{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:13:39Z","timestamp":1791972819345,"version":"4.3.4"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Forschungszentrum Medizintechnik Hamburg","award":["04fmthh2020"],"award-info":[{"award-number":["04fmthh2020"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Opposed to other spectral CT techniques, fat quantification in dual-layer detector CT (dlCT) has only recently been developed. The impact of concomitant iron overload and dlCT-specific protocol settings such as the dose right index (DRI), a measure of image noise and tube current, on dlCT fat quantification was unclear. Further, spectral information became newly available &lt;120 kV. Therefore, this study\u2019s objective was to evaluate the impact of iron, changing tube voltage, and DRI on dlCT fat quantification.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material and methods<\/jats:title>\n<jats:p>Phantoms with 0 and 8mg\/cm<jats:sup>3<\/jats:sup> iron; 0 and 5mg\/cm<jats:sup>3<\/jats:sup> iodine; 0, 10, 20, 35, 50, and 100% fat and liver equivalent, respectively, were scanned with a dlCT (CT7500, Philips, the Netherlands) at 100kV\/20DRI, 120kV\/20DRI, 140kV\/20DRI, and at 120kV\/16DRI, 120kV\/24DRI.<\/jats:p>\n<jats:p>Material decomposition was done for fat, liver, and iodine (A1); for fat, liver, and iron (A2); and for fat, liver, and combined reference values of iodine and iron (A3). All scans were analyzed with reference values from 120kV\/20DRI. For statistics, the intraclass correlation coefficient (ICC) and Bland-Altman analyses were used.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In phantoms with iron and iodine, results were best for A3 with a mean deviation to phantom fat of 1.3\u00b12.6% (ICC 0.999 [95%-confidence interval 0.996\u20131]). The standard approach A1 yielded a deviation of -2.5\u00b13.0% (0.998[0.994\u20130.999]), A2 of 6.1\u00b14.8% (0.991[0.974\u20130.997]). With A3 and changing tube voltage, the maximal difference between quantified fat and the phantom ground truth occurred at 100kV with 4.6\u00b12.1%. Differences between scans were largest between 100kV and 140kV (2.0%[-7.1\u201311.2]). The maximal difference of changing DRI occurred between 16 and 24 DRI with 0.4%[-2.2\u20133.0].<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>For dlCT fat quantification in the presence of iron, material decomposition with combined reference values for iodine and iron delivers the most accurate results. Tube voltage-specific calibration of reference values is advisable while the impact of the DRI on dlCT fat quantification is neglectable.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302863","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:38:38Z","timestamp":1716485918000},"page":"e0302863","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fat quantification in dual-layer detector spectral CT: How to handle iron overload, varying tube voltage and radiation dose Indices"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4542-0140","authenticated-orcid":true,"given":"Isabel","family":"Molwitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme 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Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review","author":"I Molwitz","year":"2020","journal-title":"Rofo"},{"key":"pone.0302863.ref002","article-title":"Skeletal muscle fat quantification by dual-energy computed tomography in comparison with 3T MR imaging","author":"I Molwitz","year":"2021","journal-title":"Eur Radiol"},{"key":"pone.0302863.ref003","first-page":"324","article-title":"Contrast-independent liver-fat quantification from spectral CT exams","volume":"16","author":"PR Mendonca","year":"2013","journal-title":"Med Image Comput Comput Assist Interv"},{"key":"pone.0302863.ref004","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.nut.2017.02.011","article-title":"Body composition measurement using computed tomography: Does the phase of the scan matter?","volume":"41","author":"KE 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Takumi","year":"2021","journal-title":"Radiol Case Rep"},{"issue":"3","key":"pone.0302863.ref008","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1148\/radiol.2015142631","article-title":"Dual- and Multi-Energy CT: Principles, Technical Approaches, and Clinical Applications","volume":"276","author":"CH McCollough","year":"2015","journal-title":"Radiology"},{"issue":"1","key":"pone.0302863.ref009","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5152\/dir.2019.19136","article-title":"Technical background of a novel detector-based approach to dual-energy computed tomography","volume":"26","author":"N Grosse Hokamp","year":"2020","journal-title":"Diagn Interv Radiol"},{"issue":"7","key":"pone.0302863.ref010","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1097\/RLI.0000000000000858","article-title":"Fat Quantification in Dual-Layer Detector Spectral Computed Tomography: Experimental Development and First In-Patient Validation","volume":"57","author":"I Molwitz","year":"2022","journal-title":"Invest Radiol"},{"key":"pone.0302863.ref011","article-title":"Hepatic fat quantification in dual-layer computed tomography using a three-material decomposition algorithm","author":"E Demondion","year":"2023","journal-title":"Eur Radiol"},{"issue":"3","key":"pone.0302863.ref012","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.mric.2010.08.014","article-title":"Magnetic resonance imaging quantification of liver iron","volume":"18","author":"CB Sirlin","year":"2010","journal-title":"Magn Reson Imaging Clin N Am"},{"key":"pone.0302863.ref013","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.12659\/MSM.896494","article-title":"The Role of Iron and Iron Overload in Chronic Liver Disease","volume":"22","author":"S Milic","year":"2016","journal-title":"Med Sci Monit"},{"issue":"1","key":"pone.0302863.ref014","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12902-022-00980-1","article-title":"Non-alcoholic fatty 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iron and iodine: an ex-vivo dual-energy CT study","volume":"46","author":"MA Fischer","year":"2011","journal-title":"Invest Radiol"},{"issue":"2","key":"pone.0302863.ref018","doi-asserted-by":"crossref","first-page":"924","DOI":"10.21037\/qims-22-552","article-title":"Phantom-based quantification of the spectral accuracy in dual-layer spectral CT for pediatric imaging at 100 kVp","volume":"13","author":"S Meyer","year":"2023","journal-title":"Quant Imaging Med Surg"},{"key":"pone.0302863.ref019","unstructured":"PhilipsHealthcare. Patient-centered CT imaging: New methods for patient-specific optimization of image quality and radiation dose 2012 [cited 2023 06.06.]. Available from: https:\/\/www.documents.philips.com\/assets\/20170523\/b403654beee646ba9feca77c0143a15c.pdf."},{"issue":"4","key":"pone.0302863.ref020","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1557\/mrc.2020.86","article-title":"Material decomposition with dual- and multi-energy computed tomography","volume":"10","author":"R Bhayana","year":"2020","journal-title":"MRS Communications"},{"issue":"2","key":"pone.0302863.ref021","doi-asserted-by":"crossref","first-page":"15593258211011359","DOI":"10.1177\/15593258211011359","article-title":"Investigating Dual-Energy CT Post-Contrast Phases for Liver Iron Quantification: A Preliminary Study","volume":"19","author":"L Basso","year":"2021","journal-title":"Dose Response"},{"issue":"1","key":"pone.0302863.ref022","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"issue":"6","key":"pone.0302863.ref023","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1002\/hep.20701","article-title":"Design and validation of a histological scoring system for nonalcoholic fatty liver disease","volume":"41","author":"DE Kleiner","year":"2005","journal-title":"Hepatology"},{"issue":"8","key":"pone.0302863.ref024","doi-asserted-by":"crossref","first-page":"530","DOI":"10.4254\/wjh.v10.i8.530","article-title":"Current status of imaging in nonalcoholic fatty liver disease","volume":"10","author":"Q Li","year":"2018","journal-title":"World J Hepatol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:39:37Z","timestamp":1716485977000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302863"}},"subtitle":[],"editor":[{"given":"Pascal A. 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