Rapid kVp-switching DECT portal venous phase abdominal CT scans in patients with large body habitus: image quality considerations

Purpose To assess the diagnostic image quality and material decomposition characteristics of portal venous phase abdominal CT scans performed on rapid kVp-switching DECT (rsDECT) in patients with large body habitus. Methods We retrospectively included consecutive patients with large body habitus (≥ 90 kg) undergoing portal venous phase abdominal CT scans on rsDECT scanners between Sep 2014 and March 2018. Qualitative and quantitative assessment of the DECT data sets [65 keV monoenergetic, material density iodine (MD-I) and material density water (MD-W) images] was performed for determination of image quality (IQ) and image noise. Correlation of qualitative assessment scores with weight, BMI and patients’ diameter were calculated using Pearson correlation test. Optimal thresholds were calculated using AUC and Youden index to define most appropriate size cut off, below which the IQ of material density images is largely acceptable. Results The 65 keV monoenergetic images were of diagnostic quality (diagnostic acceptability, DA ≥ 3) in 97.8% of patients ( n = 91/93). However, there was significant IQ degradation of MD-I images in 20.4% ( n = 19/93, DA < 3) of patients. Similarly, there was significant degradation (DA < 3) of MD-W images in 26.9% (25/92). Clinically significant artifacts (PA ≥ 3/4) were seen in 31% ( n = 29/93) and 32.3% (30/93) of MD-I and MD-W images respectively. Optimal threshold for diagnostic acceptability of MD-I images were 110 kg for weight and 33.5 kg/m 2 for BMI. Conclusion Rapid kVp-switching DECT provides diagnostically acceptable monoenergetic images for patients with large body habitus (≥ 90 kg). There is degradation of IQ in the material density specific images particularly in patients weighing > 110 kg and with BMI > 33.5 kg/m 2 , due to higher number of artifacts.