title: Application of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Routine Pancreas Imaging.
abstract: OBJECTIVE
  To compare image quality on contrast-enhanced dual-energy computed tomography (DECT) during the pancreatic parenchymal phase of pancreatic masses between linearly-blended simulated 120 kVp images (routine) and advanced image-based virtual monoenergetic reconstructions at 55 keV.
  
  
  METHODS
  This was a retrospective evaluation of 24 nonconsecutive adults found to have a focal pancreatic mass on a multiphasic abdominal dual-source DECT (12 adenocarcinoma, 5 neuroendocrine, 7 cystic tumors). For pancreatic-parenchymal phase images, subjects had routine and 55 keV images reconstructed at the time of clinical evaluation. Quantitative evaluation by contrast-to-noise ratio and qualitative evaluations of image quality by (1) direct comparison of image pairs (preference) and (2) blinded assessment of image quality measures based on Likert scores were performed.
  
  
  RESULTS
  Mean patient weight was 205.8 ± 26.6 lbs. Mean pancreatic lesion contrast-to-noise ratio was significantly higher at 55 keV (6.8 ± 4.1) compared to the routine image series (5.8 ± 3.8; P = 0.0002). All 3 readers preferred the 55-keV images over routine blended images in 70.1% to 95.8% of cases. No significant differences were observed for subjective sharpness of the mass, visualization of internal mass structures, or image noise.
  
  
  CONCLUSIONS
  Use of a single advanced image-based virtual monoenergetic reconstruction at 55 keV in pancreatic DECT showed improved objective image quality and reader preference compared to routine images. As this image reconstruction can be incorporated into the scan protocol, this technique should be considered for routine clinical use.
authors.affiliation: From the *Department of Radiology and Radiological Science, †Department of Surgery, Medical University of South Carolina, Charleston, SC; and ‡Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hardie
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Picard
authors.forename: E Ramsay
authors.initials: ER
authors.lastname: Camp
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Perry
authors.forename: Pal
authors.initials: P
authors.lastname: Suranyi
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media