Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations

Recent advances in computed tomography (CT) technology allow for acquisition of two CT datasets with different X-ray spectra. There are different dual-energy computed tomography (DECT) technical approaches such as: the dual-source CT, the fast kilovoltage-switching method, and the sandwich detectors technique. There are various postprocessing algorithms that are available to provide clinically relevant spectral information. There are several clinical applications of DECT that are easily accessible in the emergency setting. In this review article, we aim to provide the emergency radiologist with a discussion on how this new technology works and how some of its applications can be useful in the emergency room setting.

[1]  S A Chiaramida,et al.  Dual-energy computed tomography imaging of myocardial infarction , 2008, Heart.

[2]  M. Oudkerk,et al.  Dual-energy CT of the heart. , 2012, AJR. American journal of roentgenology.

[3]  J. Remy,et al.  Evaluation of Peripheral Pulmonary Arteries at 80 kV and at 140 kV: Dual-Energy Computed Tomography Assessment in 51 Patients , 2009, Journal of computer assisted tomography.

[4]  C. McCollough,et al.  Quantitative imaging of element composition and mass fraction using dual-energy CT: three-material decomposition. , 2009, Medical physics.

[5]  P. Munk,et al.  Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. , 2012, AJR. American journal of roentgenology.

[6]  E. Fishman,et al.  State-of-the-art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls, and pitfalls , 2013, Emergency Radiology.

[7]  J. Seo,et al.  Dual-energy computed tomography characterization of solitary pulmonary nodules. , 2010, Journal of thoracic imaging.

[8]  S. Schindera,et al.  Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients , 2009, European Radiology.

[9]  R. Rubinshtein,et al.  Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard , 2009, Heart.

[10]  C. Angeletti,et al.  Vascular endothelial growth factor is associated with neovascularization and influences progression of non-small cell lung carcinoma. , 1997, Clinical cancer research : an official journal of the American Association for Cancer Research.

[11]  P. Marcy,et al.  Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography , 2010, European Radiology.

[12]  Ernst Klotz,et al.  The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography , 2009, European Radiology.

[13]  D. Naidich,et al.  Dual-energy Computed Tomography Imaging of the Aorta , 2010, Journal of thoracic imaging.

[14]  Bernhard Schmidt,et al.  Radiation dose and image quality in pediatric CT: effect of technical factors and phantom size and shape. , 2004, Radiology.

[15]  C. Fink,et al.  Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results. , 2012, European journal of radiology.

[16]  R. Gonzalez,et al.  Magnetic Resonance Imaging Improves Detection of Intracerebral Hemorrhage Over Computed Tomography After Intra-Arterial Thrombolysis , 2004, Stroke.

[17]  T. Flohr,et al.  High-Temporal Resolution Dual-Energy Computed Tomography of the Heart Using a Novel Hybrid Image Reconstruction Algorithm: Initial Experience , 2011, Journal of computer assisted tomography.

[18]  J. Goo,et al.  Dual-energy CT: clinical applications in various pulmonary diseases. , 2010, Radiographics : a review publication of the Radiological Society of North America, Inc.

[19]  K. Stierstorfer,et al.  First performance evaluation of a dual-source CT (DSCT) system , 2006, European Radiology.

[20]  K. Stierstorfer,et al.  Technical principles of dual source CT. , 2008, European journal of radiology.

[21]  C. Claussen,et al.  Dual-energy CT for the characterization of urinary calculi: In vitro and in vivo evaluation of a low-dose scanning protocol , 2009, European Radiology.

[22]  T. Lehnert,et al.  Dose and image quality at CT pulmonary angiography—comparison of first and second generation dual-energy CT and 64-slice CT , 2011, European Radiology.

[23]  J. Aldrich,et al.  The utilization of dual source CT in imaging of polytrauma. , 2008, European journal of radiology.

[24]  P. Joseph,et al.  Noise considerations in dual energy CT scanning. , 1979, Medical physics.

[25]  M. Reiser,et al.  Dual-energy lung perfusion computed tomography: a novel pulmonary functional imaging method. , 2010, Seminars in ultrasound, CT, and MR.

[26]  U. Schoepf,et al.  Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. , 2010, Seminars in ultrasound, CT, and MR.

[27]  Willi A Kalender,et al.  CT: the unexpected evolution of an imaging modality , 2005, European radiology.

[28]  T. Johnson,et al.  Dual-energy CT: general principles. , 2012, AJR. American journal of roentgenology.

[29]  Arjun Nair,et al.  Dual-energy CT: vascular applications. , 2012, AJR. American journal of roentgenology.

[30]  L. Quint,et al.  “Sweet Spot” for Endoleak Detection: Optimizing Contrast to Noise Using Low keV Reconstructions From Fast-Switch kVp Dual-Energy CT , 2012, Journal of computer assisted tomography.

[31]  Mulugeta Gebregziabher,et al.  Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience , 2008, European Radiology.

[32]  G W Rouan,et al.  Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. , 1987, The American journal of cardiology.

[33]  M. Reiser,et al.  Material differentiation by dual energy CT: initial experience , 2007, European Radiology.

[34]  J. Seo,et al.  Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: initial experience. , 2008, Radiology.

[35]  Andreas H Mahnken,et al.  Spectral rhoZ-projection method for characterization of body fluids in computed tomography: ex vivo experiments. , 2009, Academic radiology.

[36]  Sang Hyun Park,et al.  Dual energy CT in patients with acute abdomen; is it possible for virtual non-enhanced images to replace true non-enhanced images? , 2013, Emergency Radiology.

[37]  Guang-Hong Chen,et al.  Dual energy CT using slow kVp switching acquisition and prior image constrained compressed sensing , 2010, Physics in medicine and biology.

[38]  Multidetector Computed Tomography Chest Examinations With Low-Kilovoltage Protocols in Adults: Effect on Image Quality and Radiation Dose , 2009, Journal of computer assisted tomography.

[39]  W. Huda,et al.  Patient size and x-ray technique factors in head computed tomography examinations. I. Radiation doses. , 2004, Medical physics.

[40]  K Nikolaou,et al.  Dual-Energy CT Angiography of the Lung in Patients with Suspected Pulmonary Embolism: Initial Results , 2008, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[41]  T. Lehnert,et al.  Dual energy CT pulmonary blood volume assessment in acute pulmonary embolism – correlation with D-dimer level, right heart strain and clinical outcome , 2011, European Radiology.

[42]  M. Karçaaltıncaba,et al.  Dual-energy CT revisited with multidetector CT: review of principles and clinical applications. , 2011, Diagnostic and interventional radiology.

[43]  Joon Beom Seo,et al.  Dual-energy CT for assessment of the severity of acute pulmonary embolism: pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio. , 2010, AJR. American journal of roentgenology.

[44]  Hersh Chandarana,et al.  Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms--initial observations. , 2008, Radiology.

[45]  B. Yeh,et al.  Dual-energy computed tomography in pulmonary embolism. , 2010, The British journal of radiology.

[46]  D. Gopalan,et al.  Dual-energy CT pulmonary angiography: a novel technique for assessing acute and chronic pulmonary thromboembolism. , 2009, Clinical radiology.

[47]  Michael Jerosch-Herold,et al.  Quantification of Myocardial Perfusion Using Dynamic 64-Detector Computed Tomography , 2007, Investigative radiology.

[48]  Aortic Endograft Surveillance: Use of Fast-Switch kVp Dual-Energy Computed Tomography With Virtual Noncontrast Imaging , 2011, Journal of computer assisted tomography.

[49]  Thomas Henzler,et al.  Dual-energy CT: radiation dose aspects. , 2012, AJR. American journal of roentgenology.

[50]  S. Nicolaou,et al.  Dual energy computed tomography in tophaceous gout , 2008, Annals of the rheumatic diseases.

[51]  Konstantin Nikolaou,et al.  Dual Energy CT of the Chest: How About the Dose? , 2010, Investigative radiology.

[52]  D. Fischman,et al.  Is coronary stent assessment improved with spectral analysis of dual energy CT? , 2009, Academic radiology.

[53]  Guang Ming Lu,et al.  Dual-energy CT of the lung. , 2012, AJR. American journal of roentgenology.

[54]  G. Seeley,et al.  Image Quality , 1989, [1989] Proceedings. The First International Conference on Image Management and Communication in Patient Care: Implementation and Impact.

[55]  Konstantin Nikolaou,et al.  Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation , 2011, European Radiology.

[56]  B. Sundaram,et al.  Imaging of acute pulmonary embolism , 2013, Emergency Radiology.

[57]  R. Gupta,et al.  Differentiation of Hemorrhage from Iodinated Contrast in Different Intracranial Compartments Using Dual-Energy Head CT , 2012, American Journal of Neuroradiology.

[58]  S J Riederer,et al.  Relative properties of tomography, K-edge imaging, and K-edge tomography. , 1977, Medical physics.

[59]  M. Reiser,et al.  Polytrauma: Optimal Imaging and Evaluation Algorithm , 2013, Seminars in Musculoskeletal Radiology.

[60]  D. Hough,et al.  Evaluation of non-linear blending in dual-energy computed tomography. , 2008, European journal of radiology.

[61]  G. Lu,et al.  Detection of pulmonary embolism using dual-energy computed tomography and correlation with cardiovascular measurements: a preliminary study , 2009, Acta radiologica.

[62]  B. Yeh,et al.  Dual-energy and low-kVp CT in the abdomen. , 2009, AJR. American journal of roentgenology.

[63]  Takeshi Nakaura,et al.  Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. , 2005, Radiology.

[64]  J. Remy,et al.  Thoracic applications of dual-source CT technology. , 2008, European journal of radiology.

[65]  A. Macovski,et al.  Energy-selective reconstructions in X-ray computerised tomography , 1976, Physics in medicine and biology.

[66]  Thomas Lehnert,et al.  Dose levels at coronary CT angiography—a comparison of Dual Energy-, Dual Source- and 16-slice CT , 2011, European Radiology.

[67]  A. Czarnecka,et al.  Novel clinical applications of dual energy computed tomography. , 2012, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[68]  Jae Hyung Park,et al.  The Image Quality and Radiation Dose of 100-kVp versus 120-kVp ECG-Gated 16-Slice CT Coronary Angiography , 2009, Korean journal of radiology.

[69]  Richard H Cohan,et al.  Distinguishing enhancing from nonenhancing renal lesions with fast kilovoltage-switching dual-energy CT. , 2011, AJR. American journal of roentgenology.

[70]  Thomas Flohr,et al.  Lung perfusion with dual-energy multidetector-row CT (MDCT): feasibility for the evaluation of acute pulmonary embolism in 117 consecutive patients. , 2008, Academic radiology.

[71]  Walter Huda,et al.  Patient size and x-ray technique factors in head computed tomography examinations. II. Image quality. , 2004, Medical physics.

[72]  J. Remy,et al.  Thoracic applications of dual energy. , 2010, Radiologic clinics of North America.

[73]  Christoph Thomas,et al.  Dual-Energy Computed Tomography: Is There a Penalty in Image Quality and Radiation Dose Compared With Single-Energy Computed Tomography? , 2010, Journal of computer assisted tomography.

[74]  Christianne Leidecker,et al.  Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? , 2009, Radiology.

[75]  M. L. R. D. Christenson.  Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: comparison of standard and low kilovoltage settings , 2010 .

[76]  Shuai Leng,et al.  Dual-energy CT-based monochromatic imaging. , 2012, AJR. American journal of roentgenology.

[77]  D. Sahani,et al.  Best practice: implementation and use of abdominal dual-energy CT in routine patient care. , 2012, AJR. American journal of roentgenology.

[78]  Peter Vock,et al.  Patient Exposure and Image Quality of Low-Dose Pulmonary Computed Tomography Angiography: Comparison of 100- and 80-kVp Protocols , 2008, Investigative radiology.

[79]  Cynthia H McCollough,et al.  Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy CT. , 2009, Medical physics.

[80]  Stefan Delorme,et al.  Improved Vascular Opacification in Cerebral Computed Tomography Angiography With 80 kVp , 2005, Investigative radiology.

[81]  Joon Beom Seo,et al.  Xenon ventilation CT with a dual-energy technique of dual-source CT: initial experience. , 2008, Radiology.

[82]  R. Nelson,et al.  Dual-energy CT applications in the abdomen. , 2012, AJR. American journal of roentgenology.

[83]  Christianne Leidecker,et al.  Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. , 2010, Radiology.

[84]  John M Boone,et al.  Dose reduction in pediatric CT: a rational approach. , 2003, Radiology.

[85]  C. Leidecker,et al.  Basic principles and postprocessing techniques of dual-energy CT: illustrated by selected congenital abnormalities of the thorax. , 2009, Journal of thoracic imaging.

[86]  U. Schoepf,et al.  Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. , 2009, The American journal of cardiology.

[87]  Takeshi Nakaura,et al.  Lower tube voltage reduces contrast material and radiation doses on 16-MDCT aortography. , 2006, AJR. American journal of roentgenology.

[88]  Mathias Prokop,et al.  CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. , 2006, Radiology.

[89]  M. Reiser,et al.  CT detection of myocardial blood volume deficits: dual-energy CT compared with single-energy CT spectra. , 2009, Journal of cardiovascular computed tomography.