Focal cystic high-attenuation lesions: characterization in renal phantom by using photon-counting spectral CT--improved differentiation of lesion composition.
OBJECTIVE
To evaluate the capability of spectral computed tomography (CT) to improve the characterization of cystic high-attenuation lesions in a renal phantom and to test the hypothesis that spectral CT will improve the differentiation of cystic renal lesions with high protein content and those that have undergone hemorrhage or malignant contrast-enhancing transformation.


METHODS
A renal phantom that contained cystic lesions grouped in nonenhancing cyst and hemorrhage series and an iodine-enhancing series was developed. Spectral CT is based on new detector designs that may possess energy-sensitive photon-counting abilities, thereby facilitating the assessment of quantitative information about the elemental and molecular composition of tissue or contrast materials. Imaging of the renal phantom was performed with a prototype scanner at 20 mAs and 70 keV, allowing characterization of x-ray photons at 25-34, 34-39, 39-44, 44-49, 49-55, and more than 55 keV. Region of interest analysis was used to determine lesion attenuation values at various x-ray energies. Statistical analysis was performed to assess attenuation patterns and identify distinct levels of attenuation on the basis of curve regression analysis with analysis of variance tables.


RESULTS
Spectral CT depicted linear clusters for the cyst (P < .001, R(2) > 0.940) and hemorrhage (P < .001, R(2) > 0.962) series without spectral overlap. A distinct linear attenuation profile without spectral overlap was also detected for the iodine-enhancing series (P < .001, R(2) > 0.964), with attenuation values attained in the 34-39-keV energy bin statistically identified as outliers (mean slope variation, >37%), corresponding with iodine k-edge effects at 33.2 keV.


CONCLUSIONS
Spectral CT has the potential to enable distinct characterization of hyperattenuating fluids in a renal phantom by helping identify proteinaceous and hemorrhagic lesions through assessment of their distinct levels of attenuation as well as by revealing iodine-containing lesions through analysis of their specific k-edge discontinuities.
Boll
Daniel T
DT
Department of Radiology, Duke University Medical Center, Durham, NC, USA. daniel.boll@duke.edu
Patil
Neil A
NA
Paulson
Erik K
EK
Merkle
Elmar M
EM
Nelson
Rendon C
RC
Schindera
Sebastian T
ST
Roessl
Ewald
E
Martens
Gerhard
G
Proksa
Roland
R
Fleiter
Thorsten R
TR
Schlomka
Jens-Peter
JP
D003287:Contrast Media; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000000981:diagnostic imaging* / Q000473:pathology; D019047:Phantoms, Imaging; D017785:Photons; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*
D003287:Contrast Media