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Review article

Principles and Clinical Application of Dual-energy Computed Tomography in the Evaluation of Cerebrovascular Disease

Charlie Chia-Tsong HsuGigi Nga Chi KwanDalveer SinghJit PratapTrevor William Watkins
Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Date of Submission: 30-Mar-2016, Date of Acceptance: 22-May-2016, Date of Web Publication: 29-Jun-2016.
Corresponding Author:
Corresponding Author

Charlie Chia‑Tsong Hsu

E-mail: charlie.ct.hsu@gmail.com

Corresponding Author:
Corresponding Author

Charlie Chia‑Tsong Hsu

E-mail: charlie.ct.hsu@gmail.com

DOI: 10.4103/2156-7514.185003 Facebook Twitter Google Linkedin


Dual-energy computed tomography (DECT) simultaneously acquires images at two X-ray energy levels, at both high- and low-peak voltages (kVp). The material attenuation difference obtained from the two X-ray energies can be processed by software to analyze material decomposition and to create additional image datasets, namely, virtual noncontrast, virtual contrast also known as iodine overlay, and bone/calcium subtraction images. DECT has a vast array of clinical applications in imaging cerebrovascular diseases, which includes: (1) Identification of active extravasation of iodinated contrast in various types of intracranial hemorrhage; (2) differentiation between hemorrhagic transformation and iodine staining in acute ischemic stroke following diagnostic and/or therapeutic catheter angiography; (3) identification of culprit lesions in intra-axial hemorrhage; (4) calcium subtraction from atheromatous plaque for the assessment of plaque morphology and improved quantification of luminal stenosis; (5) bone subtraction to improve the depiction of vascular anatomy with more clarity, especially at the skull base; (6) metal artifact reduction utilizing virtual monoenergetic reconstructions for improved luminal assessment postaneurysm coiling or clipping. We discuss the physical principles of DECT and review the clinical applications of DECT for the evaluation of cerebrovascular diseases.
Keywords: Artifacts, Atherosclerotic, Carotid Stenosis, Cerebrovascular Disorders, Intracranial Hemorrhages, Multidetector Computed Tomography, Plaque

Cited in 7 Documents

  1. D. Mera Fernández, E. Santos Armentia, A. Bustos Fiore, A.M. Villanueva Campos, E. Utrera Pérez and M. Souto Bayarri (2018) The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling. Radiología (English Edition) 60(4):310. doi: 10.1016/j.rxeng.2018.02.007
  2. Shahmir Kamalian, Michael H. Lev and Stuart R. Pomerantz (2017) Dual-Energy Computed Tomography Angiography of the Head and Neck and Related Applications. Neuroimaging Clinics of North America 27(3):429. doi: 10.1016/j.nic.2017.04.009
  3. Mohammed F. Mohammed, Olivia Marais, Adam Min, David Ferguson, Sabeena Jalal, Faisal Khosa, Michael OʼKeeffe, Tim OʼConnell, Heiko Schmiedeskamp, Bernhard Krauss, Axel Rohr and Savvas Nicolaou (2018) Unenhanced Dual-Energy Computed Tomography. Investigative Radiology 53(2):63. doi: 10.1097/RLI.0000000000000413
  4. D. Mera Fernández, E. Santos Armentia, A. Bustos Fiore, A.M. Villanueva Campos, E. Utrera Pérez and M. Souto Bayarri (2018) Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales. Radiología 60(4):312. doi: 10.1016/j.rx.2018.02.009
  5. Giovanna Negrao de Figueiredo and Birgit Ertl-Wagner (2017) . (Chapter 150):. doi: 10.1007/174_2017_150
  6. Jin-Er Shu, Ming-Liang Ying, Xiao-Rong Chen, Jian-Jun Hua, Jie-Ting Fu, Xiu-Mei Xia, Yong-Hao Pan and Yang Jiang (2017) Prognostic value of high-resolution magnetic resonance imaging in evaluating carotid atherosclerotic plaque in patients with ischemic stroke. Medicine 96(45):e8515. doi: 10.1097/MD.0000000000008515
  7. Yu Chen, Xiaobo Zhang, Huadan Xue, Yuanli Zhu, Yun Wang, Yumei Li, Zhuhua Zhang and Zhengyu Jin (2017) Head and neck angiography at 70 kVp with a third-generation dual-source CT system in patients: comparison with 100 kVp. Neuroradiology 59(11):1071. doi: 10.1007/s00234-017-1901-4

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