Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT

Authors: Moritz H. Albrecht, Thomas J. Vogl, Simon S. Martin, John W. Nance, Taylor M. Duguay, Julian L. Wichmann, Carlo N. De Cecco, Akos Varga-Szemes, Marly van Assen, Christian Tesche, U. Joseph Schoepf


A growing body of literature encourages routine implementation of virtual monoenergetic imaging for dual-energy CT because it affords fewer beam-hardening artifacts, reduced iodine dose, and better contrast between enhancing and nonenhancing areas, ultimately providing greater diagnostic value.

In this article, the authors discuss the technical background and summarize the current body of literature regarding virtual monoenergetic (VM) images derived from dual-energy CT data, which can be reconstructed between 40 and 200 keV. Substantially improved iodine attenuation at lower kiloelectron volt levels and reduced beam-hardening artifacts at higher kiloelectron volt levels have been demonstrated from all major manufacturers of dual-energy CT units. Improved contrast attenuation with VM imaging at lower kiloelectron volt levels enables better delineation and diagnostic accuracy in the detection of various vascular or oncologic abnormalities. Low-kiloelectron-volt VM imaging may be useful for salvaging CT studies with suboptimal contrast material delivery or providing additional information on the arterial vasculature obtained from venous phase acquisitions. For patients with renal impairment, substantial reductions in the use of iodinated contrast material can be achieved by using lower-energy VM imaging. The authors recommend routine reconstruction of VM images at 50 keV when using dual-energy CT to exploit the increased contrast properties. For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment.

© RSNA, 2019