title: Evaluation of image quality, radiation dose and diagnostic performance of dual-energy CT datasets in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate image quality and diagnostic accuracy of different dual-energy computed tomography (DECT) datasets for identification of hepatocellular carcinoma (HCC), assess the reliability of virtual unenhanced (VU) images in replacing standard unenhanced (SU) images, and quantify effective dose (ED) at different tube voltages.
  
  
  METHODS
  Thirty cirrhotic patients underwent liver contrast-enhanced DECT. Two blinded observers retrospectively evaluated conventional unenhanced and VU images, 140 kVp/80 kVp/mixed tube potential arterial datasets and conventional portal-venous/late phases in consensus. Final diagnosis was based on pathological proof or imaging criteria. Image quality, ED, sensitivity, and specificity of arterial datasets were calculated.
  
  
  RESULTS
  Thirty-eight HCC and 18 benign lesions were detected at 80 kVp, 33 HCC and 22 benign lesions were detected at 140 kVp, and 36 HCC and 20 benign lesions were detected at mixed tube potentials. Final diagnosis confirmed 37 HCC and 20 benign lesions. There was no significant difference in diagnostic confidence between 80 kVp, 140 kVp, and mixed tube potential arterial datasets (p>0.05). Image quality was adequate for all datasets, with increased quality at higher tube potential (80 versus 140 kVp, p=0.001; mixed versus 140 kVp, p=0.001; 80 kVp versus mixed, p=0.0024). Significant ED reduction was observed between 140 and 80 kVp datasets (p<0.001).
  
  
  CONCLUSIONS
  The 140 kVp dataset provided higher image quality. The 80 kVp images were more sensitive in detecting HCC. VU images are adequate in replacing SU images. The ED of the 80 kVp dataset was significantly lower.
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Anzidei
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Martino
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy. Electronic address: beatrice.sacconi@fastwebnet.it.
authors.forename: B
authors.initials: B
authors.lastname: Sacconi
authors.affiliation: Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Saba
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Boni
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Zaccagna
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Geiger
authors.affiliation: Bracco Imaging, Milan, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Kirchin
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Napoli
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bezzi
authors.affiliation: Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol