Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma

ObjectivesThe aim of this study was to assess the objective and subjective image characteristics of monoenergetic images (MEI[+]), using a noise-optimized algorithm at different kiloelectron volts (keV) compared to polyenergetic images (PEI), in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsThis retrospective, institutional review board-approved study included 45 patients (18 male, 27 female; mean age 66years; range, 42-96years) with PDAC who had undergone a dual-energy CT (DECT) of the abdomen for staging. One standard polyenergetic image (PEI) and five MEI(+) images in 10-keV intervals, ranging from 40 to 80keV, were reconstructed. Line-density profile analysis, as well as the contrast-to-noise ratio (CNR) of the tumor, the signal-to-noise ratio (SNR) of the regular pancreas parenchyma and the tumor, and the CNR of the three main peripancreatic vessels, was calculated. For subjective quality assessment, two readers independently assessed the images using a 5-point Likert scale. Reader reliability was evaluated using an intraclass correlation coefficient.ResultsLine-density profile analysis revealed the largest gradient in attenuation between PDAC and regular tissue in MEI(+) at 40keV. Low-keV MEI(+)reconstructions at 40 and 50keV increased CNR and SNR compared to PEI (40keV: CNR 46.8 vs. 7.5; SNRPankreas 32.5 vs. 15.7; SNRLesion 13.5 vs. 8.6; p<0.001). MEI(+) at 40keV and 50keV were consistently preferred by the observers (p<0.05), showing a high intra-observer 0.937 (0.92-0.95) and inter-observer 0.911 (0.89-0.93) agreement.ConclusionMEI(+) reconstructions at 40keV and 50keV provide better objective and subjective image quality compared to conventional PEI of DECT in patients with PDAC.Key Points center dot Low-keV MEI(+) reconstructions at 40 and 50keV increase tumor-to-pancreas contrast compared to PEI.center dot Low-keV MEI(+) reconstructions improve objective and subjective image quality parameters compared to PEI.center dot Dual-energy post-processing might be a valuable tool in the diagnostic workup of patients with PDAC.