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1/2024
vol. 89 Cardiovascular radiology
abstract:
Original paper
Optimisation of virtual monoenergetic reconstructions for the diagnosis of pulmonary embolism using photon-counting detector computed tomography angiography
Jordan H. Chamberlin
1
,
Adrienn Toth
1
,
Shaun Hinen
1
,
Jim O’Doherty
1, 2
,
Dhiraj Baruah
1
,
Dhruw Maisuria
1
,
Aaron McGuire
1
,
Heather Knight
1
,
U. Joseph Schoepf
1
,
Reginald F. Munden
1
,
Ismail M. Kabakus
1
1.
Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, United States
2.
Siemens Medical Solutions, Malvern, PA, United States
© Pol J Radiol 2024; 89: e63-e69
Online publish date: 2024/01/31
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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. keywords:
optimisation, pulmonary embolism, PCCT, VMI |