Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: evaluation of CT severity index, interobserver agreement and radiation dose

Publication

Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: evaluation of CT severity index, interobserver agreement and radiation dose

Journal Paper/Review - Jul 17, 2014

Wichmann Julian L, Vogl Thomas J, Hammerstingl Renate, Gruber-Rouh Tatjana, Kerl J Matthias, Bauer Ralf, Wesarg Stefan, Schulz Boris, Kromen Wolfgang, Beeres Martin, Majenka Pawel, Lehnert Thomas

Citation

Wichmann J, Vogl T, Hammerstingl R, Gruber-Rouh T, Kerl J, Bauer R, Wesarg S, Schulz B, Kromen W, Beeres M, Majenka P, Lehnert T. Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: evaluation of CT severity index, interobserver agreement and radiation dose. Eur Radiol 2014; 24:2927-35.

Type

Journal Paper/Review (English)

Journal

Eur Radiol 2014; 24

Publication Date

Jul 17, 2014

Issn Electronic

1432-1084

Pages

2927-35

Brief description/objective

OBJECTIVES
To intra-individually compare single-portal-phase low-tube-voltage (100-kVp) computed tomography (CT) with 120-kVp images for short-term follow-up assessment of CT severity index (CTSI) of acute pancreatitis, interobserver agreement and radiation dose.

METHODS
We retrospectively analysed 66 patients with acute pancreatitis who underwent initial dual-contrast-phase CT (unenhanced, arterial, portal phase) at admission and short-term (mean interval 11.4 days) follow-up dual-contrast-phase dual-energy CT. The 100-kVp and linearly blended images representing 120-kVp acquisition follow-up CT images were independently evaluated by three radiologists using a modified CTSI assessing pancreatic inflammation, necrosis and extrapancreatic complications. Scores were compared with paired t test and interobserver agreement was evaluated using intraclass correlation coefficients (ICC).

RESULTS
Mean CTSI scores on unenhanced, portal- and dual-contrast-phase images were 4.9, 6.1 and 6.2 (120 kVp) and 5.0, 6.0 and 6.1 (100 kVp), respectively. Contrast-enhanced series showed a higher CTSI compared to unenhanced images (P < 0.05) but no significant differences between single- and dual-contrast-phase series (P > 0.7). CTSI scores were comparable for 100-kVp and 120-kVp images (P > 0.05). Interobserver agreement was substantial for all evaluated series and subcategories (ICC 0.67-0.93). DLP of single-portal-phase 100-kVp images was reduced by 41 % compared to 120-kVp images (363.8 versus 615.9 mGy cm).

CONCLUSIONS
Low-tube-voltage single-phase 100-kVp CT provides sufficient information for follow-up evaluation of acute pancreatitis and significantly reduces radiation exposure.

KEY POINTS
• Single-portal-phase CT provides sufficient evaluation for follow-up of acute pancreatitis. • Follow-up CT does not benefit from unenhanced or arterial-phase acquisition. • CT severity index scores are equal for dual-contrast-phase 100-/120-kVp acquisition (P > 0.05). • 100-kVp single-portal-phase follow-up CT of acute pancreatitis significantly reduces radiation exposure.