Original InvestigationMeasurement Reliability and Diagnostic Accuracy of Virtual Monoenergetic Dual-Energy CT in Patients with Colorectal Liver Metastases
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INTRODUCTION
Colorectal liver metastases (CRLM) are the most common type of distant metastases and an important life-limiting factor of patients with colorectal cancer (CRC) (1,2). The detection and precise evaluation of CRLM is crucial for accurate patient management, as intrahepatic tumor burden directly impacts individual treatment regimens (3,4). Liver resection is considered to be the only potential curative therapy option for patients with CRLM, however, only around 20% of affected patients are
Patient Population
This retrospective study received institutional review board approval with a waiver for written informed consent. We searched our Radiology Information System and Picture Archiving and Communication System to identify patients with CRC who had undergone abdominal portal-venous-phase DECT examinations between January 2017 and July 2018. The query revealed 116 patients with histologically proven CRC who were examined for baseline staging (n = 45) or follow-up imaging (n = 71). CRLM was present in
Patient Population
MRI of the liver revealed ≥5 liver metastases in 26 patients, <5 in 15 patients, and a single liver metastasis in eight patients. Bilobar hepatic tumor burden was found in 35 patients (71%). All patients underwent systemic chemotherapy. Additional local tumor therapy was performed in seven patients (transarterial chemoembolization, n = 4; microwave ablation, n = 3), while five patients were treated with hemihepatectomy. Abdominal DECT radiation metrics in portal-venous phase acquisition were
DISCUSSION
In this study, we aimed to evaluate measurement reliability and diagnostic accuracy for the assessment of hypoattenuating CRLM using standard linearly-blended and 40-keV VMI reconstructions, with MRI as the standard of reference. Our findings demonstrate significantly improved sensitivity, specificity, and diagnostic accuracy for the detection of CRLM by applying low-keV VMI image series compared to standard reconstructions. In addition, slightly increased measurement reliability was observed
Authors Contributions
Lukas Lenga: Data acquisition, manuscript preparation, manuscript editing, data analysis.
Marvin Lange: Data acquisition.
Christophe T. Arendt: Data acquisition, data analysis.
Christian Booz: Statistical analysis, manuscript review.
Ibrahim Yel: Statistical analysis, manuscript review.
Boris Bodelle: Manuscript review.
Tommaso D'Angelo: Manuscript review.
Renate M. Hammerstingl: Study design, manuscript editing.
Nicole A. Huizinga: Manuscript review, manuscript editing.
Thomas J. Vogl: Study concept,
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