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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(02): 114-120
DOI: 10.1055/s-0042-1744494
Review Article

Dual-Energy CT in the Pancreas

Nayla Mroueh
1   Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Jinjin Cao 
1   Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Avinash Kambadakone
1   Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding None.
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Abstract

Dual-energy computed tomography (DECT) is an evolving imaging technology that is gaining popularity, particularly in different abdominopelvic applications. Essentially, DECT uses two energy spectra simultaneously to acquire CT attenuation data which is used to distinguish among structures with different tissue composition. The wide variety of reconstructed image data sets makes DECT especially attractive in pancreatic imaging. This article reviews the current literature on DECT as it applies to imaging the pancreas, focusing on pancreatitis, trauma, pancreatic ductal adenocarcinoma, and other solid and cystic neoplasms. The advantages of DECT over conventional CT are highlighted, including improved lesion detection, radiation dose reduction, and enhanced image contrast. Additionally, data exploring the ideal protocol for pancreatic imaging using DECT is reviewed. Finally, limitations of DECT in pancreatic imaging as well as recommendations for future research are provided.

Keywords

dual-energy CT - pancreas - pancreatic imaging


Publication History

Article published online:
05 May 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Graser A, Johnson TRC, Chandarana H, Macari M. Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur Radiol 2009; 19 (01) 13-23
    CrossrefPubMedSearch in Google Scholar
  • 2 Kelcz F, Joseph PM, Hilal SK. Noise considerations in dual energy CT scanning. Med Phys 1979; 6 (05) 418-425
    CrossrefPubMedSearch in Google Scholar
  • 3 George E, Wortman JR, Fulwadhva UP, Uyeda JW, Sodickson AD. Dual energy CT applications in pancreatic pathologies. Br J Radiol 2017; 90 (1080): 20170411
    CrossrefPubMedSearch in Google Scholar
  • 4 McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 2015; 276 (03) 637-653
    CrossrefPubMedSearch in Google Scholar
  • 5 Marin D, Boll DT, Mileto A, Nelson RC. State of the art: dual-energy CT of the abdomen. Radiology 2014; 271 (02) 327-342
    CrossrefPubMedSearch in Google Scholar
  • 6 Johnson TRC, Krauss B, Sedlmair M. et al. Material differentiation by dual energy CT: initial experience. Eur Radiol 2007; 17 (06) 1510-1517
    Search in Google Scholar
  • 7 Agostini A, Borgheresi A, Mari A. et al. Dual-energy CT: theoretical principles and clinical applications. Radiol Med (Torino) 2019; 124 (12) 1281-1295
    CrossrefPubMedSearch in Google Scholar
  • 8 Sun EX, Wortman JR, Uyeda JW, Lacson R, Sodickson AD. Virtual monoenergetic dual-energy CT for evaluation of hepatic and splenic lacerations. Emerg Radiol 2019; 26 (04) 419-425
    CrossrefPubMedSearch in Google Scholar
  • 9 Obmann MM, Punjabi G, Obmann VC. et al. Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2021;
    CrossrefPubMedSearch in Google Scholar
  • 10 McNamara MM, Little MD, Alexander LF, Carroll LV, Beasley TM, Morgan DE. 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 2015; 40 (05) 1230-1240
    CrossrefPubMedSearch in Google Scholar
  • 11 De Cecco CN, Darnell A, Macías N. et al. Virtual unenhanced images of the abdomen with second-generation dual-source dual-energy computed tomography: image quality and liver lesion detection. Invest Radiol 2013; 48 (01) 1-9
    CrossrefPubMedSearch in Google Scholar
  • 12 Mileto A, Mazziotti S, Gaeta M. et al. Pancreatic dual-source dual-energy CT: is it time to discard unenhanced imaging?. Clin Radiol 2012; 67 (04) 334-339
    CrossrefPubMedSearch in Google Scholar
  • 13 Kaufmann S, Sauter A, Spira D. et al. Tin-filter enhanced dual-energy-CT: image quality and accuracy of CT numbers in virtual noncontrast imaging. Acad Radiol 2013; 20 (05) 596-603
    CrossrefPubMedSearch in Google Scholar
  • 14 Yamada Y, Jinzaki M, Hosokawa T, Tanami Y, Abe T, Kuribayashi S. Abdominal CT: an intra-individual comparison between virtual monochromatic spectral and polychromatic 120-kVp images obtained during the same examination. Eur J Radiol 2014; 83 (10) 1715-1722
    CrossrefPubMedSearch in Google Scholar
  • 15 Gupta S, Wagner-Bartak N, Jensen CT. et al. Dual-energy CT of pancreatic adenocarcinoma: reproducibility of primary tumor measurements and assessment of tumor conspicuity and margin sharpness. Abdom Radiol (NY) 2016; 41 (07) 1317-1324
    CrossrefPubMedSearch in Google Scholar
  • 16 Yu L, Leng S, McCollough CH. Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 2012; 199 (5, Suppl): S9-S15
    CrossrefPubMedSearch in Google Scholar
  • 17 Patel BN, Alexander L, Allen B. et al. Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols. Abdom Radiol (NY) 2017; 42 (03) 676-687
    CrossrefPubMedSearch in Google Scholar
  • 18 Noda Y, Goshima S, Kaga T. et al. Virtual monochromatic image at lower energy level for assessing pancreatic ductal adenocarcinoma in fast kV-switching dual-energy CT. Clin Radiol 2020; 75 (04) 320.e17-320.e23
    CrossrefPubMedSearch in Google Scholar
  • 19 Tabari A, Gee MS, Singh R. et al. Reducing radiation dose and contrast medium volume with application of dual-energy CT in children and young adults. AJR Am J Roentgenol 2020; 214 (06) 1199-1205
    CrossrefPubMedSearch in Google Scholar
  • 20 Noda Y, Tochigi T, Parakh A, Joseph E, Hahn PF, Kambadakone A. Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity. Eur Radiol 2021; 31 (09) 6898-6908
    CrossrefPubMedSearch in Google Scholar
  • 21 Martin SS, Trapp F, Wichmann JL. et al. Dual-energy CT in early acute pancreatitis: improved detection using iodine quantification. Eur Radiol 2019; 29 (05) 2226-2232
    CrossrefPubMedSearch in Google Scholar
  • 22 Dar G, Goldberg SN, Hiller N. et al. CT severity indices derived from low monoenergetic images at dual-energy CT may improve prediction of outcome in acute pancreatitis. Eur Radiol 2021; 31 (07) 4710-4719
    CrossrefPubMedSearch in Google Scholar
  • 23 Yuan Y, Huang ZX, Li ZL, Bin S, Deng LP. Dual-source dual-energy computed tomography imaging of acute necrotizing pancreatitis–preliminary study [in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban 2011; 42 (05) 691-694
    PubMedSearch in Google Scholar
  • 24 Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S. Dual-energy CT in evaluation of the acute abdomen. Radiographics 2019; 39 (01) 264-286
    CrossrefPubMedSearch in Google Scholar
  • 25 Wang GJ, Gao CF, Wei D, Wang C, Ding SQ. Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol 2009; 15 (12) 1427-1430
    CrossrefPubMedSearch in Google Scholar
  • 26 Uyeda JW, Richardson IJ, Sodickson AD. Making the invisible visible: improving conspicuity of noncalcified gallstones using dual-energy CT. Abdom Radiol (NY) 2017; 42 (12) 2933-2939
    CrossrefPubMedSearch in Google Scholar
  • 27 Yang CB, Zhang S, Jia YJ. et al. Clinical application of dual-energy spectral computed tomography in detecting cholesterol gallstones from surrounding bile. Acad Radiol 2017; 24 (04) 478-482
    CrossrefPubMedSearch in Google Scholar
  • 28 Li H, He D, Lao Q. et al. Clinical value of spectral CT in diagnosis of negative gallstones and common bile duct stones. Abdom Imaging 2015; 40 (06) 1587-1594
    CrossrefPubMedSearch in Google Scholar
  • 29 Yin Q, Zou X, Zai X. et al. Pancreatic ductal adenocarcinoma and chronic mass-forming pancreatitis: differentiation with dual-energy MDCT in spectral imaging mode. Eur J Radiol 2015; 84 (12) 2470-2476
    CrossrefPubMedSearch in Google Scholar
  • 30 Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K. Pancreatic trauma: a concise review. World J Gastroenterol 2013; 19 (47) 9003-9011
    CrossrefPubMedSearch in Google Scholar
  • 31 Goshima S, Kanematsu M, Kondo H. et al. Pancreas: optimal scan delay for contrast-enhanced multi-detector row CT. Radiology 2006; 241 (01) 167-174
    CrossrefPubMedSearch in Google Scholar
  • 32 Rekhi S, Anderson SW, Rhea JT, Soto JA. Imaging of blunt pancreatic trauma. Emerg Radiol 2010; 17 (01) 13-19
    CrossrefPubMedSearch in Google Scholar
  • 33 Sugrue G, Walsh JP, Zhang Y. et al. Virtual monochromatic reconstructions of dual energy CT in abdominal trauma: optimization of energy level improves pancreas laceration conspicuity and diagnostic confidence. Emerg Radiol 2021; 28 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 34 Leng S, Yu L, Fletcher JG, McCollough CH. Maximizing iodine contrast-to-noise ratios in abdominal CT imaging through use of energy domain noise reduction and virtual monoenergetic dual-energy CT. Radiology 2015; 276 (02) 562-570
    CrossrefPubMedSearch in Google Scholar
  • 35 Wortman JR, Uyeda JW, Fulwadhva UP, Sodickson AD. Dual-energy CT for abdominal and pelvic trauma. Radiographics 2018; 38 (02) 586-602
    CrossrefPubMedSearch in Google Scholar
  • 36 Vlahos I, Chung R, Nair A, Morgan R. Dual-energy CT: vascular applications. AJR Am J Roentgenol 2012; 199 (5, Suppl): S87-S97
    CrossrefPubMedSearch in Google Scholar
  • 37 Mongan J, Rathnayake S, Fu Y, Gao DW, Yeh BM. Extravasated contrast material in penetrating abdominopelvic trauma: dual-contrast dual-energy CT for improved diagnosis–preliminary results in an animal model. Radiology 2013; 268 (03) 738-742
    CrossrefPubMedSearch in Google Scholar
  • 38 Adamska A, Domenichini A, Falasca M. Pancreatic ductal adenocarcinoma: current and evolving therapies. Int J Mol Sci 2017; 18 (07) E1338
    CrossrefPubMedSearch in Google Scholar
  • 39 McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018; 24 (43) 4846-4861
    Search in Google Scholar
  • 40 Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey Jr RB. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002; 224 (03) 764-768
    CrossrefPubMedSearch in Google Scholar
  • 41 Patel BN, Thomas JV, Lockhart ME, Berland LL, Morgan DE. Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: optimization of energy level viewing significantly increases lesion contrast. Clin Radiol 2013; 68 (02) 148-154
    CrossrefPubMedSearch in Google Scholar
  • 42 Noda Y, Tochigi T, Parakh A, Kambadakone A. Simulated twin-phase pancreatic CT generated using single portal venous phase dual-energy CT acquisition in pancreatic ductal adenocarcinoma. Abdom Radiol (NY) 2021; 46 (06) 2610-2619
    CrossrefPubMedSearch in Google Scholar
  • 43 Bhosale P, Le O, Balachandran A, Fox P, Paulson E, Tamm E. 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 2015; 39 (06) 907-913
    CrossrefPubMedSearch in Google Scholar
  • 44 Chu AJ, Lee JM, Lee YJ, Moon SK, Han JK, Choi BI. Dual-source, dual-energy multidetector CT for the evaluation of pancreatic tumours. Br J Radiol 2012; 85 (1018): e891-e898
    CrossrefPubMedSearch in Google Scholar
  • 45 Noda Y, Goshima S, Miyoshi T. et al. Assessing chemotherapeutic response in pancreatic ductal adenocarcinoma: histogram analysis of iodine concentration and CT number in single-source dual-energy CT. AJR Am J Roentgenol 2018; 211 (06) 1221-1226
    CrossrefPubMedSearch in Google Scholar
  • 46 Pessis E, Campagna R, Sverzut JM. et al. Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics 2013; 33 (02) 573-583
    Search in Google Scholar
  • 47 Li H-ou, Guo J, Sun C. et al. Assessment of pancreatic adenocarcinoma: use of low-dose whole pancreatic CT perfusion and individualized dual-energy CT scanning. J Med Imaging Radiat Oncol 2015; 59 (05) 590-598
    CrossrefPubMedSearch in Google Scholar
  • 48 Klauss M, Stiller W, Pahn G. et al. Dual-energy perfusion-CT of pancreatic adenocarcinoma. Eur J Radiol 2013; 82 (02) 208-214
    CrossrefPubMedSearch in Google Scholar
  • 49 Li C, Lin X, Hui C, Lam KM, Zhang S. Computer-aided diagnosis for distinguishing pancreatic mucinous cystic neoplasms from serous oligocystic adenomas in spectral CT images. Technol Cancer Res Treat 2016; 15 (01) 44-54
    CrossrefPubMedSearch in Google Scholar
  • 50 Lee L, Ito T, Jensen RT. Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies. Expert Rev Anticancer Ther 2018; 18 (09) 837-860
    CrossrefPubMedSearch in Google Scholar
  • 51 Lin XZ, Wu ZY, Tao R. et al. Dual energy spectral CT imaging of insulinoma-Value in preoperative diagnosis compared with conventional multi-detector CT. Eur J Radiol 2012; 81 (10) 2487-2494
    CrossrefPubMedSearch in Google Scholar
  • 52 Hardie AD, Picard MM, Camp ER. et al. 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 2015; 39 (05) 716-720
    CrossrefPubMedSearch in Google Scholar
  • 53 Böning G, Feldhaus F, Adelt S, Kahn J, Fehrenbach U, Streitparth F. Clinical routine use of virtual monochromatic datasets based on spectral CT in patients with hypervascularized abdominal tumors - evaluation of effectiveness and efficiency. Acta Radiol 2019; 60 (04) 425-432
    CrossrefPubMedSearch in Google Scholar