Multivendor comparison of quantification accuracy of effective atomic number by Dual-Energy CT: A phantom study.

PURPOSE: Our study aimed to compare the accuracy of the effective atomic number (Zeff) of five dual-energy CT (DECT) from three vendors and different generations under different scanning parameters. METHODS: Zeff accuracy of five DECT scanners with twelve tube voltage configurations was evaluated by using the TomoTherapy cheese phantom. The potential dose dependence of the Zeff was investigated using three radiation dose (5, 15, and 25 mGy), and the robustness of Zeff was simulated for different organs of the body by placing the inserts at different positional depths. Bias and mean absolute percentage error (MAPE) were used to characterize the accuracy of Zeff. Data underwent analysis using one-way ANOVA, followed by the Turky and LSD post hoc tests, simple linear regression, and linear mixed models. RESULTS: All tube voltage configurations had a bias of less than 1. Dual layer detector DECT (dl-DECT) -140 kV has the lowest MAPE (1.79 %±1.93 %). The third generation dual source DECT (ds-DECT) and the second generation rapid switch DECT (rs-DECT) have higher MAPE than their predecessor DECT. The results of the linear mixed model showed that tube voltage configuration (F=16.92, p < 0.001) and insert type (F=53.26, p < 0.001) significantly affect the MAPE. In contrast, radiation dose only has a significant effect on the MAPE of rs-DECT. The inserts position does not affect the final MAPE. CONCLUSION: When scanning different inserts, Zeff accuracy varies by vendor and DECT generation. Of all the scanners, dl-DECT had the highest Zeff accuracy. Upgrading DECT generation doesn't lead to higher accuracy, or even lower.

Dual-Energy Computed Tomography in Urological Diseases: A Narrative Review.

Dual-Energy computed tomography (DECT) with its various advanced techniques, including Virtual Non-Contrast (VNC), effective atomic number (Z-eff) calculation, Z-maps, Iodine Density Index (IDI), and so on, holds great promise in the diagnosis and management of urogenital tumours. In this narrative review, we analyze the current status of knowledge of this technology to provide better lesion characterization, improve the staging accuracy, and give more precise treatment response assessments in relation to urological tumours.

Clinical application of dual-layer spectral CT multi-parameter feature to predict microvascular invasion in hepatocellular carcinoma.

OBJECTIVE: This study aimed to investigate the feasibility of using dual-layer spectral CT multi-parameter feature to predict microvascular invasion of hepatocellular carcinoma. METHODS: This retrospective study enrolled 50 HCC patients who underwent multiphase contrast-enhanced spectral CT studies preoperatively. Combined clinical data, radiological features with spectral CT quantitative parameter were constructed to predict MVI. ROC was applied to identify potential predictors of MVI. The CT values obtained by simulating the conventional CT scans with 70 keV images were compared with those obtained with 40 keV images. RESULTS: 50 hepatocellular carcinomas were detected with 30 lesions (Group A) with microvascular invasion and 20 (Group B) without. There were significant differences in AFP,tumer size, IC, NIC,slope and effective atomic number in AP and ICrr in VP between Group A ((1000(10.875,1000),4.360±0.3105, 1.7750 (1.5350,1.8825) mg/ml, 0.1785 (0.1621,0.2124), 2.0362±0.2108,8.0960±0.1043,0.2830±0.0777) and Group B (4.750(3.325,20.425),3.190±0.2979,1.4700 (1.4500,1.5775) mg/ml, 0.1441 (0.1373,0.1490),1.8601±0.1595, 7.8105±0.7830 and 0.2228±0.0612) (all p < 0.05). Using 0.1586 as the threshold for NIC, one could obtain an area-under-curve (AUC) of 0.875 in ROC to differentiate between tumours with and without microvascular invasion. AUC was 0.625 with CT value at 70 keV and improved to 0.843 at 40 keV. CONCLUSION: Dual-layer spectral CT provides additional quantitative parameters than conventional CT to enhance the differentiation between hepatocellular carcinoma with and without microvascular invasion. Especially, the normalized iodine concentration (NIC) in arterial phase has the greatest potential application value in determining whether microvascular invasion exists, and can offer an important reference for clinical treatment plan and prognosis assessment.

Role of effective atomic number of paraspinal muscles in the prediction of acute vertebral fracture risk assessment: a cross-sectional case-control study.

OBJECTIVES: We aim to investigate the relations among effective atomic number (Zeff), density, and area of paraspinal muscles, volumetric bone mineral density (vBMD), and acute vertebral fractures (VF) by using spectral base images (SBIs) and routine CT images. METHODS: A total of 223 patients (52 men and 171 women) with acute lumber VF and 776 subjects (286 men and 390 women) without VF of at least 60 years were enrolled and underwent dual-layer detector CT scans. We quantified the cross-sectional area, density (paraSMD), and Zeff of paraspinal muscles by CT images and SBIs and measured vBMD of the lumbar spine by quantitative CT. RESULTS: Higher vBMD was associated with lower VF risk in both sexes (adjusted OR, 0.33 and 0.43). After adjusting for age and body mass index, the associations of paraSMD with VF were not significant in men, and in women the association was borderline significant (OR, 0.80; 95% CI, 0.64-1.00). However, higher Zeff of paraspinal muscles was associated with lower VF risk in men (adjusted OR, 0.59; 0.36-0.96) but not in women. The associations of all muscle indexes with VF were not significant after further adjusting for vBMD. CONCLUSIONS: A higher Zeff of paraspinal muscles is associated with lower VF risk in older men but not in older women. The density, area, and Zeff of paraspinal muscles were not vBMD independent risk factors for acute VF. ADVANCES IN KNOWLEDGE: The effective atomic number of paraspinal muscles might be a potential marker for VF risk prediction.

A comparative evaluation of polymeric materials as tissue equivalent phantoms in diagnostic radiology.

In this study tissue equivalency of the polymeric materials was investigated by comparing with ICRP 110 Male Adult Computational Phantom tissues. For this purpose, radiological properties of polyamide (PA), high density polyethylene (HDPE), ultra-high molecular weight polyethylene (UHMWPE), polypropylene (PP), polyvinyl chloride (PVC), polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), polyoxymethylene (POM) and polyurethane foam (PU FOAM) were evaluated in the diagnostic energy range (15-150 keV). The radiological properties of the materials and ICRP 110 Male and Female Adult Computational Phantom tissues were calculated with Phy-X/PSD software. No major differences were seen except for sex-specific organs, and comparisons were made using an adult male phantom. To confirm the results experimentally, a chest phantom was designed with the polymeric materials. The phantom was scanned by Siemens SOMATOM Edge CT device with tube voltage of 120 kVp and Hounsfield Unit (HU) values were measured. In addition, HU values were calculated using theoretical relationships and significant agreement was obtained between measured and calculated HUs. It was determined that PA, PP, UHMWPE and HDPE were equivalent to muscle and adipose tissue, PVC and PTFE were equivalent to mineral bone, PET and POM were equivalent to spongiosa bone and PU FOAM was equivalent to lung tissue.

Conversion of single-energy CT to parametric maps of dual-energy CT using convolutional neural network.

OBJECTIVES: We propose a deep learning (DL) multitask learning framework using convolutional neural network for a direct conversion of single-energy CT (SECT) to 3 different parametric maps of dual-energy CT (DECT): virtual-monochromatic image (VMI), effective atomic number (EAN), and relative electron density (RED). METHODS: We propose VMI-Net for conversion of SECT to 70, 120, and 200 keV VMIs. In addition, EAN-Net and RED-Net were also developed to convert SECT to EAN and RED. We trained and validated our model using 67 patients collected between 2019 and 2020. Single-layer CT images with 120 kVp acquired by the DECT (IQon spectral CT; Philips Healthcare, Amsterdam, Netherlands) were used as input, while the VMIs, EAN, and RED acquired by the same device were used as target. The performance of the DL framework was evaluated by absolute difference (AD) and relative difference (RD). RESULTS: The VMI-Net converted 120 kVp SECT to the VMIs with AD of 9.02 Hounsfield Unit, and RD of 0.41% compared to the ground truth VMIs. The ADs of the converted EAN and RED were 0.29 and 0.96, respectively, while the RDs were 1.99% and 0.50% for the converted EAN and RED, respectively. CONCLUSIONS: SECT images were directly converted to the 3 parametric maps of DECT (ie, VMIs, EAN, and RED). By using this model, one can generate the parametric information from SECT images without DECT device. Our model can help investigate the parametric information from SECT retrospectively. ADVANCES IN KNOWLEDGE: DL framework enables converting SECT to various high-quality parametric maps of DECT.

Characterization of Normal Bone in the Equine Distal Limb with Effective Atomic Number and Electron Density Determined with Single-Source Dual Energy and Detector-Based Spectral Computed Tomography.

Single-source dual energy (SSDECT) and detector-based spectral computed tomography (DBSCT) are emerging technologies allowing the interrogation of materials that have different attenuation properties at different energies. Both technologies enable the calculation of effective atomic number (EAN), an index to determine tissue composition, and electron density (ED), which is assumed to be associated with cellularity in tissues. In the present prospective observational study, EAN and ED values were determined for 16 zones in normal subchondral and trabecular bone of 37 equine cadaver limbs. Using both technologies, the following findings were obtained: 1. palmar/plantar EAN zone values in the fetlock increased significantly with increasing age of the horse; 2. all EAN and ED values were significantly lower in the trabecular bone than in the subchondral bone of all phalanges; 3. in the distal phalanx and navicular bone, most EAN and ED values were significantly lower compared to the proximal and middle phalanx; and 4. some EAN and ED values were significantly different between front and hind limbs. Several EAN and ED values significantly differed between SSDECT and DBSCT. The reported EAN and ED values in the subchondral and trabecular bone of the equine distal limb may serve as preliminary reference values and aid future evaluation and classification of diseases.

Diagnostic Value of Carotid Plaque Assessment with AIS Based on Quantitative Parameters of Dual-Layer Detector Spectral CT.

Purpose: To investigate the quantitative assessment of carotid plaque by each parameter of dual-layer detector spectral CT and its diagnostic value in patients with acute cerebral infarction. Patients and Methods: Eighty-three patients with carotid atherosclerotic plaques who underwent spectral CT scanning were retrospectively included. Forty-two patients with acute ischaemic stroke (AIS) were included in the study group, and 41 patients without AIS were included in the control group. We compared the detection of carotid plaques in the two groups and the differences in the spectral quantitative parameters of the plaques in the two groups, and their diagnostic efficacy was obtained. Results: The detection rate of carotid plaques in the AIS group was higher than that in the non-AIS group (p<0.05); the carotid plaques in the AIS group mainly consisted of non-calcified plaques, while those in the non-AIS group mainly consisted of calcified plaques. The effective atomic number (Zeff), slope of the energy spectrum curve (λH), electron density (ED), and iodine-no-water value of the carotid plaques in the AIS group were lower than those in the non-AIS (p<0.05). For the differentiation of the carotid plaques in the AIS group from those in the non-AIS group, the area under the curve (AUC) of Zeff amounted to 0.637 (cut-off value: 11.865; sensitivity: 72.5%; specificity: 56.2%), the AUC of λH amounted to 0.628 (cut-off value: 19.56; sensitivity: 76.3%; specificity: 51.6%), and that for ED amounted to 0.624 (cut-off value: 110.45; sensitivity: 60.0%; specificity: 64.1%), AUC of iodine-no-water value amounted to 0.645 (cut-off value: 9.125; sensitivity: 61.3%; specificity: 65.6%). Conclusion: In summary, the quantitative parameters of dual-layer detector spectral CT can be used to assess plaque stability and have certain value in the diagnosis of AIS. The quantitative parameters can effectively differentiate carotid plaques in AIS and non-AIS patients.

A blurring correction method suitable to analyze quantitative x-ray images derived from energy-resolving photon counting detector.

Objective.The purpose of this study is to propose a novel blurring correction method that enables accurate quantitative analysis of the object edge when using energy-resolving photon counting detectors (ERPCDs). Although the ERPCDs have the ability to generate various quantitative analysis techniques, such as the derivations of effective atomic number (Zeff) and bone mineral density values, at the object edge in these quantitative images, accurate quantitative information cannot be obtained. This is because image blurring prevents the gathering of accurate primary x-ray attenuation information.Approach.We developed the following procedure for blurring correction. A 5 × 5 pixels masking region was set as the processing area, and the pixels affected by blurring were extracted from the analysis of pixel value distribution. The blurred pixel values were then corrected to the proper values estimated by analyzing minimum and/or maximum values in the set mask area. The suitability of our correction method was verified by a simulation study and an experiment using a prototype ERPCD.Main results. WhenZeffimage of aluminum objects (Zeff= 13) were analyzed without applying our correction method, regardless of raw data or correction data applying a conventional edge enhancement method, the properZeffvalues could not be derived for the object edge. In contrast, when applying our correction method, 82% of pixels affected by blurring were corrected and the properZeffvalues were calculated for those pixels. As a result of investigating the applicability limits of our method through simulation, it was proven that it works effectively for objects with 4 × 4 pixels or more.Significance. Our method is effective in correcting image blurring when the quantitative image is calculated based on multiple images. It will become an in-demand technology for putting a quantitative diagnosis into actual medical examinations.

Performance of Iron Phosphate Glass Containing Various Heavy Metal Oxides for Particulate Nuclear Radiation Shielding.

BACKGROUND: Employees may be exposed to different kinds of ionizing radiation at work. When ionizing radiation interacts with human cells, it can cause damage to the cells and genetic material. Therefore, one of the scientists' primary objectives has always been to create the best radiation-shielding materials. Glass could offer promising shielding material resulting from the high flexibility of composition, simplicity of production, and good thermal stability. MATERIALS AND METHODS: The melt-quenching technique was used to create a glass having the following formula: 50% P2O5+20% Na2O+20% Fe2O3+10% X, where X = As2O3, SrO, BaO, CdO, and Sb2O3 mol %. The impact of the different heavy metal additions on the structure of the glass networks was studied using FTIR spectroscopy. Glass's ability to attenuate neutrons and/or charged particles has been theoretically investigated. The performance of the developed glass as a shield was examined by a comparison against commercial glass (RS 253 G18), ordinary concrete (OC), and water (H2O). RESULTS: For charged particle radiations (Electrons, Protons, and Alpha), the shielding parameters like the mass stopping power, the projected range, and the effective atomic number were evaluated, where S5/Sb glass achieves the best performance. In the case of Neutrons, the results values reveal that S3/Ba glass ( ΣR = 0.105) is the best-modified glass for neutron shielding. CONCLUSION: Among all the investigated glasses, S5/Sb glass composition has a smaller range and provides superior protection against charged particles. In contrast, the S3/Ba glass composition is a superior choice for shielding against neutron radiation.

Dual-Layer Spectral Detector Computed Tomography Quantitative Parameters: A Potential Tool for Lymph Node Activity Determination in Lymphoma Patients.

Dual-energy CT has shown promising results in determining tumor characteristics and treatment effectiveness through spectral data by assessing normalized iodine concentration (nIC), normalized effective atomic number (nZeff), normalized electron density (nED), and extracellular volume (ECV). This study explores the value of quantitative parameters in contrast-enhanced dual-layer spectral detector CT (SDCT) as a potential tool for detecting lymph node activity in lymphoma patients. A retrospective analysis of 55 lymphoma patients with 289 lymph nodes, assessed through 18FDG-PET/CT and the Deauville five-point scale, revealed significantly higher values of nIC, nZeff, nED, and ECV in active lymph nodes compared to inactive ones (p < 0.001). Generalized linear mixed models showed statistically significant fixed-effect parameters for nIC, nZeff, and ECV (p < 0.05). The area under the receiver operating characteristic curve (AUROC) values of nIC, nZeff, and ECV reached 0.822, 0.845, and 0.811 for diagnosing lymph node activity. In conclusion, the use of g nIC, nZeff, and ECV as alternative imaging biomarkers to PET/CT for identifying lymph node activity in lymphoma holds potential as a reliable diagnostic tool that can guide treatment decisions.

Technical note: Error analysis of material-decomposition-based effective atomic number quantification method.

BACKGROUND: The effective atomic number (Zeff ) is widely applied to the identification of unknown materials. One method to determine the Zeff is material-decomposition-based spectral X-ray imaging. The method relies on certain approximations of the X-ray interaction cross-sections such as empirical model coefficients. The impact of such approximations on the accuracy of Zeff quantification has not been fully investigated. PURPOSE: To perform an error analysis of the material-decomposition-based Zeff quantification method and propose a coefficient calibration-in-groups method to improve the modeling accuracy and reduce the Zeff quantification error. METHODS: The model of the material-decomposition-based Zeff quantification method relies on the dependence of the interaction cross-sections  (σPE ) on the atomic number Z and corresponding coefficient, that is, σ PE ∝ Z m $\sigma _\mathrm{PE}\propto Z^m$ . In this work, all the data is from the National Institute of Standards and Technology (NIST) website. First, the coefficient m is calibrated through a logarithmic fitting method to quickly determine the m values for any certain energy and Zeff ranges. Then materials including elements and common compounds with Zeff ranging from 6-20 are selected as the objects whose effective atomic numbers are to be quantified. Different combinations of basis materials are applied to decompose the object materials and their quantification errors are analyzed. With the help of error analysis, the object materials are divided into high-error and low-error groups based on the decomposition coefficient ratio a m i n / a m a x $a_{min}/a_{max}$ , which is found to have a strong correlation with error, and their coefficients are calibrated in groups. Finally, the average errors of three m selection strategies: (1) using an empirical m value of 3.94, which is also considered a standard method; (2) using a single m value, which is calibrated through the logarithmic fitting method; (3) using different m values calibrated in groups, are calculated to test the effectiveness of our method. RESULTS: The approximation of the X-ray interaction cross-section leads to certain errors in Zeff quantification and the error distributions for different basis materials are different. The average errors for most basis material combinations (C(6)/Ca(20), C(6)/Al(13), Al(13)/Ca(20), C(6)/Ne(10), Na(11)/P(15)) are lower than 0.5, maintaining good average accuracy. While the average error for S(16)/Ca(20) is up to 0.8461, leading to more misjudgments on atomic number. Meanwhile, the error distribution regularity can be observed. The Pearson's correlation coefficients of absolute errors and decomposition coefficient ratios are 0.743, 0.8432 and 0.7126 for basis material combinations C(6)/Ca(20), C(6)/Al(13) and Al(13)/Ca(20), indicating a good correlation. The method using either empirical m value of 3.94 or single calibrated m value of 4.619 has relatively high average errors. The proposed method using different m values calibrated in groups has the lowest average errors 0.254, 0.203 and 0.169, which are reduced by 21.6%(0.07), 3.8%(0.008) and 62.9%(0.286) respectively compared with the standard method. CONCLUSIONS: The error analysis demonstrates that the approximation of X-ray interaction cross-sections leads to inevitable errors, while also revealing certain error distribution regularity. The coefficient calibrated-in-groups method has better modeling accuracy and has effectively reduced the error compared with the standard method using a single empirical m value of 3.94.

Evaluation of microcirculation in asymptomatic cerebral infarction with multi-parameter imaging of spectral CT.

OBJECTIVE: To investigate the role of spectral CT multiparametric imaging in the evaluation of cerebral microcirculatory perfusion. METHODS: The imaging data of 145 patients with asymptomatic cerebral infarction confirmed by MR were retrospectively analyzed, and all cases underwent head CTA and cranial CT perfusion imaging (CTP) on double-layer detector spectral CT. Single energy level images (MonoE45 keV), iodine density maps, and effective atomic number maps were reconstructed based on spectral CTA data, and CT values, iodine density values, and effective atomic number values were measured in the infarcted area, healthy control area, centrum semiovale and posterior limb of the internal capsule, respectively; perfusion values, such as cerebral blood volume (CBV) values, cerebral blood flow (CBF) values, time to peak (TTP) values, and mean passage time, were measured in the above-mentioned areas on CTP images. (TTP) values, and mean time to passage (MTT) values. CT values, iodine density values, effective atomic number values, and perfused CBV, CBF, TTP, and MTT values were compared between the infarcted area and the healthy side, the center of the hemianopia, and the posterior limb of the internal capsule. The role of spectral CT parameters and perfusion parameters in the evaluation of asymptomatic cerebral infarction was analyzed. RESULTS: CT values, iodine density values, and effective atomic number values were statistically different between the infarcted area and the healthy side; CT values, iodine density values, and effective atomic number values were not statistically different between the infarcted side and the healthy side of the hemispheric centrum and the posterior limb of the internal capsule; CBV and CBF were statistically different between the infarcted side and the healthy side, and MTT and TTP were not statistically different. There were statistically significant differences in TTP between the infarcted area and the healthy side of the hemiaxial center, and no statistically significant differences in CBV, CBF, and MTT. There were no statistical differences in CBV, CBF, TTP, and MTT in the inner capsule area. ROC curve analysis of spectral CT-related parameters and CT perfusion parameters for the diagnosis of asymptomatic cerebral infarction: area under the curve of MonoE 45Kv 0.71, area under the curve of iodine density values 0.76, area under the curve of effective atomic number values 0.74; area under the curve of CBV value 0.64, area under the curve of CBF value 0.61, area under the curve of MTT value 0.50, The area under the TTP curve was 0.52. The area under the ROC curve of the multivariate logistic regression model based on spectral parameters is 0.76, which is higher than that of the logistic regression model with perfusion parameters (P < 0.05). CONCLUSION: Spectral CT can better demonstrate small intracranial ischemic lesions, and iodine density values have a better evaluation of microcirculation in asymptomatic cerebral infarcts.

Research on accuracy of material identification based on photon counting spectral CT.

BACKGROUND: Photon counting spectral CT is a significant direction in the development of CT technology and material identification is an important application of spectral CT. However, spectrum estimation in photon counting spectral CT is highly complex and may affect quantification accuracy of material identification. OBJECTIVE: To address the problem of energy spectrum estimation in photon-counting spectral CT, this study investigates empirical material decomposition algorithms to achieve accurate quantitative decomposition of the effective atomic number. METHODS: The spectrum is first calibrated using the empirical dual-energy calibration (EDEC) method and the effective atomic number is then quantitatively estimated based on the EDEC method. The accuracy of estimating the effective atomic number of materials under different calibration conditions is investigated by designing different calibration phantoms, and accurate quantitation is achieved using suitable calibration settings. Last, the validity of this method is verified through simulations and experimental studies. RESULTS: The results demonstrate that the error in estimating the effective atomic number is reduced to within 4% for low and medium Z materials, thereby enabling accurate material identification. CONCLUSION: The empirical dual-energy correction method can solve the problem of energy spectrum estimation in photon counting spectral CT. Accurate effective atomic number estimation can be achieved with suitable calibration.

Characterization of breast tissues in density and effective atomic number basis via spectral X-ray computed tomography.

Objective.Differentiation of breast tissues is challenging in X-ray imaging because tissues might share similar or even the same linear attenuation coefficientsµ. Spectral computed tomography (CT) allows for more quantitative characterization in terms of tissue density (ρ) and effective atomic number (Zeff) by exploiting the energy dependence ofµ. The objective of this study was to examine the potential ofρ/Zeffdecomposition in spectral breast CT so as to explore the benefits of tissue characterization and improve the diagnostic accuracy of this emerging 3D imaging technique.Approach.In this work, 5 mastectomy samples and a phantom with inserts mimicking breast soft tissues were evaluated in a retrospective study. The samples were imaged at three monochromatic energy levels in the range of 24-38 keV at 5 mGy per scan using a propagation-based phase-contrast setup at SYRMEP beamline at the Italian national synchrotron Elettra.Main results.A custom-made algorithm incorporating CT reconstructions of an arbitrary number of spectral energy channels was developed to extract the density and effective atomic number of adipose, fibro-glandular, pure glandular, tumor, and skin from regions selected by a radiologist.Significance.Preliminary results suggest that, via spectral CT, it is possible to enhance tissue differentiation. It was found that adipose, fibro-glandular and tumorous tissues have average effective atomic numbers (5.94 ± 0.09, 7.03 ± 0.012, and 7.40 ± 0.10) and densities (0.90 ± 0.02, 0.96 ± 0.02, and 1.07 ± 0.03 g cm-3) and can be better distinguished if both quantitative values are observed together.

A quantitative analysis of spectral computed tomography characteristics of osseous metastases.

INTRODUCTION: Spectral detector computed tomography (SDCT) is a recent advancement that enables elemental material decomposition which could improve the detection of osseous metastases in the oncologic patient. METHODS: Sixteen patients who underwent oncologic staging SDCT as well as WBBS with Technetium-99 m hydroxydiphosphonate (Tc99m HDP) were included in this retrospective study. A total of 50 osseous metastases were identified and confirmed on bone scintigraphy. Quantitative ROI-based measurements of each lesion and a similar region of normal bone were performed, and the acquired spectral data were used for comparison. These parameters included effective atomic number (Zeff ), electron density (%EDW) and calcium suppression (HU). Receiver operating characteristic (ROC) analysis was performed. RESULTS: In comparison to normal bone, osseous metastases showed statistically significantly elevated values in effective atomic number, electron density and calcium suppression. ROC analysis demonstrated outstanding discrimination with area under the curve (AUC) values of 0.934 and 0.915 for effective atomic number and electron density, and excellent discrimination with an AUC value of 0.884 for calcium suppression. Threshold values of effective atomic number (Zeff ) >9.7, electron density >115% EDW and calcium suppression values >0 HU were demonstrated to be able to differentiate an osseous lesion from normal bone with a sensitivity of 82%, 82% and 84% and a specificity of 86%, 92% and 88% respectively. CONCLUSION: Spectral analysis of osseous metastases demonstrated significantly elevated values in effective atomic number, electron density and calcium suppression as compared to normal bone which would be useful adjunct quantitative parameters in CT imaging to increase diagnostic confidence.

The diagnostic value of quantitative parameters on dual-layer detector-based spectral CT in identifying ischaemic stroke.

Objective: To investigate the diagnostic value of quantitative parameters of spectral computed tomography (CT) in ischaemic stroke areas. Methods: The medical records of 57 patients with acute ischaemic stroke (AIS) who underwent plain computed tomography (CT) head scans, CT angiography (CTA), and CT perfusion (CTP) were retrospectively reviewed. The ischaemic areas (including the core infarct area and penumbra) and non-ischaemic areas in each patient were quantitatively analyzed using F-STROKE software. Two independent readers measured the corresponding values of the spectroscopic quantitative parameters (effective atomic number [Zeff value], iodine density value, and iodine-no-water value) in the ischaemic area and contralateral normal area alone. The differences in spectroscopic quantitative parameters between the two groups were compared, and their diagnostic efficacy was obtained. Results: The Zeff, iodine-no-water value, and iodine density value of the ischaemic area all showed significant lower than those of non-ischaemic tissue (P < 0.001). For differentiating the ischaemic area from non-ischaemic tissue, the area under the curve (AUC) of the Zeff value reached 0.869 (cut-off value: 7.385; sensitivity: 93.0%; specificity: 70.2%), the AUC of the iodine density value reached 0.932 (cut-off value: 0.235; sensitivity: 91.2%; specificity: 82.5%), and the AUC of the iodine-no-water value reached 0.922 (cut-off value: 0.205; sensitivity: 96.5%; specificity: 78.9%). Conclusion: The study showed the spectral CT would be a potential novel rapid method for identifying AIS. The spectral CT quantitative parameters (Zeff, iodine density values, and iodine-no-water values) can effectively differentiate the ischaemic area from non-ischaemic tissue in stroke patients.

Quantitative parameters in novel spectral computed tomography: Assessment of Ki-67 expression in patients with gastric adenocarcinoma.

BACKGROUND: The level of Ki-67 expression has served as a prognostic factor in gastric cancer. The quantitative parameters based on the novel dual-layer spectral detector computed tomography (DLSDCT) in discriminating the Ki-67 expression status are unclear. AIM: To investigate the diagnostic ability of DLSDCT-derived parameters for Ki-67 expression status in gastric carcinoma (GC). METHODS: Dual-phase enhanced abdominal DLSDCT was performed preoperatively in 108 patients with gastric adenocarcinoma. Primary tumor monoenergetic CT attenuation value at 40-100 kilo electron volt (kev), the slope of the spectral curve (λHU), iodine concentration (IC), normalized IC (nIC), effective atomic number (Zeff) and normalized Zeff (nZeff) in the arterial phase (AP) and venous phase (VP) were retrospectively compared between patients with low and high Ki-67 expression in gastric adenocarcinoma. Spearman's correlation coefficient was used to analyze the association between the above parameters and Ki-67 expression status. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic efficacy of the statistically significant parameters between two groups. RESULTS: Thirty-seven and 71 patients were classified as having low and high Ki-67 expression, respectively. CT40 kev-VP, CT70 kev-VP, CT100 kev-VP, and Zeff-related parameters were significantly higher, but IC-related parameters were lower in the group with low Ki-67 expression status than the group with high Ki-67 expression status, and other analyzed parameters showed no statistical difference between the two groups. Spearman's correlation analysis showed that CT40 kev-VP, CT70 kev-VP, CT100 kev-VP, Zeff, and nZeff exhibited a negative correlation with Ki-67 status, whereas IC and nIC had positive correlation with Ki-67 status. The ROC analysis demonstrated that the multi-variable model of spectral parameters performed well in identifying the Ki-67 status [area under the curve (AUC) = 0.967; sensitivity 95.77%; specificity 91.89%)]. Nevertheless, the differentiating capabilities of single-variable model were moderate (AUC value 0.630 - 0.835). In addition, the nZeff VP and nICVP (AUC 0.835 and 0.805) showed better performance than CT40 kev-VP, CT70 kev-VP and CT100 kev-VP (AUC 0.630, 0.631 and 0.662) in discriminating the Ki-67 status. CONCLUSION: Quantitative spectral parameters are feasible to distinguish low and high Ki-67 expression in gastric adenocarcinoma. Zeff and IC may be useful parameters for evaluating the Ki-67 expression.

Investigation of the nuclear radiation interaction parameters of selected polymers for radiation therapy and dosimetry.

The mass attenuation coefficient (MAC), effective atomic number (Zeff), equivalent atomic number (Zeq), fast neutron removal cross-section (FNRCS), energy absorption buildup factor (EABF), mass-energy absorption coefficient (MenAC), relative kerma, and computed tomography (CT) numbers were calculated for the alginates, bisphenol A-glycidyl methacrylate (Bis-GMA), chitin, hyaluronic acid, polycaprolactone (PCL), polyether ether ketone (PEEK), polyethylene glycol (PEG), polyglycolide (PGA), polylactic acid (PLA), poly lacto-co-glycolic acid (PLGA), poly methyl methacrylate (PMMA), poly vinyl alcohol (PVA), polyvinylpyrrolidone (PVP), triethylene glycol dimethacrylate (TEGDMA), and urethane dimethacrylate (UDMA) polymers using the Phy-X/PSD and Py-MLBUF software. The total stopping power (TSP) of electrons, protons, and alpha particles was calculated for the selected polymers using the ESTAR, PSTAR, and ASTAR programs. The effective atomic number for absorption and charged particle (electron, proton, alpha, and carbon ion) interactions were estimated for the selected polymers using Phy-X/ZeXTRa software. The FNRCS values of Bis-GMA, PCL, PEG, PMMA, and PVP were similar to those of the human tissues. For the selected polymers, the Zeff values for electron, proton, alpha, and carbon ion interactions of PCL, PEG, PLGA, and PVA were similar to those of human tissues, except for the cortical bone, across the entire energy range. These results are expected to assist in selecting suitable polymers as tissue-equivalent materials in the desired energy range for photon, neutron, and charged-particle interactions. This study is expected to be useful for radiation therapy and dosimetry.

Gamma Attenuation Features of White Cement Mortars Reinforced by Micro/Nano Bi2O3 Particles.

This study aims to explore the radiation protection properties of white mortars based on white cement as a binder and Bi2O3 micro and nanoparticles in proportions of 15 and 30% by weight as replacement sand. The average particle size of micro- and nano-Bi2O3 was measured using a transmission electron microscope (TEM). The cross-sectional morphology and distribution of Bi2O3 within the samples can be obtained by scanning electron microscopy (SEM), showing that nanoscale Bi2O3 particles have a more homogeneous distribution within the samples than microscale Bi2O3 particles. The shielding parameters of the proposed mortars were measured using the HPGe detector at various γ-ray energies emitted by standard radioactive point sources 241Am, 133Ba, 60Co, 137Cs, and 152Eu. The experimental values of the prepared mortars' mass attenuation coefficients (MAC) match well with those determined theoretically from the XCOM database. Other shielding parameters, including half value layer (HVL), tenth value layer (TVL), mean free path (MFP), effective electron density (Neff), effective atomic number (Zeff), equivalent atomic number (Zeq), and exposure buildup factor (EBF), were also determined at different photon energies to provide more shielding information about the penetration of gamma radiation into the selected mortars. The obtained results indicated that the sample containing 30% by weight of nano Bi2O3 has the largest attenuation coefficient value. Furthermore, the results show that the sample with a high concentration of Bi2O3 has the highest equivalent atomic numbers and the lowest HVL, TVL, MFP, and EBF values. Finally, it can be concluded that Bi2O3 nanoparticles have higher efficiency and protection compared to microparticles, especially at lower gamma-ray energies.