Detection and size measurements of kidney stones on virtual non-contrast reconstructions derived from dual-layer computed tomography in an ex vivo phantom setup

OBJECTIVES: To systematically investigate the usability of virtual non-contrast reconstructions (VNC) derived from dual-layer CT (DLCT) for detection and size measurements of kidney stones with regards to different degrees of surrounding iodine-induced attenuation and radiation dose. METHODS: Ninety-two kidney stones of varying size (3–14 mm) and composition were placed in a phantom filled with different contrast media/water mixtures exhibiting specific iodine-induced attenuation (0–1500 HU). DLCT-scans were acquired using CTDI(vol) of 2 mGy and 10 mGy. Conventional images (CI) and VNC(0H-1500HU) were reconstructed. Reference stone size was determined using a digital caliper (Man-M). Visibility and stone size were assessed. Statistical analysis was performed using the McNemar test, Wilcoxon test, and the coefficient of determination. RESULTS: All stones were visible on CI(0HU) and VNC(200HU). Starting at VNC(400 HU), the detection rate decreased with increasing HU and was significantly lower as compared to CI(0HU) on VNC(≥ 600HU) (100.0 vs. 94.0%, p < 0.05). The overall detection rate was higher using 10 mGy as compared to 2 mGy protocol (87.9 vs. 81.8%; p < 0.001). Stone size was significantly overestimated on all VNC compared to Man-M (7.0 ± 3.5 vs. 6.6 ± 2.8 mm, p < 0.001). Again, the 10 mGy protocol tended to show a better correlation with Man-M as compared to 2 mGy protocol (R(2) = 0.39–0.68 vs. R(2) = 0.31–0.57). CONCLUSIONS: Detection and size measurements of kidney stones surrounded by contrast media on VNC are feasible. The detection rate of kidney stones decreases with increasing iodine-induced attenuation and with decreasing radiation dose as well as stone size, while remaining comparable to CI(0HU) on VNC (≤ 400 HU). KEY POINTS: • The detection rate of kidney stones on VNC depends on the surrounding iodine-induced attenuation, the used radiation dose, and the stone size. • The detection rate of kidney stones on VNC decreases with greater iodine-induced attenuation and with lower radiation dose, particularly in small stones. • The visibility of kidney stones on VNC (≤ 400 HU) remains comparable to true-non-contrast scans even when using a low-dose technique. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-09261-w.