Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT

<b>Objectives</b>: To evaluate the value of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) for discriminability of severe lung injury and atelectasis in polytraumatized patients. <b>Materials & Methods</b>: Contrast-enhanced PCD-CT examinatio...

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Main Authors: Hanns Leonhard Kaatsch, Maximilian Franz Völlmecke, Benjamin V. Becker, Daniel Dillinger, Laura Kubitscheck, Aliona Wöhler, Sebastian Schaaf, Joel Piechotka, Christof Schreyer, Robert Schwab, Daniel Overhoff, Stephan Waldeck
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Language:English
Published: MDPI AG 2024-10-01
Series:Diagnostics
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Online Access:https://www.mdpi.com/2075-4418/14/19/2231
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author Hanns Leonhard Kaatsch
Maximilian Franz Völlmecke
Benjamin V. Becker
Daniel Dillinger
Laura Kubitscheck
Aliona Wöhler
Sebastian Schaaf
Joel Piechotka
Christof Schreyer
Robert Schwab
Daniel Overhoff
Stephan Waldeck
author_facet Hanns Leonhard Kaatsch
Maximilian Franz Völlmecke
Benjamin V. Becker
Daniel Dillinger
Laura Kubitscheck
Aliona Wöhler
Sebastian Schaaf
Joel Piechotka
Christof Schreyer
Robert Schwab
Daniel Overhoff
Stephan Waldeck
author_sort Hanns Leonhard Kaatsch
collection DOAJ
description <b>Objectives</b>: To evaluate the value of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) for discriminability of severe lung injury and atelectasis in polytraumatized patients. <b>Materials & Methods</b>: Contrast-enhanced PCD-CT examinations of 20 polytraumatized patients with severe thoracic trauma were included in this retrospective study. Spectral PCD-CT data were reconstructed using a noise-optimized virtual monoenergetic imaging (VMI) algorithm with calculated VMIs ranging from 40 to 120 keV at 10 keV increments. Injury-to-atelectasis contrast-to-noise ratio (CNR) was calculated and compared at each energy level based on CT number measurements in severely injured as well as atelectatic lung areas. Three radiologists assessed subjective discriminability, noise perception, and overall image quality. <b>Results</b>: CT values for atelectasis decreased as photon energy increased from 40 keV to 120 keV (mean Hounsfield units (HU): 69 at 40 keV; 342 at 120 keV), whereas CT values for severe lung injury remained near-constant from 40 keV to 120 keV (mean HU: 42 at 40 keV; 44 at 120 keV) with significant differences at each keV level (<i>p</i> < 0.001). The optimal injury-to-atelectasis CNR was observed at 40 keV in comparison with the remaining energy levels (<i>p</i> < 0.001) except for 50 keV (<i>p</i> > 0.05). In line with this, VMIs at 40 keV were rated best regarding subjective discriminability. VMIs at 60–70 keV, however, provided the highest subjective observer parameters regarding subjective image noise as well as image quality. <b>Conclusions</b>: Discriminability between severely injured and atelectatic lung areas after thoracic trauma can be substantially improved by virtual monoenergetic imaging from PCD-CT with superior contrast and visual discriminability at 40–50 keV.
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spelling doaj-art-85e68cfab42c411d8acdb5957381b4382025-08-20T01:47:44ZengMDPI AGDiagnostics2075-44182024-10-011419223110.3390/diagnostics14192231Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CTHanns Leonhard Kaatsch0Maximilian Franz Völlmecke1Benjamin V. Becker2Daniel Dillinger3Laura Kubitscheck4Aliona Wöhler5Sebastian Schaaf6Joel Piechotka7Christof Schreyer8Robert Schwab9Daniel Overhoff10Stephan Waldeck11Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Plastic, Hand and Reconstructive Surgery, Burn Centre, Sarcoma Centre, BG University Hospital Bergmannsheil, 44789 Bochum, GermanyDepartment of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Vascular Surgery and Endovascular Surgery, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, GermanyDepartment of Radiology and Neuroradiology, Bundeswehr Central Hospital, 56072 Koblenz, Germany<b>Objectives</b>: To evaluate the value of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) for discriminability of severe lung injury and atelectasis in polytraumatized patients. <b>Materials & Methods</b>: Contrast-enhanced PCD-CT examinations of 20 polytraumatized patients with severe thoracic trauma were included in this retrospective study. Spectral PCD-CT data were reconstructed using a noise-optimized virtual monoenergetic imaging (VMI) algorithm with calculated VMIs ranging from 40 to 120 keV at 10 keV increments. Injury-to-atelectasis contrast-to-noise ratio (CNR) was calculated and compared at each energy level based on CT number measurements in severely injured as well as atelectatic lung areas. Three radiologists assessed subjective discriminability, noise perception, and overall image quality. <b>Results</b>: CT values for atelectasis decreased as photon energy increased from 40 keV to 120 keV (mean Hounsfield units (HU): 69 at 40 keV; 342 at 120 keV), whereas CT values for severe lung injury remained near-constant from 40 keV to 120 keV (mean HU: 42 at 40 keV; 44 at 120 keV) with significant differences at each keV level (<i>p</i> < 0.001). The optimal injury-to-atelectasis CNR was observed at 40 keV in comparison with the remaining energy levels (<i>p</i> < 0.001) except for 50 keV (<i>p</i> > 0.05). In line with this, VMIs at 40 keV were rated best regarding subjective discriminability. VMIs at 60–70 keV, however, provided the highest subjective observer parameters regarding subjective image noise as well as image quality. <b>Conclusions</b>: Discriminability between severely injured and atelectatic lung areas after thoracic trauma can be substantially improved by virtual monoenergetic imaging from PCD-CT with superior contrast and visual discriminability at 40–50 keV.https://www.mdpi.com/2075-4418/14/19/2231photon-counting detector CTvirtual monoenergetic imagingchest traumalung injuryatelectasisemergency radiology
spellingShingle Hanns Leonhard Kaatsch
Maximilian Franz Völlmecke
Benjamin V. Becker
Daniel Dillinger
Laura Kubitscheck
Aliona Wöhler
Sebastian Schaaf
Joel Piechotka
Christof Schreyer
Robert Schwab
Daniel Overhoff
Stephan Waldeck
Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
Diagnostics
photon-counting detector CT
virtual monoenergetic imaging
chest trauma
lung injury
atelectasis
emergency radiology
title Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
title_full Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
title_fullStr Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
title_full_unstemmed Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
title_short Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT
title_sort improved discriminability of severe lung injury and atelectasis in thoracic trauma at low kev virtual monoenergetic images from photon counting detector ct
topic photon-counting detector CT
virtual monoenergetic imaging
chest trauma
lung injury
atelectasis
emergency radiology
url https://www.mdpi.com/2075-4418/14/19/2231
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