title: Multidetector CT of pancreatic ductal adenocarcinoma: Effect of tube voltage and iodine load on tumour conspicuity and image quality.
abstract: OBJECTIVE
  To compare a low-tube-voltage with or without high-iodine-load multidetector CT (MDCT) protocol with a normal-tube-voltage, normal-iodine-load (standard) protocol in patients with pancreatic ductal adenocarcinoma (PDAC) with respect to tumour conspicuity and image quality.
  
  
  METHODS
  Thirty consecutive patients (mean age: 66 years, men/women: 14/16) preoperatively underwent triple-phase 64-channel MDCT examinations twice according to: (i) 120-kV standard protocol (PS; 0.75 g iodine (I)/kg body weight, n = 30) and (ii) 80-kV protocol A (PA; 0.75 g I/kg, n = 14) or protocol B (PB; 1 g I/kg, n = 16). Two independent readers evaluated tumour delineation and image quality blindly for all protocols. A third reader estimated the pancreas-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test.
  
  
  RESULTS
  Tumour delineation was significantly better in PB and PA compared with PS (P = 0.02). The evaluation of image quality was similar for the three protocols (all, P > 0.05). The highest CNR was observed with PB and was significantly better compared to PA (P = 0.02) and PS (P = 0.0002).
  
  
  CONCLUSIONS
  In patients with PDAC, a low-tube-voltage, high-iodine-load protocol improves tumour delineation and CNR leading to higher tumour conspicuity compared to standard protocol MDCT.
  
  
  CONCLUSIONS
  • Low-tube-voltage high-iodine-load MDCT improves pancreatic cancer conspicuity compared to a standard protocol. • The pancreas-to-tumour attenuation difference increases significantly by reducing the tube voltage. • The radiation exposure dose decreases by reducing the tube voltage.
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden. louiza.loizou@gmail.com.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. louiza.loizou@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Loizou
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, Ersta Hospital, 11691, Stockholm, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Albiin
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Leidner
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Axelsson
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: M A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Grigoriadis
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Del Chiaro
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Segersvärd
authors.affiliation: Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Verbeke
authors.affiliation: Department of Surgical Sciences, Division of Radiology, Uppsala University and Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sundin
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.|Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Kartalis
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D014283:Triiodobenzoic Acids / Q000493:pharmacokinetics*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C057937:iomeprol; C044834:iodixanol; D007479:Iopamidol
keywords: Contrast media; Image enhancement; Multidetector computed tomography; Pancreatic neoplasm; Radiation dosage