Abstract
BackgroundPancreatic ductal adenocarcinoma (PDAC) remains a malignancy with poor prognosis, appropriate surgical resection and neoadjuvant therapy depend on the accurate identification of pancreatic supplying arteries. We aim to evaluate the ability of monoenergetic images (MEI [+]) of dual-energy CT (DECT) to improve the visualization of pancreatic supplying arteries compared to conventional polyenergetic images (PEI) and investigate the implications of vascular variation in pancreatic surgery and transarterial interventions.ResultsOne hundred patients without pancreatic diseases underwent DECT examinations were retrospectively enrolled in this study. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at 40-keV MEI (+) were significantly higher than those of PEI (p < 0.05). All subjective MEI (+) scores were significantly higher than those of PEI (p < 0.05). The visualization rates were significantly higher for posterior superior pancreaticoduodenal artery (PSPDA), anterior and posterior inferior pancreaticoduodenal artery (AIPDA, PIPDA), anterior and posterior pancreaticoduodenal arcade (APAC, PPAC), transverse and caudal pancreatic artery (TPA, PCA) at 40-keV MEI (+) than those of PEI (p < 0.05). However, there were no significant differences for visualizing anterior superior pancreaticoduodenal artery (ASPDA), inferior pancreaticoduodenal artery (IPDA), dorsal and magnificent pancreatic artery (DPA, MPA) between 40-keV MEI (+) and PEI (p > 0.05). Four types of variations were observed in the origin of DPA and three to five types in the origin of PSPDA, AIPDA and PIPDA.Conclusions40-keV MEI (+) of DECT improves the visualization and objective and subjective image quality of pancreatic supplying arteries compared to PEI. Pancreatic supplying arteries have great variations, which has important implications for preoperative planning of technically challenging surgeries and transarterial interventions.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer deaths in the USA, with an overall survival rate of 6–7% [1, 2]
Objective image parameters 40-keV MEI (+) significantly improved the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the Gastroduodenal artery (GDA), anterior superior pancreaticoduodenal artery (ASPDA), and Dorsal pancreatic artery (DPA) compared with the polyenergetic images (PEI) (p < 0.05)
For all vessels analyses, compared with PEI, the CNR and SNR of the GDA obtained at 40-keV MEI (+) increased by 60.03% and 50.76%, respectively (p < 0.001)
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer deaths in the USA, with an overall survival rate of 6–7% [1, 2]. Appropriate surgical resections and local arterial interventions depend on a comprehensive understanding of pancreatic supplying arteries and their variations. MEI (+) approximates the image obtained by monoenergetic X-rays, in which iodine attenuation increases as the energy approximates the iodine k-edge (33.2 keV), so as to acquire higher vessel contrast [3, 13]. Pancreatic ductal adenocarcinoma (PDAC) remains a malignancy with poor prognosis, appropriate surgical resection and neoadjuvant therapy depend on the accurate identification of pancreatic supplying arteries. We aim to evaluate the ability of monoenergetic images (MEI [+]) of dual-energy CT (DECT) to improve the visualization of pancreatic supplying arteries compared to conventional polyenergetic images (PEI) and investigate the implica‐ tions of vascular variation in pancreatic surgery and transarterial interventions
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