Yang Yanzhao, Zhu Naiyi, Lin Huimin, Xu Zhihan, Chang Rui, Chai Weimin, Yan Fuhua
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Siemens Healthineers CT Collaboration, Shanghai, China.
Eur J Radiol. 2025 Sep;190:112268. doi: 10.1016/j.ejrad.2025.112268. Epub 2025 Jun 27.
This study reports initial experience with a modified one-stop, multienergy pancreatic VPCT protocol using PCCT, designed for comprehensive morphologic analysis and functional perfusion assessment of pancreatic ductal adenocarcinoma (PDAC).
From April 2024 to October 2024, participants with suspected PDAC were prospectively enrolled and underwent preoperative pancreatic dynamic VPCT. Individual phase images were extracted from perfusion datasets using T3D, virtual monoenergetic images (VMIs) at 55 and 70 keV reconstruction for diagnostic interpretation. Diagnostic image quality was assessed both quantitatively and subjectively. Perfusion maps were generated for analysis. Perfusion parameters were compared between PDAC lesions and normal parenchyma, as well as among PDAC histopathological differentiation. Radiation doses were recorded.
A total of 65 participants (39 male; mean age, 66.2 ± 6.3 years) with histologically confirmed PDAC were included. The protocol achieved a mean effective radiation dose of 16.4 ± 4.5 mSv. All individual phase images met diagnostic quality standards (subjective scores ≥ 3). Among these, 55 keV VMIs demonstrated the highest CNR for PDAC lesions and adjacent vasculature, and superior subjective scores for lesion conspicuity in both pancreatic parenchymal and portal venous phases (all p < 0.05). Perfusion parameters, including blood flow (BF), blood volume (BV), time to drain (TTD), mean transit time, time to start, Tmax, and flow extraction product (FEP), differed significantly between PDAC lesions and normal parenchyma (all p < 0.05). Poorly differentiated PDAC lesions exhibited significantly lower BF, BV, TTD, and Tmax values and reduced lesion-to-parenchyma ratios of BF, BV, and FEP compared to moderately-to-well-differentiated PDAC lesions.
The one-stop, multienergy pancreatic VPCT protocol using PCCT enables high-quality morphologic imaging and reliable functional perfusion assessment at reduced radiation doses. It provides valuable insights into PDAC differentiation and histopathological grading, with potential implications for improved clinical management.
本研究报告了使用光子计数CT（PCCT）的改良一站式多能量胰腺虚拟胰腺CT（VPCT）方案的初步经验，该方案旨在对胰腺导管腺癌（PDAC）进行全面的形态学分析和功能灌注评估。
2024年4月至2024年10月，前瞻性纳入疑似PDAC的参与者，并在术前进行胰腺动态VPCT。使用T3D从灌注数据集中提取各个时相图像，重建55 keV和70 keV的虚拟单能量图像（VMIs）用于诊断解读。从定量和主观两方面评估诊断图像质量。生成灌注图进行分析。比较PDAC病变与正常实质之间以及不同PDAC组织病理学分化程度之间的灌注参数。记录辐射剂量。
共纳入65例经组织学证实为PDAC的参与者（39例男性；平均年龄66.2±6.3岁）。该方案的平均有效辐射剂量为16.4±4.5 mSv。所有个体时相图像均符合诊断质量标准（主观评分≥3）。其中，55 keV的VMIs对PDAC病变和相邻血管显示出最高的对比噪声比（CNR），并且在胰腺实质期和门静脉期对病变的显示具有更高的主观评分（所有p<0.05）。PDAC病变与正常实质之间的灌注参数，包括血流量（BF）、血容量（BV）、排泄时间（TTD）、平均通过时间、起始时间、Tmax和血流提取产物（FEP），差异均有统计学意义（所有p<0.05）。与中高分化的PDAC病变相比，低分化的PDAC病变表现出明显更低的BF、BV、TTD和Tmax值，并且BF、BV和FEP的病变与实质比值降低。
使用PCCT的一站式多能量胰腺VPCT方案能够在降低辐射剂量的情况下实现高质量的形态学成像和可靠的功能灌注评估。它为PDAC的分化和组织病理学分级提供了有价值的见解，对改善临床管理具有潜在意义。
