Comparison of true non-contrast and virtual non-contrast images in the characterization of renal lesions using detector-based spectral CT

Renal lesions are sometimes incidentally detected during computed tomography (CT) examinations in which an unenhanced series is not included, preventing the lesions from being fully characterized. The aim of this study was to investigate the feasibility to use virtual non-contrast (VNC) images, acquired using a detector-based dual-energy CT, for the characterization of renal lesions.Twenty-seven patients (12 women) underwent a renal CT scan, including a non-contrast, an arterial, and a venous phase contrast-enhanced series, using a detector-based dual-energy CT scanner. VNC images were reconstructed from the venous contrast-enhanced series. The mean attenuation values of 65 renal lesions in both the VNC and true non-contrast (TNC) images were measured and compared quantitatively. Three radiologists blindly assessed all lesions using either VNC or TNC images in combination with contrast-enhanced images.Sixteen patients had cystic lesions, five had angiomyolipoma (AML), and six had suspected renal cell carcinomas (RCC). Attenuation values in VNC and TNC images were strongly correlated (ρ = 0.7, mean difference -6.0 ± 13 HU). The largest differences were found for unenhanced high-attenuation lesions. Radiologists classified 86% of the lesions correctly using VNC images.In 70% of the patients, incidentally detected renal lesions could be accurately characterized using VNC images, resulting in less patient burden and a reduction in radiation exposure.This study shows that renal lesions can be accurately characterized using VNC images acquired by detector-based dual-energy CT, which is in agreement with previous studies using dual-source and rapid X-ray tube potential switching technique.