Impact of dual-energy CT prior to radioembolization (RE).
BACKGROUND
Depiction of the exact arterial liver anatomy as well as identifying potential extrahepatic non-target vessels is crucial for a successful preparation of radioembolization (RE).


OBJECTIVE
To compare the diagnostic impact of dual-energy computed tomography (DECT) to digital subtraction angiography prior to RE.


METHODS
DECT was applied in 46 patients with hepatocellular carcinoma (HCC) prior to RE. Eighty kV DE as well as reconstructed 120 kV equivalent DE datasets were evaluated in comparison to correlating digital subtraction angiography (DSA) datasets. Two radiologists evaluated in consensus the delineation of liver arteries and extrahepatic non-target vessels utilizing a 4-point scale (4 = excellent delineation; 1 = non-diagnostic). In addition, the arterial vascularization of liver segment IV was evaluated and classified: signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR; liver arteries to adjacent liver tissue) were obtained via ROI analysis.


RESULTS
Both imaging techniques (DECT, DSA) enabled high-quality assessment of all analyzed liver arteries. Out of the two CT datasets, 80 kVp-DE datasets offered superior delineation of the right gastric artery (3.5 ± 0.7 vs. 2.5 ± 0.5), the vascularization of segment IV (3.9 ± 0.2 vs. 3.3 ± 0.5) as well as potential extrahepatic non-target vessels (3.9 ± 0.1 vs. 3.3 ± 0.5). In accordance to the results of the qualitative analysis, 80 kVp-DE datasets also yielded higher SNR (34.84 vs. 29.31) and CNR (28.29 vs. 21.8) values in comparison to the 120 kVp datasets.


CONCLUSIONS
Eighty kVp DECT enables a significantly better assessment of the arteries of the upper abdomen for therapy planning in comparison to correlating 120 kVp datasets. This may allow for identification of potential extrahepatic non-target vessels and assessment of target volume for therapy planning prior to DSA.
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany jens.altenbernd@uk-essen.de.
Jens-Christian
JC
Altenbernd
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Ilka
I
von der Stein
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Axel
A
Wetter
Institute of Nuclear Medicine, University Hospital Essen, Germany.
James
J
Nagarajah
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Lale
L
Umutlu
Institute of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Germany.
Till
T
Heusner
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Jens M
JM
Theysohn
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Adrian
A
Ringelstein
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Michael
M
Forsting
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
Thomas
T
Lauenstein
D000368:Aged; D000792:Angiography; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D019275:Radiopharmaceuticals; C093233:iobitridol; D007472:Iohexol
Abdomen; CT angiography; liver; vascular