title: Differentiation of urinary calculi with dual energy CT: effect of spectral shaping by high energy tin filtration.
abstract: OBJECTIVE
  In dual energy (DE) computed tomography (CT), spectral shaping by additional filtration of the high energy spectrum can theoretically improve dual energy contrast. The aim of this in vitro study was to examine the influence of an additional tin filter for the differentiation of human urinary calculi by dual energy CT.
  
  
  METHODS
  A total of 36 pure human urinary calculi (uric acid, cystine, calciumoxalate monohydrate, calciumoxalate dihydrate, carbonatapatite, brushite, average diameter 10.5 mm) were placed in a phantom and imaged with 2 dual source CT scanners. One scanner was equipped with an additional tin (Sn) filter. Different combinations of tube voltages (140/80 kV, 140/100 kV, Sn140/100 kV, Sn140/80 kV, with Sn140 referring to 140 kV with the tin filter) were applied. Tube currents were adapted to yield comparable dose indices. Low- and high energy images were reconstructed. The calculi were segmented semiautomatically in the datasets and DE ratios (attenuation@low_kV/attenuation@high_kV) and were calculated for each calculus. DE contrasts (DE-ratio_material1/DE-ratio_material2) were computed for uric acid, cystine and calcified calculi and compared between the combinations of tube voltages.
  
  
  RESULTS
  Using exclusively DE ratios, all uric acid, cystine and calcified calculi (as a group) could be differentiated in all protocols; the calcified calculi could not be differentiated among each other in any examination protocol. The highest DE ratios and DE contrasts were measured for the Sn140/80 protocol (53%-62% higher DE contrast than in the 140/80 kV protocol without additional filtration). The DE ratios and DE contrasts of the 80/140 kV and 100/Sn140 kV protocols were comparable.
  
  
  CONCLUSIONS
  Uric acid, cystine and calcified calculi could be reliably differentiated by any of the protocols. A dose-neutral gain of DE contrast was found in the Sn-filter protocols, which might improve the differentiation of smaller calculi (Sn140/80 kV) and improve image quality and calculi differentiation in larger patients (Sn140/100 kV). However, even with the improved spectral separation of the Sn-filter protocols, the DE ratios of calcified calculi are not sufficiently distinct to allow a differentiation within this group.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany. Christoph.thomas@med.uni-tuebingen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomas
authors.forename: Bernhard
authors.initials: B
authors.lastname: Krauss
authors.forename: Dominik
authors.initials: D
authors.lastname: Ketelsen
authors.forename: Ilias
authors.initials: I
authors.lastname: Tsiflikas
authors.forename: Anja
authors.initials: A
authors.lastname: Reimann
authors.forename: Matthias
authors.initials: M
authors.lastname: Werner
authors.forename: David
authors.initials: D
authors.lastname: Schilling
authors.forename: Jörg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.forename: Martin
authors.initials: M
authors.lastname: Heuschmid
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D005374:Filtration / Q000379:methods*; D006801:Humans; D019047:Phantoms, Imaging; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014001:Tin; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D014545:Urinary Calculi / Q000000981:diagnostic imaging*; D014567:Urography / Q000379:methods*
chemical_list: D014001:Tin