Advanced Virtual Monochromatic Images from Dual Source Dual-Energy CT for a Reduction in the Contrast Medium Dose (389 mgI/kg) in Multiphase Liver CT: Evaluation of Image Quality and Focal Lesion Conspicuity

Background: Low-energy advanced virtual monochromatic images (VMIs) from dual source dual-energy CT(DSCT) could be applied to reduce contrast medium dose due to superior iodine contrast-to-noise ratios (CNRs). Objectives: To investigate feasibility of advanced VMIs from DSCT to reduce contrast medium dose in multiphase liver CT without impairing image quality and conspicuity of focal hepatic lesions (FHLs). Patients and Methods: Ninety-four patients with 110 FHL5 underwent follow-up CT twice prospectively with different protocols: protocol A, conventional 100 kVp and 555 mgI/kg; protocol B, dual-energy mode and 389 mgI/kg. The signal-to-noise ratio (SNR) and lesion-to-liver CNR were compared between the VMIs (40 -120 keV,10-keV interval) reconstructed using advanced image-based algorithm and conventional images. Two radiologists qualitatively evaluated VMIs, compared with the 100 kVp images, using a six-point scale. Results: The SNRs of pancreas, aorta, portal and hepatic vein were similar to those at 100 kVp images (P > 0.05) at 40-50 key images during late arterial phase (LAP) and at 40-60 key images during portal venous phase (PVP) except for the SNRs of aorta and veins at 40 key images which were significantly higher (P < 0.0109) during both phases and PVP, respectively. The CNR of 56 hypervascular FHLs was significantly higher at 40 - 50 keV images (P < 0.0002) and was similar at 60 keV images (P > 0.05) during LAP. The CNR of 58 hypovascular FHLs was similar at 40 -120 key images (P > 0.05) during PVP. Among the VMIs, 50 keV and 50 - 60 keV images received the highest scores (P < 0.0315 and P < 0.0041) by both reviewers during LAP and PVP, respectively. Conclusion: Advanced 50 - 60 keV images from DSCT allowed contrast dose reduction by 30% in multiphase liver CT without impairing image quality and conspicuity of FHL5, compared with the conventional 100 kVp images with 555 mgI/kg.