Multi-institutional study for comparison of detectability of hypovascular liver metastases between 70- and 40-keV images: DELMIO study.
Ichikawa S, Funayama S, Hyodo T, Ozaki K, Ito A, Kakuya M, Kobayashi T, Tanahashi Y, Kozaka K, Igarashi S, Suto T, Noda Y, Matsuo M, Narita A, Okada H, Suzuki K, Goshima S
To compare the lesion detectability of hypovascular liver metastases between 70-keV and 40-keV images from dual energy-computed tomography (CT) reconstructed with deep-learning image reconstruction (DLIR). This multi-institutional, retrospective study included adult patients both pre- and post-treatment for gastrointestinal adenocarcinoma. All patients underwent contrast-enhanced CT with reconstruction at 40-keV and 70-keV. Liver metastases were confirmed using gadoxetic acid-enhanced magnetic resonance imaging. Four radiologists independently assessed lesion conspicuity (per-patient and per-lesion) using a 5-point scale. A radiologic technologist measured image noise, tumor-to-liver contrast, and contrast-to-noise ratio (CNR). Quantitative and qualitative results were compared between 70-keV and 40-keV images. The study included 138 patients (mean age, 69 ± 12 years; 80 men) with 208 liver metastases. Seventy-one patients had liver metastases, while 67 did not. Primary cancer sites included 68 cases of pancreas, 50 colorectal, 12 stomach, and 8 gallbladder/bile duct. No significant difference in per-patient lesion detectability was found between 70-keV images (sensitivity, 71.8-90.1%; specificity, 61.2-85.1%; accuracy, 73.9-79.7%) and 40-keV images (sensitivity, 76.1-90.1%; specificity, 53.7-82.1%; accuracy, 71.7-79.0%) (p = 0.18-> 0.99). Similarly, no significant difference in per-lesion lesion detectability was observed between 70-keV (sensitivity, 67.3-82.2%) and 40-keV images (sensitivity, 68.8-81.7%) (p = 0.20-> 0.99). However, Image noise was significantly higher at 40 keV, along with greater tumor-to-liver contrast and CNRs for both hepatic parenchyma and tumors (p < 0.01). There was no significant difference in hypovascular liver metastases detectability between 70-keV and 40-keV images using the DLIR technology.