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  • Title: Can Realistic Liver Tissue Surrogates Accurately Quantify the Impact of Reduced-kV Imaging on Attenuation and Contrast of Parenchyma and Lesions?
    Author: Euler A, Solomon J, FitzGerald PF, Samei E, Nelson RC.
    Journal: Acad Radiol; 2019 May; 26(5):640-650. PubMed ID: 30269958.
    Abstract:
    RATIONALE AND OBJECTIVES: To assess if a liquid tissue surrogate for the liver (LTSL) can emulate contrast-enhanced liver parenchyma and lesions and quantify the impact of reduced-kV imaging as a function of lesion contrast, phase of enhancement, and phantom size. MATERIALS AND METHODS: First, CT attenuation of LTSL- and water-iodine solutions were measured as a function of iodine concentration and tube potential. For each solution, the iodine concentration was determined to emulate liver parenchyma at 120 kV. CT attenuation for both solutions was predicted for different tube potentials and compared to published patient data. Second, liver parenchyma in late arterial phase (LA: +92 HU at 120 kV) and portal venous phase (PV: +112 HU at 120 kV) was emulated using LTSL-iodine and a two-size phantom. Fourteen setups of hyper- and hypoattenuating lesions (lesion-to-parenchyma contrast (CLP) = -50 to +50HU) were created. Each combination of CLP, phase, and size was imaged at 80, 100, 120, and 140 kV at constant radiation dose. CT attenuation, CLP, and lesion-to-parenchyma contrast-to-noise ratio (CNRLP) were assessed and compared to a theoretical model. RESULTS: LTSL-iodine more accurately emulated the CT attenuation of liver parenchyma across different tube potentials compared to water-iodine solutions. The theoretical model was confirmed by the empirical measurements using LTSL-iodine solutions: attenuation, CLP, and CNRLP increased when the tube potential decreased (p < 0.001). This trend was independent of lesion contrast, phase, and size. The absolute improvement in CLP and CNRLP, however, was inversely related to the magnitude of CLP at 140kV. CONCLUSION: LTSL accurately emulated the energy-dependent CT attenuation characteristics of contrast-enhanced liver parenchyma and lesions. The relative improvement in CLP and CNRLP by applying reduced-kV imaging was independent of lesion contrast, phase, and size while the absolute improvement decreased for low-contrast lesions.
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