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European Radiology

, Volume 29, Issue 5, pp 2226–2232 | Cite as

Dual-energy CT in early acute pancreatitis: improved detection using iodine quantification

  • Simon S. Martin
  • Franziska Trapp
  • Julian L. WichmannEmail author
  • Moritz H. Albrecht
  • Lukas Lenga
  • James Durden
  • Christian Booz
  • Thomas J. Vogl
  • Tommaso D’Angelo
Computed Tomography
  • 152 Downloads

Abstract

Objectives

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

Methods

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.

Results

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).

Conclusion

DECT using iodine quantification allows for diagnosis of early acute pancreatitis with higher sensitivity compared to standard image evaluation.

Key Points

• 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.

Keywords

Multidetector computed tomography Pancreas Pancreatitis Iodine Diagnostic imaging 

Abbreviations

AUC

Area under the curve

CT

Computed tomography

DECT

Dual-energy computed tomography

ROC

Receiver operating characteristics

ROI

Region of interest

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Simon S. Martin
    • 1
    • 2
  • Franziska Trapp
    • 1
  • Julian L. Wichmann
    • 1
    Email author
  • Moritz H. Albrecht
    • 1
  • Lukas Lenga
    • 1
  • James Durden
    • 2
  • Christian Booz
    • 1
  • Thomas J. Vogl
    • 1
  • Tommaso D’Angelo
    • 1
    • 3
  1. 1.Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  2. 2.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  3. 3.Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional ImagingPoliclinico G. Martino—University Hospital MessinaMessinaItaly

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