Value of optimized imaging of periampullary great vessels in pancreatic malignant tumors: based on spectral CT monoenergetic imaging_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yu ¹ , WANG Yuqi ¹ , YU Haopeng ¹ , LIU Liqiong ¹ , XUE Qianyuan ¹ , SHUAI Tao ¹ ,  SONG Bin ^1,2,3

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Radiology, Sanya People’s Hospital, Sanya, Hainan 572000, P. R. China;

Corresponding?author：

SONG Bin, Email: songlab_radiology@163.com

Keywords：

peripancreatic great vessels; pancreatic malignant tumors; spectral CT; monoenergetic image

DOI：

10.7507/1007-9424.202505014

Video：

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Objective To evaluate the value of spectral CT monoenergetic imaging in optimizing the image quality of peripancreatic great vessels in patients with pancreatic malignant tumors. Methods The imaging data of 62 patients with pancreatic malignant tumors who underwent contrast-enhanced spectral CT at West China Hospital of Sichuan University from July 2018 to March 2021 were retrospectively analyzed. A total of 21 monoenergetic image sets (from 40 to 140 keV at 5 keV intervals) were reconstructed. The CT value, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the peripancreatic great vessels (including the celiac artery, common hepatic artery, superior mesenteric artery, portal vein, and superior mesenteric vein), as well as the tumor-to-parenchyma ratio (TPR) in the pancreatic parenchymal and portal venous phases, were compared between the mixed-energy images and the monoenergetic images. Additionally, subjective evaluations of vascular involvement in both the mixed-energy and optimal monoenergetic images were performed. Results The overall differences in CT values, SNR, and CNR of the peripancreatic great vessels among mixed-energy and 21 monoenergetic image sets were all statistically significant (all P<0.001). In the monoenergetic images, as the energy level increased, the CT values, SNR, and CNR of the five peripancreatic great vessels showed consistent decreasing trends (all P<0.001). The 40 keV group exhibited the highest values for all indexes, indicating the best visualization. Regarding the TPR, both the pancreatic parenchymal and the portal venous phases showed a decrease as the energy level increased. The intergroup difference in TPR in the pancreatic parenchymal phase was statistically significant (P<0.001), while no significant difference was observed in the portal venous phase (P>0.05). The 40 keV monoenergetic images achieved the highest TPR, providing optimal lesion visualization. The subjective evaluations by two physicians on vascular involvement in 40 keV monoenergetic images and mixed-energy images showed good to excellent interobserver agreement (Kappa=0.775–1.000, all P<0.001). Conclusion The 40 keV image from spectral CT can significantly optimize the imaging of peripancreatic great vessels, providing better subjective and objective image quality.

Citation： LI Yu, WANG Yuqi, YU Haopeng, LIU Liqiong, XUE Qianyuan, SHUAI Tao, SONG Bin. Value of optimized imaging of periampullary great vessels in pancreatic malignant tumors: based on spectral CT monoenergetic imaging. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(11): 1408-1412. doi: 10.7507/1007-9424.202505014 Copy

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12.	辛彥杰, 姜慧杰, 趙成磊. 能譜CT在血管成像中的應用進展. 國際醫學放射學雜志, 2023, 46(3): 326-332.
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14.	中華醫學會放射學分會, 中國醫師協會放射醫師分會, 安徽省影像臨床醫學研究中心. 能量CT臨床應用中國專家共識. 中華放射學雜志, 2022, 56(5): 476-487.
15.	Liang H, Zhou Y, Zheng Q, et al. Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma. Insights Imaging, 2022, 13(1): 153. doi: 10.1186/s13244-022-01297-2.
16.	楊琰昭, 常蕊, 王晴柔, 等. 雙層探測器光譜CT虛擬單能量圖像在胰腺導管腺癌術前評估中的優化研究. 上海交通大學學報(醫學版), 2022, 42(9): 1323-1328.
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18.	European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.

1. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
2. Halbrook CJ, Lyssiotis CA, Pasca di Magliano M, et al. Pancreatic cancer: advances and challenges. Cell, 2023, 186(8): 1729-1754.
3. Klein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol, 2021, 18(7): 493-502.
4. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma. Version 2.2024. https://www.nccn.org. 2024-04-30/2024-07-16.
5. 中國醫師協會胰腺病學專業委員會, 國家消化系統疾病臨床醫學研究中心(上海). 中國胰腺實性腫瘤影像學診斷報告規范循證學指南. 中華胰腺病雜志, 2024, 24(2): 100-113.
6. Zhang L, Sanagapalli S, Stoita A. Challenges in diagnosis of pancreatic cancer. World J Gastroenterol, 2018, 24(19): 2047-2060.
7. Joo I, Lee JM, Lee ES, et al. Preoperative CT classification of the resectability of pancreatic cancer: interobserver agreement. Radiology, 2019, 293(2): 343-349.
8. Albrecht MH, Vogl TJ, Martin SS, et al. Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology, 2019, 293(2): 260-271.
9. Wang S, Zhang Y, Xu Y, et al. Progress in the application of dual-energy CT in pancreatic diseases. Eur J Radiol, 2023, 168: 111090. doi: 10.1016/j.ejrad.2023.111090.
10. Ahmed SA, Atta H, Hassan RA. The utility of multi-detector computed tomography criteria after neoadjuvant therapy in borderline resectable pancreatic cancer: prospective, bi-institutional study. Eur J Radiol, 2021, 139: 109685. doi: 10.1016/j.ejrad.2021.109685.
11. Lee W, Park HJ, Lee YN, et al. Computed tomography-based vascular burden index as a predictor of vascular resection and pathological vascular invasion in pancreatic cancer with neo-adjuvant chemotherapy. Eur J Surg Oncol, 2024, 50(9): 108494. doi: 10.1016/j.ejso.2024.108494.
12. 辛彥杰, 姜慧杰, 趙成磊. 能譜CT在血管成像中的應用進展. 國際醫學放射學雜志, 2023, 46(3): 326-332.
13. 林曉珠, 沈云, 陳克敏. CT能譜成像的基本原理與臨床應用研究進展. 中華放射學雜志, 2011, 45(8): 798-800.
14. 中華醫學會放射學分會, 中國醫師協會放射醫師分會, 安徽省影像臨床醫學研究中心. 能量CT臨床應用中國專家共識. 中華放射學雜志, 2022, 56(5): 476-487.
15. Liang H, Zhou Y, Zheng Q, et al. Dual-energy CT with virtual monoenergetic images and iodine maps improves tumor conspicuity in patients with pancreatic ductal adenocarcinoma. Insights Imaging, 2022, 13(1): 153. doi: 10.1186/s13244-022-01297-2.
16. 楊琰昭, 常蕊, 王晴柔, 等. 雙層探測器光譜CT虛擬單能量圖像在胰腺導管腺癌術前評估中的優化研究. 上海交通大學學報(醫學版), 2022, 42(9): 1323-1328.
17. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, 2017, 17(5): 738-753.
18. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of optimized imaging of periampullary great vessels in pancreatic malignant tumors: based on spectral CT monoenergetic imaging

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