Dual-Layer Spectral CT of Pancreas Ductal Adenocarcinoma: Can Virtual Monoenergetic Images of the Portal Venous Phase Be an Alternative to the Pancreatic-Phase Scan?

Objectives: To determine the performance of virtual monoenergetic images (VMIs) of the portal venous phase (PVP) compared with the pancreatic-phase image for pancreatic ductal adenocarcinoma (PDAC) evaluation.

Materials and methods: This retrospective study enrolled 64 patients with PDAC who underwent pancreatic CT with dual-layer spectral CT between February 2018 and January 2020. A polychromatic pancreatic-phase image and VMIs at 40 (VMI₄₀), 55 (VMI₅₅), and 70 keV (VMI₇₀) of the PVP were generated. The tumor-to-pancreas contrast-to-noise ratio (CNR), attenuation difference, peripancreatic vascular signal-to-noise ratio (SNR), and CNR were compared among the four images. Subjective image analysis was performed for tumor conspicuity, heterogeneity, size, and arterial invasion.

Results: VMI₄₀ and VMI₅₅ demonstrated higher tumor-to-pancreas CNR, attenuation difference, and higher peripancreatic vascular CNR and SNR than the pancreatic-phase image and VMI₇₀ (p < .001). On subjective analysis, VMI₅₅ showed the best tumor conspicuity. Moreover, the inter-reader agreement for arterial invasion in VMIs from the PVP was not inferior to that in the pancreatic-phase image.

Conclusion: For evaluating PDAC, the VMI₅₅ of the PVP was superior to the pancreatic-phase image in terms of tumor conspicuity and peripancreatic vascular enhancement. Therefore, the VMI₅₅ of the PVP could be an alternative to the pancreatic-phase scan in patients suspicious of PDAC.