Pancreatic cancer detection with dual-energy CT: diagnostic performance of 40 keV and 70 keV virtual monoenergetic images,La radiologia medica

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Pancreatic cancer detection with dual-energy CT: diagnostic performance of 40 keV and 70 keV virtual monoenergetic images
La radiologia medica ( IF 8.9 ) Pub Date : 2024-03-21 , DOI: 10.1007/s11547-024-01806-x
Yoshifumi Noda , Tomohiro Ando , Tetsuro Kaga , Nao Yamda , Takuya Seko , Takuma Ishihara , Nobuyuki Kawai , Toshiharu Miyoshi , Akio Ito , Takuya Naruse , Fuminori Hyodo , Hiroki Kato , Avinash R. Kambadakone , Masayuki Matsuo

Purpose

To compare the diagnostic performance of 40 keV and 70 keV virtual monoenergetic images (VMIs) generated from dual-energy CT in the detection of pancreatic cancer.

Methods

This retrospective study included patients who underwent pancreatic protocol dual-energy CT from January 2019 to August 2022. Four radiologists (1–11 years of experience), who were blinded to the final diagnosis, independently and randomly interpreted 40 keV and 70 keV VMIs and graded the presence or absence of pancreatic cancer. For each image set (40 keV and 70 keV VMIs), the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The diagnostic performance of each image set was compared using generalized estimating equations.

Results

Overall, 137 patients (median age, 71 years; interquartile range, 63–78 years; 77 men) were included. Among them, 62 patients (45%) had pathologically proven pancreatic cancer. The 40 keV VMIs had higher specificity (75% vs. 67%; P < .001), PPV (76% vs. 71%; P < .001), and accuracy (85% vs. 81%; P = .001) than the 70 keV VMIs. On the contrary, 40 keV VMIs had lower sensitivity (96% vs. 98%; P = .02) and NPV (96% vs. 98%; P = .004) than 70 keV VMIs. However, the diagnostic confidence in patients with (P < .001) and without (P = .001) pancreatic cancer was improved in 40 keV VMIs than in 70 keV VMIs.

Conclusions

The 40 keV VMIs showed better diagnostic performance in diagnosing pancreatic cancer than the 70 keV VMIs, along with higher reader confidence.

中文翻译：

双能 CT 胰腺癌检测：40 keV 和 70 keV 虚拟单能图像的诊断性能

目的

比较双能 CT 生成的 40 keV 和 70 keV 虚拟单能图像 (VMI) 在胰腺癌检测中的诊断性能。

方法

这项回顾性研究纳入了 2019 年 1 月至 2022 年 8 月接受胰腺方案双能 CT 的患者。四位放射科医生（1-11 年经验）对最终诊断不知情，独立随机解释了 40 keV 和 70 keV VMI 和对是否存在胰腺癌进行分级。对于每个图像集（40 keV 和 70 keV VMI），计算灵敏度、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和准确性。使用广义估计方程比较每个图像集的诊断性能。

结果

总体而言，共纳入 137 名患者（中位年龄 71 岁；四分位数范围 63-78 岁；77 名男性）。其中，62名患者（45%）经病理证实患有胰腺癌。 40 keV VMI 具有更高的特异性（75% vs. 67%；P < .001）、PPV（76% vs. 71%；P < .001）和准确性（85% vs. 81%；P = .001 ））比 70 keV VMI 更好。相反，40 keV VMI 的灵敏度（96% vs. 98%；P = .02）和 NPV（96% vs. 98%；P = .004）低于 70 keV VMI。然而，40 keV VMI 中患有 ( P < .001) 和非 ( P = .001) 胰腺癌患者的诊断置信度比 70 keV VMI 有所提高。