Chiao-Yun Chen, Presenter: Nothing to Disclose

Twei-Shiun Jaw MD, Abstract Co-Author: Nothing to Disclose

Gin Chung Liu MD, Abstract Co-Author: Nothing to Disclose

Lo-Yeh Lee MD, Abstract Co-Author: Nothing to Disclose

Jui-Sheng Hsu MD, PhD, Abstract Co-Author: Nothing to Disclose

Ming-Chen Paul Shih MD, Abstract Co-Author: Nothing to Disclose

Chun-Nung Huang, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic performance of portal venous phase split-bolus dual-energy CT(DECT) in patients with hematuria and to measure the potential radiation dose reduction using a single-phase acquisition.

This retrospective study received protocol approval with a waiver of informed consent from our institutional review board. Study included 110 consecutive patients who underwent unenhanced single energy CT and enhanced DECT urography for hematuria. Enhanced weighted average(WA) 120kVp, iodine-overlay and virtual nonenhanced(VNE) images were reconstructed from enhanced 80 and Sn140kVp scans. Single-phase enhanced DECT urography (iodine-overlay and VNE) images were independently reviewed by two radiologists blinded to the final diagnosis. Prospective interpretations of the true nonenhanced(TNE) and enhanced WA 120kVp images(dual-phase) were also reviewed. The standard of reference included all available clinical, imaging, pathology and laboratory data for up to 12 months after DECT urography. Sensitivities, specificities and diagnostic accuracies were recorded for prospective(dual-phase) and retrospective(single-phase) interpretations. The overall imaging quality(5-point scale) of the TNE and VNE images was also evaluated. The potential dose reduction of a single-phase from dual-phase protocol was calculated. Results were tested for statistical significance.

Final diagnoses for hematuria were renal cell carcinoma, 17(15.5%); ureter urothelial cancer, 16(14.5%); bladder cancer, 17(15.5%); renal angiomyolipoma, 14(12.7%) urolithiasis 31(28.2%); complex cyst, 5(4.5%) and no detectable cause, 10(9%). Overall accuracy for single-phase acquisition and dual-phase acquisition were 96.7% and 97.2%(p>.05). Although the overall imaging quality of the VNE was significantly inferior to the TNE images, the quality scales of the VNE were excellent or good. The mean scores were 1.7±0.5 vs 1.0±0.2(p<.05). The mean dose of the single-phase DECT acquisition was 6.7mSv comparing with 15.4mSv of the dual-phase study.

Single portal venous phase split-bolus DECT urography using iodine overlay techniques and VNE images yield high diagnostic accuracy in patients with hematuria and potentiality to reduce radiation exposure.

In patients with hematuria, single-phase split-bolus DECT urography provides high diagnostic accuracy and potential to reduce radiation exposure.

Chen, C, Jaw, T, Liu, G, Lee, L, Hsu, J, Shih, M, Huang, C, Single-Phase Split-bolus Dual-Energy CT-Urography in Patients with Hematuria: Diagnostic Performance and Potential Dose Reduction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016222.html