Characterization of size‐specific effects during dual‐energy CT material decomposition of non‐iodine materials

PURPOSE: The dual‐energy CT (DECT) LiverVNC application class in the Siemens Syngo.via software has been used to perform non‐iodine material decompositions. However, the LiverVNC application is designed with an optional size‐specific calibration based on iodine measurements. This work investigates the effects of this iodine‐based size‐specific calibration on non‐iodine material decomposition and benchmarks alternative methods for size‐specific calibrations. METHODS: Calcium quantification was performed with split‐filter and sequential‐scanning DECT techniques on the Siemens SOMATOM Definition Edge CT scanner. Images were acquired of the Gammex MECT abdomen and head phantom containing calcium inserts with concentrations ranging from 50–300 mgCa/ml. Several workflows were explored investigating the effects of size‐specific dual‐energy ratios (DERs) and the beam hardening correction (BHC) function in the LiverVNC application. Effects of image noise were also investigated by varying CTDI(vol) and using iterative reconstruction (ADMIRE). RESULTS: With the default BHC activated, Syngo.via underestimated the calcium concentrations in the abdomen for sequential‐scanning acquisitions, leaving residual calcium in the virtual non‐contrast images and underestimating calcium in the enhancement images for all DERs. Activation of the BHC with split‐filter images resulted in a calcium over‐ or underestimation depending on the DER. With the BHC inactivated, the use of a single DER led to an under‐ or overestimate of calcium concentration depending on phantom size and DECT modality. Optimal results were found with BHC inactivated using size‐specific DERs. CTDI(vol) levels and ADMIRE had no significant effect on results. CONCLUSION: When performing non‐iodine material decomposition in the LiverVNC application class, it is important to understand the implications of the BHC function and to account for patient size appropriately. The BHC in the LiverVNC application is specific to iodine and leads to inaccurate quantification of other materials. The inaccuracies can be overcome by deactivating the BHC function and using size‐specific DERs, which provided the most accurate calcium quantification.