The Potential of Dual-energy Virtual Monochromatic Imaging in Reducing Renal Cyst Pseudoenhancement: a Phantom Study

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  • Yamada Sachiko
    Department of Radiology, Osaka University Hospital Department of Health Science, Osaka Kyoiku University Graduate School of Education
  • Ueguchi Takashi
    Department of Radiology, Osaka University Hospital
  • Ukai Isao
    Department of Emergency and Critical Care Center, Hyogo Prefectural Nishinomiya Hospital
  • Nagai Yumiko
    Department of Health Science, Osaka Kyoiku University Graduate School of Education
  • Yamakawa Masanobu
    Department of Health Science, Osaka Kyoiku University Graduate School of Education
  • Shimosegawa Eku
    Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine
  • Shimazu Takeshi
    Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
  • Hatazawa Jun
    Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine

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Other Title
  • 仮想単色CTによる腎嚢胞のPseudoenhancement抑制効果：腎嚢胞ファントムモデルによる検証
  • 仮想単色CTによる腎囊胞のPseudoenhancement抑制効果 : 腎囊胞ファントムモデルによる検証
  • カソウ タンショク CT ニ ヨル ジンノウホウ ノ Pseudoenhancement ヨクセイ コウカ : ジンノウホウファントムモデル ニ ヨル ケンショウ

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Abstract

Renal cyst pseudoenhancement, an artifactual increase of computed tomography (CT) attenuation for cysts with increased iodine concentrations in the renal parenchyma, complicates the classification of cysts and may thus lead to the mischaracterization of a benign non-enhancing lesion as an enhancing mass. The purpose of this study was to use a phantom model to assess the ability of dual-energy virtual monochromatic imaging to reduce renal pseudoenhancement. A water-filled cylindrical cyst model suspended in varying concentrations of iodine solution, to simulate varying levels of parenchymal enhancement, was scanned with a dual-energy CT scanner using the following three scanning protocols with different combinations of tube voltage: 80 and 140 kV; 80 and 140 kV with tin filter; and 100 and 140 kV with tin filter. Virtual monochromatic images were then synthesized for each dual-energy scan. Single-energy scan with a tube voltage of 120 kV was also performed to obtain polychromatic images as controls. Mean attenuation values (in Hounsfield units) of cyst proxies were measured on both polychromatic and virtual monochromatic images. Pseudoenhancement was considered to be present when the cyst attenuation level increased by more than 10 HU as the background iodine concentration increased from 0.0% to 0.4%, 1.5%, or 2.5%. Our results revealed that pseudoenhancement was not observed on any of the monochromatic images, but appeared on polychromatic images at a background iodine concentration of 2.5%. We thus conclude that dual-energy virtual monochromatic images have a potential to reduce renal pseudoenhancement.

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