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Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures

The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy...

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Autores principales: Winkelmann, Moritz T., Hagen, Florian, Artzner, Kerstin, Bongers, Malte N., Artzner, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9601488/
https://www.ncbi.nlm.nih.gov/pubmed/36292231
http://dx.doi.org/10.3390/diagnostics12102542
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author Winkelmann, Moritz T.
Hagen, Florian
Artzner, Kerstin
Bongers, Malte N.
Artzner, Christoph
author_facet Winkelmann, Moritz T.
Hagen, Florian
Artzner, Kerstin
Bongers, Malte N.
Artzner, Christoph
author_sort Winkelmann, Moritz T.
collection PubMed
description The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7–100% vs. 88.2–96.7%; specificity: 100% vs. 96.7–100%; p < 0.0001; ICC: 0.96–0.99) and confidence (Likert: 5; IRQ [5–5] vs. 4, IRQ [3–4; 4–5]; p < 0.0001; ICC: 0.80–0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images.
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spelling pubmed-96014882022-10-27 Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures Winkelmann, Moritz T. Hagen, Florian Artzner, Kerstin Bongers, Malte N. Artzner, Christoph Diagnostics (Basel) Article The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7–100% vs. 88.2–96.7%; specificity: 100% vs. 96.7–100%; p < 0.0001; ICC: 0.96–0.99) and confidence (Likert: 5; IRQ [5–5] vs. 4, IRQ [3–4; 4–5]; p < 0.0001; ICC: 0.80–0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images. MDPI 2022-10-20 /pmc/articles/PMC9601488/ /pubmed/36292231 http://dx.doi.org/10.3390/diagnostics12102542 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Winkelmann, Moritz T.
Hagen, Florian
Artzner, Kerstin
Bongers, Malte N.
Artzner, Christoph
Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title_full Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title_fullStr Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title_full_unstemmed Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title_short Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures
title_sort dual-energy ct for accurate discrimination of intraperitoneal hematoma and intestinal structures
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9601488/
https://www.ncbi.nlm.nih.gov/pubmed/36292231
http://dx.doi.org/10.3390/diagnostics12102542
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