Mono40 keV images provided the best pancreatic ductal adenocarcinoma conspicuity on PCCT in both arterial and portal venous phases.
Quantitatively, tumor-parenchyma attenuation difference and CNR were highest at 40 keV and decreased stepwise with rising keV.
Readers still preferred polyenergetic images for overall image quality and lowest perceived noise, despite better lesion conspicuity on low-keV VMI.
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Figure 4. PCCT images of the pancreas with a superior mesenteric artery encasing PDAC in arterial (A–C) and portal venous (D–F) contrast phase. A and D are polyenergetic reconstructions. B and E are monoenergetic reconstructions at 40 keV. C and F are monoenergetic reconstructions at 70 keV.
Source: Woeltjen et al., European Journal of Radiology, 2024
Protocol
Detail | Value |
|---|
Scanner | NAEOTOM Alpha |
Scan mode | QuantumPlus |
Tube voltage [kVp] | 120–140 |
Slice collimation | 144 × 0.4 mm |
Tube current modulation | CARE Dose4D |
IQ level | 170 |
Pitch | 0.8 |
Rotation time [s] | 0.5 |
CTDIvol [mGy] | 8.1 ± 2.5 mGy arterial 7.7 ± 1.9 mGy portal venous |
Doselength product [mGy*cm] | 209.8 ± 78.9 arterial 443.2 ± 149.5 portal venous |
Contrast agent | ACCUPAQUE 300 |
Contrast dose | 1 mL/kg |
Injection flow | 4 mL/s for initial diagnostic scans; 2.5 mL/s for follow-up venous-only scans |
Bolus trigger | ROI in descending aorta, threshold 100 |
Arterial delay | 7 s after threshold |
Venous delay | 60 s after threshold |
Post-processing software | Syngo.Via VB60 |
VMI range | 40–70 keV in 5 keV steps |
Polyenergetic kernel | Br36 |
Spectral | 40 keV images |
VMI kernel | Qr36 |
Iterative reconstruction | Quantum iterative reconstruction Q4 |
Slice thickness / increment | 1.0 mm / 0.6 mm |
Woeltjen MM, Niehoff JH, Roggel R, et al. Pancreatic cancer in photon-counting CT: Low keV virtual monoenergetic images improve tumor conspicuity. Eur J Radiol. 2024;173:111374.
