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. 2021 Sep;31(9):6898-6908.
doi: 10.1007/s00330-021-07744-w. Epub 2021 Mar 20.

Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity

Yoshifumi Noda  1   2 , Toru Tochigi  1   3 , Anushri Parakh  1 , Evita Joseph  1 , Peter F Hahn  1 , Avinash Kambadakone  4
Affiliations

Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity

Yoshifumi Noda et al. Eur Radiol. 2021 Sep.

Abstract

Objective: To assess the feasibility of a proposed pancreatic protocol CT generated from portal-venous phase (PVP) dual-energy CT (DECT) acquisition and its impact on image quality, lesion conspicuity, and arterial visualization/involvement.

Methods: We included 111 patients (mean age, 66.8 years) who underwent pancreatic protocol DECT (pancreatic phase, PP, and PVP). The original DECT acquisition was used to create two data sets-standard protocol (50 keV PP/65 keV PVP) and proposed protocol (40 keV/65 keV PVP). Three reviewers evaluated the two data sets for image quality, lesion conspicuity, and arterial visualization/involvement using a 5-point scale. The signal-to-noise ratio (SNR) of pancreas and lesion-to-pancreas contrast-to-noise ratio (CNR) was calculated. Qualitative scores, quantitative parameters, and dose-length product (DLP) were compared between standard and proposed protocols.

Results: The image quality, SNR of pancreas, and lesion-to-pancreas CNR of the standard and proposed protocol were comparable (p = 0.11-1.00). Lesion conspicuity was comparable between the standard and proposed protocols for pancreatic ductal adenocarcinoma (p = 0.55) and pancreatic cysts (p = 0.28). The visualization of larger arteries and arterial involvement were comparable between the two protocols (p = 0.056-1.00) while the scores were higher for smaller vessels in the standard protocol (p < 0.0001-0.0015). DLP of the proposed protocol (670.4 mGy·cm) showed a projected 42% reduction than the standard protocol (1145.9 mGy·cm) (p < 0.0001).

Conclusion: Pancreatic protocol CT generated from a single PVP DECT acquisition is feasible and could potentially be an alternative to the standard pancreatic protocol with PP and PVP.

Key points: • The lesion conspicuity for focal pancreatic lesions was comparable between the proposed protocol and standard dual-phase pancreatic protocol CT. • Qualitative and quantitative image assessments were almost comparable between two protocols. • The radiation dose of a proposed protocol showed a projected 42% reduction from the conventional protocol.

Keywords: Cancer screening; Multidetector-row computed tomography; Pancreatic neoplasms; Radiation dosage.

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References

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