Renal lesion characterization: clinical utility of single-phase dual-energy CT compared to MRI and dual-phase single-energy CT

Objectives To assess the impact of dual-energy CT (DECT) utilization in practice by measuring the readers’ confidence, the need for additional image requests, and diagnostic performance in renal lesion assessment, compared to single-energy CT (SECT) using contrast-enhanced MRI to establish the reference standard. Materials and methods Sixty-nine patients (M/F = 47/22) who underwent a dual-phase renal SECT ( n = 34) or DECT ( n = 35) and had a contrast-enhanced MRI within 180 days were retrospectively collected. Three radiologists assessed images on different sessions (SECT, DECT, and MRI) for (1) likely diagnosis (enhancing/non-enhancing); (2) diagnostic confidence (5-point Likert scale); (3) need for additional imaging test (yes/no); and (4) need for follow-up imaging (yes/no). Diagnostic accuracy was compared using AUC; p value < 0.05 was considered significant. Results One hundred fifty-six lesions consisting of 18% enhancing ( n = 28/156, mean size: 30.37 mm, range: 9.9–94 mm) and 82% non-enhancing ( n = 128/156, mean size: 23.91 mm, range: 5.0–94.2 mm) were included. The confidence level was significantly lower for SECT than their MRI (4.50 vs. 4.80, p value < 0.05) but not significantly different for DECT and the corresponding MRI (4.78 vs. 4.78, p > 0.05). There were significantly more requests for additional imaging in the SECT session than the corresponding MRI (20% vs. 4%), which was not significantly different between DECT and their MRI counterpart session (5.7% vs. 4.9%). Inter-reader agreement was almost perfect for DECT and MRI (kappa: 0.8–1) and substantial in SECT sessions (kappa: 0.6–0.8) with comparable diagnostic accuracy between SECT, DECT, and MRI ( p value > 0.05). Conclusion Single-phase DECT allows confident and reproducible characterization of renal masses with fewer recommendation for additional and follow-up imaging tests than dual-phase SECT and a performance similar to MRI. Key Points • DECT utilization leads to similar additional image requests to MRI (5.7% vs. 4.9%, p value > 0.05), whereas single-energy CT utilization leads to significantly higher image requests (20% vs. 4%, p value < 0.05). • DECT and MRI utilization bring highly reproducible results with almost perfect inter-reader agreement (kappa: 0.8–1), better than the inter-reader agreement in SECT utilization (kappa: 0.6–0.8). • Readers’ confidence was not significantly altered between DECT and their MRI readout session (p value > 0.05). In contrast, confidence in th