title: Added value of 80 kVp images to averaged 120 kVp images in the detection of hepatocellular carcinomas in liver transplantation candidates using dual-source dual-energy MDCT: results of JAFROC analysis.
abstract: BACKGROUND
  To assess the added value of 80 kVp images to weighted average 120 kVp images for detecting hepatocellular carcinomas (HCCs) using dual-source, dual-energy MDCT.
  
  
  METHODS
  Forty-one HCCs in 42 patients who underwent liver transplantation (LT) were included. All patients underwent quadruple-phase CT using a 64-row dual-source, dual-energy MDCT with 80 kVp and 140 kVp. For 120 kVp, a linear blending ratio of 0.3 was chosen. Interval reviews for both simulated 120 kVp images without and with pure 80 kVp data were performed independently by two radiologists. They detected HCCs using a 4-point confidence scale. Tumor-to-liver contrast-to-noise ratio (CNR) was calculated and compared between the 80 kVp and simulated 120 kVp images. The additional diagnostic value of 80 kVp images was evaluated by jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis.
  
  
  RESULTS
  There were 41 HCCs on pathology and 37 of the 41 HCCs were depicted on CT scan. The mean CNR of the 37 HCCs in late arterial and portal-phase images was significantly better in the 80 kVp images than in 120 kVp images. The average JAFROC figure of merit, however, was not significantly improved when 80 kVp was added. Furthermore, the number of false-positives was significantly increased in reader 1 when adding 80kVp data.
  
  
  CONCLUSIONS
  The addition of 80 kVp CT images to simulated 120 kVp images did not significantly improve the detection of HCCs despite of the significantly better CNR of 80 kVp images.
authors.affiliation: Department of Radiology, Seoul National University Hospital, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Park
authors.forename: Gi Hyeon
authors.initials: GH
authors.lastname: Kim
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011829:Radiation Dosage; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media