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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2016 June;23(2):87-93
Dual-energy CT: qualitative and quantitative evaluation of virtual non-contrast reconstruction images in patients affected by abdominal aortic aneurysms
Antonio SOLAZZO 1, Vitaliano BUFFA 1, Maria C. TODARO 2, Barbara SESSA 1, Manuela MADAU 1, Monica LUZIETTI 1, Margherita TRINCI 1, Vittorio MIELE 1
1 Department of Cardiovascular and Emergency Radiology, S. Camillo-Forlanini Hospital, Rome, Italy; 2 Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
BACKGROUND: Ionizing radiation is the main limit of CT angiography because it entails the risk of inducing carcinogenesis, particularly in patients who require a life-long follow-up. The aim of the current study is to compare qualitatively and quantitatively a virtual non-contrast reconstruction (VNC) reconstruction to a non-enhanced phase in order to assess whether VNC reconstruction might be effective enough to replace the non-enhanced phase during the follow-up of patients affected by abdominal aortic aneurysms.
METHODS: We included 196 patients (M=159, F=37, mean age 76±8.2) referred to perform a dual-energy CTA of the abdominal aorta for abdominal aortic aneurysm detection or surveillance. VNC reconstructions were compared to non-enhanced phase by two radiologists in consensus to evaluate image quality, calcium subtraction, acceptance level for diagnostic purposes and to perform a quantitative measure of density within aortic lumen. Furthermore, cumulative effective dose (ED) reduction was evaluated by replacing the non-enhanced phase with a VNC reconstruction.
RESULTS: Image quality was good for VNC reconstructions, excellent for non-enhanced acquisitions. Calcification over-subtraction in VNC images was classified as minimal in 50%, moderate in 29.0%, severe in 2.5%,while the mean density at the level of the abdominal aorta was 38.3±6.4 HU for VNC reconstructions, and 40.7±5.7 HU for non-enhanced acquisitions. Acceptance level of VNC reconstructions was complete in 86.2% of cases, with restrictions in 13.8%, no acceptance in none circumstance. The replacement of non-contrast scan with a VNC reconstruction allows to reduce the cumulative ED of 39.7%.
CONCLUSIONS: Acceptance level of VNC reconstructions allows to use them for diagnostic purposes in replacement of non-enhanced acquisitions reducing the cumulative effective dose.