title: Dual-energy CT discrimination of iodine and calcium: experimental results and implications for lower extremity CT angiography.
abstract: OBJECTIVE
  The purpose of this work was to measure the accuracy of dual-energy computed tomography for identifying iodine and calcium and to determine the effects of calcium suppression in phantoms and lower-extremity computed tomographic (CT) angiographic data sets.
  
  
  METHODS
  Using a three-material basis decomposition method for 80- and 140-kVp data, the accuracy of correctly identified contrast medium and calcium voxels and the mean attenuation before and after calcium suppression were computed. Experiments were first performed on a phantom of homogenous contrast medium and hydroxyapatite samples with mean attenuation of 57.2, 126, and 274 Hounsfield units (HU) and 50.0, 122, and 265 HU, respectively. Experiments were repeated in corresponding attenuation groups of voxels from manually segmented bones and contrast medium-enhanced arteries in a lower-extremity CT angiographic data set with mean attenuation of 293 and 434 HU, respectively. Calcium suppression in atherosclerotic plaques of a cadaveric specimen was also studied, using micro-computed tomography as a reference, and in a lower-extremity CT angiographic data set with substantial below-knee calcified plaques.
  
  
  RESULTS
  Higher concentrations showed increased accuracy of iodine and hydroxyapatite identification of 87.4%, 99.7%, and 99.9% and 88.0%, 95.0%, and 99.9%, respectively. Calcium suppression was also more accurate with higher concentrations of iodine and hydroxyapatite, with mean attenuation after suppression of 47.1, 122, and 263 HU and 7.14, 11.6, and 12.6 HU, respectively. Similar patterns were seen in the corresponding attenuation groups of the contrast medium-enhanced arteries and bone in the clinical data set, which had overall accuracy of 81.3% and 78.9%, respectively, and mean attenuation after calcium suppression of 254 and 73.7 HU, respectively. The suppression of calcified atherosclerotic plaque was accurate compared with the micro-CT reference; however, the suppression in the clinical data set showed probable inappropriate suppression of the small vessels.
  
  
  CONCLUSIONS
  Dual-energy computed tomography can detect and differentiate between contrast medium and calcified tissues, but its accuracy is dependent on the CT density of tissues and limited when CT attenuation is low.
authors.affiliation: School of Medicine, Stanford University Medical Center, Stanford, CA 94305-5105, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Tran
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.forename: Justus E
authors.initials: JE
authors.lastname: Roos
authors.forename: Sandy
authors.initials: S
authors.lastname: Napel
authors.forename: Dominik
authors.initials: D
authors.lastname: Fleischmann
mesh_terms: D000792:Angiography / Q000379:methods*; D001158:Arteries / Q000378:metabolism*; D002118:Calcium / Q000032:analysis*; D006801:Humans; D007455:Iodine / Q000032:analysis*; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*
chemical_list: D007455:Iodine; D002118:Calcium