Multidetector CT of pancreatic ductal adenocarcinoma: Effect of tube voltage and iodine load on tumour conspicuity and image quality

• Published in: European radiology Vol. 26; no. 11; pp. 4021 - 4029
• Main Authors: Loizou, L., Albiin, N., Leidner, B., Axelsson, E., Fischer, M. A., Grigoriadis, A., Del Chiaro, M., Segersvärd, R., Verbeke, C., Sundin, A., Kartalis, N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2016; Springer Nature B.V
• Subjects: Aged; Carcinoma, Pancreatic Ductal - diagnostic imaging; Computed Tomography; Contrast Media - pharmacokinetics; Diagnostic Radiology; Female; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Iodine; Iopamidol - analogs & derivatives; Iopamidol - pharmacokinetics; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Multidetector Computed Tomography - methods; Neuroradiology; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Prospective Studies; Radiation; Radiation Dosage; Radiographic Image Enhancement - methods; Radiographic Image Interpretation, Computer-Assisted - methods; Radiology; Reproducibility of Results; Tomography; Triiodobenzoic Acids - pharmacokinetics; Ultrasound; Sweden; Pancreatic neoplasm; Image enhancement; Contrast media; Radiation dosage; Multidetector computed tomography
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-016-4273-y

Objectives To compare a low-tube-voltage with or without high-iodine-load multidetector CT (MDCT) protocol with a normal-tube-voltage, normal-iodine-load (standard) protocol in patients with pancreatic ductal adenocarcinoma (PDAC) with respect to tumour conspicuity and image quality. Methods Thirty consecutive patients (mean age: 66 years, men/women: 14/16) preoperatively underwent triple-phase 64-channel MDCT examinations twice according to: (i) 120-kV standard protocol (PS; 0.75 g iodine (I)/kg body weight, n = 30) and (ii) 80-kV protocol A (PA; 0.75 g I/kg, n = 14) or protocol B (PB; 1 g I/kg, n = 16). Two independent readers evaluated tumour delineation and image quality blindly for all protocols. A third reader estimated the pancreas-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test. Results Tumour delineation was significantly better in PB and PA compared with PS ( P  = 0.02). The evaluation of image quality was similar for the three protocols (all, P  > 0.05). The highest CNR was observed with PB and was significantly better compared to PA ( P  = 0.02) and PS ( P  = 0.0002). Conclusion In patients with PDAC, a low-tube-voltage, high-iodine-load protocol improves tumour delineation and CNR leading to higher tumour conspicuity compared to standard protocol MDCT. Key Points • Low-tube-voltage high-iodine-load MDCT improves pancreatic cancer conspicuity compared to a standard protocol. • The pancreas-to-tumour attenuation difference increases significantly by reducing the tube voltage. • The radiation exposure dose decreases by reducing the tube voltage.