Clinical Feasibility of Dual-Layer CT With Virtual Monochromatic Image for Preoperative Staging in Patients With Breast Cancer - A Comparison With Breast MRI

Sep 21, 2026

Objective: Dual-layer CT (DLCT) enables virtual monochromatic images (VMIs) at multiple energy levels, particularly low keV, offering high contrast-to-noise. This study assessed the clinical feasibility of contrast-enhanced chest DLCT using low keV VMI for preoperative breast cancer staging, compared with breast MRI. Methods: 152 patients with 155 index cancers underwent 40 keV VMI chest DLCT with 3D MIP reconstruction and breast MRI review by two radiologists in separate sessions. Detection rate and tumor size agreement were evaluated. Results: Detection and size metrics were comparable with good measurement agreement. Conclusion: Chest DLCT with low keV VMI is a feasible alternative for preoperative staging when MRI is contraindicated.

LanguageEnglish

CategoryHealthcare

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Materials and Methods

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Introduction

Original Article | Breast Imaging eISSN 2005-8330 [https://doi.org/10.3348/kjr.2023.1312](https://doi.org/10.3348/kjr.2023.1312) [Korean J Radiol 2024](Korean J Radiol 2024);[25](25)([9](9))[:798-806](:798-806) Clinical Feasibility of Dual-Layer CT With Virtual Monochromatic Image for Preoperative Staging in Patients With Breast Cancer: A Comparison With Breast MRI Bokdong Yeo1, Kyung Min Shin2, Byunggeon Park2, Hye Jung Kim2 *, Won Hwa Kim2 * 1 Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea 2 Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea Objective: Dual-layer CT (DLCT) can create virtual monochromatic images (VMIs) at various monochromatic X-ray energies, particularly at low keV levels, with high contrast-to-noise ratio. The purpose of this study was to assess the clinical feasibility of contrast-enhanced chest DLCT with a low keV VMI for preoperative breast cancer staging, in comparison to breast MRI. Materials and Methods: A total of 152 patients with 155 index breast cancers were enrolled in the study. VMIs were generated from contrast-enhanced chest DLCT at 40 keV and maximum intensity projection (MIP) with three-dimensional (3D) reconstruction was performed for both bilateral breast areas. Two radiologists reviewed in consensus the 3D MIP images of the chest DLCT with VMI and breast MRI in separate sessions with a 3-month wash-out period. The detection rate and mean tumor size of the index cancer were compared between the chest DLCT with VMI and breast MRI. Additionally, the agreement of tumor size measurement between the two imaging modalities were evaluated. Results: Of all index cancers, 84.5%(131/155) were detected in the chest DLCT with VMI, while 88.4%(137/155) were detected in the breast MRI (P = 0.210) . The Bland–Altman agreement between the chest DLCT with VMI and breast MRI was a mean difference of-0.05 cm with 95% limits of agreement of-1.29 to 1.19 cm. The tumor size in the chest DLCT with VMI (2.3 ± 1.7 cm) was not significantly different from that in the breast MRI (2.4 ± 1.6 cm) (P = 0.106) . Conclusion: The feasibility of chest DLCT with VMI was demonstrated for preoperative tumor staging in breast cancer patients, showing comparable cancer detectability and good agreement in tumor size measurement compared to breast MRI. This suggests that chest DLCT with VMI can serve as a potential alternative for patients who have contraindications to breast MRI. Keywords: Breast cancer; Dual-layer CT; Virtual monochromatic image; Low keV; Cancer staging INTRODUCTION Recently, dual-energy CT (DECT) has emerged as an advanced clinical imaging technique that utilizes two different energy levels to acquire images. This method involves the simultaneous or sequential acquisition of CT data at two distinct X-ray energy levels, typically referred to as high and low energy levels. Dual-layer CT (DLCT) is a specific subtype of DECT, distinguished by its ability to automatically register the radiation spectrum received by two layers of a detector as two energetically different energy spectra, without altering the tube voltage and tube Received: January 3, 2024 Revised: July 2, 2024 Accepted: July 12, 2024 *These authors contributed equally to this work. Corresponding author: Won Hwa Kim, MD, PhD, Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea • E-mail: [oaktree9@knu.ac.kr](oaktree9@knu.ac.kr) Corresponding author: Hye Jung Kim, MD, PhD, Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea • E-mail: [mamrad@knu.ac.kr](mamrad@knu.ac.kr) This is an Open Access article distributed under the terms of

FAQs

What was the purpose of comparing chest dual-layer CT with VMI against breast MRI?

To assess whether contrast-enhanced chest DLCT using low keV virtual monochromatic images is clinically feasible for preoperative breast cancer staging, compared with breast MRI.

How were the virtual monochromatic images generated and evaluated in the study?

VMIs were generated from contrast-enhanced chest DLCT at 40 keV, with maximum intensity projection and 3D reconstruction for bilateral breast areas. Two radiologists reviewed the 3D MIP images and the MRI in separate sessions with a 3-month wash-out period.

What did the results show about tumor detection and tumor size measurement?

The detection rates of index cancers were comparable between chest DLCT with VMI and breast MRI, and tumor size measurements showed no significant difference, with good agreement between modalities.

Sep 21, 2026

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