Virtual non-enhanced dual-energy computed tomography reconstruction: a candidate to replace true non-enhanced computed tomography scans in the setting of suspected liver alveolar echinococcosis

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Kantarcı M., AYDIN S., KAHRAMAN A., Oğul H., İRGÜL B., LEVENT A.

Diagnostic and Interventional Radiology, vol.29, no.6, pp.736-740, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 6
  • Publication Date: 2023
  • Doi Number: 10.4274/dir.2023.221806
  • Journal Name: Diagnostic and Interventional Radiology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.736-740
  • Keywords: alveolar echinococcosis, DECT, DLP, radiation, virtual non-enhanced
  • Ataturk University Affiliated: Yes


PURPOSE When a suspected hepatic alveolar echinococcosis (AE) lesion is detected on a contrast enhanced computed tomography (CT) scan, an additional triphasic or non-enhanced CT scan is required to determine the presence of calcification and enhancement. As a result, imaging costs and exposure to ionizing radiation will increase. We can create a non-enhanced series from routine contrast-en-hanced images using dual-energy CT (DECT) and virtual non-enhanced (VNE) images. This study’s objective is to assess virtual non-enhanced DECT reconstruction as a potential diagnostic tool for hepatic AE. METHODS Triphasic CT scans and a routine dual energy venous phase were acquired using a third-generation DECT system. A commercially available software package was used to generate VNE images. Indi-vidual evaluations were conducted by two radiologists. RESULTS The study population consisted of 100 patients (30 AE, 70 other solid liver masses). All AE cases were diagnosed [no false positives/negatives, 95% confidence interval (CI) sensitivity: 91.3%–100%; 95% CI specificity: 95.3%–100%]. Interrater agreement was k: 0.79. In total, 33 (33.00%) of the patients had AE, which was detected using both true non-enhanced (TNE) and VNE images. The mean dose-length product of a standard triphasic CT was significantly higher than biphasic dual-energy VNE images. CONCLUSION In terms of diagnostic confidence, VNE images are comparable with actual non-enhanced imaging when evaluating hepatic AE. Further, VNE images could replace TNE images with a substantial radiation dose reduction. Advances in knowledge: hepatic cystic echinococcosis and AE are serious and severe diseases with high fatality rates and a poor prognosis if managed incorrectly, especially AE. Moreover, VNE images produce equal diagnostic confidence to TNE images for assessing liver AE, with a significant reduction in radiation dose.