title: Dual-energy CT of the pancreas: improved carcinoma-to-pancreas contrast with a noise-optimized monoenergetic reconstruction algorithm.
abstract: OBJECTIVE
  To evaluate a novel monoenergetic reconstruction algorithm (nMERA) with improved noise reduction for dual-energy CT (DECT) of pancreatic adenocarcinoma.
  
  
  METHODS
  Sixty patients with suspected pancreatic carcinoma underwent dual-source dual-energy CT with arterial phase. Images were reconstructed as linearly-blended 120-kV series (M_0.6) and with the standard monoenergetic (sMERA) and the novel monoenergetic algorithm (nMERA) with photon energies of 40, 55, 70 and 80 keV. Objective image quality was compared regarding image noise, pancreas attenuation, signal-to-noise ratio (SNR) and pancreas-to-lesion contrast. Subjective image quality was assessed by two observers.
  
  
  RESULTS
  Thirty pancreatic adenocarcinomas were detected. nMERA showed significantly reduced image noise at low keV levels compared with sMERA images (55 keV: 7.19 ± 2.75 vs. 20.68 ± 7.01 HU; 40 keV: 7.33 ± 3.20 vs. 37.22 ± 14.66 HU) and M_0.6 (10.69 ± 3.57 HU). nMERA pancreatic SNR was significantly superior to standard monoenergetic at 40 (47.02 ± 23.41 vs. 9.37 ± 5.83) and 55 keV (28.29 ± 16.86 vs. 9.88 ± 7.01), and M_0.6 series (11.42 ± 6.00). Pancreas-to-lesion contrast peaked in the nMERA 40 keV series (26.39 ± 16.83) and was significantly higher than in all other series (p<0.001). nMERA 55 keV images series were consistently preferred by both observers over all other series (p<0.01).
  
  
  CONCLUSIONS
  nMERA DECT can significantly improve image quality and pancreas-to-lesion contrast in the diagnosis of pancreatic adenocarcinoma.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Frellesen
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Freia
authors.initials: F
authors.lastname: Fessler
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hardie
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Kerl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schulz
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Hammerstingl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Electronic address: ralfwbauer@aol.com.
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Bauer
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: Dual-energy CT; Lesion conspicuity; Monoenergetic reconstruction; Pancreatic adenocarcinoma; Tumor contrast