Pancreatic ductal adenocarcinoma and local staging with MDCT: Effect of tube voltage and iodine load on assessment of vascular involvement

Louiza Loizou, Bertil Leidner, Elisabet Axelsson, Marco Del Chiaro, Christoph Ansorge, Caroline Verbeke, Anders Sundin, Nikolaos Kartalis

Abstract


Purpose: In patients with pancreatic ductal adenocarcinoma (PDAC) a low-tube-voltage, high-iodine-load multidetector computed tomography (MDCT) protocol has been shown to increase tumour conspicuity compared to normal-tube-voltage, normal-iodine-load (standard) protocol. The aim of this study was to prospectively compare a low-tube-voltage with high- or normal-iodine-load MDCT protocol with a standard protocol regarding vascular involvement in patients with PDAC.

Material and Methods: Thirty consecutive patients (16 women-14 men; mean age 67 and 65 years, respectively) with PDAC, deemed primary resectable at the multidisciplinary board, underwent twice preoperative triple-phase MDCT according to: (i) 120-kV standard protocol (PS; 0.75g iodine (I)/kg body weight, n=30) and (ii) 80-kV protocol A (PA; 0.75g I/kg, n=14) or protocol B (PB; 1g I/kg, n=16). Two independent readers evaluated vascular involvement and accuracy per protocol was calculated. A third reader calculated the vessel-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test. Standard of reference was surgical and histopathological findings.

Results: For readers 1/2, the accuracy of PS, PA, and PB was 91/91, 92/94, and 92/90%, respectively (P>0.05). Compared to PS, PA and PB showed significantly higher artery-to-tumour CNR in the parenchymal phase (P=0.015 and 0.0016, respectively) and vein-to-tumour CNR in the portal-venous phase (both, P<0.001). PB had significantly higherartery-to-tumour CNR compared to PA in parenchymal phase (P=0.049).

Conclusions: In primary resectable PDAC, vascular involvement was assessed with similarly high accuracy with all protocols. Low-tube-voltage protocols, particularly with high-iodine-load, increase the vessels-to-tumour CNR compared to standard protocol and may prove beneficial in patients with locally advanced tumours where assessment of vascular invasion may be challenging.


Keywords


pancreatic neoplasm/ductal; tumour staging; multidetector CT/protocols; contrast media

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References


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