Multiparametric Evaluation of Head and Neck Squamous Cell Carcinoma Using a Single-Source Dual-Energy CT with Fast kVp Switching: State of the Art
<p>Different dual-energy CT (DECT) scanners currently in clinical use. (<b>A</b>) Illustration of a dual source DECT, consisting of two source x-ray tubes with corresponding detectors; (<b>B</b>) Illustration of a single source DECT with rapid kVp switching. With this type of scanner, the tube voltage follows a pulsed curve, and projection data are collected twice for every projection, one at high and one at low tube voltage, during rapid kVp switching; (<b>C</b>) Illustration of a dual layer DECT, consisting of a single source and single (but layered) detector. The detector is composed of two scintillation layers enabling separation of high and low energy spectra produced by a single source.</p> "> Figure 2
<p>Increased tumor attenuation on 40 keV virtual monochromatic images (VMIs). (<b>A</b>) 70 keV single energy equivalent CT image of a right base of tongue tumor (large black arrow) and pathologic right level IIA lymph node (small white arrow) is shown. Note the similar density of both lesions compared to the normal right sternocleidomastoid muscle (M); (<b>B</b>) On the 40 keV image displayed using the same window-level settings, note the higher lesion density as well as higher relative contrast compared to muscle (M). Also note the increased image noise on the 40 keV VMI (<b>B</b>) compared to 70 keV VMI (<b>A</b>).</p> "> Figure 3
<p>Virtual monochromatic images (VMIs) and iodine overlay map of a laryngeal tumor (T) invading the left thyroid cartilage. (<b>A</b>) 65 keV VMI; (<b>B</b>) 40 keV VMI; and (<b>C</b>) iodine-water (iodine overlay) material decomposition maps are shown. Note the increased tumor conspicuity on the 40 keV (<b>B</b>) compared to the 65 keV (<b>A</b>) VMIs. The iodine overlay map provides a quantitative estimate of iodine content of different tissues and demonstrates iodine containing tumor transgressing the left thyroid cartilage (arrow). It is noteworthy that the tumor edge of the extralaryngeal component (arrow) is more clearly seen on the 40 keV VMI (<b>B</b>) and iodine overlay map (<b>C</b>) than on the SECT equivalent 65 keV VMI (A).</p> "> Figure 4
<p>Quantitative region of interest analysis comparing the spectral Hounsfield unit attenuation curves of HNSCC to non-ossified thyroid cartilage (NOTC) [<a href="#B16-cancers-07-00886" class="html-bibr">16</a>]. Pooled analysis of 30 tumors and NOTC from 30 normal patients is shown. At 65 or 70 keV, the attenuation of tumor can be very similar to normal NOTC, explaining the difficulties that may be encountered in differentiating between the 2 on conventional single energy CT scans. On the other hand, there is spectral separation at either end of the curve, with the best density separation achieved in the high energy range.</p> "> Figure 5
<p>High energy virtual monochromatic images (VMIs) for evaluation of non-ossified thyroid cartilage (NOTC). 140 keV image from the same patient as in <a href="#cancers-07-00886-f003" class="html-fig">Figure 3</a> is shown. The laryngeal tumor invades the left thyroid cartilage, and the invaded portion appears as a relatively low density defect (double arrows) because of suppression of iodine density within the enhancing tumor on high keV images (compare to <a href="#cancers-07-00886-f003" class="html-fig">Figure 3</a>A,B). In this case, there is partial non-ossification of the thyroid cartilage on the left posteriorly. Note the preserved high attenuation of the NOTC (single arrow). There is clear attenuation difference between normal NOTC and tumor on the 140 keV image but the density on conventional single energy equivalent 65 keV image is nearly identical (compare to <a href="#cancers-07-00886-f003" class="html-fig">Figure 3</a>A). It is noteworthy that the tumor itself is not well seen on the 140 keV images, and these VMIs should be used in conjunction with the 65 and/or 40 keV VMIs and not in isolation.</p> "> Figure 6
<p>Use of high energy DECT virtual monochromatic images (VMIs) for dental artifact reduction. (<b>A</b>) 65 keV and (<b>B</b>) 140 keV VMIs are shown from the same level in the neck. Note significant reduction of artifact such as in the region of retromolar trigone (black arrow) or oral tongue (white arrow) on the higher energy, 140 keV VMI compared to the 65 keV VMI.</p> "> Figure 7
<p>Use of high energy DECT virtual monochromatic images (VMIs) for dental artifact reduction in a patient with a gingival-buccal tumor. (<b>A</b>) 65 keV (equivalent to single energy CT) and (<b>B</b>) 95 keV VMIs are shown from the same level in the neck. Note reduction of artifact and improved visualization of the enhancing tumor on the 95 keV VMI compared to the 65 keV VMI.</p> ">
Abstract
:1. Introduction
2. Basic Principles of DECT
3. Types of DECT Scanners
4. Radiation Dose Considerations
5. Improved HNSCC Evaluation and Soft Tissue Boundary Delineation Using Low Energy Reconstructions
6. Evaluation of Thyroid Cartilage Invasion
7. Dental Artifact
8. Other Potential DECT Applications for the Evaluation of HNSCC
9. Practical, Multi-Parametric DECT Approach for HNSCC Evaluation
Recommended reconstructions for all dual energy CT scans of the neck: |
65 and 40 keV VMIs |
Recommended reconstructions for evaluation of laryngeal tumors: |
65 and 40 keV VMIs + Iodine overlay maps; High energy VMIs (95 keV or greater) |
Recommended reconstructions for evaluation of oral cavity and possibly oropharyngeal tumors: |
65 and 40 keV VMIs + Consider supplemental high energy VMIs for dental artifact reduction |
10. Future Prospects and Concluding Remarks
Author Contributions
Conflicts of Interest
References
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Lam, S.; Gupta, R.; Kelly, H.; Curtin, H.D.; Forghani, R. Multiparametric Evaluation of Head and Neck Squamous Cell Carcinoma Using a Single-Source Dual-Energy CT with Fast kVp Switching: State of the Art. Cancers 2015, 7, 2201-2216. https://doi.org/10.3390/cancers7040886
Lam S, Gupta R, Kelly H, Curtin HD, Forghani R. Multiparametric Evaluation of Head and Neck Squamous Cell Carcinoma Using a Single-Source Dual-Energy CT with Fast kVp Switching: State of the Art. Cancers. 2015; 7(4):2201-2216. https://doi.org/10.3390/cancers7040886
Chicago/Turabian StyleLam, Stephanie, Rajiv Gupta, Hillary Kelly, Hugh D. Curtin, and Reza Forghani. 2015. "Multiparametric Evaluation of Head and Neck Squamous Cell Carcinoma Using a Single-Source Dual-Energy CT with Fast kVp Switching: State of the Art" Cancers 7, no. 4: 2201-2216. https://doi.org/10.3390/cancers7040886