Skip to main content
SpringerLink
Log in

Inter-reader agreement of pancreatic adenocarcinoma resectability assessment with photon counting versus energy integrating detector CT

  • Pancreas
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the inter-reader agreement of pancreatic adenocarcinoma resectability assessment at pancreatic protocol photon-counting CT (PCCT) with conventional energy-integrating detector CT (EID-CT).

Methods

A retrospective single institution database search identified all contrast-enhanced pancreatic mass protocol abdominal CT performed at an outpatient facility with both a PCCT and EID-CT from 4/11/2022 to 10/30/2022. Patients without pancreatic adenocarcinoma were excluded. Four fellowship-trained abdominal radiologists, blinded to CT type, independently assessed vascular tumor involvement (uninvolved, abuts ≤ 180°, encases > 180°; celiac, superior mesenteric artery (SMA), common hepatic artery (CHA), superior mesenteric vein (SMV), main portal vein), the presence/absence of metastases, overall tumor resectability (resectable, borderline resectable, locally advanced, metastatic), and diagnostic confidence. Fleiss’s kappa was used to calculate inter-reader agreement. CTDIvol was recorded. Radiation dose metrics were compared with a two-sample t-test. A p < .05 indicated statistical significance.

Results

145 patients (71 men, mean[SD] age: 66[9] years) were included. There was substantial inter-reader agreement, for celiac artery, SMA, and SMV involvement at PCCT (kappa = 0.61–0.69) versus moderate agreement at EID-CT (kappa = 0.56–0.59). CHA had substantial inter-reader agreement at both PCCT (kappa = 0.67) and EIDCT (kappa = 0.70). For metastasis identification, radiologists had substantial inter-reader agreement at PCCT (kappa = 0.78) versus moderate agreement at EID-CT (kappa = 0.56). CTDIvol for PCCT and EID-CT were 16.9[7.4]mGy and 29.8[26.6]mGy, respectively (p < .001).

Conclusion

There was substantial inter-reader agreement for involvement of 4/5 major peripancreatic vessels (celiac artery, SMA, CHA, and SMV) at PCCT compared with 2/5 for EID-CT. PCCT also afforded substantial inter-reader agreement for metastasis detection versus moderate agreement at EID-CT with statistically significant radiation dose reduction.

Grpahical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Available.

Code availability

Not applicable.

References

  1. Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin 73(1):17-48. https://doi.org/10.3322/caac.21763

    Article  PubMed  Google Scholar 

  2. Ilic I, Ilic M (2022) International patterns in incidence and mortality trends of pancreatic cancer in the last three decades: A joinpoint regression analysis. World J Gastroenterol 28(32):4698-4715. https://doi.org/10.3748/wjg.v28.i32.4698

    Article  PubMed  PubMed Central  Google Scholar 

  3. Isaji S, Mizuno S, Windsor JA, et al. (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2-11. https://doi.org/10.1016/j.pan.2017.11.011

    Article  PubMed  Google Scholar 

  4. Joo I, Lee JM, Lee ES, et al. (2019) Preoperative CT Classification of the Resectability of Pancreatic Cancer: Interobserver Agreement. Radiology 293(2):343-349. https://doi.org/10.1148/radiol.2019190422

    Article  PubMed  Google Scholar 

  5. Pereira SP, Oldfield L, Ney A, et al. (2020) Early detection of pancreatic cancer. Lancet Gastroenterol Hepatol 5(7):698-710. https://doi.org/10.1016/S2468-1253(19)30416-9

    Article  PubMed  PubMed Central  Google Scholar 

  6. Callery MP, Chang KJ, Fishman EK, et al. (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727-1733. https://doi.org/10.1245/s10434-009-0408-6

    Article  PubMed  Google Scholar 

  7. Wong JC, Lu DS (2008) Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol 6(12):1301-1308. https://doi.org/10.1016/j.cgh.2008.09.014

    Article  PubMed  Google Scholar 

  8. Fuhrman GM, Charnsangavej C, Abbruzzese JL, et al. (1994) Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 167(1):104-111; discussion 111-103. https://doi.org/10.1016/0002-9610(94)90060-4

    Article  CAS  PubMed  Google Scholar 

  9. Tempero MA, Malafa MP, Al-Hawary M, et al. (2021) Pancreatic Adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 19(4):439-457. https://doi.org/10.6004/jnccn.2021.0017

    Article  CAS  PubMed  Google Scholar 

  10. Kulkarni NM, Soloff EV, Tolat PP, et al. (2020) White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease. Abdom Radiol (NY) 45(3):716-728. https://doi.org/10.1007/s00261-019-02289-5

    Article  PubMed  Google Scholar 

  11. Rajendran K, Petersilka M, Henning A, et al. (2022) First Clinical Photon-counting Detector CT System: Technical Evaluation. Radiology 303(1):130-138. https://doi.org/10.1148/radiol.212579

    Article  PubMed  Google Scholar 

  12. Flohr T, Petersilka M, Henning A, et al. (2020) Photon-counting CT review. Phys Med 79:126-136. https://doi.org/10.1016/j.ejmp.2020.10.030

    Article  PubMed  Google Scholar 

  13. Pourmorteza A, Symons R, Henning A, et al. (2018) Dose Efficiency of Quarter-Millimeter Photon-Counting Computed Tomography: First-in-Human Results. Invest Radiol 53(6):365-372. https://doi.org/10.1097/RLI.0000000000000463

    Article  PubMed  Google Scholar 

  14. Yu Z, Leng S, Kappler S, et al. (2016) Noise performance of low-dose CT: comparison between an energy integrating detector and a photon counting detector using a whole-body research photon counting CT scanner. J Med Imaging (Bellingham) 3(4):043503. https://doi.org/10.1117/1.JMI.3.4.043503

    Article  PubMed  Google Scholar 

  15. Benchoufi M, Matzner-Lober E, Molinari N, et al. (2020) Interobserver agreement issues in radiology. Diagn Interv Imaging 101(10):639-641. https://doi.org/10.1016/j.diii.2020.09.001

    Article  CAS  PubMed  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159-174.

    Article  CAS  PubMed  Google Scholar 

  17. Leng S, Bruesewitz M, Tao S, et al. (2019) Photon-counting Detector CT: System Design and Clinical Applications of an Emerging Technology. Radiographics 39(3):729-743. https://doi.org/10.1148/rg.2019180115

    Article  PubMed  Google Scholar 

  18. Leng S, Rajendran K, Gong H, et al. (2018) 150-mum Spatial Resolution Using Photon-Counting Detector Computed Tomography Technology: Technical Performance and First Patient Images. Invest Radiol 53(11):655-662. https://doi.org/10.1097/RLI.0000000000000488

    Article  PubMed  PubMed Central  Google Scholar 

  19. Booij R, van der Werf NR, Dijkshoorn ML, et al. (2022) Assessment of Iodine Contrast-To-Noise Ratio in Virtual Monoenergetic Images Reconstructed from Dual-Source Energy-Integrating CT and Photon-Counting CT Data. Diagnostics (Basel) 12(6) https://doi.org/10.3390/diagnostics12061467

    Article  PubMed  Google Scholar 

  20. Sawall S, Klein L, Amato C, et al. (2020) Iodine contrast-to-noise ratio improvement at unit dose and contrast media volume reduction in whole-body photon-counting CT. Eur J Radiol 126:108909. https://doi.org/10.1016/j.ejrad.2020.108909

    Article  CAS  PubMed  Google Scholar 

  21. Badgery HE, Muhlen-Schulte T, Zalcberg JR, et al. (2023) Determination of "borderline resectable" pancreatic cancer - A global assessment of 30 shades of grey. HPB (Oxford) 25(11):1393-1401. https://doi.org/10.1016/j.hpb.2023.07.883

    Article  PubMed  Google Scholar 

  22. Bette S, Decker JA, Braun FM, et al. (2022) Optimal Conspicuity of Liver Metastases in Virtual Monochromatic Imaging Reconstructions on a Novel Photon-Counting Detector CT-Effect of keV Settings and BMI. Diagnostics (Basel) 12(5) https://doi.org/10.3390/diagnostics12051231

    Article  PubMed  Google Scholar 

  23. Esquivel A, Ferrero A, Mileto A, et al. (2022) Photon-Counting Detector CT: Key Points Radiologists Should Know. Korean J Radiol 23(9):854-865. https://doi.org/10.3348/kjr.2022.0377

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None

Author information

Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA

    Jesi Kim, Tarub Mabud, Chenchan Huang, Juan Lloret del Hoyo, Robert Petrocelli, Abhinav Vij & Bari Dane

Authors
  1. Jesi Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarub Mabud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chenchan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan Lloret del Hoyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Petrocelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abhinav Vij
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bari Dane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jesi Kim.

Ethics declarations

Conflicts of interest

Bari Dane received speaker honorarium from Siemens Healthineers.

Ethical approval

This study was institutional review board approved and Health Insurance Portability and Accountability Act compliant.

Consent to participate

Waiver of the requirement for informed consent.

Consent for publication

Yes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Mabud, T., Huang, C. et al. Inter-reader agreement of pancreatic adenocarcinoma resectability assessment with photon counting versus energy integrating detector CT. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04298-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00261-024-04298-5

Keywords

Search

Navigation