Application value of dual-energy computed tomography virtual monoenergetic images for pediatric hand angiography

While single-energy hand computed tomography angiography (CTA) often yields suboptimal visualization of distal vessels, dual-energy computed tomography (CT) with low-keV virtual monoenergetic image (VMI) reconstruction enhances small-vessel conspicuity.

To evaluate the value of dual-energy CT VMIs in pediatric hand CTA.

This retrospective study included 49 pediatric patients. Seven image series per patient were generated from dual-energy data: an M_0.5 image (50% 70 kVp+50% tin-filtered 150 kVp), a 70-kVp image, and five VMIs at 40-80 keV (10-keV increments). Objective metrics (attenuation, vessel noise, signal-to-noise ratio, contrast-to-noise ratio) and subjective scores were assessed for five vessels: the radial artery, the ulnar artery, the common palmar digital artery, and the proximal and distal parts of the proper palmar digital artery. Subjective image quality was independently evaluated by two radiologists using a 4-point Likert scale.

The 40-keV VMIs provided the highest vascular attenuation across all vessels, albeit with the highest noise. Subjective scores for the radial, ulnar, and common palmar digital arteries showed no significant differences among the 40-keV, 50-keV, and 70-kVp series. However, for the small distal proper palmar digital arteries and total image quality, the 40-keV series was rated superior to the other series. No significant differences in image quality existed between the 70-kVp and 50-keV images.

For pediatric hand CTA, 40-keV VMIs provide optimal vascular conspicuity for small distal vessels, yielding the highest diagnostic confidence and total image quality score, and this benefit outweighs the associated increase in vessel noise.