Optimisation of virtual monoenergetic reconstructions for the diagnosis of pulmonary embolism using photon-counting detector computed tomography angiography.

Polish journal of radiology Pub Date : 2024-01-31 eCollection Date: 2024-01-01 DOI:10.5114/pjr.2024.134905
Jordan H Chamberlin, Adrienn Toth, Shaun Hinen, Jim O'Doherty, Dhiraj Baruah, Dhruw Maisuria, Aaron McGuire, Heather Knight, U Joseph Schoepf, Reginald F Munden, Ismail M Kabakus
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Abstract

Purpose: Computed tomography (CT) pulmonary angiography is considered the gold standard for pulmonary embolism (PE) diagnosis, relying on the discrimination between contrast and embolus. Photon-counting detector CT (PCD-CT) generates monoenergetic reconstructions through energy-resolved detection. Virtual monoenergetic images (VMI) at low keV can be used to improve pulmonary artery opacification. While studies have assessed VMI for PE diagnosis on dual-energy CT (DECT), there is a lack of literature on optimal settings for PCD-CT-PE reconstructions, warranting further investigation.

Material and methods: Twenty-five sequential patients who underwent PCD-CT pulmonary angiography for suspicion of acute PE were retrospectively included in this study. Quantitative metrics including signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio were calculated for 4 VMI values (40, 60, 80, and 100 keV). Qualitative measures of diagnostic quality were obtained for proximal to distal pulmonary artery branches by 2 cardiothoracic radiologists using a 5-point modified Likert scale.

Results: SNR and CNR were highest for the 40 keV VMI (49.3 ± 22.2 and 48.2 ± 22.1, respectively) and were inversely related to monoenergetic keV. Qualitatively, 40 and 60 keV both exhibited excellent diagnostic quality (mean main pulmonary artery: 5.0 ± 0 and 5.0 ± 0; subsegmental pulmonary arteries 4.9 ± 0.1 and 4.9 ± 0.1, respectively) while distal segments at high (80-100) keVs had worse quality.

Conclusions: 40 keV was the best individual VMI for the detection of pulmonary embolism by quantitative metrics. Qualitatively, 40-60 keV reconstructions may be used without a significant decrease in subjective quality. VMIs at higher keV lead to reduced opacification of the distal pulmonary arteries, resulting in decreased image quality.

使用光子计数探测器计算机断层扫描血管造影诊断肺栓塞的虚拟单能重建优化。
目的:计算机断层扫描(CT)肺血管造影被认为是诊断肺栓塞(PE)的金标准,它依赖于对比剂和栓子之间的鉴别。光子计数探测器 CT(PCD-CT)通过能量分辨检测生成单能重建。低 keV 的虚拟单能量图像 (VMI) 可用于改善肺动脉不透明性。虽然已有研究对双能量 CT(DECT)上 PE 诊断的 VMI 进行了评估,但关于 PCD-CT-PE 重建的最佳设置还缺乏文献,因此值得进一步研究:本研究回顾性地纳入了 25 例因怀疑急性 PE 而连续接受 PCD-CT 肺血管造影术的患者。计算了 4 个 VMI 值(40、60、80 和 100 千伏)的定量指标,包括信噪比(SNR)和对比度与噪声比(CNR)。两名心胸放射科医生采用 5 分改良李克特量表对肺动脉近端和远端分支的诊断质量进行了定性测量:40 keV VMI 的 SNR 和 CNR 最高(分别为 49.3 ± 22.2 和 48.2 ± 22.1),与单能量 keV 成反比。从质量上看,40 和 60 千伏的诊断质量都很好(主肺动脉平均值分别为:5.0 ± 0 和 5.0 ± 0;肺动脉亚段分别为 4.9 ± 0.1 和 4.9 ± 0.1),而高(80-100)千伏的远段诊断质量较差:结论:从定量指标来看,40 keV 是检测肺栓塞的最佳单个 VMI。结论:从定量指标来看,40 keV 是检测肺栓塞的最佳单个 VMI,而从定性指标来看,40-60 keV 重建的主观质量不会显著下降。更高的 VMI 会导致远端肺动脉的不透明性降低,从而导致图像质量下降。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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