title: Hypodense liver lesions in patients with hepatic steatosis: do we profit from dual-energy computed tomography?
abstract: OBJECTIVE
  To evaluate dual-energy CT (DECT) imaging of hypodense liver lesions in patients with hepatic steatosis, having a high incidence in the general population and among cancer patients receiving chemotherapy.
  
  
  METHODS
  One hundred and five patients with hepatic steatosis (liver parenchyma <40 HU) underwent contrast-enhanced DECT with reconstruction of pure iodine (PI), optimum contrast (OC), 80 kVp, and 120 kVp-equivalent data sets. Image noise (IN), lesion to liver signal to noise (SNR) and contrast to noise (CNR) ratios were quantitatively analysed; image quality was rated on a 5-point scale (1, excellent; 2, good; 3, fair; 4, poor; 5, non-diagnostic) by two independent reviewers.
  
  
  RESULTS
  In 21 patients with hypodense liver lesions, IN was lowest in PI followed by 120 kVp-equivalent and OC, and highest in 80 kVp. SNR was highest in PI (1.30), followed by 120 kVp-equivalent (0.72) and 80 kVp (0.63), and lowest in OC (0.55). CNR was highest in 120 kVp-equivalent (4.95), followed by OC (4.55) and 80 kVp (4.14), and lowest in PI (3.63). The 120 kVp-equivalent series exhibited best overall qualitative image score (1.88), followed by OC (1.98), 80 kVp (3.00) and PI (3.67).
  
  
  CONCLUSIONS
  In our study, the 120 kVp-equivalent series was best suited for visualization of hypodense lesions within steatotic liver parenchyma, while using DECT currently seems to offer no additional diagnostic advantage.
  
  
  CONCLUSIONS
  • Hepatic steatosis has high incidence in the general population and following chemotherapy. • Hypodense liver lesions can be obscured by steatotic liver parenchyma in CT. • Low kV p -CT shows no advantage in detecting hypodense lesions in steatotic livers. • Additional DECT image information does not improve visualization of hypodense lesions in steatosis. • 120 kV p -equivalent imaging yields best quantitative and qualitative image analysis results.
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. johanna.nattenmueller@med.uni-heidelberg.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Nattenmüller
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. waldemar.hosch@urz.uni-heidelberg.de.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Hosch
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. tri-thien.nguyen@stud.uni-heidelberg.de.
authors.forename: Tri-Thien
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. stephan.skornitzke@med.uni-heidelberg.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Skornitzke
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. andreas.joeres@gmx.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jöres
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. lars.grenacher@med.uni-heidelberg.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Grenacher
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. hu.kauczor@med.uni-heidelberg.de.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. christof.sommer@med.uni-heidelberg.de.
authors.forename: Christof M
authors.initials: CM
authors.lastname: Sommer
authors.affiliation: Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. wolfram.stiller@med.uni-heidelberg.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Stiller
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003287:Contrast Media; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Dual energy; Fatty liver; Metastasis; Obesity