Aim of this ex vivo phantom study was to evaluate the contrast enhancement applying a new frequency split nonlinear blending algorithm (best contrast [BC]) and to compare it with standard 120-kV single-energy computed tomography (SECT) images, as well as with low-kiloelectron volt monoenergetic extrapolations (Mono+40–100keV) from dual-energy CT (DECT) and with low-kilovolt (70–100 kV) SECT acquisitions.Materials and Methods
A dilution series of iodinated contrast material–filled syringes was centered in an attenuation phantom and was scanned with SECT70–120kV and DECT80–100/Sn150. Monoenergetic images (40–100 keV) were reconstructed, and a new manual frequency split nonlinear blending algorithm (BC) was applied to SECT70kV and SECT120kV images. Manual BC settings were set to simulate a reading situation with fixed overall best values (FVBC120kV) as well as to achieve best possible values for each syringe (BVBC120kV) for maximum contrast enhancement. Contrast-to-noise ratios (CNRs) were used as an objective region of interest–based image analysis parameter. Two radiologists evaluated the detectability of hyperdense and hypodense syringes (Likert). Results were compared between SECT70–100kV, Mono+40–100keV, and DECT80–100/Sn150kV, as well as FVBC120kV, BVBC120kV, and BC70kV.Results
Highest CNR without BC was detected at SECT70kV (5.04 ± 0.12) and Mono+40keV (4.40 ± 0.11). FVBC and BVBC images allow a significant increase of CNR compared with SECT120kV (CNRBVBC, 5.21 ± 0.15; CNRFVBC, 5.12 ± 0.16; CNRSECT120kV, 2.5 ± 0.08; all P ≤ 0.01). There was no significant difference in CNR between BVBC and FVBC. Averaged CNR in BVBC and FVBC was significantly higher compared with Mono+40–100keV (all P ≤ 0.01). Compared with SECT70kV, averaged CNR in BVBC and FVBC show no significant differences. BVBC70kV (7.67 ± 0.17) significantly increases CNR in SECT70kV up to 213%.Results
Subjective image analysis showed an interobserver agreement of 0.63 to 0.83 (κ), confirming the superiority of BC in detecting hyperdense and hypodense syringes, when compared with SECT120kV. Compared with SECT120kV, BVBC70kV was scored highest, followed by SECT70kV. BVBC showed higher scores when comparing to Mono+40keV, however almost identical to those of SECT70kV. Scores of FVBC were slightly lower than SECT70kV, but in the range of Mono+40keV.Conclusions
The new frequency split nonlinear blending algorithm with fixed settings offers a superior differentiation of contrast levels from low- to high-contrast settings. Using the optimal settings, this algorithm shows an equivalent contrast enhancement when compared with SECT70kV. Because of the non–DECT-based algorithm of BC, the new method of contrast enhancement seems to be particularly valuable for implementation in CT systems not equipped for dual-energy or spectral CT imaging.