Interdependencies of acquisition, detection, and reconstruction techniques on the accuracy of iodine quantification in varying patient sizes employing dual-energy CT

Purpose To assess the impact of patient habitus, acquisition parameters, detector efficiencies, and reconstruction techniques on the accuracy of iodine quantification using dual-source dual-energy CT (DECT). Materials and methods Two phantoms simulating small and large patients contained 20 iodine solutions mimicking vascular and parenchymal enhancement from saline isodensity to 400 HU and 30 iodine solutions simulating enhancement of the urinary collecting system from 400 to 2,000 HU. DECT acquisition (80/140 kVp and 100/140 kVp) was performed using two DECT systems equipped with standard and integrated electronics detector technologies. DECT raw datasets were reconstructed using filtered backprojection (FBP), and iterative reconstruction (SAFIRE I/V). Results Accuracy for iodine quantification was significantly higher for the small compared to the large phantoms (9.2 %+/- 7.5 vs. 24.3 %+/- 26.1, P=0.0001), the integrated compared to the conventional detectors (14.8 %+/- 20.6 vs. 18.8 %+/- 20.4, respectively; P=0.006), and SAFIRE V compared to SAFIRE I and FBP reconstructions (15.2%+/- 18.1 vs. 16.1%+/- 17.6 and 18.9 %+/- 20.4, respectively; P <= 0.003). A significant synergism was observed when the most effective detector and reconstruction techniques were combined with habitus-adapted dual-energy pairs. Conclusion In a second-generation dual-source DECT system, the accuracy of iodine quantification can be substantially improved by an optimal choice and combination of acquisition parameters, detector, and reconstruction techniques.