Bernhard Schmid

Performance of Dual-Energy CT with Tin Filter Technology for the Discrimination of Renal Cysts and Enhancing Masses

RATIONALE AND OBJECTIVES To assess the performance of dual-energy computed tomography (DECT) equipped with the new tin filter technology to classify phantom renal lesions as cysts or enhancing masses. MATERIALS AND METHODS Forty spherical lesion proxies ranging in diameter from 6 to 27 mm were filled with either distilled water (n = 10) representing cysts or titrated iodinated contrast solutions with a concentration of 0.45 (n = 10), 0.9 (n = 10), and 1.8 mg/mL (n = 10) representing enhancing masses. The lesion proxies were placed in a 12-cm diameter renal phantom containing minced beef and submerged in a 28-cm water bath. DECT was performed using the new dual-source CT system (Definition Flash, Siemens Healthcare, Forchheim, Germany) allowing for an improved energy separation by using a tin filter. DECT was performed at tube voltages of 140/80 kV without the tin filter (protocol A) and with tin filter (protocol B). The tube current time product was selected in each protocol to achieve a constant CTDI (computed tomography dose index) with both protocols of 19 mGy (full dose), 9.5 mGy (half dose), and 4.8 mGy (quarter dose). Two blinded readers classified each lesion as a cyst or enhancing mass by using iodine overlay (IO) images. One reader measured the CT numbers of each lesion at 120 kV, in the IO, linear blending (LB), and virtual noncontrast (VNC) images. RESULTS The CT numbers of the lesions at 120 kV were 0.1 +/- 0.7 HU (0 mg iodine/mL), 9.1 +/- 0.7 HU (0.45 mg/mL), 18.1 +/- 1.4 HU (0.9 mg/mL), and 37.6 +/- 1.6 HU (1.8 mg/mL). Mean diameter of the lesion proxies filled with water or different iodine concentrations was similar (P = 0.38). Image noise was not significantly different in protocols A and B at the corresponding dose levels. At full dose, protocol A had a sensitivity of 93% and a specificity of 60% for discriminating renal lesions. Sensitivity and specificity declined to 84% and 38% at quarter dose. In protocol B, sensitivity was 100% and specificity was 90% at full dose and 93% and 70% at quarter dose. All misclassifications occurred in cyst or low iodine concentration (0.45 mg/mL) lesion proxies. The differences between CT numbers at 120 kV and in the IO, VNC, and AW (average weighted) images were significantly lower in protocol B compared to protocol A (each P < .05). CONCLUSIONS DECT using the tin filter results in an improved sensitivity and specificity for discriminating renal cysts from enhancing masses in a kidney phantom model and demonstrates higher dose efficiency as compared to former dual energy technology without tin filters.