title: Single-phase dual-energy CT allows for characterization of renal masses as benign or malignant.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of dual-energy CT (DECT) in renal mass characterization using a single-phase acquisition.
  
  
  METHODS
  A total of 202 patients (148 males, 54 females; 63 +/- 13 years) with ultrasound-based suspicion of a renal mass underwent unenhanced single energy and nephrographic phase DECT on a dual source scanner (Siemens Somatom Definition Dual Source, n = 174; Somatom Definition Flash, n = 28). Scan parameters for DECT were: tube potential, 80/100 and 100/Sn140 kVp; exposure, 404/300 and 96/232 effective mAs; collimation, 14 x 1.2/32 x 0.6 mm. Two abdominal radiologists assessed DECT and SECT image quality and noise on a 5-point visual analogue scale. Using solely the DE acquisition including virtual nonenhanced (VNE) and color coded iodine images that enable direct visualization of iodine, masses were characterized as benign or malignant. In a second reading session after 34 to 72 (average: 55) days, the same assessment was again performed using both the true nonenhanced (TNE) and nephrographic phase scans thereby simulating conventional single-energy CT. Sensitivities, specificities, diagnostic accuracies, and interpretation times and were recorded for both reading paradigms. Dose reduction of a single-phase over a dual-phase protocol was calculated. Results were tested for statistical significance using the paired Wilcoxon signed rank test and student t test. Differences in sensitivities were tested for significance using the McNemar test.
  
  
  RESULTS
  Of the 202 patients, 115 (56.9%) underwent surgical resection of renal masses. Histopathology showed malignancy in 99 and benign tumors in 18 patients, in 48 patients (23.7%), follow-up imaging showed size stability of lesions diagnosed as benign, and 37 patients (18.3%) had no mass. Based on DECT only, 95/99 (96.0%) patients with malignancy and 96/103 (93.2%) patients without malignancy were correctly identified, for an overall accuracy of 94.6%. The dual-phase approach identified 96/99 (97.0%) and 98/103 (95.1%), accuracy 96.0%, P > 0.05 for both. Mean interpretation time was 2.2 +/- 0.8 minutes for DECT, and 3.5 +/- 1.0 minutes for the dual-phase protocol, P < 0.001. Mean VNE/TNE image quality was 1.68 +/- 0.65/1.30 +/- 0.59, noise was 2.03 +/- 0.57/1.18 +/- 0.29, P < 0.001 for both. Omission of the true unenhanced phase lead to a 48.9 +/- 7.0% dose reduction.
  
  
  CONCLUSIONS
  DECT allows for fast and accurate characterization of renal masses in a single-phase acquisition. Interpretation of color coded images significantly reduces interpretation time. Omission of a nonenhanced acquisition can reduce radiation exposure by almost 50%.
authors.affiliation: Department of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany. anno.graser@med.uni-muenchen.de
authors.forename: Anno
authors.initials: A
authors.lastname: Graser
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.forename: Dirk A
authors.initials: DA
authors.lastname: Clevert
authors.forename: Michael
authors.initials: M
authors.lastname: Macari
authors.forename: Niko
authors.initials: N
authors.lastname: Arndt
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Wieland
authors.initials: W
authors.lastname: Sommer
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Thorsten R C
authors.initials: TR
authors.lastname: Johnson
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000000981:diagnostic imaging*; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*