Virtual non-contrast images calculated from dual-energy CT shoulder arthrography improve the detection of intraarticular loose bodies

This study aims to evaluate the image quality of virtual non-contrast (VNC) images calculated from dual-energy CT shoulder arthrography (DECT-A) and their ability to detect periosteal calcifications and intraarticular loose bodies. In 129 shoulders of 123 patients, DECT arthrography (80 kV/140 kV) was performed with diluted iodinated contrast material (80 mg/ml). VNC images were calculated with image postprocessing. VNC image quality (1 = worst, 5 = best), dose parameters, and CT numbers (intraarticular iodine, muscle, VNC joint fluid density) were assessed. Image contrast (iodine/muscle) and percentage of iodine removal were calculated. Two independent readers evaluated VNC and DECT-A images for periosteal calcifications and intraarticular loose bodies, and diagnostic confidence (1 = low, 4 = very high) was assessed. VNC images (129/129) were of good quality (median 4 (3-4)), and the mean effective dose of DECT-A scans was 2.21 mSv (± 1.0 mSv). CT numbers of iodine, muscle, and VNC joint fluid density were mean 1017.6 HU (± 251.6 HU), 64.6 HU (± 8.2 HU), and 85.3 HU (± 39.5 HU), respectively. Image contrast was mean 953.1 HU (± 251 HU) on DECT-A and 31.3 HU (± 32.3 HU) on VNC images. Iodine removal on VNC images was 91% on average. No difference was observed in the detection of periosteal calcifications between VNC (n = 25) and DECT-A images (n = 21) (p = 0.29), while the detection of intraarticular loose bodies was superior on VNC images (14 vs. 7; p = 0.02). Diagnostic confidence was higher on VNC images for both periosteal calcifications (median 3 (3-3) vs. 3 (3-3); p = 0.009) and intraarticular loose bodies (median 3 (3-4) vs. 3 (3-3); p < 0.001). VNC images from DECT shoulder arthrography are superior to DECT-A images for the detection of intraarticular loose bodies and increase the confidence in detecting periosteal calcifications.