.5）和RAV可见性（LAP：4.5 ± 0.8 vs. 3.5 ± 0.8；PVP：3.7 ± 1.0 vs. 2.6 ± 0.9）方面的评分均高于PEI（所有p < 0.001）。使用PEI时，PVP时的RAV检测率低于LAP时（54.8% vs. 89.7%，p < 0.001）。在PVP时使用VMI达到了与LAP时PEI相同的检测率（89.7%，p = 1.0），并且AHV可评估率高于PVP时的PEI（96.8% vs. 80.2%，p < 0.001）。
DLCT - VMI改善了AVS前的RAV评估。在PVP时使用VMI对RAV的显示等同于LAP时的PEI，并且对AHV的可评估性优于PVP时的PEI，表明其作为专用多期CT替代方法的潜力。
