Can dual-energy CT improve the assessment of tumor margins in oral cancer?

• Published in: Oral oncology Vol. 50; no. 3; pp. 221 - 227
• Main Authors: Toepker, Michael, Czerny, Christian, Ringl, Helmut, Fruehwald-Pallamar, Julia, Wolf, Florian, Weber, Michael, Ploder, Oliver, Klug, Clemens
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-03-2014; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Verrucous - diagnostic imaging; Contrast Media; Dental Restoration, Permanent - adverse effects; Dual energy; Female; Hematology, Oncology and Palliative Medicine; Humans; Image quality; Male; Medical sciences; Middle Aged; Mouth Neoplasms - diagnostic imaging; Multidetector computed tomography; Oral cancer; Otolaryngology; Otorhinolaryngology. Stomatology; Radiographic Image Enhancement - methods; Reproducibility of Results; Signal-To-Noise Ratio; Tomography, X-Ray Computed - methods; Tumor margin; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult; milliampere seconds; dual-energy computed tomography; Oral cancer; Tumor margin; kilovolt; mixed; kV; MDCT; line density profile; DECT; M; HU; Multidetector computed tomography; Image quality; OC; multi-detector computed tomography; SNR; signal-to-noise ratio; Dual energy; optimum contrast; LDP; mAs; hounsfield units; Radiodiagnosis; Stomatology; ENT; Malignant tumor; Multidetector scanner; Cancerology; Medical imagery; Oral cavity disease; Computerized axial tomography; Cancer
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2013.12.001

Summary Objectives The aim was to investigate the image quality of dual-energy computed-tomography (DECT) compared to single-energy images at 80 kV and 140 kV in oral tumors. Materials and methods Forty patients underwent a contrast-enhanced DECT scan on a definition flash-CT. Four reconstructions (80 kV, 140 kV, mixed (M), and optimum-contrast (OC)) were assessed by four blinded readers for subjective image quality (10-point scale/10 = best). For objective quality assessment, linear attenuation measurements (line density profiles (LDP)) were positioned at the tumor margin, and the difference between minimum and maximum was calculated. Signal-to-noise ratios (SNR) were measured in the tongue. Results The mean image quality for all readers was 5.1 ± 0.3, 8.4 ± 0.3, 8.1 ± 0.2, and 8.3 ± 0.2 for the 140 kV, 80 kV, M, and OC, respectively ( P < 001 between 140 kV and all others). The mean difference between the minimum and maximum within the LDP was 139.4 ± 59.0, 65.7 ± 29.5, 105.1 ± 46.5, and 118.7 ± 59.4 for the 80 kV, 140 kV, M, and OC, respectively ( P < 001). The SNR for the tongue was 3.8 ± 2.1, 3.8 ± 2.1, 4.2 ± 2.4, and 4.1 ± 2.3 for the 80 kV, 140 kV, M, and OC, respectively. Discussion DECT of oral tumors offers high image quality, with subjectively rated image quality and attenuation contrast at the tumor margin similar to that of 80 kV; DECT, however, provides a significantly higher SNR compared to 80 kV.