In vivo assessment of tissue-specific radiological parameters with intra- and inter-patient variation using dual-energy computed tomography

Purpose/objective: Experimental in vivo determination of radiological tissue parameters of organs in the
head and pelvis within a large patient cohort, expanding on the current standard human tissue database
summarized in ICRU46.
Material/methods: Relative electron density (RED), effective atomic number (EAN) and stopping-power
ratio (SPR) were obtained from clinical dual-energy CT scans using a clinically validated DirectSPR imple-
mentation and organ segmentations of 107 brain-tumor (brain, brainstem, spinal cord, chiasm, optical
nerve, lens) and 120 pelvic cancer patients (prostate, kidney, liver, bladder). The impact of contamination
by surrounding tissues on the tissue parameters was reduced with a dedicated contour adaption routine.
Tissue parameters were characterized regarding the cohort mean value as well as the variation within
each patient (2rintra) and between patients (2rinter ). For the brain, age-dependent differences were deter-
mined.
Results: For 10 organs, including 4 structures not listed in ICRU46, the mean RED, EAN and SPR as well as
their respective intra- and inter-patient variation were determined. SPR intra-patient variation was
higher than 1.3% (1.3–4.6%) in all organs and always exceeded the inter-patient variation of the organ
mean SPR (0.6–2.1%). For the brain, a significant SPR variation between pediatric and non-pediatric
patients was determined.
Conclusion: Radiological tissue parameters in the head and pelvis were characterized in vivo for a large
patient cohort using dual-energy CT. This reassesses parts of the current standard database defined in
ICRU46, furthermore complementing the data described in literature by smaller substructures in the
brain as well as by the quantification of organ-specific inter- and intra-patient variation.