Reliability of virtual non-contrast computed tomography angiography: comparing it with the real deal

Background:

Computed tomographic angiography (CTA) may require a non-contrast enhanced dataset for the diagnostic workup. By using dual-energy acquisition, it is possible to obtain a virtual non-contrast-enhanced (VNC) dataset, thereby possibly eliminating the non-contrast acquisition and reducing the radiation dose.
Purpose:

To compare image quality of VNC images reconstructed from arterial phase dual-energy CTA to true non-contrast (TNC) images, and to assess whether VNC images were of sufficient quality to replace TNC images.
Material and methods:

Thirty consecutive patients with suspected abdominal aortic aneurysm, aortic dissection, or subacute control after EVAR/TEVAR were examined with dual-energy CT (DECT). The examination protocol included a single-energy TNC, DECT arterial phase (80 kV/Sn140 kV), and single-energy in venous phase of the aorta. A VNC dataset was obtained from the DE acquisition from arterial phase scans. Mean attenuation and image noise were measured within regions of interest at three levels in the aorta in TNC and VNC images. Comparison of the TNC and VNC images for artefacts was made side-by-side. Subjective evaluation included overall image quality on a 4-grade scale, and quantitative analysis of algorithm-induced artefacts by two experienced readers.
Results:

For all cases, the aortic attenuation was significantly higher at VNC than at TNC. Image noise measured quantitatively was also significantly higher at VNC than at TNC. Subjective image quality was lower for VNC (mean = 3.1 for VNC, 3.7 = for TNC) but there were no cases rated non-diagnostic.
Conclusion:

VNC images based on arterial phase CTA have significantly higher mean attenuation and higher noise levels compared to TNC.