Dual-layer spectral detector CT for improved assessment of right adrenal vein in patients with primary aldosteronism

Purpose To investigate whether virtual-monoenergetic images (VMI) from dual-layer spectral-detector computed tomography (DLCT) improve right adrenal vein (RAV) assessment before adrenal venous sampling (AVS), and portal-venous-phase (PVP) images alone can replace conventional multiphase CT combining late-arterial phase (LAP) and PVP. Methods Sixty-three patients with primary aldosteronism who underwent LAP and PVP DLCT before AVS were retrospectively analyzed. Conventional polyenergetic-images (PEI) and VMI at 40–70 keV (VMI 40–70 ) were reconstructed. Image noise and contrast-to-noise ratio (CNR) of RAV were quantified. VMI with the highest CNR was predefined as the best-VMI. Two radiologists evaluated four image series (PEI and best-VMI at LAP and PVP) separately for RAV visibility, accessory hepatic vein (AHV) assessability, and image noise using five-point scales (1 = worst, 5 = best). RAV detection and AHV assessability rates were compared among image series. Results In both enhancement phases, VMI 40–70 showed lower image noise and VMI 40–60 higher CNR than PEI (all p < 0.05), with VMI 40 providing the highest CNR and being designated as the best VMI. Compared to PEI at LAP, CNR was lower with PEI at PVP but higher with VMI 40 at PVP (both, p < 0.001). In subjective analysis, VMI 40 showed better scores than PEI for image noise (LAP: 4.0 ± 0.5 vs. 2.4 ± 0.6; PVP: 4.0 ± 0.6 vs. 2.5 ± 0.5) and RAV visibility (LAP: 4.5 ± 0.8 vs. 3.5 ± 0.8; PVP: 3.7 ± 1.0 vs. 2.6 ± 0.9) (all p < 0.001). With PEI, the RAV detection rate was lower at PVP than at LAP (54.8% vs. 89.7%, p < 0.001). Use of VMI 40 at PVP achieved the same detection rate as PEI at LAP (89.7%, p = 1.0) and higher AHV assessability rate than PEI at PVP (96.8% vs. 80.2%, p < 0.001). Conclusion DLCT-VMI improved RAV assessments before AVS. Using VMI 40 for PVP provided RAV depiction equivalent to PEI at LAP and superior AHV assessability to PEI at PVP, suggesting its potential as a surrogate for dedicated multiphase CT.