Comparison of Image Quality and Radiation Dose Between Single-Energy and Dual-Energy Images for the Brain With Stereotactic Frames on Dual-Energy Cerebral CT

BACKGROUND: Preoperative stereotactic planning of deep brain stimulation (DBS) using computed tomography (CT) imaging in patients with Parkinson's disease (PD) is of clinical interest. However, frame-induced metal artifacts are common in clinical practice, which can be challenging for neurosurgeons to visualize brain structures. OBJECTIVES: To evaluate the image quality and radiation exposure of patients with stereotactic frame brain CT acquired using a dual-source CT (DSCT) system in single- and dual-energy modes. MATERIALS AND METHODS: We included 60 consecutive patients with Parkinson's disease (PD) and randomized them into two groups. CT images of the brain were performed using DSCT (Group A, an 80/Sn150 kVp dual-energy mode; Group B, a 120 kVp single-energy mode). One set of single-energy images (120 kVp) and 10 sets of virtual monochromatic images (50–140 keV) were obtained. Subjective image analysis of overall image quality was performed using a five-point Likert scale. For objective image quality evaluation, CT values, image noise, signal-to-noise ratio (SNR), and contrast-to-noise (CNR) were calculated. The radiation dose was recorded for each patient. RESULTS: The mean effective radiation dose was reduced in the dual-energy mode (1.73 mSv ± 0.45 mSv) compared to the single-energy mode (3.16 mSv ± 0.64 mSv) (p < 0.001). Image noise was reduced by 46–52% for 120–140 keV VMI compared to 120 kVp images (both p < 0.01). CT values were higher at 100–140 keV than at 120 kVp images. At 120–140 keV, CT values of brain tissue showed significant differences at the level of the most severe metal artifacts (all p < 0.05). SNR was also higher in the dual-energy mode 90–140 keV compared to 120 kVp images, showing a significant difference between the two groups at 120–140 keV (all p < 0.01). The CNR was significantly better in Group A for 60–140 keV VMI compared to Group B (both p < 0.001). The highest subjective image scores were found in the 120 keV images, while 110–140 keV images had significantly higher scores than 120 kVp images (all p < 0.05). CONCLUSION: DSCT images using dual-energy modes provide better objective and subjective image quality for patients with PD at lower radiation doses compared to single-energy modes and facilitate brain tissue visualization with stereotactic frame DBS procedures.