The Iodine Maps Created from Dual-Source Dual-Energy CT for The Diagnosis of Pancreatic Necrosis in The Early Stage of Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 QIANRong , YUANYuan , HUANGZi-xing ,  SONGBin

Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

SONGBin, Email: cjr.songbin@vip.163.com

Keywords：

Acute pancreatitis; Necrosis; Dual-source dual-energy CT; Iodine map; Diagnostic value

DOI：

10.7507/1007-9424.20150096

Video：

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Objective To evaluate the value of 120 kV portal venous phase images combined with iodine maps created from dual-source dual-energy CT (DECT) for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. Methods This prospective study enrolled 17 patients who underwent abdominal dual-source DECT within 72 hours from the onset of acute pancreatitis. All patients had received treatment in West China Hospital from May 2014 to August 2014. Comparison of the diagnostic value of 120 kV portal venous phase images alone and 120 kV portal venous phase images combined with iodine maps created from dual-source DECT was performed. Results Six of the 17 patients were found the presence of pancreatic necrosis (4 patients without obvious necrosis in the early stage developed to pancreatic necrosis, and 2 patients with the presence of necrosis in the early stage improved). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images for the diagnosis of pancreatic necrosis were 50.0% (3/6), 100% (11/11), and 82.4% (14/17), respectively, and it had a good diagnostic value (AUC=0.856, P=0.018). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images combined with iodine maps created from dual-source DECT for predicting pancreatic necrosis were 100% (6/6), 90.9% (10/11), and 94.1% (16/17), respectively, and this method had good value too (AUC=0.977, P=0.002), which higher than that of 120 kV portal venous phase images (P=0.002). Conclusions The 120 kV portal venous phase images combined with iodine maps created from dual-source DECT is helpful to improve subjective judgment in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. It also contributes to the display of hypo-perfusion area of the pancreatic parenchyma, and has higher diagnostic value.

Citation： QIANRong, YUANYuan, HUANGZi-xing, SONGBin. The Iodine Maps Created from Dual-Source Dual-Energy CT for The Diagnosis of Pancreatic Necrosis in The Early Stage of Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 357-360. doi: 10.7507/1007-9424.20150096 Copy

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19.	Takahashi N, Papachristou GI, Schmit GD, et al. CT findings of walled-off pancreatic necrosis (WOPN):differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol, 2008, 18(11):2522-2529.
20.	De Cecco CN, Darnell A, Rengo M, et al. Dual-energy CT:oncologic applications. AJR Am J Roentgenol, 2012, 199(5 Suppl):S98-S105.
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22.	Silva AC, Morse BG, Hara AK, et al. Dual-energy (spectral) CT:applications in abdominal imaging. Radiographics, 2011, 31(4):1031-1046.
23.	Brown CL, Hartman RP, Dzyubak OP, et al. Dual-energy CT iodine overlay technique for characterization of renal masses as cyst or solid:a phantom feasibility study. Eur Radiol, 2009, 19(5):1289-1295.
24.	Gupta R, Phan CM, Leidecker C, et al. Evalution of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1):205-211.
25.	袁元, 黄子星, 李真林, 等. 双源CT双能量扫描对急性坏死性胰腺炎影像诊断价值的初步探讨. 四川大学学报:医学版, 2011, 42(5):691-694.

1. 王吉耀. 内科学. 第2版. 北京:人民卫生出版社, 2010:548-555.
2. Mofidi R, Patil PV, Suttie SA, et al. Risk assessment in acute pancreatitis. Br J Surg, 2009, 96(2):137-150.
3. Bruennler T, Hamer OW, Lang S, et al. Outcome in a large unse-lected series of patients with acute pancreatitis. Hepatogastroentero-logy, 2009, 56(91-92):871-876.
4. Chu AJ, Lee JM, Lee YJ, et al. Dual-source, dual-energy multide-tector CT for the evaluation of pancreatic tumours. Br J Radiol, 2012, 85(118):e891-e898.
5. Heiss P, Bruennler T, Salzberger B, et al. Severe acute pancreatitis requiring drainage therapy:findings on computed tomography as predictor of patient outcome. Pancreatology, 2010, 10(6):726-733.
6. Saokar A, Rabinowitz CB, Sahani DV. Cross-sectional imaging in acute pancreatitis. Radiol Clin North Am, 2007, 45(3):447-460.
7. Scaglione M, Casciani E, Pinto A, et al. Imaging assessment of acute pancreatitis:a review. Semin Ultrasound CT MR, 2008, 29(5):322-340.
8. Lin XZ, Wu ZY, Tao R, et al. Dual energy spectral CT imaging of insulinoma-value in preoperative diagnosis compared with conventional multi-detector CT. Eur J Radiol, 2012, 81(10):2487-2494.
9. 袁元, 黄子星, 李真林, 等. 双源CT双能量碘图对急性坏死性胰腺炎影像的诊断价值. 四川大学学报:医学版, 2012, 43(4):597-600.
10. Johnson TR, Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT:initial experience. Eur Radiol, 2007, 17(6):1510-1517.
11. Fletcher JG, Takahashi N, Hartman R, et al. Dual-energy and dual-source CT:is there a role in the abdomen and pelvis?. Radiol Clin North Am, 2009, 47(1):41-57.
12. 袁元, 黄子星, 李真林, 等. 胰腺双能量CT虚拟平扫与真实平扫的初步对比研究. 放射学实践, 2013, 28(12):1191-1195.
13. Chandarana H, Godoy MC, Vlahos I, et al. Abdominal aorta:evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms-initial observations. Radiology, 2008, 249(2):692-700.
14. Tsuji Y, Takahashi N, Fletcher JG, et al. Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis. AJR Am J Roentgenol,2014, 202(4):W349-W356.
15. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1):102-111.
16. Spanier BW, Nio Y, Van Der Hulst RW, et al. Practice and yield of early CT scan in acute pancreatitis:a Dutch Observational Multicenter Study. Pancreatology, 2010, 10(2-3):222-228.
17. Casas JD, Diaz R, Valderas G, et al. Prognostic value of CT in the early assessment of patients with acute pancreatitis. AJR Am J Roentgenol, 2004, 182(3):569-574.
18. Wijffels NA, Van Walraven LA, Ophof PJ, et al. Late development of pancreas necrosis during acute pancreatitis:an underestimated phenomenon associated with high morbidity and mortality. Pancreas, 2007, 34(2):215-219.
19. Takahashi N, Papachristou GI, Schmit GD, et al. CT findings of walled-off pancreatic necrosis (WOPN):differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol, 2008, 18(11):2522-2529.
20. De Cecco CN, Darnell A, Rengo M, et al. Dual-energy CT:oncologic applications. AJR Am J Roentgenol, 2012, 199(5 Suppl):S98-S105.
21. Fornaro J, Lescka S, Hibbeln D, et al. Dual-and multi-energy CT:approach to functional imaging. Insights Imaging, 2011, 2(2):149-159.
22. Silva AC, Morse BG, Hara AK, et al. Dual-energy (spectral) CT:applications in abdominal imaging. Radiographics, 2011, 31(4):1031-1046.
23. Brown CL, Hartman RP, Dzyubak OP, et al. Dual-energy CT iodine overlay technique for characterization of renal masses as cyst or solid:a phantom feasibility study. Eur Radiol, 2009, 19(5):1289-1295.
24. Gupta R, Phan CM, Leidecker C, et al. Evalution of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1):205-211.
25. 袁元, 黄子星, 李真林, 等. 双源CT双能量扫描对急性坏死性胰腺炎影像诊断价值的初步探讨. 四川大学学报:医学版, 2011, 42(5):691-694.

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The Iodine Maps Created from Dual-Source Dual-Energy CT for The Diagnosis of Pancreatic Necrosis in The Early Stage of Acute Pancreatitis

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