Lesion conspicuity assessment of prone 40-keV virtual monoenergetic imaging in arterial-phase photon-counting CT for breast cancer: a retrospective comparison with DCE-MRI
Abstract
Purpose: This study investigated whether contrast enhanced whole-body photon-counting detector (PCD)-CT performed for staging in the prone position can provide breast lesion conspicuity comparable to dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI).
Methods: This single-center, retrospective diagnostic feasibility study included 22 women with surgically confirmed primary breast cancer who underwent preoperative prone PCD-CT and DCE-MRI. Then, 40- and 70-keV virtual monoenergetic image (VMI) from a single arterial-phase PCD-CT acquisition were reconstructed. Three readers independently evaluated 40- and 70-keV VMI and DCE-T1WI. The primary endpoint was lesion conspicuity. The secondary endpoints included, size error, detection rate, background parenchymal enhancement (BPE), subjective noise, and reading time.
Results: Lesion conspicuity was highest on 40-keV VMI, which outperformed 70-keV VMI and DCE-T1WI. Absolute size error was numerically larger for 40-keV VMI than for DCE-T1WI, but this difference was not statistically significant. Directional error indicated that 40-keV VMI significantly underestimated lesion size relative to DCE-T1WI. Detection rates showed an overall difference among modalities, but pairwise differences were not statistically significant. Further, 40-keV VMI had a higher BPE and a greater perceived noise than 70-keV VMI, and it required a longer reading time than DCE-T1WI. The radiation dose did not differ between VMI energy levels as both were…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 22 participants or records.
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