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Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: Evaluation of CT severity index, interobserver agreement and radiation dose

: Wichmann, Julian L.; Majenka, Pavel; Beeres, Martin; Kromen, Wolfgang; Schulz, Boris; Wesarg, Stefan; Bauer, Ralf W.; Kerl, J. Matthias; Gruber-Rouh, Tatjana; Hammerstingl, Renate; Vogl, Thomas J.; Lehnert, Thomas


European radiology 24 (2014), No.11, pp.2927-2935
ISSN: 0938-7994
ISSN: 1613-3749
ISSN: 1432-1084
Journal Article
Fraunhofer IGD ()
computed tomography (CT); evaluation; monitoring; Business Field: Visual decision support; Research Area: Computer vision (CV); Research Area: Human computer interaction (HCI)

To intra-individually compare single-portal-phase low-tube-voltage (100-kVp) computed tomography (CT) with 120-kVp images for short-term follow-up assessment of CT severity index (CTSI) of acute pancreatitis, interobserver agreement and radiation dose.
We retrospectively analysed 66 patients with acute pancreatitis who underwent initial dual-contrast-phase CT (unenhanced, arterial, portal phase) at admission and short-term (mean interval 11.4 days) follow-up dual-contrast-phase dual-energy CT. The 100-kVp and linearly blended images representing 120-kVp acquisition follow-up CT images were independently evaluated by three radiologists using a modified CTSI assessing pancreatic inflammation, necrosis and extrapancreatic complications. Scores were compared with paired t test and interobserver agreement was evaluated using intraclass correlation coefficients (ICC).
Mean CTSI scores on unenhanced, portal- and dual-contrast-phase images were 4.9, 6 .1 and 6.2 (120 kVp) and 5.0, 6.0 and 6.1 (100 kVp), respectively. Contrast-enhanced series showed a higher CTSI compared to unenhanced images (P < 0.05) but no significant differences between single- and dual-contrast-phase series (P > 0.7). CTSI scores were comparable for 100-kVp and 120-kVp images (P > 0.05). Interobserver agreement was substantial for all evaluated series and subcategories (ICC 0.67-0.93). DLP of single-portal-phase 100-kVp images was reduced by 41 % compared to 120-kVp images (363.8 versus 615.9 mGy cm).
Low-tube-voltage single-phase 100-kVp CT provides sufficient information for follow-up evaluation of acute pancreatitis and significantly reduces radiation exposure.