Timely diagnosis of mesenteric vascular diseases, especially acute mesenteric ischemia (AMI) due to embolism in the superior mesenteric artery (SMA), is crucial for effective intervention. Dual-energy computed tomography angiography (DE-CTA) is a key diagnostic tool; however, concerns about contrast-induced nephropathy and radiation exposure persist. This study assesses the diagnostic performance of DE-CTA for detecting mesenteric vascular diseases and compares the effectiveness of image reconstruction algorithms, specifically ASIR-V and DLIR, in enhancing image quality while minimizing the risks associated with contrast agents and radiation exposure. DE-CTA with virtual monoenergetic imaging (VMI) at 40 keV was performed on 50 patients. Image quality was evaluated using contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and standard deviation (SD). The performance of DLIR and ASIR-V algorithms was compared, with an emphasis on minimizing radiation dose and contrast agent use through optimized low-dose protocols. DLIR-H significantly outperformed both ASIR-V 50% and DLIR-M in terms of CNR and SNR, with CNR improving by 25% and SNR by 30% compared to ASIR-V 50%. DLIR-H also demonstrated superior noise reduction, with a 35% reduction in SD compared to ASIR-V. Furthermore, by effectively suppressing the elevated image noise inherent to low-dose scanning protocols, DLIR maintained excellent diagnostic image quality. This highlights its potential for dose reduction in clinical practice, which is crucial for minimizing the risks of radiation exposure and contrast-induced nephropathy. For mesenteric DE-CTA imaging at 40 keV, DLIR significantly improves objective image quality and subjective reader confidence compared to ASIR-V. By preserving fine vascular details at higher noise levels, DLIR demonstrates the potential to facilitate low-radiation and low-contrast-dose protocols in clinical practice. DLIR-H significantly improves image quality in mesenteric vascular imaging, achieving higher CNR and SNR compared to ASIR-V. DLIR-H enhances the visualization of critical mesenteric structures, such as the SMA, SMV, and gastrocolic trunk of Henle, which are vital for diagnosing mesenteric ischemia. The combination of DLIR and 40 keV VMI effectively suppresses background noise and improves CNR, demonstrating the strong potential to support low-radiation and low-contrast DE-CTA protocols while maintaining high diagnostic confidence.
Yang et al. (Wed,) studied this question.