Dual-Energy Multidetector Computed Tomography With Iodine Quantification in the Evaluation of Portal Vein Thrombosis: Is It Possible to Discard the Unenhanced.

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Dual-Energy Multidetector Computed Tomography With Iodine Quantification in the Evaluation of Portal Vein Thrombosis: Is It Possible to Discard the Unenhanced Phase? Giorgio Ascenti, MD, Carmelo Sofia, MD, Salvatore Silipigni, MD, Sergio Vinci, MD, Stefano Pergolizzi, MD, Daniele Marin, MD, Achille Mileto, MD, Silvio Mazziotti, MD Canadian Association of Radiologists Journal Volume 66, Issue 4, Pages 348-355 (November 2015) DOI: 10.1016/j.carj.2015.04.001 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 Neoplastic thrombus in a 69-year-old man with hepatic cirrhosis and hepatocellular carcinoma. Axial computed tomography images. Thrombus attenuation was 50.2 Hounsfield units (HU) on single-energy true unenhanced image (A), 49.1 HU on dual-energy (DE) virtual unenhanced (VUE) image (B), 90.8 HU on DE arterial phase color-coded iodine overlay image (C), and 84.1 HU on single-energy portal venous phase image (D). Thrombus attenuation value in colour-coded iodine overlay image is obtained summing VUE (49.1) and overlay (41.7) HU. Although the high attenuation of neoplastic thrombus in the venous phase, the presence of large hypervascular hepatocellular carcinoma with direct invasion of main portal vein is well demonstrated only in the arterial phase. Subtle hepatic calcifications (arrows in A) as well as minimal aortic wall calcification were erroneously considered as iodine and subtracted on virtual noncontrast images. Also note lowered attenuation of aortic lumen in VUE image due to excessive iodine subtraction. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 348-355DOI: (10.1016/j.carj.2015.04.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 Calcified bland thrombus in a 72-year-old woman with hepatic cirrhosis and hepatocellular carcinoma. Axial computed tomography images. Thrombus attenuation was 76.4 Hounsfield units (HU) on single-energy true unenhanced image (A), 50.7 HU on dual-energy (DE) virtual unenhanced (VUE) image (B), 85.7 HU on DE arterial phase colour-coded iodine overlay image (C), and 80.7 HU on single-energy portal venous phase image (D). Thrombus attenuation value in colour-coded iodine overlay image is obtained summing VUE (50.7) and overlay (35) HU. The presence of coarse thrombus calcifications, erroneously considered as iodine by the software, leads to a false positive diagnosis of neoplastic thrombus if colour-coded images are analysed alone. This issue can be easily overcome carefully evaluating the presence of calcifications in the VUE images. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 348-355DOI: (10.1016/j.carj.2015.04.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions