Project description:PurposeVirtual monoenergetic images (VMIs) derived from dual-energy computed tomography (DECT) have been explored for several clinical applications in recent years. However, VMIs at low and high keVs have high levels of noise. The aim of this study was to reduce image noise in VMIs by using a two-step noise reduction technique.MethodsVMI was first denoised using a modified highly constrained backprojection (HYPR) method. After the first-step denoising, a general-threshold filtering method was performed. Two sets of anthropomorphic phantoms were scanned with a clinical dual-source DECT system. DECT data (80/140Sn kV) were reconstructed as VMI series at 12 different energy levels (range, 40-150 keV, interval, 10 keV). For comparison, the averaged VMIs obtained from 10 repeated DECT scans were used as the reference standard. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and root-mean-square error (RMSE) were used to evaluate the quality of VMIs.ResultsCompared to the original HYPR method, the proposed two-step image denoising method could provide better performance in terms of SNR, CNR, and RMSE. In addition, the proposed method could achieve effective noise reduction while preserving edges and small structures, especially for low-keV VMIs.ConclusionThe proposed two-step image denoising method is a feasible method for reducing noise in VMIs obtained from a clinical DECT scanner. The proposed method can also reduce edge blurring and the loss of intensity in small lesions.
Project description:ObjectiveTo investigate the diagnostic value of dual-energy computed tomography (DECT) quantitative parameters in the identification of regional lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC).MethodsThis retrospective diagnostic study assessed 145 patients with pathologically confirmed pancreatic ductal adenocarcinoma from August 2016-October 2020. Quantitative parameters for targeted lymph nodes were measured using DECT, and all parameters were compared between benign and metastatic lymph nodes to determine their diagnostic value. A logistic regression model was constructed; the receiver operator characteristics curve was plotted; the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of each energy DECT parameter; and the DeLong test was used to compare AUC differences. Model evaluation was used for correlation analysis of each DECT parameter.ResultsStatistical differences in benign and metastatic lymph nodes were found for several parameters. Venous phase iodine density had the highest diagnostic efficacy as a single parameter, with AUC 0.949 [95% confidence interval (CI):0.915-0.972, threshold: 3.95], sensitivity 79.80%, specificity 96.00%, and accuracy 87.44%. Regression models with multiple parameters had the highest diagnostic efficacy, with AUC 0.992 (95% CI: 0.967-0.999), sensitivity 95.96%, specificity 96%, and accuracy 94.97%, which was higher than that for a single DECT parameter, and the difference was statistically significant.ConclusionAmong all DECT parameters for regional lymph node metastasis in PDAC, venous phase iodine density has the highest diagnostic efficacy as a single parameter, which is convenient for use in clinical settings, whereas a multiparametric regression model has higher diagnostic value compared with the single-parameter model.
Project description:To evaluate the influence of dual-energy CT (DECT) and Virtual monochromatic spectral (VMS) imaging on: (1) the artefact size of geometrically identical orthopaedic implants consisting of three different compositions and (2) the image quality of the surrounding bone, three similar phantoms-each featuring one femoral stem composed of either titanium, chrome-cobalt or stainless steel surrounded by five calcium pellets (200 mg hydroxyapatite/calcium carbonate) to simulate bony tissue and one reference pellet located away from the femoral stem-were built. DECT with two sequential scans (80 kVp and 140 kVp; scan-to-scan technique) was performed, and VMS images were calculated between 40 and 190 keV. The artefact sizes were measured volumetrically by semiautomatic selection of regions of interest (ROIs), considering the VMS energies and the polychromatic spectres. Moreover, density and image noise within the pellets were measured. All three phantoms exhibit artefact size reduction as energy increases from 40 to 190 keV. Titanium exhibited a stronger reduction than chrome-cobalt and stainless steel. The artefacts were dependent on the diameter of the stem. Image quality increases with higher energies on VMS with a better depiction of surrounding structures. Monoenergetic energies 70 keV and 140 keV demonstrate superior image quality to those produced by spectral energies 80 kVp and 140 kVp.
Project description:BackgroundDual-energy computed tomography (DECT) has been widely used due to improved substances identification from additional spectral information. The quality of material-specific image produced by DECT attaches great importance to the elaborated design of the basis material decomposition method.ObjectiveThe aim of this work is to develop and validate a data-driven algorithm for the image-based decomposition problem.MethodsA deep neural net, consisting of a fully convolutional net (FCN) and a fully connected net, is proposed to solve the material decomposition problem. The former net extracts the feature representation of input reconstructed images, and the latter net calculates the decomposed basic material coefficients from the joint feature vector. The whole model was trained and tested using a modified clinical dataset.ResultsThe proposed FCN delivers image with about 60% smaller bias and 70% lower standard deviation than the competing algorithms, suggesting its better material separation capability. Moreover, FCN still yields excellent performance in case of photon noise.ConclusionsOur deep cascaded network features high decomposition accuracies and noise robust property. The experimental results have shown the strong function fitting ability of the deep neural network. Deep learning paradigm could be a promising way to solve the nonlinear problem in DECT.
Project description:BackgroundMany patients with malignant tumors require chemotherapy and radiation therapy, which can result in a decline in physical function and potentially influence bone mineral density (BMD). Furthermore, these treatments necessitate enhanced computed tomography (CT) scans for determining disease staging or treatment outcomes, and opportunistic screening with available imaging data is beneficial for patients at high risk for osteoporosis if existing imaging data can be used. The study aimed to investigate the feasibility of opportunistic screening for osteoporosis using enhanced CT based on a dual-energy CT (DECT) material decomposition technique.MethodsWe prospectively enrolled 346 consecutive patients who underwent abdominal unenhanced and triphasic contrast-enhanced CT (arterial, portal venous, and delayed phases) between June 2021 and June 2022. The BMD, and the density of hydroxyapatite (HAP) on HAP-iodine images and calcium (Ca) on Ca-iodine images were measured on the L1-L3 vertebral bodies. The iodine intake was recorded. Pearson analysis was conducted to assess the correlation between iodine intake and the density values in three phases and the correlation between BMD and the densities of HAP and Ca. Furthermore, linear regression was employed for quantitative evaluation. Bland-Altman analysis was used to evaluate the agreement between calculated BMD derived from DECT (BMD-DECT) and reference BMD derived from quantitative CT (BMD-QCT). Receiver operating characteristic (ROC) analysis was applied to assess the diagnostic efficacy.ResultsThe HAP and Ca density of the L1-L3 vertebral bodies did not differ significantly among the three phases of contrast-enhanced CT (F=0.001-0.049; P>0.05). Significant positive correlations were found between HAP, Ca densities, and BMD (HAP-BMD: r=0.9472, R2=0.8973; Ca-BMD: r=0.9470, R2=0.8968; all P<0.001). Bland-Altman plots showed high agreement between BMD-DECT and BMD-QCT. The area under the curve (AUC) using HAP and Ca measurements was 0.963 [95% confidence interval (CI): 0.937-0.980] and 0.964 (95% CI: 0.939-0.981), respectively, for diagnosing osteoporosis and was 0.951 (95% CI: 0.917-0.973) and 0.950 (95% CI: 0.916-0.973), respectively, for diagnosing osteopenia.ConclusionsThe HAP and Ca density measurements generated through the material decomposition technique in DECT have good diagnostic performances in assessing BMD, which offers a new perspective for opportunistic screening of osteoporosis on contrast-enhanced CT.
Project description:PurposeWeighted average dual-energy computed tomography (DE-CT) reconstructions are considered a proxy of standard CT images of the brain, recommended for routine clinical use and used as a reference standard in DE-CT research. However, their image quality has not been assessed, which was the aim of our study.MethodsImages from 81 consecutive patients who underwent both non-contrast single-energy (SE)-CT and DE-CT of the brain on the same scanner were retrospectively evaluated. Attenuation values (HU) and SD of grey matter/white matter (GM/WM) pairs, along with SD in the posterior fossa and subcalvarial region were measured. Four readers evaluated image noise, GM/WM contrast, posterior fossa and subcalvarial artefacts, as well as overall image quality.ResultsWeighted average DE-CT GM and WM HU were significantly lower and noise higher compared to SE-CT (GM HU 36.46 v. 41.82; WM HU 28.18 v. 29.94; GM SD 2.93 v. 2.49; and WM SD 3.16 v. 2.44, all p < 0.0001). After correcting the measured SE-CT noise for 37% higher acquisition dose, DE-CT GM noise became significantly lower (2.93 v. 3.11, p = 0.0121). Measured and dose corrected SE-CT GM/WM contrast-to-noise ratio was superior to weighted average DE-CT (3.42 and 2.74 v. 1.95, both p < 0.0001). Weighted average DE-CT had significantly less artifacts on qualitative analysis.ConclusionWeighted average DE-CT images of the brain yield less artefacts at 37% dose reduction and lower noise at SE-CT equivalent dose. Dose-adjusted GM/WM contrast-to-noise ratio of weighted average DE-CT with 0.4 weighting factor remains inferior to SE-CT images.
Project description:BackgroundThis retrospective study aimed to investigate the usefulness of the optimized kiloelectron volt (keV) for virtual monoenergetic imaging (VMI) combined with iodine map in dual-energy computed tomography enterography (DECTE) in the diagnosis of Crohn's disease (CD).MethodsSeventy-two patients (mean age: 41.89 ± 17.28 years) with negative computed tomography enterography (CTE) were enrolled for investigating the optimized VMI keV in DECTE by comparing subjective and objective parameters of VMIs that were reconstructed from 40 to 90 keV. Moreover, 68 patients (38.27 ± 15.10 years; 35 normal and 33 CD) were included for evaluating the diagnostic efficacy of DECTE iodine map at the optimized VMI energy level and routine CTE for CD and active CD. Statistical analysis for all data was conducted.ResultsObjective and subjective imaging evaluations showed the best results at 60 keV for VMIs. The CT values of the normal group, active subgroup, and CD group during the small intestinal phase at routine 120 kVp or 60 keV VMI had significant differences. The diagnostic efficacy of an iodine map was the best when NIC = 4% or fat value = 45.8% for CD, whereas NIC < 0.35 or the fat value < 0.38 for active CD. The combined routine CTE and optimized VMI improved the diagnostic efficacy (P < 0.001).ConclusionsVMI at 60 keV provided the best imaging quality on DECTE. NIC and fat value provided important basis for active CD evaluation. Routine CTE combined with VMI at 60 keV improved the diagnostic efficiency for CD.
Project description:ObjectiveTo develop and validate a dual-energy computed tomography (DECT) derived radiomics model to predict peritoneal metastasis (PM) in patients with gastric cancer (GC).MethodsThis retrospective study recruited 239 GC (non-PM = 174, PM = 65) patients with histopathological confirmation for peritoneal status from January 2015 to December 2019. All patients were randomly divided into a training cohort (n = 160) and a testing cohort (n = 79). Standardized iodine-uptake (IU) images and 120-kV-equivalent mixed images (simulating conventional CT images) from portal-venous and delayed phases were used for analysis. Two regions of interest (ROIs) including the peritoneal area and the primary tumor were independently delineated. Subsequently, 1691 and 1226 radiomics features were extracted from the peritoneal area and the primary tumor from IU and mixed images on each phase. Boruta and Spearman correlation analysis were used for feature selection. Three radiomics models were established, including the R_IU model for IU images, the R_MIX model for mixed images and the combined radiomics model (the R_comb model). Random forest was used to tune the optimal radiomics model. The performance of the clinical model and human experts to assess PM was also recorded.ResultsFourteen and three radiomics features with low redundancy and high importance were extracted from the IU and mixed images, respectively. The R_IU model showed significantly better performance to predict PM than the R_MIX model in the training cohort (AUC, 0.981 vs. 0.917, p = 0.034). No improvement was observed in the R_comb model (AUC = 0.967). The R_IU model was the optimal radiomics model which showed no overfitting in the testing cohort (AUC = 0.967, p = 0.528). The R_IU model demonstrated significantly higher predictive value on peritoneal status than the clinical model and human experts in the testing cohort (AUC, 0.785, p = 0.005; AUC, 0.732, p <0.001, respectively).ConclusionDECT derived radiomics could serve as a non-invasive and easy-to-use biomarker to preoperatively predict PM for GC, providing opportunity for those patients to tailor appropriate treatment.
Project description:Purpose: To investigate the correlation between 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters and clinicopathological factors in pathological subtypes of invasive lung adenocarcinoma and prognosis. Patients and Methods: Metabolic parameters and clinicopathological factors from 176 consecutive patients with invasive lung adenocarcinoma between August 2008 and August 2016 who underwent 18F-FDG PET/CT examination were retrospectively analyzed. Invasive lung adenocarcinoma was divided into five pathological subtypes:lepidic predominant adenocarcinoma (LPA), acinar predominant adenocarcinoma (APA), papillary predominant adenocarcinoma (PPA), solid predominant adenocarcinoma (SPA), and micropapillary predominant adenocarcinoma (MPA). The differences in metabolic parameters [maximal standard uptake value (SUVmax), mean standard uptake value (SUVmean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV)] and tumor diameter for different pathological subtypes were analyzed. Patients were divided into two groups according to their prognosis: good prognosis group (LPA, APA, PPA) and poor prognosis group (SPA, MPA). Logistic regression was used to filter predictors and construct a predictive model, and areas under the receiver operating curve (AUC) were calculated. Cox regression analysis was performed on prognostic factors. Results: 82 (46.6%) females and 94 (53.4%) males of patients with invasive lung adenocarcinoma were enrolled in this study. Metabolic parameters and tumor diameter of different pathological subtype had statistically significant (P < 0.05). The predictive model constructed using independent predictors (Distant metastasis, Ki-67, and SUVmax) had good classification performance for both groups. The AUC for SUVmax was 0.694 and combined with clinicopathological factors were 0.745. Cox regression analysis revealed that Stage, TTF-1, MTV, and pathological subtype were independent risk factors for patient prognosis. The hazard ratio (HR) of the poor prognosis group was 1.948 (95% CI 1.042-3.641) times the good prognosis group. The mean survival times of good and poor prognosis group were 50.2621 (95% CI 47.818-52.706) and 35.8214 (95% CI 27.483-44.159) months, respectively, while the median survival time was 47.00 (95% CI 45.000-50.000) and 31.50 (95% CI 23.000-49.000) months, respectively. Conclusion: PET/CT metabolic parameters combined with clinicopathological factors had good classification performance for the different pathological subtypes, which may provide a reference for treatment strategies and prognosis evaluation of patients.