Nikhileswar Kondaveeti, Sharma Sanjay, Srivastava Deep Narayan, Sahni Peush, Das Prasenjit, Pandey Ravindra Mohan, Madhusudhan Kumble Seetharama
Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
Abdom Radiol (NY). 2025 Jul 11. doi: 10.1007/s00261-025-05111-7.
To compare the image quality, definition of vascular invasion and radiation dose of split bolus dual energy CT (DECT) with standard multiphase CT in biliary malignancies.
This prospective study performed from December 2020 to November 2022 included 88 patients of biliary malignancies randomized into two groups and scanned on rapid-switching dual energy CT scanner. Group 1 (n = 43, mean age: 54.6 years, 12 males) underwent the standard multiphase protocol (MPP; arterial, venous phases), while group 2 (n = 45, mean age: 52.6 years, 20 males) underwent split bolus dual-energy protocol (SBP; split-bolus phase). The mean attenuation, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of tumor, liver and hepatic vessels were measured and compared between the two groups along with dose-length product. Two readers independently assessed image quality and vascular invasion (5-point Likert scale) in each phase and inter-reader agreement was compared within groups. Mann Whitney U-test and kappa statistics were used for comparison.
The mean attenuation, CNR and SNR of arteries were significantly higher in the arterial phase of group 1 and significantly lower in the venous phase of group 1 than the SBP of group 2 (p < 0.001). The quantitative parameters of veins and tumor between venous phase (group 1) and SBP (group 2) were comparable. Good-to-strong inter-reader agreement (k = 0.45 to 0.75) for image quality for both protocols was observed. For hepatic arterial invasion, the SBP had significantly higher inter-reader agreement compared to the arterial phase of MPP (p < 0.001). The SBP had a 37% lower radiation dose than the MPP (p < 0.001).
The image quality of SBP was non-inferior to the standard MPP for biliary malignancies. However, SBP showed significantly better inter-observer agreement for arterial invasion indicating better assessment of vascular involvement with significantly lower radiation dose.
Biliary malignancies are better defined in the venous phase in which arteries are indistinct, making arterial invasion assessment tough. SBP overcomes this by clearly depicting arteries and tumor in the same phase for confident assessment.
比较在胆道恶性肿瘤中，团注分割双能量CT（DECT）与标准多期CT的图像质量、血管侵犯清晰度及辐射剂量。
这项前瞻性研究于2020年12月至2022年11月进行，纳入88例胆道恶性肿瘤患者，随机分为两组，在快速切换双能量CT扫描仪上进行扫描。第1组（n = 43，平均年龄：54.6岁，男性12例）采用标准多期扫描方案（MPP；动脉期、静脉期），而第2组（n = 45，平均年龄：52.6岁，男性20例）采用团注分割双能量扫描方案（SBP；团注分割期）。测量并比较两组肿瘤、肝脏及肝血管的平均衰减、对比噪声比（CNR）和信噪比（SNR），同时比较剂量长度乘积。两名阅片者独立评估各期的图像质量和血管侵犯情况（采用5分李克特量表），并比较组内阅片者间的一致性。采用曼-惠特尼U检验和kappa统计进行比较。
第1组动脉期动脉的平均衰减、CNR和SNR显著高于第2组SBP，第1组静脉期则显著低于第2组SBP（p < 0.001）。静脉期（第1组）和SBP（第2组）之间静脉和肿瘤的定量参数具有可比性。两种扫描方案的图像质量在阅片者间均具有良好至高度的一致性（k = 0.45至0.75）。对于肝动脉侵犯情况，SBP的阅片者间一致性显著高于MPP的动脉期（p < 0.001）。SBP的辐射剂量比MPP低37%（p < 0.001）。
对于胆道恶性肿瘤，SBP的图像质量不劣于标准MPP。然而，SBP在动脉侵犯方面显示出显著更好的观察者间一致性，表明对血管受累情况的评估更好，且辐射剂量显著更低。
在静脉期，胆道恶性肿瘤显示更清晰，动脉则不清晰，这使得动脉侵犯评估困难。SBP通过在同一期清晰显示动脉和肿瘤，从而能进行可靠评估，克服了这一问题。
