Value of spectral detector computed tomography for assessment of pancreatic lesions

Purpose: Dual energy CT (DECT) can contribute to the diagnosis of benign and malignant pancreatic lesions. This study examined whether a novel, detector-based spectral CT scanner (SDCT) may improve subjective assessment of different types of pancreatic lesions and if various quantitative maps may improve lesion contrast and differentiation.

Materials and methods: 61 consecutive patients who underwent clinical, contrast-agent enhanced, abdominal SDCT scans and showed pancreatic lesions of different origins were included. Subjective image analysis was performed by two readers who assessed image quality, lesion conspicuity and diagnostic confidence on 5-point Likert scales for conventional polyenergetic reconstructions (polyE), virtual monoenergetic images (monoE), virtual non-contrast images, iodine density, iodine overlay, and Z effective (Z_eff) maps. Two readers acquired quantitative values from these maps ROI-based from which contrast-to-noise and lesion-to-parenchyma ratios were calculated.

Results: MonoE images at low keV levels yielded highest Likert scores regarding lesion conspicuity and reader confidence; iodine overlays facilitated lesion delineation. Inter-observer agreement ranged between substantial and excellent (kappa values 0.73-0.81). Contrast-to-noise-ratios for low keV monoE images were significantly higher, compared to polyE images (e.g. monoE 40 keV p < 0.0001). Marked overlap between PDAC and miscellaneous non-PDAC lesions was present in various spectral reconstructions.

Conclusions: In line with previous studies, monoE images at low keV levels and iodine overlay maps facilitated subjective lesion delineation which was substantiated by the quantitative analysis. Hence, spectral detector CT improves pancreatic lesion conspicuity, while its value for lesion differentiation needs to be further evaluated in larger study cohorts.