Use of dual-energy CT for renal mass assessment
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Use of dual-energy CT for renal mass assessment Shanigarn Thiravit 1,2 & Christina Brunnquell 1 & Larry M. Cai 1 & Mena Flemon 1 & Achille Mileto 1 Received: 5 May 2020 / Revised: 11 August 2020 / Accepted: 14 October 2020 # European Society of Radiology 2020
Abstract Although dual-energy CT (DECT) may prove useful in a variety of abdominal imaging tasks, renal mass evaluation represents the area where this technology can be most impactful in abdominal imaging compared to routinely performed contrast-enhanced– only single-energy CT exams. DECT post-processing techniques, such as creation of virtual unenhanced and iodine density images, can help in the characterization of incidentally discovered renal masses that would otherwise remain indeterminate based on post-contrast imaging only. The purpose of this article is to review the use of DECT for renal mass assessment, including its benefits and existing limitations. Key Points • If DECT is selected as the scanning mode for most common abdominal protocols, many incidentally found renal masses can be fully triaged within the same exam. • Virtual unenhanced and iodine density DECT images can provide additional information when renal masses are discovered in the post-contrast–only setting. • For renal mass evaluation, virtual unenhanced and iodine density DECT images should be interpreted side-by-side to troubleshoot pitfalls that can potentially lead to erroneous interpretation. Keywords Tomography, X-ray computed . Iodine . Kidney . Incidental findings . Kidney neoplasm
Abbreviations DECT DL-DECT DS-DECT IVP KVS-DECT PACS RCC
Dual-energy CT Dual-layer dual-energy CT Dual-source dual-energy CT Intravenous pyelography Rapid kilovoltage-peak switching dual-energy CT Picture archiving and communication system Renal cell carcinoma
* Achille Mileto [email protected] 1
Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195, USA
2
Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
SECT SF-DECT SS-DECT VMCI VUE
Single-energy CT Split-filter dual-energy CT Sequential scanning dual-energy CT Virtual monochromatic images Virtual unenhanced
Introduction Dual-energy CT (DECT) has proved to be a modality that can improve radiologists’ ability to diagnose many abdominal pathologies, such as renal masses [1–6]. Compared to conventional single-energy CT (SECT), DECT holds considerable potential to improve lesion detection and tumor characterization and to provide additional information in multiple ways with radiation dose neutrality or near-neutrality [1, 7–9]. The foremost advantage of DECT use is represented by material decomposition techniques, used to selectively display and quantify the iodinated contrast material [10]. In the post-
Eur Radiol
contrast–only CT setting, this approach enables one to discriminate between non-iodine-containing and iodinecontaining renal masses, hence reducing diagnostic hesitati
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