title: Assessment of an Advanced Monoenergetic Reconstruction Technique in Dual-Energy Computed Tomography of Head and Neck Cancer.
abstract: OBJECTIVE
  To define optimal keV settings for advanced monoenergetic (Mono+) dual-energy computed tomography (DECT) in patients with head and neck squamous cell carcinoma (SCC).
  
  
  METHODS
  DECT data of 44 patients (34 men, mean age 55.5 ± 16.0 years) with histopathologically confirmed SCC were reconstructed as 40, 55, 70 keV Mono + and M_0.3 (30 % 80 kV) linearly blended series. Attenuation of tumour, sternocleidomastoid muscle, internal jugular vein, submandibular gland, and noise were measured. Three radiologists with >3 years of experience subjectively assessed image quality, lesion delineation, image sharpness, and noise.
  
  
  RESULTS
  The highest lesion attenuation was shown for 40 keV series (248.1 ± 94.1 HU), followed by 55 keV (150.2 ± 55.5 HU; P = 0.001). Contrast-to-noise ratio (CNR) at 40 keV (19.09 ± 13.84) was significantly superior to all other reconstructions (55 keV, 10.25 ± 9.11; 70 keV, 7.68 ± 6.31; M_0.3, 5.49 ± 3.28; all P < 0.005). Subjective image quality was highest for 55 keV images (4.53; κ = 0.38, P = 0.003), followed by 40 keV (4.14; κ = 0.43, P < 0.001) and 70 keV reconstructions (4.06; κ = 0.32, P = 0.005), all superior (P < 0.004) to linear blending M_0.3 (3.81; κ = 0.280, P = 0.056).
  
  
  CONCLUSIONS
  Mono + DECT at low keV levels significantly improves CNR and subjective image quality in patients with head and neck SCC, as tumour CNR peaks at 40 keV, and 55 keV images are preferred by observers.
  
  
  CONCLUSIONS
  • Mono + DECT combines increased contrast with reduced image noise, unlike linearly blended images. • Mono + DECT imaging allows for superior CNR and subjective image quality. • Head and neck tumour contrast-to-noise ratio peaks at 40 keV. • 55 keV images are preferred over all other series by observers.
authors: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany, MoritzAlbrecht@gmx.net.
authors: Moritz H
authors: MH
authors: Albrecht
authors: Jan-Erik
authors: JE
authors: Scholtz
authors: Johannes
authors: J
authors: Kraft
authors: Ralf W
authors: RW
authors: Bauer
authors: Moritz
authors: M
authors: Kaup
authors: Patricia
authors: P
authors: Dewes
authors: Andreas M
authors: AM
authors: Bucher
authors: Iris
authors: I
authors: Burck
authors: Jens
authors: J
authors: Wagenblast
authors: Thomas
authors: T
authors: Lehnert
authors: J Matthias
authors: JM
authors: Kerl
authors: Thomas J
authors: TJ
authors: Vogl
authors: Julian L
authors: JL
authors: Wichmann
mesh_terms: D003287:Contrast Media; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media