Third generation dual-energy CT with 80/150 Sn kV for head and neck tumor imaging

Abstract

Background

Dual-energy CT (DECT) provides additional image datasets which enable improved tumor delineation or reduction of beam hardening artifacts in patients with head and neck squamous cell carcinoma (SCC).

Purpose

To assess radiation dose and image quality of third-generation DECT of the head and neck in comparison to single-energy CT (SECT).

Material and Methods

Thirty patients with SCC who underwent both SECT (reference tube voltage 120 kVp) and DECT (80/150 Sn kVp) of the head and neck region for staging were retrospectively selected. Attenuation measurements of the sternomastoid muscle, internal jugular vein, submandibular gland and tongue were compared. Image noise was assessed at five anatomic levels. Subjective image quality was evaluated by two radiologists in consensus.

Results

CTDI_vol was 55% lower with DECT (4.2 vs. 9.3 mGy; P = 0.002). Median image noise was equal or lower in DECT at all levels (nasopharynx: 3.9 vs. 5.8, P < 0.0001; floor of mouth: 3.6 vs. 4.5, P = 0.0002; arytenoids: 3.6 vs. 3.1, P = 0.096; lower thyroid: 4.4 vs. 5.7, P = 0.002; arch of aorta: 5.6 vs. 6.5, P = 0.001). Attenuation was significantly lower in DECT (P < 0.05). Subjective image analysis revealed that DECT is equal or superior to SECT with regard to overall image quality (nasopharynx: 5 vs. 5, P = 1; floor of mouth: 5 vs. 5, P = 0.0041; arytenoids: 5 vs. 5, P = 0.6; lower thyroid: 5 vs. 3, P < 0.0001; arch of aorta: 5 vs. 4, P < 0.0001).

Conclusion

Head and neck imaging with third-generation DECT can reduce radiation dose by half compared to SECT, while maintaining excellent image quality.

Keywords

Head/neck CT dual-energy CT radiation exposure image quality

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References

Sadick

Schoenberg

Hoermann

et al.

[Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer]. Laryngorhinootologie 2012; 91 (Suppl. 1): S27–47.

Tawfik

Kerl

Bauer

et al.

Dual-energy CT of head and neck cancer: average weighting of low- and high-voltage acquisitions to improve lesion delineation and image quality-initial clinical experience. Invest Radiol 2012; 47: 306–311.

Toepker

Czerny

Ringl

et al.

Can dual-energy CT improve the assessment of tumor margins in oral cancer?

Oral Oncol 2014; 50: 221–227.

Hermans

. Staging of laryngeal and hypopharyngeal cancer: value of imaging studies. Eur Radiol 2006; 16: 2386–2400.

Becker

Burkhardt

Dulguerov

et al.

Imaging of the larynx and hypopharynx. Eur J Radiol 2008; 66: 460–479.

Vogl

Schulz

Bauer

et al.

Dual-energy CT applications in head and neck imaging. Am J Roentgenol 2012; 199: S34–39.

Tawfik

Kerl

Razek

et al.

Image quality and radiation dose of dual-energy CT of the head and neck compared with a standard 120-kVp acquisition. Am J Neuroradiol 2011; 32: 1994–1999.

Paul

Vogl

Mbalisike

. Oncological applications of dual-energy computed tomography imaging. J Comput Assist Tomogr 2014; 38: 834–842.

Paul

Mbalisike

Nour-Eldin

et al.

Dual-source 128-slice MDCT neck: radiation dose and image quality estimation of three different protocols. Eur J Radiol 2013; 82: 787–796.

10.

De Cecco

Darnell

Rengo

et al.

Dual-energy CT: oncologic applications. Am J Roentgenol 2012; 199: S98–S105.

11.

Simons

Kachelriess

Schlemmer

. Recent developments of dual-energy CT in oncology. Eur Radiol 2014; 24: 930–939.

12.

Wichmann

Noske

Kraft

et al.

Virtual monoenergetic dual-energy computed tomography: optimization of kiloelectron volt settings in head and neck cancer. Invest Radiol 2014; 49: 735–741.

13.

Albrecht

Scholtz

Kraft

et al.

Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer. Eur Radiol 2015; 25: 2493–2501.

14.

Bamberg

Dierks

Nikolaou

et al.

Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol 2011; 21: 1424–1429.

15.

Krauss

Grant

Schmidt

et al.

The importance of spectral separation: an assessment of dual-energy spectral separation for quantitative ability and dose efficiency. Invest Radiol 2015; 50: 114–118.

16.

McCollough C, Cody D, Edyvean S, et al. The Measurement, Reporting, and Management of Radiation Dose in CT. College Park, MD: AAPM, 2007. Available at: https://www.aapm.org/pubs/reports/RPT_96.pdf (accessed on 21st January 2018).

17.

Martin

Albrecht

Wichmann

et al.

Value of a noise-optimized virtual monoenergetic reconstruction technique in dual-energy CT for planning of transcatheter aortic valve replacement. Eur Radiol 2017; 27: 705–714.

18.

Mourits

Nijhof

van Leuken

et al.

Reducing contrast medium volume and tube voltage in CT angiography of the pulmonary artery. Clin Radiol 2016; 71: 615.e7–615.e13.

19.

Ibrahim

Parmar

Christodoulou

et al.

Raise the bar and lower the dose: current and future strategies for radiation dose reduction in head and neck imaging. Am J Neuroradiol 2014; 35: 619–624.

20.

Scholtz

Husers

Kaup

et al.

Evaluation of image quality and dose reduction of 80 kVp neck computed tomography in patients with suspected peritonsillar abscess. Clin Radiol 2015; 70: e67–73.

21.

Yamauchi

Buehler

Goodsitt

et al.

Dual-energy CT-based differentiation of benign posttreatment changes from primary or recurrent malignancy of the head and neck: comparison of spectral Hounsfield units at 40 and 70 keV and iodine concentration. Am J Roentgenol 2016; 206: 580–587.

22.

Kuno

Onaya

Iwata

et al.

Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology 2012; 265: 488–496.

23.

Scholtz

Kaup

Kraft

et al.

Objective and subjective image quality of primary and recurrent squamous cell carcinoma on head and neck low-tube-voltage 80-kVp computed tomography. Neuroradiology 2015; 57: 645–651.