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

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

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.

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Abbreviations

ANOVA:

Analysis of variance

ATCM:

Automatic tube current modulation

BMI:

Body mass index

CA:

Coeliac axis

CM:

Contrast medium

CNR:

Contrast-to-noise ratio

CTDIvol:

Volume dose index CT

DLP:

Dose length product

ED:

Effective dose

FOM:

Figure of merit

I:

Iodine

kV:

Kilovolt

MDCT:

Multidetector computed tomography

MTB:

Multidisciplinary tumour board

NCP:

Non-contrast phase

PDAC:

Pancreatic ductal adenocarcinoma

PPP:

Pancreatic parenchymal phase

PPV:

Positive predictive value

PVP:

Portal venous phase

ROI:

Region of interest

SD:

Standard deviation

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Acknowledgments

The authors would like to thank the research nurses G. Gagnö and B. Holmberg for their contributions in patient recruitment, the CT technologist N. Jallo and the physicist J. Holm for their contributions in imaging acquisition as well as the biostatistician P. Näsman for his contributions to the statistical analysis. The scientific guarantor of this publication is Nikolaos Kartalis, M.D., Ph.D., Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Per Näsman kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: prospective, randomised diagnostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden

    L. Loizou, N. Albiin, B. Leidner, E. Axelsson, M. A. Fischer, A. Grigoriadis & N. Kartalis

  2. Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    L. Loizou, B. Leidner, E. Axelsson, M. A. Fischer, A. Grigoriadis & N. Kartalis

  3. Department of Radiology, Ersta Hospital, 11691, Stockholm, Sweden

    N. Albiin

  4. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    M. Del Chiaro & R. Segersvärd

  5. Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    C. Verbeke

  6. Department of Surgical Sciences, Division of Radiology, Uppsala University and Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden

    A. Sundin

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  1. L. Loizou
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  2. N. Albiin
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  3. B. Leidner
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  10. A. Sundin
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Correspondence to L. Loizou.

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Loizou, L., Albiin, N., Leidner, B. et al. Multidetector CT of pancreatic ductal adenocarcinoma: Effect of tube voltage and iodine load on tumour conspicuity and image quality. Eur Radiol 26, 4021–4029 (2016). https://doi.org/10.1007/s00330-016-4273-y

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  • DOI: https://doi.org/10.1007/s00330-016-4273-y

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