Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Radiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, 10330, Thailand.
Abdom Radiol (NY). 2024 Oct;49(10):3496-3506. doi: 10.1007/s00261-024-04451-0. Epub 2024 Jun 25.
To assess the value of material density (MD) images generated from a rapid kilovoltage-switching dual-energy CT (rsDECT) in early detection of peritoneal carcinomatosis (PC).
Thirty patients (60 ± 13 years; 24 women) with PC detected on multiple abdominal DECT scans were included. Four separate DECTs with varying findings of PC from each patient were used for qualitative/quantitative analysis, resulting in a total of 120 DECT scans (n = 30 × 4). Three radiologists independently reviewed DECT images (65 keV alone and 65 keV + MD) for diagnosis of PC (diagnostic confidence, lesion conspicuity, sharpness/delineation and image quality) using a 5-point Likert scale. Quantitative estimation of contrast-to-noise ratio (CNR) was done. Wilcoxon signed-rank test and Odds ratio calculation were used to compare between the two protocols. Inter-observer agreement was evaluated using Kappa coefficient analysis. P values < 0.05 were considered statistically significant.
65 keV + MD images showed a slightly higher sensitivity (89%[95%CI:84,92]) for PC detection compared with 65 keV images alone without statistical significance (84%[95%CI:78,88], p = 0.11) with the experienced reader showing significant improvement (98%[95%CI:93,100] vs. 90%[95%CI:83,94], p = 0.02). On a per-patient basis, use of MD images allowed earlier diagnosis for PC in an additional 13-23% of patients. On sub-group analysis, earlier diagnosis of PC was particularly beneficial in patients with BMI ≤ 29.9 kg/m. 65 keV + MD images showed higher diagnostic confidence, lesion conspicuity, and lesion sharpness for the experienced reader (p < 0.001). CNR was higher in MD images (1.7 ± 0.5) than 65 keV images (0.1 ± 0.02, p < 0.001). All readers showed moderate interobserver agreement for determining PC by both protocols (κ = 0.58 and κ = 0.47).
MD images allow earlier and improved detection of PC with the degree of benefit varying based on reader experience and patient body habitus.
评估快速千伏切换双能 CT（rsDECT）生成的物质密度（MD）图像在早期检测腹膜癌（PC）中的价值。
纳入 30 名经多次腹部 DECT 扫描发现 PC 的患者（60±13 岁，24 名女性）。每位患者的 4 个不同的 DECT 扫描结果均有不同程度的 PC，共计 120 个 DECT 扫描（n=30×4）。3 名放射科医生分别对 DECT 图像（仅 65keV 和 65keV+MD）进行诊断，使用 5 分 Likert 量表评估 PC 的诊断信心、病灶显影、清晰度/描绘度和图像质量。使用对比噪声比（CNR）定量估计。使用 Wilcoxon 符号秩检验和计算比值比来比较两种方案。采用 Kappa 系数分析评估观察者间的一致性。p 值<0.05 为具有统计学意义。
65keV+MD 图像对 PC 的检测敏感性（89%[95%CI：84,92]）略高于仅 65keV 图像（84%[95%CI：78,88]），但差异无统计学意义（p=0.11），经验丰富的读者显示出显著改善（98%[95%CI：93,100] vs. 90%[95%CI：83,94]，p=0.02）。按患者个体分析，MD 图像可使额外 13%-23%的患者更早诊断出 PC。在亚组分析中，对于 BMI≤29.9kg/m 的患者，早期诊断 PC 尤其有益。65keV+MD 图像为经验丰富的读者提供了更高的诊断信心、病灶显影和病灶清晰度（p<0.001）。MD 图像的 CNR 高于 65keV 图像（1.7±0.5 比 0.1±0.02，p<0.001）。所有读者在两种方案下判断 PC 时均显示出中度观察者间一致性（κ=0.58 和 κ=0.47）。
MD 图像可更早、更准确地检测出 PC，受益程度取决于读者经验和患者体型。
