Improved detectability of hypoattenuating focal pancreatic lesions by dual-layer computed tomography using virtual monoenergetic images

Background Multidetector CT is the mainstay for radiologic evaluation of pancreatic pathology. Still, imaging of focal pancreatic lesions using MDCT is faced by a number of challenges that are related to the limited contrast between the lesion and surrounding parenchyma, such as detecting early-stage pancreatic cancer and subtle features of cystic lesions that point to malignancy. Dual-layer CT is the first dual-energy CT machine based on separation of high- and low-energy photons at the detector level. If improved contrast between the lesions and normal pancreatic parenchyma could be achieved on CT images, we may expect enhanced CT detection of pancreatic lesions. The purpose of this study was to evaluate whether virtual monoenergetic reconstructions generated using contrast-enhanced dual-layer CT could improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions. Results Fifty-four lesions were identified and verified by histopathology or follow-up CT, MRCP, and/or EUS along with clinical data. Across the virtual monoenergetic spectrum, 40 KeV images had the highest contrast-to-noise and signal-to-noise ratios ( p < 0.001, p < 0.001) and were significantly higher than conventional images ( p < 0.001). Subjective scores for lesion visibility at low kiloelectron volt monoenergetic (40 and 50 KeV) images greatly exceeded conventional images ( p < 0.001). Conclusion Low kiloelectron volt monoenergetic reconstructions of contrast-enhanced dual-layer CT significantly improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions.