Clinical Application of Dual-Energy Spectral Computed Tomography in Detecting Cholesterol Gallstones From Surrounding Bile

Rationale and Objective: This study aimed to investigate the clinical value of spectral computed tomography (CT) in the detection of cholesterol gallstones from surrounding bile. Materials and Methods: This study was approved by the institutional review board. The unenhanced spectral CT data of 24 patients who had surgically confirmed cholesterol gallstones were analyzed. Lipid concentrations and CT numbers were measured from fat based material decomposition image and virtual monochromatic image sets (40-140 keV), respectively. The difference in lipid concentration and CT number between cholesterol gallstones and the surrounding bile were statistically analyzed. Receiver operating characteristic analysis was applied to determine the diagnostic accuracy of using lipid concentration to differentiate cholesterol gallstones from bile. Results: Cholesterol gallstones were bright on fat-based material decomposition images yielding a 92% detection rate (22 of 24). The lipid concentrations (552.65 +/- 262.36 mg/mL), CT number at 40 keV (-31.57 +/- 16.88 HU) and 140 keV (24.30 +/- 5.85 HU) for the cholesterol gallstones were significantly different from those of bile (-13.94 +/- 105.12 mg/mL; 12.99 +/- 9.39 HU and 6.19 +/- 4.97 HU, respectively). Using 182.59 mg/mL as the threshold value for lipid concentration, one could obtain sensitivity of 95.5% and specificity of 100% with accuracy of 0:994 for differentiating cholesterol gallstones tom bile. Conclusions: Virtual monochromatic. spectral CT images at 40 keV and 140 keV provide significant CT number differences between, cholesterol gallstones and the surrounding bile. Spectral CT provides an excellent detection rate for cholesterol gallstones.