title: Noise-optimized virtual monoenergetic dual-energy computed tomography: optimization of kiloelectron volt settings in patients with gastrointestinal stromal tumors.
abstract: The aim of this study was to evaluate the impact of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique on quantitative and qualitative image analysis in patients with gastrointestinal stromal tumors (GISTs) at dual-energy computed tomography (DECT) of the abdomen.
  
  
  
  Forty-five DECT datasets of 21 patients (14 men; 63.7 ± 9.2 years) with GISTs were reconstructed with the standard linearly blended (M_0.6) and VMI+ and traditional virtual monoenergetic (VMI) algorithm in 10-keV increments from 40 to 100 keV. Attenuation measurements were performed in GIST lesions and abdominal metastases to calculate objective signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Five-point scales were used to evaluate overall image quality, lesion delineation, image sharpness, and image noise.
  
  
  
  Quantitative image parameters peaked at 40-keV VMI+ series (SNR 27.8 ± 13.0; CNR 26.3 ± 12.7), significantly superior to linearly blended (SNR 16.8 ± 7.3; CNR 13.6 ± 6.9) and all VMI series (all P < 0.001). Qualitative image parameters were highest for 60-keV VMI+ reconstructions regarding overall image quality and image sharpness (median 5, respectively; P ≤ 0.023). Qualitative assessment of lesion delineation peaked in 40 and 50-keV VMI+ series (median 5, respectively). Image noise was superior in 90 and 100-keV VMI and VMI+ reconstructions (all medians 5).
  
  
  
  Low-keV VMI+ reconstructions significantly increase SNR and CNR of GISTs and improve quantitative and qualitative image quality of abdominal DECT datasets compared to traditional VMI and standard linearly blended image series.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Pfeifer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. docwichmann@gmail.com.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.|Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Moritz H
authors.initials: MH
authors.lastname: Albrecht
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Leithner
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Lenga
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.|Cardiac MR PET CT Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Scholtz
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Bodelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003287:Contrast Media; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D011860:Radiography, Abdominal / Q000379:methods*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: Dual-energy CT; Gastrointestinal stromal tumor; Image quality; Oncology; Virtual monoenergetic imaging