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. 2022 Nov 11;17(11):e0277060.
doi: 10.1371/journal.pone.0277060. eCollection 2022.

Value of low-keV virtual monoenergetic plus dual-energy computed tomographic imaging for detection of acute pulmonary embolism

Yutthaphan Wannasopha  1 , Kantheera Leesmidt  1 , Tanop Srisuwan  1 , Juntima Euathrongchit  1 , Apichat Tantraworasin  2   3
Affiliations

Value of low-keV virtual monoenergetic plus dual-energy computed tomographic imaging for detection of acute pulmonary embolism

Yutthaphan Wannasopha et al. PLoS One. .

Abstract

Objective: To compare diagnostic values between the 40 keV virtual monoenergetic plus (40 keV VMI+) dual source dual energy computed tomography (DSDECT) pulmonary angiography images and the standard mixed (90 and 150 kV) images for the detection of acute pulmonary embolism (PE).

Methods: Chest DSDECTs of 64 patients who were suspected of having acute PE were retrospectively reviewed by two independent reviewers. The assessments of acute PE of all patients on a per-location basis were compared between the 40 keV VMI+ and the standard mixed datasets (reference standard) with a two-week interval.

Results: This study consisted of 64 patients (33 women and 31 men; mean age, 60.2 years; range 18-90 years), with a total of 512 locations. The interobserver agreement (Kappa) for detection of acute PE using the 40 keV VMI+ images and the standard mixed CT images were 0.7478 and 0.8750 respectively. The area under receiver operating characteristics (AuROC) for diagnosis of acute PE using the 40 keV VMI+ was 0.882. Four locations (0.78%) revealed a false negative result. Hypodense filling defects were identified in twelve locations (1.95%) in the 40 keV VMI+ images but had been interpreted as a negative study in the standard mixed CT images. The repeated reviews revealed that each location contained a hypodense filling defect but was overlooked on the standard mixed CT images.

Conclusions: Low-energy VMI + DSDECT images have beneficial in improving the diagnostic value of acute PE in doubtful or disregarded standard mixed images.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison between the standard mixed image and the low-energy VMI+ image.
A 65-year-old man with acute pulmonary embolism. DSDECT images at the level of the right pulmonary artery are shown in the standard mixed image (A) and in the low-energy VMI+ (B). Increased contrast enhancement of the vessels at the same CT window level and width is demonstrated in the low-energy VMI+. Hypodense filling defects of acute pulmonary emboli are also detected in the descending pulmonary arteries in the bilateral lower lobes. DSDECT, dual source dual energy computed tomography; VMI+, virtual monoenergetic plus.
Fig 2
Fig 2. Study workflow for patient recruitment.
PE, pulmonary embolism; DSDECT, dual source dual energy computed tomography.
Fig 3
Fig 3. Sample of an overlooked case.
A 22-year-old man with acute pulmonary embolism. DSDECT images at the level of the left atrium are displayed. A small right lower lobe segmental embolus (arrow) was unnoticed in the standard mixed image (A) but was identified in the low-energy VMI+ (B). DSDECT, dual source dual energy computed tomography; VMI+, virtual monoenergetic plus.
Fig 4
Fig 4. Sample of an overlooked case.
A 76-year-old woman with acute pulmonary embolism. DSDECT images at the level of the aortic arch are displayed. A subtle left upper lobe segmental embolus (arrow) was unidentified in the standard mixed image (A) but was identified in the low-energy VMI+ (B). DSDECT, dual source dual energy computed tomography; VMI+, virtual monoenergetic plus.
Fig 5
Fig 5. Sample of an overlooked case.
A 22-year-old man with acute pulmonary embolism. DSDECT images at the level of the mid heart are displayed. A small left lower lobe segmental embolus (arrow) was overlooked in the standard mixed image (A) but was detected in the low-energy VMI+ (B). DSDECT, dual source dual energy computed tomography; VMI+, virtual monoenergetic plus.
See this image and copyright information in PMC

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