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The PRETEXT (Pretreatment Extent of Disease) staging system, based on CT images, is a crucial basis for surgical planning. Therefore, improving the image quality and diagnostic confidence of PRETEXT staging impacts the overall therapeutic outcomes in pediatric hepatoblastoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether thin-slice 40\u00a0keV dual-energy CT (DECT) images combined with a deep learning image reconstruction (DLIR) algorithm can improve image quality and diagnostic confidence for the evaluation of PRETEXT staging for pediatric hepatoblastoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study included 53 pediatric patients (mean age, 3.54\u2009\u00b1\u20092.26 years) with pathologically confirmed hepatoblastoma who underwent contrast-enhanced abdominal DECT. From the raw data, three distinct image series were reconstructed with a slice thickness of 0.625\u00a0mm for comparison: (A) standard-energy 68\u00a0keV VMI (virtual monoenergetic image) with 50% adaptive statistical iterative reconstruction-V (ASIR-V50%); (B) 68\u00a0keV VMI with high-level DLIR (DLIR-H); and (C) low-energy 40\u00a0keV VMI with DLIR-H. Objective image quality was quantified by the contrast-to-noise ratio (CNR) and Edge Rise Slope (ERS) of hepatic veins. Two independent radiologists performed PRETEXT staging and subjectively assessed image noise, hepatic vein visualization, and diagnostic confidence using a 5-point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final PRETEXT staging results showed no statistically significant difference among the three image groups. However, objectively, the 40\u00a0keV DLIR-H images demonstrated significantly superior ERS (83.73\u2009\u00b1\u200946.50), indicating the sharpest vessel boundaries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and CNR values for the hepatic veins. Subjectively, the 40\u00a0keV DLIR-H images received the highest scores for hepatic vein visualization and diagnostic confidence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and was the only group consistently deemed sufficient to meet all diagnostic requirements for staging.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 0.625\u00a0mm thin-slice 40\u00a0keV VMI in DECT combined with DLIR-H reconstruction provides superior image quality and significantly enhances the diagnostic confidence for PRETEXT staging, and may be considered for routine clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12880-026-02476-z","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:46:58Z","timestamp":1780292818000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving image quality and diagnostic confidence for PRETEXT staging in pediatric hepatoblastoma using thin-slice and low-energy virtual monochromatic images in dual-energy CT with deep learning image reconstruction algorithm"],"prefix":"10.1186","volume":"26","author":[{"given":"Guangheng","family":"Yin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoyan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoyao","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"issue":"5","key":"2476_CR1","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1002\/pbc.24215","volume":"59","author":"LG Spector","year":"2012","unstructured":"Spector LG, Birch J. 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PubMed PMID: 34698569.","journal-title":"Radiology"}],"container-title":["BMC Medical Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12880-026-02476-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-026-02476-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-026-02476-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:02:55Z","timestamp":1785848575000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12880-026-02476-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2476"],"URL":"https:\/\/doi.org\/10.1186\/s12880-026-02476-z","relation":{},"ISSN":["1471-2342"],"issn-type":[{"value":"1471-2342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,30]]},"assertion":[{"value":"9 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the Ethics Committee of Beijing Children\u2019s Hospital (approval number: 2025-E-136-R), and all procedures were performed in accordance with the approved guidelines and regulations of our institution. The requirement for informed consent was waived.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"375"}}