Impact of photon counting detector CT derived virtual monoenergetic images and iodine maps on the diagnosis of pleural empyema - 01/02/23
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Highlights |
• | Low virtual monoenergetic image energies lead to higher accuracy and confidence in the diagnosis of pleural empyema vs. non-infectious pleural effusion. |
• | Diagnostic accuracy and confidence at higher virtual monoenergetic image energies can be improved with the addition of iodine maps. |
• | Computed tomopography attenuation values of the pleura are greater in patients with empyema compared to those with non-infectious pleural effusion (P < 0.001). |
Abstract |
Purpose |
The purpose of this study was to evaluate the impact of virtual monoenergetic image (VMI) energies and iodine maps on the diagnosis of pleural empyema with photon counting detector computed tomography (PCD-CT).
Materials and methods |
In this IRB-approved retrospective study, consecutive patients with non-infectious pleural effusion or histopathology-proven empyema were included. PCD-CT examinations were performed on a dual-source PCD-CT in the multi-energy (QuantumPlus) mode at 120 kV with weight-adjusted intravenous contrast-agent. VMIs from 40-70 keV obtained in 10 keV intervals and an iodine map was reconstructed for each scan. CT attenuation was measured in the aorta, the pleura and the peripleural fat (between autochthonous dorsal muscles and dorsal ribs). Contrast-to-noise (CNR) and signal-to-noise (SNR) ratios were calculated. Two blinded radiologists evaluated if empyema was present (yes/no), and rated diagnostic confidence (1 to 4; not confident to fully confident, respectively) with and without using the iodine map. Sensitivity, specificity and diagnostic confidence were estimated. Interobserver agreement was estimated using an unweighted Cohen kappa test. A one-way ANOVA was used to compare variables. Differences in sensitivity and specificity between the different levels of energy were searched using McNemar test.
Results |
Sixty patients (median age, 60 years; 26 women) were included. A strong negative correlation was found between image noise and VMI energies (r = -0.98; P = 0.001) and CNR increased with lower VMI energies (r = -0.98; P = 0.002). Diagnostic accuracy (96%; 95% CI: 82–100) as well as diagnostic confidence (3.4 ± 0.75 [SD]) were highest at 40 keV. Diagnostic accuracy and confidence at higher VMI energies improved with the addition of iodine maps (P ≤0.001). Overall, no difference in CT attenuation of peripleural fat between patients with empyema and those with pleural effusion was found (P = 0.07).
Conclusion |
Low VMI energies lead to a higher diagnostic accuracy and diagnostic confidence in the diagnosis of pleural empyema. Iodine maps help in diagnosing empyema only at high VMI energies.
Le texte complet de cet article est disponible en PDF.Key words : Computed tomography, Empyema, Pleura, Image processing, Computer-assisted image interpretation, Chest
Abbreviations : CNR, CT, CTDI, DECT, IQ, PCD, QIR, ROI, SD, SNR, VMI
Plan
Vol 104 - N° 2
P. 84-90 - février 2023 Retour au numéro
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