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Review

An update on advanced dual-energy CT for head and neck cancer imaging

Pages 633-644 | Received 11 Apr 2019, Accepted 29 May 2019, Published online: 21 Jun 2019
 

ABSTRACT

Introduction: Dual-energy-computed tomography (DECT) is an advanced form of computed tomography (CT) that enables spectral tissue characterization beyond what is possible with conventional CT scans. DECT can improve non-invasive diagnostic evaluation of the neck, especially for the evaluation of head and neck cancer.

Areas covered: This article is a review of current applications of DECT for the evaluation of head and neck cancer, focusing largely on squamous cell carcinoma (HNSCC). The article will begin with a brief overview of principles and different approaches for DECT scanning. This will be followed by a review of different DECT applications in diagnostic imaging and radiation oncology, practical and workflow considerations, and various emerging advanced applications for tumor analysis, including the use of DECT datasets for radiomics and machine learning applications.

Expert opinion: Using a multi-parametric approach, different DECT reconstructions can be used to improve diagnostic evaluation and surveillance of head and neck cancer, including improving visibility of HNSCC, determination of tumor boundaries and extent, and invasion of critical organs such as the thyroid cartilage. In the future, the large amount of quantitative information on DECT scans may be leveraged for improving radiomic and machine learning models for tumor characterization.

Article highlights

  • Dual-energy CT (DECT) is an advanced type of CT that enables generation of additional reconstruction and quantitative analysis far beyond what is possible with conventional, single-energy CT scans

  • In head and neck imaging, DECT has been shown to improve tumor visibility, tumor boundary delineation, and determination of invasion of critical structures such as the thyroid cartilage

  • Diagnostic evaluation with DECT can be performed using additional image reconstructions as well as advanced spectral quantitative region of interest analysis when necessary

  • Some DECT reconstructions can also be used to reduce dental artifact on neck CT, along with other applications under development

  • Evaluation of head and neck cancer using DECT is best performed by a multi-parametric approach, combining the information on different reconstructions for an optimal diagnostic evaluation

  • In addition to applications in diagnostic imaging, there are multiple potential advantages and applications of DECT in radiation oncology

  • There is great potential for the use of the large amount of spectral quantitative information generated by DECT scanners and incorporation into radiomic and machine learning models to enable or improve the prediction of clinical, pathological, and molecular endpoints of interest

  • More widespread adoption of DECT will likely require additional evidence of a significant clinical impact and a seamless workflow, and would be further promoted by the right incentive models and demonstration of cost-benefits of the technology that may garner sufficient interest in decision makers to promote more widespread adoption of this technology

Declaration of interest

R. Forghani has acted as consultant and speaker for GE Healthcare and is a founder and stockholder of 4Intel Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

R Forghani is a clinical research scholar (chercheur-boursier clinicien) supported by the FRQS (Fonds de recherche en santé du Québec).

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