TY - JOUR
T1 - Improved sensitivity and reader confidence in CT colonography using dual-Layer spectral CT
T2 - A phantom study
AU - Obmann, Markus M.
AU - An, Chansik
AU - Schaefer, Amanda
AU - Sun, Yuxin
AU - Wang, Zhen J.
AU - Yee, Judy
AU - Yeh, Benjamin M.
N1 - Funding Information:
Supported by a grant from Philips Healthcare and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R42DK104580).
Publisher Copyright:
© RSNA, 2020.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Limited cathartic preparations for CT colonography with fecal tagging can improve patient comfort but may result in nondiagnostic examinations from poorly tagged stool. Dual-energy CT may overcome this limitation by improving the conspicuity of the contrast agent, but more data are needed. Purpose: To investigate whether dual-energy CT improves polyp detection in CT colonography compared with conventional CT at different fecal tagging levels in vitro. Materials and Methods: In this HIPAA-compliant study, between December 2017 and August 2019, a colon phantom 30 cm in diameter containing 60 polyps of different shapes (spherical, ellipsoid, flat) and size groups (5–9 mm, 11–15 mm) was constructed and serially filled with simulated feces tagged with four different iodine concentrations (1.26, 2.45, 4.88, and 21.00 mg of iodine per milliliter), then it was scanned with dual-energy CT with and without an outer fat ring to simulate large body size (total diameter, 42 cm). Two readers independently reviewed conventional 120-kVp CT and 40-keV monoenergetic dual-energy CT images to record the presence of polyps and confidence (three-point scale.) Generalized estimating equations were used for sensitivity comparisons between conventional CT and dual-energy CT, and a Wilcoxon signed-rank test was used for reader confidence. Results: Dual-energy CT had higher overall sensitivity for polyp detection than conventional CT (58.8%; 95% confidence interval [CI]: 49.7%, 67.3%; 564 of 960 polyps vs 42.1%; 95% CI: 32.1%, 52.8%; 404 of 960 polyps; P , .001), including with the fat ring (48% and 31%, P , .001). Reader confidence improved with dual-energy CT compared with conventional images on all tagging levels (P , .001). Interrater agreement was substantial (k = 0.74; 95% CI: 0.70, 0.77). Conclusion: Compared with conventional 120-kVp CT, dual-energy CT improved polyp detection and reader confidence in a dedicated dual-energy CT colonography phantom, especially with suboptimal fecal tagging.
AB - Background: Limited cathartic preparations for CT colonography with fecal tagging can improve patient comfort but may result in nondiagnostic examinations from poorly tagged stool. Dual-energy CT may overcome this limitation by improving the conspicuity of the contrast agent, but more data are needed. Purpose: To investigate whether dual-energy CT improves polyp detection in CT colonography compared with conventional CT at different fecal tagging levels in vitro. Materials and Methods: In this HIPAA-compliant study, between December 2017 and August 2019, a colon phantom 30 cm in diameter containing 60 polyps of different shapes (spherical, ellipsoid, flat) and size groups (5–9 mm, 11–15 mm) was constructed and serially filled with simulated feces tagged with four different iodine concentrations (1.26, 2.45, 4.88, and 21.00 mg of iodine per milliliter), then it was scanned with dual-energy CT with and without an outer fat ring to simulate large body size (total diameter, 42 cm). Two readers independently reviewed conventional 120-kVp CT and 40-keV monoenergetic dual-energy CT images to record the presence of polyps and confidence (three-point scale.) Generalized estimating equations were used for sensitivity comparisons between conventional CT and dual-energy CT, and a Wilcoxon signed-rank test was used for reader confidence. Results: Dual-energy CT had higher overall sensitivity for polyp detection than conventional CT (58.8%; 95% confidence interval [CI]: 49.7%, 67.3%; 564 of 960 polyps vs 42.1%; 95% CI: 32.1%, 52.8%; 404 of 960 polyps; P , .001), including with the fat ring (48% and 31%, P , .001). Reader confidence improved with dual-energy CT compared with conventional images on all tagging levels (P , .001). Interrater agreement was substantial (k = 0.74; 95% CI: 0.70, 0.77). Conclusion: Compared with conventional 120-kVp CT, dual-energy CT improved polyp detection and reader confidence in a dedicated dual-energy CT colonography phantom, especially with suboptimal fecal tagging.
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U2 - 10.1148/radiol.2020200032
DO - 10.1148/radiol.2020200032
M3 - Article
C2 - 32720868
AN - SCOPUS:85091469966
SN - 0033-8419
VL - 297
SP - 99
EP - 107
JO - RADIOLOGY
JF - RADIOLOGY
IS - 1
ER -