Dual-energy CT adds value to routine interpretations of imaging studies

… at Vancouver General Hospital are saying after finding that the advanced form of imaging, which combines elements of CT and MR technology, …
Dual-Energy CT in the emergency department reduces the need for downstream imaging and associated costs, while boosting radiologists’ confidence in diagnoses.

That’s what researchers at Vancouver General Hospital are saying after finding that the advanced form of imaging, which combines elements of CT and MR technology, provides value to routine interpretations of ED imaging studies.

“Dual-energy CT (DECT) has presented itself as the technology that can combine some of the capabilities of MR imaging with those of CT, along with some powerful, additional benefits,” said the authors in their study.

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The team evaluated all DECT studies performed in the ED between January 1 and December 31, 2016. CT exams were sorted into head and neck, chest, abdomen and pelvis, spine, and musculoskeletal. A board-certified radiologist who was not initially involved in reading the scans reviewed the corresponding reports on dual-energy or spectral examination as part of the study interpretation.

Studies in which DECT was mentioned in the report were a second time, in a randomized blind manner, to determine the impact of DECT on downstream imaging. This was done with the mixed imaging data set only, which simulates conventional CT images. The difference between the numbers of follow-up studies recommended after conventional CT and DECT were converted into U.S. dollars based on the U.S. Centers for Medicare & Medicaid Services Physician Fee Schedule and 2019 Current Procedural Terminology Codes, to estimate a projected cost benefit brought on by any reduction in follow-up imaging.

Among the 3,159 cases examined, use of dual-energy or spectral analysis potentially affected management in 298 (9.4%) cases. It confirmed suspected observations and increased diagnostic confidence in 455 (14.4%) and provided relevant additional information on an observation in 174 (5.5%) cases, which resulted in characterization of an incidental finding in 44 (1.4%). It was noncontributory in three (0.09%) cases.

Of the 298 cases for the musculoskeletal system, DECT potentially altered management in 266, with the most common use of it being to confirm gout (185/266). While DECT was not noted in 2,272 reports (71.9%), compared with conventional CT alone, DECT findings avoided 162 – 191 recommended follow-up MR examinations, 21 – 28 CT exams, and 2 – 25 ultrasound exams. It did, however, lead to one additional recommended interventional angiography procedure, one ventilation-perfusion scan, and one imaging-guided biopsy.

“DECT findings led to a decrease in recommended follow-up imaging examinations totaling an estimated $52,991.53 – 61,598.44,” said the authors about the Vancouver General ED in 2016.

Vancouver General has since completed implementation of DECT acquisition for all CT exams performed in the ED to help referring clinicians adapt to DECT and gain trust in its added value.

The findings were published in American Journal of Roentgenology.