Clinical implementation of contrast-enhanced four-dimensional dual-energy computed tomography for target delineation of pancreatic cancer

Publication date: Available online 6 February 2018
Source:Radiotherapy and Oncology
Author(s): Shingo Ohira, Kentaro Wada, Takero Hirata, Naoyuki Kanayama, Toshiki Ikawa, Tsukasa Karino, Yuya Nitta, Masaru Isono, Yoshihiro Ueda, Masayoshi Miyazaki, Masahiko Koizumi, Teruki Teshima
Background and purposeThe accurate delineation of pancreatic tumor with respiratory motion is challenging. This study demonstrates the application of contrast-enhanced four-dimensional dual-energy computed tomography (CE-4D-DECT) for tumor delineation and assesses the objective and subjective image quality.Material and methodsTwelve patients underwent CE-4D-DECT, and quantitative spectral analysis was performed on the resulting virtual monochromatic images (VMI) to determine the optimal VMI (O-VMI) with the highest contrast-to-noise ratio (CNR). The objective value of the CNR between pancreatic parenchyma and tumor, and the subjective measurement with five-point scale were compared between O-VMI, standard VMI (S-VMI, 77 keV) and single energy CT (SECT, 120 kVp).ResultsThe CNR was the highest in the VMI at 60 keV, and the corresponding CNR in the O-VMI (3.4) was significantly higher (p < 0.05) than that in the S-VMI (2.4) and the SECT (2.7). The overall mean subjective measurements among 4 radiation oncologists were higher for the O-VMI over the S-VMI and SECT with respect to overall image quality (4.0, 3.3 and 3.7, respectively), tumor enhancement (3.4, 2.6 and 3.2, respectively), and vessel delineation (4.2, 3.6 and 4.2, respectively).ConclusionsThe O-VMI derived from the CE-4D-DECT demonstrated its superiority over the S-VMI and SECT in depicting pancreatic tumor.



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