ArticleAbdominal radiology (New York)2025
Optimizing photon counting CT enterography: determining the optimal virtual monoenergy for bowel imaging.
Article in Abdominal radiology (New York), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo determine the optimal virtual monoenergy for viewing the bowel at photon-counting CT enterography using quantitative assessment of mural attenuation, contrast-to-noise ratio, signal-to-noise ratio and noise.
methodsThis study was institutional review board approved and Health Insurance Portability and Accountability Act compliant. Consecutive adults (≥ 18 years) who underwent photon-counting CT enterography from 5/1/2022-5/31/2022 with available Spectral Postprocessing (SPP) images for retrospective virtual monoenergy creation were identified. Nine virtual monoenergetic series (40-120 keV, 10 keV increments) were created. Two region-of-interest measurements were placed in the stomach wall, jejunum wall, ileum wall, and each psoas muscle by two radiologists on 0.6 mm images in PACS. Region-of-interests were copied to other virtual monoenergies to ensure identical placement and size. Attenuation (HU) and noise (HU standard deviation) were recorded from each region-of-interest. Signal-to-noise ratio and contrast-to-noise ratio were computed for stomach, jejunum, ileum, and all bowel combined. Pairwise comparisons for attenuation, noise, signal-to-noise ratio and contrast-to-noise ratio for each virtual monoenergy were performed with ANOVA. A p <.05 indicated statistical significance.
results50 patients (32 female; mean[SD] age: 57 years) were included. Attenuation and noise for all bowel regions were highest at 40 keV with statistically significant pairwise comparisons from 40 to 70 keV (all p <.05), but similar for 70-120 keV (all p >.05). Signal-to-noise ratio was similar from 40 to 70 keV (all p >.05) for all bowel regions. Contrast-to-noise ratio decreased with increasing keV. Contrast-to-noise ratio was similar for all bowel at 40 keV and 50 keV (p =.06), for stomach from 40 to 70 keV (all p >.05), for jejunum from 40 to 50 keV (p =.21), and for ileum from 40 to 60 keV (all p >.05).
conclusion50 keV virtual monoenergetic images from photon-counting CT enterography optimizes contrast-to-noise ratio while mitigating noise and should routinely be utilized for bowel assessment at photon-counting CT enterography. As most photon-counting CT users primarily interpret virtual monoenergetic images in clinical practice, knowledge of the optimal virtual monoenergy can inform protocol development.
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