Dual-energy perfusion-CT of pancreatic adenocarcinoma

Purpose: To evaluate the feasibility of dual-energy CT (DECT)-perfusion of pancreatic carcinomas for assessing the differences in perfusion, permeability and blood volume of healthy pancreatic tissue and histopathologically confirmed solid pancreatic carcinoma. Materials and methods: 24 patients with histologically proven pancreatic carcinoma were examined prospectively with a 64-slice dual source CT using a dynamic sequence of 34 dual-energy (DE) acquisitions every 1.5 s (80 ml of iodinated contrast material, 370 mg/ml, flow rate 5 ml/s). 80 kVp, 140 kVp, and weighted average (linearly blended M0.3) 120 kVp-equivalent dual-energy perfusion image data sets were evaluated with a body-perfusion CT tool (Body-PCT, Siemens Medical Solutions, Erlangen, Germany) for estimating perfusion, permeability, and blood volume values. Color-coded parameter maps were generated. Results: In all 24 patients dual-energy CT-perfusion was. All carcinomas could be identified in the color-coded perfusion maps. Calculated perfusion, permeability and blood volume values were significantly lower in pancreatic carcinomas compared to healthy pancreatic tissue. Weighted average 120 kVp-equivalent perfusion-, permeability- and blood volume-values determined from DE image data were 0.27 ± 0.04 min−1 vs. 0.91 ± 0.04 min−1 (p < 0.0001), 0.5 ± 0.07 *0.5 min−1 vs. 0.67 ± 0.05 *0.5 min−1 (p = 0.06) and 0.49 ± 0.07 min−1 vs. 1.28 ± 0.11 min−1 (p < 0.0001). Compared with 80 and 140 kVp the standard deviations of the kVp120 kVp-equivalent values were manifestly smaller. Conclusion: Dual-energy CT-perfusion of the pancreas is feasible. The use of DECT improves the accuracy of CT-perfusion of the pancreas by fully exploiting the advantages of enhanced iodine contrast at 80 kVp in combination with the noise reduction at 140 kVp. Therefore using dual-energy perfusion data could improve the delineation of pancreatic carcinomas