A prospective study comparing different iodine concentrations for triphasic multidetector row CT of the upper abdomen

The purpose of this study was to determine the influence of two different iodine concentrations of the non-ionic contrast agent, Iomeprol, on contrast enhancement in multislice CT (MSCT) of the pancreas. To achieve this MSCT of the pancreas was performed in 50 patients (mean age 57+/-14 years) with suspected or known pancreatic tumours. The patients were randomly assigned to group A (n=25 patients) or group B (n=25 patients). There were no statistically significant differences in age, height or weight between the patients of the two groups. The contrast agent, Iomeprol, was injected with iodine concentrations of 300 mg ml(-1) in group A (130 ml, injection rate 5 ml s(-1)) and 400 mg ml(-1) in group B (98 ml, injection rate 5 ml s(-1)). Arterial and portal venous phase contrast enhancement (HU) of the vessels, organs, and pancreatic masses were measured and a qualitative image assessment was performed by two independent readers. In the arterial phase, Iomeprol 400 led to a significantly greater enhancement in the aorta, superior mesenteric artery, coeliac trunk, pancreas, pancreatic carcinomas, kidneys, spleen and wall of the small intestine than Iomeprol 300. Portal venous phase enhancement was significantly greater in the pancreas, pancreatic carcinomas, wall of the small intestine and portal vein with Iomeprol 400. The two independent readers considered Iomeprol 400 superior over Iomeprol 300 concerning technical quality, contribution of the contrast agent to the diagnostic value, and evaluability of vessels in the arterial phase. No differences were found for tumour delineation and evaluability of infiltration of organs adjacent to the pancreas between the two iodine concentrations. In conclusion the higher iodine concentration leads to a higher arterial phase contrast enhancement of large and small arteries in MSCT of the pancreas and therefore improves the evaluability of vessels in the arterial phase.

ObjectivesThis study aimed to investigate the ability of quantitative parameters of dual-energy computed tomography (DECT) and nodule size for differentiation between lung cancers and benign lesions in solid pulmonary nodules.Materials and MethodsA total of 151 pathologically confirmed solid pulmonary nodules including 78 lung cancers and 73 benign lesions from 147 patients were consecutively and retrospectively enrolled who underwent dual-phase contrast-enhanced DECT. The following features were analyzed: diameter, volume, Lung CT Screening Reporting and Data System (Lung-RADS) categorization, and DECT-derived quantitative parameters including effective atomic number (Zeff), iodine concentration (IC), and normalized iodine concentration (NIC) in arterial and venous phases. Multivariable logistic regression analysis was used to build a combined model. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity.ResultsThe independent factors for differentiating lung cancers from benign solid pulmonary nodules included diameter, Lung-RADS categorization of diameter, volume, Zeff in arterial phase (Zeff_A), IC in arterial phase (IC_A), NIC in arterial phase (NIC_A), Zeff in venous phase (Zeff_V), IC in venous phase (IC_V), and NIC in venous phase (NIC_V) (all P < 0.05). The IC_V, NIC_V, and combined model consisting of diameter and NIC_V showed good diagnostic performance with AUCs of 0.891, 0.888, and 0.893, which were superior to the diameter, Lung-RADS categorization of diameter, volume, Zeff_A, and Zeff_V (all P < 0.001). The sensitivities of IC_V, NIC_V, and combined model were higher than those of IC_A and NIC_A (all P < 0.001). The combined model did not increase the AUCs compared with IC_V (P = 0.869) or NIC_V (P = 0.633).ConclusionThe DECT-derived IC_V and NIC_V may be useful in differentiating lung cancers from benign lesions in solid pulmonary nodules.

The objective of this study was to compare the capability of arterial, portal venous, and delayed phases of helical CT with that of iodized-oil CT for revealing nodular hepatocellular carcinomas. Forty-eight patients with nodular hepatocellular carcinomas underwent triphasic helical CT examination with 10-mm collimation at 10-mm/sec table speed. We injected 120 ml of contrast material (36 g of iodine) at the rate of 3 ml/sec. Arterial-phase, portal venous-phase, and delayed-phase images were obtained with 30-sec, 65-sec, and 360-sec delays, respectively. All 48 patients also underwent angiography and intraarterial infusion of iodized oil after helical CT; iodized-oil CT was performed about 2 weeks after infusion of iodized oil. Helical CT images were compared with iodized-oil CT images for revealing hepatic nodules. In 48 patients, 79 hepatocellular carcinomas were seen with iodized-oil CT. Using helical CT, the arterial phase revealed 68 lesions (86%), the portal venous phase revealed 53 lesions (67%), and the delayed phase revealed 57 lesions (72%). The arterial phase proved superior to the portal venous and delayed phases for revealing lesions (p = .0025). The portal venous phase showed no significant difference for revealing lesions compared with the delayed phase. When combined, helical CT of the arterial and portal venous phases revealed 73 lesions (92%); a combination of the arterial and delayed phases revealed 72 lesions (91%); and a combination of the portal venous and delayed phases revealed 63 lesions (80%). Any combination of two phases that included the arterial phase proved superior to the combination of the portal venous and delayed phases (p = .0033). Overall, the combination of the arterial and portal venous phases (92%) or the combination of all three phases (92%) proved best at revealing lesions. The arterial phase of helical CT is better for revealing nodular hypervascular hepatocellular carcinoma than are the portal venous and delayed phases. The combination of the arterial and portal venous phases is superior to the arterial phase alone. Also, the combination of the arterial and portal venous phases is equal to the combination of the three phases for revealing hypervascular hepatocellular carcinomas.

Tomografía computarizada con energía espectral en la diferenciación de los adenomas y metástasis suprarrenales: utilidad de los mapas de descomposición de materiales y de imágenes monocromáticas

Background: Laryngeal cancer stage is essential for determining the appropriate treatment strategies and evaluating prognosis for laryngeal carcinoma, which is based primarily on laryngeal cartilage invasion or not. However, there was no optimal means to confirm whether cartilage was being invaded before operation. With dual-energy CT development, it provided a new potential approach for laryngeal cartilage invasion diagnosis. Objectives: To evaluate the clinical value of dual-energy computed tomography with iodine overlay images and spectrum curve in the quantitative analysis of laryngeal cartilage invasion in patients with laryngeal carcinoma. Patients and Methods: Dual-source dual-energy CT was performed for one hundred and twenty patients with confirmed diagnosis of laryngeal carcinoma by surgical pathology (56 cases with laryngeal cartilage invasion and 64 cases without invasion). The mean CT attenuation values of laryngeal cartilage and the tumor in routine scan, arterial and venous phases was measured and cartilage invasion was considered to be present with asymmetric sclerotic changes, erosion, lysis and extralaryngeal tumor spread with iodine overlay images and routine scan images. Moreover, the sensitivity and specificity were analyzed. The slope of spectral curve and iodine concentration of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage were compared between arterial phase and venous phase. Furthermore, the receiver operating characteristic (ROC) curve of mean CT attenuation value, the slope of spectral curve and iodine concentration were made comparative analysis. Results: The mean CT attenuation values of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage had significant difference among the routine scan, arterial phase and venous phase (P < 0.05). The sign of asymmetric sclerotic changes had no significant difference between iodine overlay images and routine scan images (the same specificity and sensitivity, 77.8% and 52.6%, respectively). However, the signs of erosion, lysis and extralaryngeal tumor spread had significant difference. The specificity and sensitivity of iodine overlay images were superior to that of the routine scan images in the three signs (specificity and sensitivity of erosion: 92.3% vs. 61.5%, and 86.7% vs. 60.0%, respectively; lysis: 82.4% vs. 69.2%, and 81.8% vs. 66.7%, respectively; extralaryngeal tumor spread: 90.9% vs. 68.3%, and 100% vs. 63.5% respectively). The slope of spectral curve and iodine concentration of the tumors, invaded laryngeal cartilage and non-invaded laryngeal cartilage showed significant difference (P < 0.05). The iodine concentration of the tumor was higher than invaded laryngeal cartilage. The area under the curve (AUC) value of mean CT attenuation value in routine scan, arterial phase and venous phase were 0.064, 0.265, and 0.192, respectively. The AUC value of the slope of spectral curve in arterial phase was 0.970 and its selected cutoff was considered as 1.09. In this cutoff point, the diagnostic indices including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88.9%, 100%, 100%, and 82.6%, respectively, while the AUC value of the slope of spectral curve in venous phase was 0.944 and its selected cutoff was considered as 0.95. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV, NPV, positive likelihood ratio (PLR), negative likelihood ration (NLR) were 81.5%, 96.3%, 91.7%, 77.3%, 7.76, and 19.30, respectively. The AUC value of the slope of iodine concentration in arterial phase was 0.995 and its selected cutoff was considered as 1.05. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV and NPV were 92.6%, 100%, 95.8%, and 100%, respectively. Moreover, the AUC value of the slope of iodine concentration in venous phase was 0.905 and its selected cutoff was considered as 0.75. In this cutoff point, the diagnostic indices including sensitivity, specificity, PPV, NPV, PLR, and NLR were 77.8%, 88.9%, 91.3%, 82.6%, 7.00, and 24.5, respectively. Conclusion: Dual-energy CT can provided a new potential approach for laryngeal cartilage invasion diagnosis in order to guide the selection of optimal operation plan and improve the prognosis.

To assess whether different Gd-EOB-DTPA injection rates could influence the development of artifacts during the arterial phase of liver MRI studies. All Gd-EOB-DTPA liver MRI studies performed for different clinical indications at a single tertiary referral center were retrospectively evaluated. Each examination was acquired on a 1.5T scanner with T1 In- and Out-of-Phase, T2 with and without fat-saturation, DWI, and 3D-T1 fat-sat dynamic sequences. Patients were divided into two groups according to the injection rate (1ml/s and 1.5ml/s). A single radiologist recorded the presence or absence of artifacts during different acquisition phases, respectively: (1) all examination; (2) only during the arterial phase; (3) only during the portal-venous phase; (4) both in arterial and portal-venous phases. From a total of 748 MRI studies performed, 229 were excluded due to the presence of artifacts during the entire examination. The remaining 519 MRI studies were divided into two groups according to the injection rate. The first group (flow rate = 1ml/s) was composed by 312 (60.1%) patients and the second group (flow rate = 1.5ml/s) by 207 (39.9%) patients. In the first group, 2 (0.6%) patients showed artifacts in all dynamic sequences; 13 (4%) only in the arterial phase, 16 (5%) only in the portal-venous phase, and 38 (12%) both in arterial and portal-venous phases; a total of 243 (78%) showed no artifacts. In the second group, 3 (1.5%) patients had artifacts in all dynamic sequences, 82 (40%) only in the arterial phase, 20 (10%) only in the portal-venous phase, and 53 (25%) both in arterial and portal-venous phases; a total of 49 (23.5%) showed no artifacts. A significant difference between the two groups regarding the absence of artifacts in all examination and the presence of artifacts only during the arterial phase was found (p < 0.001). The development of artifacts during the arterial phase of Gd-EOB-DTPA liver MRI studies could be related to the injection rate and its reduction may help to decrease the incidence of artifacts.

The objective of this study was to analyze the relationship between quantitative parameters of spectral CT and the Ki67 expression index of tumor cells in hepatocellular carcinoma (HCC). A total of 19 patients who underwent preoperative spectral CT dual-phase enhancement and who were diagnosed with HCC by postoperative pathology were prospectively selected. Patients with ≥10% Ki67-positive tumor cells formed a high-Ki67 group, and those with <10% Ki67- positive cells formed a low-Ki67 group. The iodine concentrations (ICs) of the lesion and the descending aorta were measured during the arterial and venous phases. Relative iodine concentration (RIC) was calculated thus: RIC=IClesion/ICdescending aorta. CT values of the lesions at 40 and 70 keV were measured during the enhanced arterial and venous phases. The slope of the spectral curve (λ) was calculated thus: λ = (40 keV-70 keV) /(70-30). To compare the differences in quantitative parameters between the high- and low-Ki67 groups, either an independent samples t-test (normal distribution) or a Mann-Whitney U test (non-normal distribution) was used. Receiver operating characteristic curves were used to evaluate the effectiveness of spectral CT parameters in distinguishing between high-Ki67 and low-Ki67 groups. Pearson correlation analysis was used to evaluate the correlation between spectral CT quantitative parameters and Ki67 expression. IC, RIC and λ values for the high-Ki67 group in arterial and venous phases were higher than those for the low-Ki67 group, P < 0.05. IC, RIC, and λ values in the arterial phase were 0.83, 0.89, and 0.75, respectively; in the venous phase, the values of these three parameters were 0.76, 0.77, and 0.69, respectively. IC, RIC, and λ were positively correlated with Ki67 expression in both arterial and venous phases, with a highest correlation of 0.82 for arterial-phase RIC. The quantitative parameters of spectral CT in HCC were correlated with Ki67 expression. This finding may make it easier for clinicians to determine whether a tumor is high or low in Ki67 before surgery.

To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings. Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery. Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified. Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.

Objective To explore the quantitative characteristics of pancreatic ductal adenocarcinoma (PDAC) in single-source dual energy spectral CT imaging. Methods From January 2013 to December 2014, 113 patients underwent dual phase contrast-enhanced gemstone spectral imaging (GSI) on Discovery CT 750 HD. All diagnoses were pathologically confirmed by surgery or biopsy. The spectral HU curves of PDAC were observed, the monochromatic CT values, the effective atomic number (Zeff), the iodine concentration (IC), water concentration (WC), and the corresponding normalized values (normalized monochromatic CT values, normalized Zeff, normalized IC, normalized WC) of the lesion and the pancreatic parenchyma in late arterial phase (AP) and portal venous phase (PP) were recorded. The measurements were performed three times repeatedly. Paired t test (normal distribution) or Wilcoxon test (non-normal distribution) were used for analyzing the differences between the two phases and between PDAC and pancreatic parenchyma. Results The monochromatic CT values of PDAC in AP were lower than in PP at each energy level and the difference was more marked at lower energy. The normalized monochromatic CT values increased with the increase of energy level in both AP and PP and the difference was more distinct at lower energy. The Zeff, IC and normalized IC of PDAC all had significant differences (P<0.05), while the WC, normalized Zeff, and normalized WC had no difference between AP and PP. The Zeff and IC of pancreatic parenchyma had significant differences (P<0.05), while the WC had no difference between AP and PP. The differences of Zeff, IC, and WC between PDAC and pancreatic parenchyma were significant in both two phases (P<0.05). Conclusions Dual phase CT spectral imaging showed characteristic quantitative parameters of pancreatic ductal adenocarcinoma. The monochromatic CT values, Zeff, and iodine concentration of PDAC were lower than those of pancreatic parenchyma in both AP and PP. The monochromatic CT values, Zeff, and iodine concentration of PDAC in late arterial phase were lower than those in portal venous phase. The differences were all more distinct at lower energy. Key words: Pancreatic neoplasms; Tomography, X-ray computed; Comparative study

To compare single-detector row computed tomography (CT) and multi-detector row CT by using an experimental phantom containing a contrast-detail modulus for detection of low-contrast structures to optimize acquisition protocols. The parameters milliampere seconds, reconstructed section thickness, and elementary collimation for multi-detector CT were varied for two pitches with single- and multi-detector CT. For objective assessment of image quality, contrast-to-noise ratio (CNR) was calculated for an 8-HU low-contrast 15-mm-diameter object. Subjective assessment of image quality was performed by means of visual detection of low-contrast objects of various sizes by four independent observers. For each acquisition protocol, the effective doses required to obtain the CNR thresholds allowing 100% detection of 5-, 7-, and 9-mm-diameter objects were compared at single- and multi-detector CT at comparable section sensitivity profile with analysis of variance. Significant correlation was found between CNR measurements and subjective object detection (r = 0.95, P <.05). CNRs of 1.0, 0.8, and 0.6 were required to detect 100% of the 5-, 7-, and 9-mm-diameter objects, respectively. For reconstructed section thickness of 5-10 mm, comparable x-ray doses were required with single- and multi-detector CT to detect objects. For reconstructed sections thinner than 5 mm, single- and multi-detector CT allowed detection of only the 7- and 9-mm-thick objects, but a higher x-ray dose was required for multi- than for single-detector CT (P <.05). Multi-detector CT is less effective than single-detector CT in detection of small low-contrast objects if sections thinner than 5 mm are used. Results for single- and multi-detector CT were similar for sections 5 mm or thicker.

This study aimed to investigate whether there is a correlation between quantitative parameters of dual-energy computed tomography (DECT) and the relative expression of HIF-1&#945; in patients with non-small cell lung cancer (NSCLC) to preliminarily explore the value of DECT in evaluating the hypoxia of tumor microenvironment and tumor biological behavior and provide more information for the treatment of NSCLC. This retrospective research included 36 patients with pathologically confirmed NSCLC who underwent dual-energy enhanced CT scans. The quantitative parameters of DECT were analyzed, including iodine concentration, water concentration, the CT values corresponding to 40keV, 70keV, 100keV, and 130keV in arterial and venous phases, and the normalized iodine concentration and the slope of the energy spectrum curve were calculated. Postoperative specimens underwent HIF immunohistochemical staining by two pathologists. Spearman correlation analysis was adopted as the statistical methodology. The data were analyzed by SPSS26.0 statistical software. Water concentration (r=0.659, P&#60;0.001 and r= 0.632, P&#60;0.001, the CT values corresponding to 100keV (r=0.645, P&#60;0.001 and r= 0.566, P&#60;0.001) and 130keV (r=0.687, P&#60;0.001 and r= 0.682, P&#60;0.001) in arterial and venous phases, and CT value of 70keV in arterial phase (r=0.457, P=0.005) were positively correlated with HIF-1&#945; expression level. There was no correlation among iodine concentration, standardized iodine concentration, CT value of 40keV, λHU, and HIF-1&#945; expression in arterial and venous levels (P >0.05). The quantitative parameters of DECT have a certain correlation with HIF-1&#945; expression in NSCLC. Moreover, it has been demonstrated that DECT can be used to predict hypoxia in tumor tissues and the prognosis of lung cancer patients.

To determine the optimal phase for enhancement of the normal pancreas and peripancreatic vasculature and the maximal tumor-to-pancreatic parenchymal enhancement difference by using multiphase, contrast material-enhanced, multi-detector row helical computed tomography (CT). Forty-nine patients with a normal-appearing pancreas but suspected of having pancreatic abnormality and 28 patients with proved pancreatic adenocarcinoma underwent multiphase, contrast-enhanced, multi-detector row CT during the arterial phase (AP), pancreatic parenchymal phase (PPP), and portal venous phase (PVP). Attenuation values of the normal pancreas, pancreatic adenocarcinoma, celiac and superior mesenteric arteries, and superior mesenteric and portal veins were measured during all three imaging phases. Quantitative analysis of these measurements and subjective qualitative analysis of tumor conspicuity were performed. Maximal enhancement of the normal pancreatic parenchyma occurred during the PPP. Maximal tumor-to-parenchyma attenuation differences during the PPP and PVP were equivalent but greater than that during the AP. Subjective analysis revealed that tumor conspicuity during the PPP and PVP was equivalent but superior to that during the AP. Maximal arterial enhancement was seen during the PPP, and maximal venous enhancement was seen during the PVP. A combination of PPP and PVP imaging is sufficient for detection of pancreatic adenocarcinoma, because it provides maximal pancreatic parenchymal and peripancreatic vascular enhancement. AP imaging can be reserved for patients in whom CT angiography is required.

Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer (GC), but traditional imaging methods have some limitations in preoperative evaluation. In recent years, energy spectrum computed tomography (CT) multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail display. To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion (LVI) and nerve invasion (PNI) in GC patients. Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023, including 46 males and 16 females aged 36-71 (57.5 ± 9.1) years, were retrospectively collected. The patients were divided into a positive group (42 patients) and a negative group (20 patients) according to the presence of LVI/PNI. The CT values (CT40 keV, CT70 keV), iodine concentration (IC), and normalized IC (NIC) of lesions in the upper energy spectrum CT images of the arterial phase, venous phase, and delayed phase 40 and 70 keV were measured, and the slopes of the energy spectrum curves [K (40-70)] from 40 to 70 keV were calculated. Arterial phase combined parameter, venous phase combined parameters (VP-ALLs), and delayed phase association parameters were calculated for patients with late-stage disease. The differences in the energy spectrum parameters between the positive and negative groups were compared, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated to measure the diagnostic efficiency of each parameter. In the delayed phase, the CT40 keV, CT70 keV, K (40-70), IC, NIC, and CT70 keV and the NIC in the upper arterial and venous phases of energy spectrum CT were greater in the LVI/PNI-positive group than in the LVI-negative group. The representative parameters for the arterial phase NIC were 0.14 ± 0.04 in the positive group and 0.12 ± 0.04 in the negative group. The venous phase NIC was 0.5 (0.5, 0.6) in the positive group and 0.4 (0.4, 0.5) in the negative group. Last, for the delayed phase NIC, it was 0.6 ± 0.1 in the positive group and 0.5 ± 0.1 in the negative group (all P values are less than 0.05). ROC curve analysis demonstrated that the diagnostic efficacy of each parameter during the venous stage was superior to that during the arterial and delayed stages. Furthermore, the diagnostic efficacy of the combined parameter throughout all three stages was superior to that of any single parameter. The AUC, sensitivity, and specificity of the optimal parameter, VP-ALL, were 0.931 (95% confidence interval: 0.872-0.990), 80.95%, and 95.00%, respectively. When assessing the condition of LVI and PNI (perineural invasion) in patients with GC prior to surgery, the ability to diagnose these conditions using venous stage parameters was superior to that using arterial stage and delayed stage parameters. Furthermore, the diagnostic accuracy of using a combination of parameters was better than that of using individual parameters alone.

To investigate the usefulness of computed tomographic (CT) spectral imaging parameters in differentiating small (≤3 cm) hepatic hemangioma (HH) from small hepatocellular carcinoma (HCC), with or without cirrhosis, during the late arterial phase (AP) and portal venous phase (PVP). This prospective study was institutional review board approved, and written informed consent was obtained from all patients. The authors examined 49 patients (39 men, 10 women; 65 lesions) with CT spectral imaging during the AP and the PVP. Twenty-one patients had HH; nine, HCC with cirrhosis; and 19, HCC without cirrhosis. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PVP (ie, iodine concentration difference [ICD]) and the lesion-to-normal parenchyma ratio (LNR) were calculated. Two readers qualitatively assessed lesion types on the basis of conventional CT characteristics. Sensitivity and specificity were compared between the qualitative and quantitative studies. The two-sample t test was performed to compare quantitative parameters between HH and HCC. Normalized iodine concentrations (NICs) and LNRs in patients with HH differed significantly from those in patients with HCC and cirrhosis and those in patients with HCC without cirrhosis: Mean NICs were 0.47 mg/mL ± 0.24 (standard deviation) versus 0.23 mg/mL ± 0.10 and 0.23 mg/mL ± 0.08, respectively, during the AP and 0.83 mg/mL ± 0.38 versus 0.47 mg/mL ± 0.86 and 0.52 mg/mL ± 0.11, respectively, during the PVP. Mean LNRs were 5.87 ± 3.36 versus 2.56 ± 1.10 and 2.29 ± 0.87, respectively, during the AP and 2.01 ± 1.33 versus 0.96 ± 0.16 and 0.93 ± 0.26, respectively, during the PVP. The mean ICD for the HH group (1.37 mg/mL ± 0.84) was significantly higher than the mean ICDs for the HCC-cirrhosis (0.33 mg/mL ± 0.29) (P < .001) and HCC-no cirrhosis (0.82 mg/mL ± 0.99) (P = .03) groups. The combination of NIC and LNR had higher sensitivity and specificity compared with those of conventional qualitative CT image analysis during individual and combined phases. Use of spectral CT with fast tube voltage switching may increase the sensitivity for differentiating small hemangiomas from small HCCs in two-phase scanning.

To assess the quality of brain computed tomographic (CT) studies obtained with a four-channel multi-detector row CT scanner compared with those obtained with a single-detector row CT scanner. Forty-seven patients referred for brain CT were imaged with both single- and multi-detector row scanners. Single-detector row CT images were acquired by using a 5-mm-collimated beam in the transverse mode. Multi-detector row CT images were acquired in four simultaneous 2.5-mm-thick sections, which were combined in projection space to create two contiguous 5-mm-thick sections. Two neuroradiologists blinded to the acquisition technique independently evaluated the CT image pairs, which were presented in a stacked mode on two adjacent monitors. Each study was graded by using a five-point scale for posterior fossa artifact, overall image quality, and overall preference. Multi-detector row CT studies were acquired 1.8 times faster than single-detector row CT studies (0.92 vs 0.52 section per second). Multi-detector row CT posterior fossa artifact was less than single-detector row CT posterior fossa artifact in 87 (93%) of 94 studies. Overall preference was expressed for multi-detector row CT in 84 (89%) of 94 studies. The differences in mean posterior fossa artifact scores (P <.001) and mean overall image quality scores (P =.001) were significant. Brain CT images obtained with multi-detector row CT resulted in significantly less posterior fossa artifact and were preferred to single-detector row CT images.