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Updated: Sep 18, 2025
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Published on: March 24, 2023
Image Quality and Lesion Detectability with Low-Monoenergetic Imaging: A Study of Low-Concentration Iodine Contrast
Jae En Kim1, Yewon Lim2, Jin Sil Kim2
1College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea.
Background:
This study aimed to evaluate whether low-concentration iodine contrast-enhanced multiphase low-monoenergetic computed tomography (LCLM CT; 270 mg I/mL, 40 keV) is non-inferior to standard-dose computed tomography (SDCT; 350 mg I/mL) in image quality and lesion detectability for chronic liver disease patients.
Methods:
Sixty-seven patients underwent both protocols. Image quality was assessed using a 5-point scale with a non-inferiority margin of -0.5. Quantitative metrics included signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Lesion detectability was evaluated using jackknife free-response receiver operating characteristic (JAFROC) analysis with a -0.1 margin.
Results:
LCLM CT reduced iodine dose per kilogram by 21.9%. Despite higher image noise, it achieved higher CNR for the aorta and hepatic lesions, as well as superior hepatic artery clarity. Image quality was non-inferior (difference: -0.119; 95% CI: -0.192 to -0.047), and lesion detectability (FOM: 0.744 vs. 0.721; difference: 0.023; 95% CI: -0.170 to 0.218) also showed non-inferiority.
Conclusions:
LCLM CT maintains diagnostic performance and improves vascular contrast while reducing iodine burden, supporting its clinical utility in longitudinal HCC surveillance.
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