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Dual-layer spectral CT improves image quality of multiphasic pancreas CT in patients with pancreatic ductal adenocarcinoma

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the image quality and optimal energies of virtual monoenergetic images (VMIs) from dual-layer spectral detector computed tomography (DLCT) in multiphasic pancreatic CT and investigate whether low-keV VMI at the portal venous phase (PVP) provides sufficient tumor conspicuity and arterial depiction relative to conventional pancreatic parenchymal phase (PPP) images.

Methods

Forty-eight patients with pancreatic ductal adenocarcinoma (PDAC) underwent contrast-enhanced DLCT during PPP and PVP. Conventional polyenergetic images (PEIs) and VMI at 40–100 keV (VMI40–100, 10-keV increments) were reconstructed at each enhancement phase. Image noise and the contrast-to-noise ratio (CNR) of the pancreas, tumors, arteries, and veins were quantified. Two radiologists independently assessed tumor conspicuity, margin delineation, image noise, sharpness of pancreatic duct, and depiction of arteries and veins on a five-point scale. Size-specific dose estimate (SSDE) was calculated.

Results

Image noise for VMI40–100 was significantly lower than that for PEI (p < 0.01). The CNR in VMI increased gradually with decreasing energy; CNRs for VMI40–60 were significantly greater than that for PEI (p < 0.01). All subjective VMI scores were maximized at VMI40, followed by VMI50–60, all of which were significantly better than of PEI (p < 0.01). Objective and subjective image qualities of VMI40–50 at the PVP were equivalent to or even better compared with conventional PPP images. No significant difference in SSDE was observed between phases (p = 0.10).

Conclusions

DLCT-VMI improved the subjective and objective image quality in multiphasic pancreatic CT for patients with PDAC. Low-keV PVP imaging may yield diagnostically adequate tumor conspicuity and arterial assessment compared with polyenergetic PPP images.

Key Points

• Low-keV VMI from DLCT yields better subjective and objective image quality of multiphasic pancreas CT in comparison with conventional PEI for the assessment of pancreatic ductal adenocarcinoma.

• Tumor conspicuity and depiction of peripancreatic vasculature were maximized at VMI 40 without an increase in the image noise.

• Low-keV VMI of the portal venous phase provides sufficient tumor conspicuity and arterial depiction, potentially allowing the early detection and local staging of PDAC on routine abdominal CT performed for various clinical indications.

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Abbreviations

CNR:

Contrast-to-noise ratio

CTDIvol :

Volume CT dose index

DECT:

Dual-energy CT

DLCT:

Dual-layer spectral detector CT

PDAC:

Pancreatic ductal adenocarcinoma

PEI:

Polyenergetic image

PPP:

Pancreatic parenchymal phase

PVP:

Portal venous phase

ROI:

Region of interest

SSDE:

Size-specific dose estimate

VMI:

Virtual monoenergetic imaging

References

  1. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34

    Article  Google Scholar 

  2. Konstantinidis IT, Warshaw AL, Allen JN et al (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg 257:731–736

    Article  Google Scholar 

  3. Somers I, Bipat S (2017) Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT. Eur Radiol 27:3408–3435

    Article  Google Scholar 

  4. Al-Hawary MM, Francis IR, Chari ST et al (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 270:248–260

    Article  Google Scholar 

  5. Zaky AM, Wolfgang CL, Weiss MJ, Javed AA, Fishman EK, Zaheer A (2017) Tumor-vessel relationships in pancreatic ductal adenocarcinoma at multidetector CT: different classification systems and their influence on treatment planning. Radiographics 37:93–112

    Article  Google Scholar 

  6. Marchegiani G, Todaro V, Boninsegna E et al (2018) Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection. Eur Radiol 28:4265–4273

    Article  Google Scholar 

  7. Lu DS, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA (1996) Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 199:697–701

    Article  CAS  Google Scholar 

  8. Ichikawa T, Erturk SM, Sou H et al (2006) MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. AJR Am J Roentgenol 187:1513–1520

    Article  Google Scholar 

  9. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB Jr (2002) Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 224:764–768

    Article  Google Scholar 

  10. Ishigami K, Yoshimitsu K, Irie H et al (2009) Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol 69:139–146

    Article  Google Scholar 

  11. Falck C, Galanski M, Shin H-o (2010) Informatics in radiology: sliding-thin-slab averaging for improved depiction of low-contrast lesions with radiation dose savings at thin-section CT. Radiographics 30:317–326

    Article  Google Scholar 

  12. Yanaga Y, Awai K, Nakayama Y et al (2007) Pancreas: patient body weight tailored contrast material injection protocol versus fixed dose protocol at dynamic CT. Radiology 245:475–482

    Article  Google Scholar 

  13. Kondo H, Kanematsu M, Goshima S et al (2007) MDCT of the pancreas: optimizing scanning delay with a bolus-tracking technique for pancreatic, peripancreatic vascular, and hepatic contrast enhancement. AJR Am J Roentgenol 188:751–756

    Article  Google Scholar 

  14. Marin D, Nelson RC, Barnhart H et al (2010) Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique--preliminary results. Radiology 256:450–459

    Article  Google Scholar 

  15. Loizou L, Albiin N, Leidner B et al (2016) Multidetector CT of pancreatic ductal adenocarcinoma: effect of tube voltage and iodine load on tumour conspicuity and image quality. Eur Radiol 26:4021–4029

    Article  CAS  Google Scholar 

  16. Lin X-Z, Machida H, RT IT et al (2014) CT of the pancreas: comparison of image quality and pancreatic duct depiction among model-based iterative, adaptive statistical iterative, and filtered back projection reconstruction techniques. Abdom Imaging 39:497–505

    Article  Google Scholar 

  17. Yamamura S, Oda S, Utsunomiya D et al (2013) Dynamic computed tomography of locally advanced pancreatic cancer: effect of low tube voltage and a hybrid iterative reconstruction algorithm on image quality. J Comput Assist Tomogr 37:790–796

    Article  Google Scholar 

  18. Patel BN, Thomas JV, Lockhart ME, Berland LL, Morgan DE (2013) Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: optimization of energy level viewing significantly increases lesion contrast. Clin Radiol 68:148–154

    Article  CAS  Google Scholar 

  19. Frellesen C, Fessler F, Hardie AD et al (2015) Dual-energy CT of the pancreas: improved carcinoma-to-pancreas contrast with a noise-optimized monoenergetic reconstruction algorithm. Eur J Radiol 84:2052–2058

    Article  Google Scholar 

  20. Hardie AD, Picard MM, Camp ER et al (2015) Application of an advanced image-based virtual Monoenergetic reconstruction of dual source dual-energy CT data at low keV increases image quality for routine pancreas imaging. J Comput Assist Tomogr 39:716–720

    Article  Google Scholar 

  21. McNamara MM, Little MD, Alexander LF, Carroll LV, Beasley TM, Morgan DE (2015) Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas: complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT. Abdom Imaging 40:1230–1240

    Article  Google Scholar 

  22. Bellini D, Gupta S, Ramirez-Giraldo JC et al (2017) Use of a noise optimized monoenergetic algorithm for patient-size independent selection of an optimal energy level during dual-energy CT of the pancreas. J Comput Assist Tomogr 41:39–47

    Article  Google Scholar 

  23. Bhosale P, Le O, Balachandran A, Fox P, Paulson E, Tamm E (2015) Quantitative and qualitative comparison of single-source dual-energy computed tomography and 120-kVp computed tomography for the assessment of pancreatic ductal adenocarcinoma. J Comput Assist Tomogr 39:907–913

    Article  Google Scholar 

  24. Beer L, Toepker M, Ba-Ssalamah A et al (2019) Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma. Eur Radiol. https://doi.org/10.1007/s00330-019-06116-9

  25. Kalisz K, Rassouli N, Dhanantwari A, Jordan D, Rajiah P (2018) Noise characteristics of virtual monoenergetic images from a novel detector-based spectral CT scanner. Eur J Radiol 98:118–125

    Article  Google Scholar 

  26. Nagayama Y, Nakaura T, Oda S et al (2018) Dual-layer DECT for multiphasic hepatic CT with 50 percent iodine load: a matched-pair comparison with a 120 kVp protocol. Eur Radiol 28:1719–1730

    Article  Google Scholar 

  27. Sellerer T, Noel PB, Patino M et al (2018) Dual-energy CT: a phantom comparison of different platforms for abdominal imaging. Eur Radiol 28:2745–2755

    Article  Google Scholar 

  28. Christner JA, Braun NN, Jacobsen MC, Carter RE, Kofler JM, McCollough CH (2012) Size-specific dose estimates for adult patients at CT of the torso. Radiology 265:841–847

    Article  Google Scholar 

  29. Hickethier T, Iuga AI, Lennartz S et al (2018) Virtual monoenergetic images from a novel dual-layer spectral detector computed tomography scanner in portal venous phase: adjusted window settings depending on assessment focus are essential for image interpretation. J Comput Assist Tomogr 42:350–356

    Article  Google Scholar 

  30. Almeida RR, Lo GC, Patino M, Bizzo B, Canellas R, Sahani DV (2018) Advances in pancreatic CT imaging. AJR Am J Roentgenol 211:52–66

    Article  Google Scholar 

  31. Sakabe D, Funama Y, Taguchi K et al (2018) Image quality characteristics for virtual monoenergetic images using dual-layer spectral detector CT: comparison with conventional tube-voltage images. Phys Med 49:5–10

    Article  Google Scholar 

  32. Nagayama Y, Iyama A, Oda S et al (2019) Dual-layer dual-energy computed tomography for the assessment of hypovascular hepatic metastases: impact of closing k-edge on image quality and lesion detectability. Eur Radiol 29:2837–2847

    Article  Google Scholar 

  33. Grosse Hokamp N, Obmann VC, Kessner R et al (2018) Improved visualization of hypodense liver lesions in virtual monoenergetic images from spectral detector CT: proof of concept in a 3D-printed phantom and evaluation in 74 patients. Eur J Radiol 109:114–123

    Article  CAS  Google Scholar 

  34. Nagayama Y, Nakaura T, Oda S et al (2018) Dual-layer detector CT of chest, abdomen, and pelvis with a one-third iodine dose: image quality, radiation dose, and optimal monoenergetic settings. Clin Radiol 73:1058.e1021–1058.e1029

    Google Scholar 

  35. Brook OR, Gourtsoyianni S, Brook A, Siewert B, Kent T, Raptopoulos V (2013) Split-bolus spectral multidetector CT of the pancreas: assessment of radiation dose and tumor conspicuity. Radiology 269:139–148

    Article  Google Scholar 

  36. Hickethier T, Byrtus J, Hauger M et al (2018) Utilization of virtual mono-energetic images (MonoE) derived from a dual-layer spectral detector CT (SDCT) for the assessment of abdominal arteries in venous contrast phase scans. Eur J Radiol 99:28–33

    Article  Google Scholar 

  37. Lohofer FK, Kaissis GA, Koster FL et al (2018) Improved detection rates and treatment planning of head and neck cancer using dual-layer spectral CT. Eur Radiol 28:4925–4931

    Article  Google Scholar 

  38. Zopfs D, Lennartz S, Laukamp K et al (2018) Improved depiction of atherosclerotic carotid artery stenosis in virtual monoenergetic reconstructions of venous phase dual-layer computed tomography in comparison to polyenergetic reconstructions. Eur J Radiol 100:36–42

    Article  Google Scholar 

  39. Fletcher JG, Wiersema MJ, Farrell MA et al (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229:81–90

    Article  Google Scholar 

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Funding

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

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Yasunori Nagayama, Shota Tanoue, Taihei Inoue, Seitaro Oda, Takeshi Nakaura & Yasuyuki Yamashita

  2. Department of Diagnostic Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Daisuke Utsunomiya

Authors
  1. Yasunori Nagayama
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Correspondence to Yasunori Nagayama.

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Nagayama, Y., Tanoue, S., Inoue, T. et al. Dual-layer spectral CT improves image quality of multiphasic pancreas CT in patients with pancreatic ductal adenocarcinoma. Eur Radiol 30, 394–403 (2020). https://doi.org/10.1007/s00330-019-06337-y

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  • DOI: https://doi.org/10.1007/s00330-019-06337-y

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