Lower energy levels and iodine-based material decomposition images increase pancreatic ductal adenocarcinoma conspicuity on rapid kV-switching dual-energy CT

Aslan, Serdar; Çamlıdağ, İlkay; Nural, Mehmet Selim

doi:10.1007/s00261-018-1754-2

Cited by 10 publications

(12 citation statements)

References 16 publications

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“…Quantifying iodine amount provided indirect indication of the underlying tissue microvascular environment, which corresponded to the degree of tissue perfusion at a specific point in time, and thus reflected the vascularity within the tumor [ 24 ]. Aslan et al and McNamara et al have shown that the NIC of tumor was lower than that of pancreatic parenchyma [ 3 , 25 ]. However, the technique of this iodine quantification analysis was scantly applied in imaging of visually isoattenuating PDAC.…”

Section: Discussionmentioning

confidence: 99%

“…Multidetector computed tomography (MDCT) is the most broadly used and preferred modality for the detection of pancreatic ductal adenocarcinoma (PDAC) [1]. However, early diagnosis remains a challenge, especially for the visually isoattenuating PDAC, which the tumor attenuation on contrast-enhanced CT is indistinguishable from the parenchymal attenuation [2][3][4]. Moreover, PDAC usually shows infiltrating growth and blurry margins, making it hard to accurately measure tumor size [5].…”

Section: Introductionmentioning

confidence: 99%

“…Iodine maps are material decomposition images, which can quantitatively calculate the iodine concentration of the lesions [ 17 , 18 ]. This indicates that iodine maps may be helpful to detect visually isoattenuating PDAC [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma

et al. 2022

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Objectives To evaluate the value of monoenergetic images (MEI [+]) and iodine maps in dual-source dual-energy computed tomography (DECT) for assessing pancreatic ductal adenocarcinoma (PDAC), including the visually isoattenuating PDAC. Materials and methods This retrospective study included 75 PDAC patients, who underwent contrast-enhanced DECT examinations. Conventional polyenergetic image (PEI) and 40–80 keV MEI (+) (10-keV increments) were reconstructed. The tumor contrast, contrast-to-noise ratio (CNR) of the tumor and peripancreatic vessels, the signal-to-noise ratio (SNR) of the pancreas and tumor, and the tumor diameters were quantified. On iodine maps, the normalized iodine concentration (NIC) in the tumor and parenchyma was compared. For subjective analysis, two radiologists independently evaluated images on a 5-point scale. Results All the quantitative parameters were maximized at 40-keV MEI (+) and decreased gradually with increasing energy. The tumor contrast, SNR of pancreas and CNRs in 40–60 keV MEI (+) were significantly higher than those in PEI (p < 0.05). For visually isoattenuating PDAC, 40–50 keV MEI (+) provided significantly higher tumor CNR compared to PEI (p < 0.05). The reproducibility in tumor measurements was highest in 40-keV MEI (+) between the two radiologists. The tumor and parenchyma NIC were 1.28 ± 0.65 and 3.38 ± 0.72 mg/mL, respectively (p < 0.001). 40–50 keV MEI (+) provided the highest subjective scores, compared to PEI (p < 0.001). Conclusions Low-keV MEI (+) of DECT substantially improves the subjective and objective image quality and consistency of tumor measurements in patients with PDAC. Combining the low-keV MEI (+) and iodine maps may yield diagnostically adequate tumor conspicuity in visually isoattenuating PDAC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma

et al. 2022

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“…The monochromatic images are one of the main applications of DECT in pancreatic imaging: a virtual beam close to the k-edge of iodine significantly improves the contrast enhancement (40). In pancreatic CT, the monochromatic images at low keV (<65 keV) improved lesion detection and conspicuity of PDAC, in particular when compared to standard 120 kVp images (Figure 1) (43)(44)(45). Similarly low-voltage acquisitions, the visualization of pancreatic duct is improved with monochromatic images at low keV (Figure 2); this is valuable in chronic pancreatitis (46).…”

Section: Dual Energy Ct: Qualitative and Quantitative Evaluationsmentioning

confidence: 99%

New advances in CT imaging of pancreas diseases: a narrative review

et al. 2020

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Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the materialselective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.

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“…A large body of independent authors have shown an objective and subjective preference of low keV images for pancreatic applications [66][67][68][69]. Specifically, 50-55keV images show a high CNR between pancreatic tumor to parenchyma compared to conventional 120kVp images, decreasing the amount of contrast media required [66][67][68]70,71]. Low keV images have also been shown to improve detection of small and isoattenuating PDACs compared to conventional CT [72,71].…”

Section: Dual-energy Computerized Tomographymentioning

confidence: 99%

Advanced imaging techniques for chronic pancreatitis

Parakh

Tirkes

2019

Abdom Radiol

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MRI and MRCP play an important role in the diagnosis of chronic pancreatitis (CP) by imaging pancreatic parenchyma and ducts. MRI/MRCP is more widely used than computed tomography (CT) for mild to moderate CP due to its increased sensitivity for pancreatic ductal and gland changes; however, it does not detect the calcifications seen in advanced CP. Quantitative MR imaging offers potential advantages over conventional qualitative imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of detected changes. These techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in the diagnosis of chronic pancreatitis. Given the fact that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing an MRI/MRCP based, more robust diagnostic criteria combining ductal and parenchymal findings. Among cross-sectional imaging modalities, multi-detector CT (MDCT) has been a cornerstone for evaluating chronic pancreatitis (CP) since it is ubiquitous, assesses primary disease process, identifies complications like pseudocyst or vascular thrombosis with high sensitivity and specificity, guides therapeutic management decisions, and provides images with isotropic resolution within seconds. Conventional MDCT has certain limitations and is reserved to provide predominantly morphological (e.g. calcifications, organ size) rather than functional information. The emerging applications of radiomics and artificial intelligence is poised to extend the current capabilities of MDCT. In this review article, we will review advanced imaging techniques by MRI, MRCP, CT and ultrasound.Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1 (*)

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Lower energy levels and iodine-based material decomposition images increase pancreatic ductal adenocarcinoma conspicuity on rapid kV-switching dual-energy CT

Abstract: The use of low energy levels on rsDECT and iodine maps improves tumor conspicuity. This situation may be help better detection of pancreatic tumors.

Cited by 10 publications

References 16 publications

Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma

Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma

New advances in CT imaging of pancreas diseases: a narrative review

Advanced imaging techniques for chronic pancreatitis

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