Dual-energy CT in early acute pancreatitis: improved detection using iodine quantification
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To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based technique using iodine quantification and fat fraction analysis for the diagnosis of early acute pancreatitis
In this retrospective study, 45 patients (35 men and 10 women; mean age, 54.9 ± 14.0 years) with early acute pancreatitis were included. Serum lipase levels and follow-up examinations served as the reference standard. A matched control group (n = 45) was assembled for evaluation of material decomposition values of normal pancreatic parenchyma. Three blinded radiologists independently interpreted all cases on conventional grayscale DECT series. In addition, readers re-evaluated all cases by manually performing region-of-interest (ROI) measurements on pancreatic-phase DECT material density images of the head, body, and tail of each patient’s pancreas. Receiver operating characteristic (ROC) curve analysis was performed to estimate the optimal threshold for discriminating between inflammatory and normal pancreas parenchyma.
DECT-based iodine density values showed significant differences between inflammatory (1.8 ± 0.3 mg/mL) and normal pancreatic parenchyma (2.7 ± 0.7 mg/mL) (p ≤ 0.01). Fat fraction measurements showed no significant differences (p = 0.08). The optimal iodine density threshold for the diagnosis of acute pancreatitis was 2.1 mg/mL with a sensitivity of 96% and specificity of 77%. Iodine quantification revealed an area under the curve (AUC) of 0.86, significantly higher compared to standard image evaluation of the radiologists (AUC, 0.80; sensitivity, 78%; specificity, 82%) (p < 0.01).
DECT using iodine quantification allows for diagnosis of early acute pancreatitis with higher sensitivity compared to standard image evaluation.
• Iodine density values showed significant differences between inflammatory and normal pancreatic parenchyma.
• DECT using iodine quantification allows for diagnosis of early acute pancreatitis.
• An iodine density of ≤ 2.1 mg/mL optimizes the diagnosis of acute pancreatitis.
KeywordsMultidetector computed tomography Pancreas Pancreatitis Iodine Diagnostic imaging
Area under the curve
Dual-energy computed tomography
Receiver operating characteristics
Region of interest
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Julian L. Wichmann.
Conflict of interest
Dr. Julian L. Wichmann received speakers’ fees from GE Healthcare and Siemens Healthcare. However, all data was controlled by the authors (e.g., the corresponding author) without any potential conflict of interest. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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