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Purpose <p>To evaluate image quality and diagnostic accuracy of photon-counting detector (PCD) CT for the detection of pancreatic cystic lesions (PCLs) compared to energy-integrating detector (EID) CT with MRI serving as reference standard.</p> Material and methods <p>We included consecutive patients who underwent contrast-enhanced PCD-CT of the abdomen and for whom an additional abdominal EID-CT was available. Multiparametric MRI served as the reference standard. CT images were assessed for the presence of PCLs by three radiologists independently in a blinded reading. Image quality, lesion conspicuity, and diagnostic confidence were rated on a 5-point Likert scale (5 = excellent). The coefficient of variation (CV) and the density difference between PCLs and visually normal pancreatic parenchyma were calculated as quantitative imaging measures. Radiation dose was assessed using CTDIvol [mGy].</p> Results <p>Among 106 included patients (age 62.7 ± 12.6&#xa0;years; 45 [42.5%] male), 46 had MRI-confirmed cystic lesions (mean size 8.7 ± 7.4&#xa0;mm; range 2–45&#xa0;mm). Diagnostic accuracy for PCLs was significantly higher for PCD-CT vs. EID-CT (area under the curve: 0.81 vs. 0.74; <i>p</i> = 0.002; sensitivity: 76.8% vs. 59.4%). Image quality, lesion conspicuity, and diagnostic confidence were rated superior for PCD-CT vs. EID-CT (all <i>p</i> &lt; 0.001). Quantitative analyses revealed a significantly lower CV (0.19 vs. 0.24; <i>p</i> = 0.002) and a higher density difference (94.1 HU vs. 76.6 HU <i>p</i> &lt; 0.001) between PCLs and visually normal pancreatic parenchyma at lower radiation doses (7.13 vs. 8.68&#xa0;mGy; <i>p</i> &lt; 0.001) for PCD-CT vs. EID-CT.</p> Conclusion <p>PCD-CT provided significantly higher diagnostic accuracy and superior image quality for the detection of PCLs compared to conventional EID-CT at lower radiation dose.</p>

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Simple cystic lesions of the pancreas: image quality and diagnostic accuracy of photon-counting detector computed tomography

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月21日

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  • Stephan Rau,
  • Thomas Stein,
  • Alexander Rau,
  • Caroline Wilpert,
  • Fabian Pallasch,
  • Balazs Bogner,
  • Sebastian Faby,
  • Fabian Bamberg,
  • Jakob Weiss

摘要

Purpose

To evaluate image quality and diagnostic accuracy of photon-counting detector (PCD) CT for the detection of pancreatic cystic lesions (PCLs) compared to energy-integrating detector (EID) CT with MRI serving as reference standard.

Material and methods

We included consecutive patients who underwent contrast-enhanced PCD-CT of the abdomen and for whom an additional abdominal EID-CT was available. Multiparametric MRI served as the reference standard. CT images were assessed for the presence of PCLs by three radiologists independently in a blinded reading. Image quality, lesion conspicuity, and diagnostic confidence were rated on a 5-point Likert scale (5 = excellent). The coefficient of variation (CV) and the density difference between PCLs and visually normal pancreatic parenchyma were calculated as quantitative imaging measures. Radiation dose was assessed using CTDIvol [mGy].

Results

Among 106 included patients (age 62.7 ± 12.6 years; 45 [42.5%] male), 46 had MRI-confirmed cystic lesions (mean size 8.7 ± 7.4 mm; range 2–45 mm). Diagnostic accuracy for PCLs was significantly higher for PCD-CT vs. EID-CT (area under the curve: 0.81 vs. 0.74; p = 0.002; sensitivity: 76.8% vs. 59.4%). Image quality, lesion conspicuity, and diagnostic confidence were rated superior for PCD-CT vs. EID-CT (all p < 0.001). Quantitative analyses revealed a significantly lower CV (0.19 vs. 0.24; p = 0.002) and a higher density difference (94.1 HU vs. 76.6 HU p < 0.001) between PCLs and visually normal pancreatic parenchyma at lower radiation doses (7.13 vs. 8.68 mGy; p < 0.001) for PCD-CT vs. EID-CT.

Conclusion

PCD-CT provided significantly higher diagnostic accuracy and superior image quality for the detection of PCLs compared to conventional EID-CT at lower radiation dose.