Clinical routine use of virtual monochromatic datasets based on spectral CT in patients with hypervascularized abdominal tumors - evaluation of effectiveness and efficiency.

BACKGROUND: Virtual monochromatic images (VMI) generated using spectral computed tomography (CT) are promising recently available tools to improve diagnostic performance in oncologic patients. PURPOSE: To investigate if virtual monochromatic datasets are suitable for clinical routine use in patients with hypervascularized abdominal tumors. MATERIAL AND METHODS: A total of 41 patients with hypervascularized hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), or neuroendocrine tumors (NET) were enrolled in the study; 451 CT series were analyzed. In an intra-individual study design, virtual monochromatic datasets of the arterial phase of each scan were computed. Image quality was assessed objectively by determining signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) and subjectively by using five-point Likert-scales. The volume CT dose index (CTDIvol) was taken from each radiation dose report. The increase in reading time was estimated from the increase in the number of images. RESULTS: Intra-individual comparison of the spectral mode in the arterial phase with the portal venous phase revealed no significant increase in the applied dose. SNR, CNRtumor-to-liver , and CNRtumor-to-muscle were significantly increased by lowering virtual monochromatic energy. Subjective image quality scores revealed an increase of contrast in low energy datasets, resulting in significantly higher diagnostic confidence, but an increased image noise at low energies. While diagnostic confidence improved, taking all datasets into account resulted in a significantly longer estimated reading time. CONCLUSION: In clinical practice, the use of low energy VMI improved diagnostic confidence without a significant increase in dose. The main disadvantage is a decrease in efficiency due to longer reading times.