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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(03): 289-298
DOI: 10.4103/ijri.IJRI_241_19
Recent Advances

Applications of dual energy CT in clinical practice: A pictorial essay

Parang S Sanghavi
Jankharia Imaging Centre, Mumbai, Maharashtra, India
,
Bhavin G Jankharia
Jankharia Imaging Centre, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

In dual-energy CT (DECT), two different x-ray spectra are used to acquire two image datasets of the same region, to allow the analysis of energy-dependent changes in the attenuation of different materials. Each type of material demonstrates a relatively specific change in attenuation between images obtained with a high-energy spectrum and those obtained with a low-energy spectrum. Based on the relatively specific change in attenuation with two different energies, material composition information can be obtained to allow tissue characterization. The DECT ability of material differentiation allows bone removal in various CT angiography studies and bone marrow edema depiction, while with material optimization, metal artefacts can be significantly reduced to almost nil. DECT allows material separation to differentiate uric acid crystals from calcium to determine the composition of urinary calculi and to diagnose gout. Using the DECT ability of material decomposition, iodine maps can be generated, which are useful in the evaluation of any enhancing lesion in the body without the need to obtain a plain scan and allow perfusion maps to be created in cases of pulmonary thromboembolism.

Keywords

Dual energy CT - iodine map - material - metal artefact - uric acid


Publication History

Received: 03 June 2019

Accepted: 08 October 2019

Article published online:
22 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Curry III TS, Dowdey JE, Murry RC. Christensen’s Physics of Diagnostic Radiology. 4th ed. Philadelphia, PA: Lea and Febiger; 1990: 61-9
    Google Scholar
  • 2 Alvarez RE, Macovski A. Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 1976; 21: 733-44
    CrossrefPubMedGoogle Scholar
  • 3 Kaza RK, Platt JF, Cohan RH, Caoili EM, Al-Hawary MM, Wasnik A. Dual-energy CT with single- and dual-source scanners: Current applications in evaluating the genitourinary tract. Radiographics 2012; 32: 353-69
    CrossrefPubMedGoogle Scholar
  • 4 Morhard D, Fink C, Graser A, Reiser MF, Becker C, Johnson TR. Cervical and cranial computed tomographic angiography with automated bone removal: Dual energy computed tomography versus standard computed tomography. Invest Radiol 2009; 44: 293-7
    CrossrefPubMedGoogle Scholar
  • 5 Sommer WH, Johnson TR, Becker CR, Arnoldi E, Kramer H, Reiser MF. et al. The value of dual-energy bone removal in maximum intensity projections of lower extremity computed tomography angiography. Invest Radiol 2009; 44: 285-92
    CrossrefPubMedGoogle Scholar
  • 6 Pache G, Krauss B, Strohm P, Saueressig U, Blanke P, Bulla S. et al. Dual-energy CT virtual noncalcium technique: Detecting posttraumatic bone marrow lesions—feasibility study. Radiology 2010; 256: 617-24
    CrossrefPubMedGoogle Scholar
  • 7 Guggenberger R, Gnannt R, Hodler J, Krauss B, Wanner GA, Csuka E. et al. Diagnostic performance of dual-energy CT for the detection of traumatic bone marrow lesions in the ankle: Comparison with MR imaging. Radiology 2012; 264: 164-73
    CrossrefPubMedGoogle Scholar
  • 8 Ai S, Qu M, Glazebrook KN, Liu Y, Rhee PC, Leng S. et al. Use of dual-energy CT and virtual non-calcium techniques to evaluate post-traumatic bone bruises in knees in the subacute setting. Skeletal Radiol 2014; 43: 1289-95
    CrossrefPubMedGoogle Scholar
  • 9 Kaup M, Wichmann JL, Scholtz JE, Beeres M, Kromen W, Albrecht MH. et al. Dual-energy CT-based display of bone marrow edema in osteoporotic vertebral compression fractures: Impact on diagnostic accuracy of radiologists with varying levels of experience in correlation to MR imaging. Radiology 2016; 280: 510-9
    CrossrefPubMedGoogle Scholar
  • 10 Brooks RA, Di Chiro G. Beam hardening in X-ray reconstructive tomography. Phys Med Biol 1976; 21: 390-8
    CrossrefPubMedGoogle Scholar
  • 11 Buck FM, Jost B, Hodler J. Shoulder arthroplasty. Eur Radiol 2008; 18: 2937-48
    CrossrefPubMedGoogle Scholar
  • 12 Suh JS, Jeong EK, Shin KH, Cho JH, Na JB, Kim DH. et al. Minimizing artifacts caused by metallic implants at MR imaging: Experimental and clinical studies. AJR Am J Roentgenol 1998; 171: 1207-13
    CrossrefPubMedGoogle Scholar
  • 13 Mallinson PI, Coupal TM, McLaughlin PD, Nicolaou S, Munk PL, Ouellette HA. Dual-energy CT for musculoskeletal system. Radiology 2016; 281: 690-707
    CrossrefPubMedGoogle Scholar
  • 14 Ascenti G, Mazziotti S, Lamberto S, Bottari A, Caloggero S, Racchiusa S. et al. Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: Usefulness of colored iodine overlay. AJR Am J Roentgenol 2011; 196: 1408-14
    CrossrefPubMedGoogle Scholar
  • 15 Kambadakone AR, Eisner BH, Catalano OA, Sahani DV. New and evolving concepts in the imaging and management of urolithiasis: Urologists’ perspective. Radiographics 2010; 30: 603-23
    CrossrefPubMedGoogle Scholar
  • 16 Pascual E, Batlle-Gualda E, Martínez A, Rosas J, Vela P. Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999; 131: 756-9
    CrossrefPubMedGoogle Scholar
  • 17 Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 2011; 31: 1365-75 discussion 76-7
    CrossrefPubMedGoogle Scholar
  • 18 Fink C, Johnson TR, Michaely HJ, Morhard D, Becker C, Reiser M. et al. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism: Initial results. Rofo 2008; 180: 879-83
    PubMedGoogle Scholar
  • 19 Kang MJ, Park CM, Lee CH, Goo JM, Lee HJ. Dual-energy CT: Clinical applications in various pulmonary diseases. Radiographics 2010; 30: 685-98
    CrossrefPubMedGoogle Scholar
  • 20 Chae EJ, Song JW, Seo JB, Krauss B, Jang YM, Song KS. Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: Initial experience. Radiology 2008; 249: 671-81
    CrossrefPubMedGoogle Scholar
  • 21 Swensen SJ, Brown LR, Colby TV, Weaver AL. Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology 1995; 194: 393-8
    CrossrefPubMedGoogle Scholar
  • 22 Altenbernd J, Wetter A, Umutlu L, Hahn S, Ringelstein A, Forsting M. et al. Dual-energy computed tomography for evaluation of pulmonary nodules with emphasis on metastatic lesions. Actaradiologica 2016; 57: 437-43
    Google Scholar
  • 23 Marin D, Nelson RC, Samei E, Paulson EK, Ho LM, Boll DT. et al. Hypervascular liver tumors: Low tube voltage, high tube current multidetector CT during late hepatic arterial phase for detection—initial clinical experience. Radiology 2009; 251: 771-9
    CrossrefPubMedGoogle Scholar
  • 24 Gupta RT, Ho LM, Marin D, Boll DT, Barnhart HX, Nelson RC. Dual-energy CT for characterization of adrenal nodules: Initial experience. AJR Am J Roentgenol 2010; 194: 1479-83
    CrossrefPubMedGoogle Scholar
  • 25 Vandenbroucke F, Van Hedent S, Van Gompel G, Buls N, Craggs G, Vandemeulebroucke J. et al. Dual-energy CT after radiofrequency ablation of liver, kidney, and lung lesions: A review of features. Insights Imaging 2015; 6: 363-79
    CrossrefPubMedGoogle Scholar
  • 26 Mileto A, Allen BC, Pietryga JA, Farjat AE, Zarzour JG, Bellini D. et al. Characterization of incidental renal mass with dual-energy CT: Diagnostic accuracy of effective atomic number maps for discriminating nonenhancing cysts from enhancing masses. AJR 2017; 209: 1-10
    CrossrefPubMedGoogle Scholar
  • 27 Luo XF, Xie XQ, Cheng S, Yang Y, Yan J, Zhang H. et al. Dual-energy CT for patients suspected of having liver iron overload: Can virtual iron content imaging accurately quantify liver iron content?. Radiology 2015; 277: 95-103
    CrossrefPubMedGoogle Scholar
  • 28 Joe E, Kim SH, Lee KB, Jang JJ, Lee JY, Lee JM. et al. Feasibility and accuracy of dual-source dual-energy CT for noninvasive determination of hepatic iron accumulation. Radiology 2012; 262: 126-35
    CrossrefPubMedGoogle Scholar