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    Virtual non-enhanced dual-energy computed tomography reconstruction: a candidate to replace true non-enhanced computed tomography scans in the setting of suspected liver alveolar echinococcosis
    (Turkish Soc Radiology, 2023) Kantarci, Mecit; Aydin, Sonay; Kahraman, Aysegul; Ogul, Hayri; Irgul, Baris; Levent, Akin
    PURPOSE When a suspected hepatic alveolar echinococcosis (AE) lesion is detected on a contrast enhanced computed tomography (CT) scan, an additional triphasic or non-enhanced CT scan is required to determine the presence of calcification and enhancement. As a result, imaging costs and exposure to ionizing radiation will increase. We can create a non- enhanced series from routine contrast-enhanced images using dual-energy CT (DECT) and virtual non- enhanced (VNE) images. This study's objective is to assess virtual non-enhanced DECT reconstruction as a potential diagnostic tool for hepatic AE. METHODS Triphasic CT scans and a routine dual energy venous phase were acquired using a third-generation DECT system. A commercially available software package was used to generate VNE images. Individual evaluations were conducted by two radiologists. RESULTS The study population consisted of 100 patients (30 AE, 70 other solid liver masses). All AE cases were diagnosed [no false positives/negatives, 95% confidence interval (CI) sensitivity: 91.3%-100%; 95% CI specificity: 95.3%-100%]. Interrater agreement was k: 0.79. In total, 33 (33.00%) of the patients had AE, which was detected using both true non-enhanced (TNE) and VNE images. The mean doselength product of a standard triphasic CT was significantly higher than biphasic dual-energy VNE images. CONCLUSION In terms of diagnostic confidence, VNE images are comparable with actual non-enhanced imaging when evaluating hepatic AE. Further, VNE images could replace TNE images with a substantial radiation dose reduction. Advances in knowledge: hepatic cystic echinococcosis and AE are serious and severe diseases with high fatality rates and a poor prognosis if managed incorrectly, especially AE. Moreover, VNE images produce equal diagnostic confidence to TNE images for assessing liver AE, with a significant reduction in radiation dose.