Characterization of single‐ and multi‐energy CT performance of an oral dark borosilicate contrast media using a clinical photon‐counting‐detector CT platform
Authors: Ren Liqiang , Sun Yuxin , Yeh Benjamin , Marsh Jeffrey F. , Winfree Timothy N. , Burke Kristin A. , Rajendran Kishore , McCollough Cynthia H. , Mileto Achille , Fletcher Joel G. , Leng Shuai 
Published: September 2023

Background

The feasibility of oral dark contrast media is under exploration in abdominal computed tomography (CT) applications. One of the experimental contrast media in this class is dark borosilicate contrast media (DBCM), which has a CT attenuation lower than that of intra‐abdominal fat.

Purpose

To evaluate the performances of DBCM using single‐ and multi‐energy CT imaging on a clinical photon‐counting‐detector CT (PCD‐CT).

Methods

Five vials, three with iodinated contrast agent (5, 10, and 20 mg/mL; Omnipaque 350) and two with DBCM (6% and 12%; Nextrast, Inc.), and one solid‐water rod (neutral contrast agent) were inserted into two multi‐energy CT phantoms, and scanned on a clinical PCD‐CT system (NAEOTOM Alpha) at 90, 120, 140, Sn100, and Sn140 kV (Sn: tin filter) in multi‐energy mode. CARE keV IQ level was 180 (CTDIvol: 3.0 and 12.0 mGy for the small and large phantoms, respectively). Low‐energy threshold images were reconstructed with a quantitative kernel (Qr40, iterative reconstruction strength 2) and slice thickness/increment of 2.0/2.0 mm. Virtual monoenergetic images (VMIs) were reconstructed from 40 to 140 keV at 10 keV increments. On all images, average CT numbers for each vial/rod were measured using circular region‐of‐interests and averaged over eight slices. The contrast‐to‐noise ratio (CNR) of iodine (5 mg/mL) against DBCM was calculated and plotted against tube potential and VMI energy level, and compared to the CNR of iodine against water. Similar analyses were performed on iodine maps and VNC images derived from the multi‐energy scan at 120 kV.

Results

With increasing kV or VMI keV, the negative HU of DBCM decreased only slightly, whereas the positive HU of iodine decreased across all contrast concentrations and phantom sizes. CT numbers for DBCM decreased from −178.5 ± 9.6 to −194.4 ± 6.3 HU (small phantom) and from −181.7 ± 15.7 to −192.1 ± 11.9 HU (large phantom) for DBCM‐12% from 90 to Sn140 kV; on VMIs, the CT numbers for DBCM decreased minimally from −147.1 ± 15.7 to −185.1 ± 9.2 HU (small phantom) and −158.8 ± 28.6 to −188.9 ± 14.7 HU (large phantom) from 40 to 70 keV, but remained stable from 80 to 140 keV. The highest iodine CNR against DBCM in low‐energy threshold images was seen at 90 or Sn140 kV for the small phantom, whereas all CNR values from low‐energy threshold images for the large phantom were comparable. The CNR values of iodine against DBCM computed on VMIs were highest at 40 or 70 keV depending on iodine and DBCM concentrations. The CNR values of iodine against DBCM were consistently higher than iodine to water (up to 460% higher dependent on energy level). Further, the CNR of iodine compared to DBCM is less affected by VMI energy level than the identical comparison between iodine and water: CNR values at 140 keV were reduced by 46.6% (small phantom) or 42.6% (large phantom) compared to 40 keV; CNR values for iodine compared to water were reduced by 86.3% and 83.8% for similar phantom sizes, respectively. Compared to 70 keV VMI, the iodine CNR against DBCM was 13%–79% lower on iodine maps and VNC.

Conclusions

When evaluated at different tube potentials and VMI energy levels using a clinical PCD‐CT system, DBCM showed consistently higher CNR compared to iodine versus water (a neutral contrast).