Evidence map›Paper›PMID 42234028›Full record

ArticleEuropean radiology2026

Virtual non-contrast images from dual-layer spectral CT: comparison with true non-contrast across abdominal structures.

Domenico De Santis, Antonella Del Gaudio, Benedetta Masci, Bianca Catalano, Marta Zerunian, Michela Polici, Francesco Pucciarelli, Giuseppe Tremamunno, Tiziano Polidori, Ettore Squillaci and 4 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Domenico De SantisDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Antonella Del GaudioDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Benedetta MasciDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Bianca CatalanoDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Marta ZerunianDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Michela PoliciDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Francesco PucciarelliDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Giuseppe TremamunnoDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Tiziano PolidoriDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Ettore SquillaciUnità Operativa Complessa di Diagnostica per Immagini e Radiologia Interventistica, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy.
Cesare MainoDepartment of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Davide IppolitoDepartment of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Marco FranconeDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy. marco.francone@uniroma1.it.ORCID http://orcid.org/0000-0002-7906-3420
Damiano CarusoDepartment of Medical-Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare virtual non-contrast (VNC) images derived from arterial (VNC_A) and portal venous phase (VNC_P) of dual-layer spectral CT (DLCT) with true non-contrast (TNC) images in abdominal imaging, assessing attenuation accuracy, image quality, lesion and calcification measurements, and the potential of VNC to replace TNC in routine protocols. MATERIALS AND

methodsOne hundred consecutive patients undergoing triphasic abdominal CT were included. TNC, arterial, and portal venous phases were acquired on a DLCT scanner. VNC_A and VNC_P images were generated using a two-material decomposition algorithm. Attenuation values, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and lesion and calcification metrics were measured. Subjective image quality and diagnostic acceptability were graded by three radiologists. Agreement with TNC was evaluated using ICC, Bland-Altman analysis, ANOVA, and non-parametric tests. Radiation dose reduction achievable by omitting the TNC phase was also assessed.

resultsAlthough VNC_A showed better agreement with TNC than VNC_P, both consistently underestimated parenchymal and lesion attenuation; lesion size was preserved (12.2 ± 7.9 mm; p = 0.996). Calcification density was significantly reduced in both VNC phases, and calcification diameter was slightly underestimated in VNC_A (p < 0.001). VNC images demonstrated higher or similar SNR and CNR but inferior subjective image quality (p < 0.001), due to blotchier appearance. Only 12% of VNC_P datasets were judged fully interchangeable with TNC. Replacing TNC with VNC would yield a 33% radiation dose reduction in this specific protocol.

conclusionsVNC cannot replace TNC based on the current evidence; further refinements are required for broader clinical adoption. KEY POINTS: Question True non-contrast images (TNC) are essential in abdominal CT, yet it remains unclear whether spectral CT-derived virtual non-contrast images (VNC) can reliably replace TNC imaging. Findings VNC images approximate TNC images but introduce consistent attenuation biases, reduced subjective quality, and altered calcification metrics, preventing full replacement of dedicated non-contrast acquisitions. Clinical relevance Replacing TNC with VNC images reduces radiation exposure, yet current VNC performance shows measurable differences from TNC, indicating that algorithmic refinement is required before routine diagnostic use in abdominal CT.

Indexed as

Radiographic Image Interpretation, Computer-AssistedRadiography, AbdominalTomography, X-Ray ComputedAdultAgedAged, 80 and overAlgorithmsContrast MediaFemaleHumansMaleMiddle AgedRadiation DosageReproducibility of ResultsSensitivity and SpecificitySignal-To-Noise RatioContrast MediaAbdomenCalcificationsComputed tomographySpectral CTVirtual non-contrast imaging

Identifiers

PMID42234028
PMCPMC13574884

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.