Background: Dual-energy CT (DECT) provides additional image datasets which enable improved tumor delineation or reduction of beam hardening artifacts in patients with head and neck squamous cell carcinoma (SCC).
Purpose: To assess radiation dose and image quality of third-generation DECT of the head and neck in comparison to single-energy CT (SECT).
Material and methods: Thirty patients with SCC who underwent both SECT (reference tube voltage 120 kVp) and DECT (80/150 Sn kVp) of the head and neck region for staging were retrospectively selected. Attenuation measurements of the sternomastoid muscle, internal jugular vein, submandibular gland and tongue were compared. Image noise was assessed at five anatomic levels. Subjective image quality was evaluated by two radiologists in consensus.
Results: CTDIvol was 55% lower with DECT (4.2 vs. 9.3 mGy; P = 0.002). Median image noise was equal or lower in DECT at all levels (nasopharynx: 3.9 vs. 5.8, P < 0.0001; floor of mouth: 3.6 vs. 4.5, P = 0.0002; arytenoids: 3.6 vs. 3.1, P = 0.096; lower thyroid: 4.4 vs. 5.7, P = 0.002; arch of aorta: 5.6 vs. 6.5, P = 0.001). Attenuation was significantly lower in DECT ( P < 0.05). Subjective image analysis revealed that DECT is equal or superior to SECT with regard to overall image quality (nasopharynx: 5 vs. 5, P = 1; floor of mouth: 5 vs. 5, P = 0.0041; arytenoids: 5 vs. 5, P = 0.6; lower thyroid: 5 vs. 3, P < 0.0001; arch of aorta: 5 vs. 4, P < 0.0001).
Conclusion: Head and neck imaging with third-generation DECT can reduce radiation dose by half compared to SECT, while maintaining excellent image quality.
Keywords: CT; Head/neck; dual-energy CT; image quality; radiation exposure.