Abstract

BackgroundThis study was performed to assess whether iterative reconstruction can reduce radiation dose while maintaining acceptable image quality, and to investigate whether perfusion parameters vary from conventional filtered back projection (FBP) at the low-tube-voltage (80-kVp) during whole-pancreas perfusion examination using a 256-slice CT.Methods76 patients with known or suspected pancreatic mass underwent whole-pancreas perfusion by a 256-slice CT. High- and low-tube-voltage CT images were acquired. 120-kVp image data (protocol A) and 80-kVp image data (protocol B) were reconstructed with conventional FBP, and 80-kVp image data were reconstructed with iDose4 (protocol C) iterative reconstruction. The image noise; contrast-to-noise ratio (CNR) relative to muscle for the pancreas, liver, and aorta; and radiation dose of each protocol were assessed quantitatively. Overall image quality was assessed qualitatively. Among 76 patients, 23 were eventually proven to have a normal pancreas. Perfusion parameters of normal pancreas in each protocol including blood volume, blood flow, and permeability-surface area product were measured.ResultsIn the quantitative study, protocol C reduced image noise by 36.8% compared to protocol B (P<0.001). Protocol C yielded significantly higher CNR relative to muscle for the aorta, pancreas and liver compared to protocol B (P<0.001), and offered no significant difference compared to protocol A. In the qualitative study, protocols C and A gained similar scores and protocol B gained the lowest score for overall image quality (P<0.001). Mean effective doses were 23.37 mSv for protocol A and 10.81 mSv for protocols B and C. There were no significant differences in the normal pancreas perfusion values among three different protocols.ConclusionLow-tube-voltage and iDose4 iterative reconstruction can dramatically decrease the radiation dose with acceptable image quality during whole-pancreas CT perfusion and have no significant impact on the perfusion parameters of normal pancreas compared to the conventional FBP reconstruction using a 256-slice CT scanner.

Highlights

  • CT perfusion studies can provide anatomical and hemodynamic information of the tissues

  • Some small sample studies have been conducted to investigate the usefulness of CT perfusion in differentiating the diseased tissue in pancreatic adenocarcinoma, pancreatic endocrine tumors and pancreatitis from normal pancreatic tissue [2,3]

  • With the development of CT scanner, large axial field of detectors can provide up to 16 cm of imaging area for perfusion studies and make the whole-organ perfusion possible. This technique allows the acquisition of perfusion parameters and conventional multiphasic scanning images at the same time

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Summary

Introduction

CT perfusion studies can provide anatomical and hemodynamic information of the tissues. Miles et al [1] for the first time applied this technique in pancreas and described the major advantages of combining perfusion information and anatomical details in 1995. With the development of CT scanner, large axial field of detectors can provide up to 16 cm of imaging area for perfusion studies and make the whole-organ perfusion possible. This technique allows the acquisition of perfusion parameters and conventional multiphasic scanning images at the same time. This study was performed to assess whether iterative reconstruction can reduce radiation dose while maintaining acceptable image quality, and to investigate whether perfusion parameters vary from conventional filtered back projection (FBP) at the low-tube-voltage (80-kVp) during whole-pancreas perfusion examination using a 256-slice CT

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