Ces radiol. 2009, 63(1):89-94

A value of dual-energy CT in the assessment of necroses in acute pancreatitisOriginal article

Jiří Ferda¹, Thomas Flohr², Bernhard Schmidt², Hynek Mírka¹, Jan Baxa¹, Alena Bednářová¹, Eva Ferdová¹, Jana Koželuhová³, Martin Matějovič³, Vladislav Třeška⁴, Boris Kreuzberg¹

¹ Radiodiagnostická klinika LF UK a FN, Plzeň

² Siemens Medical Solutions, CT division, Department of Research and Development, Forchheim, Deutschland

³ I. interní klinika LF UK a FN, Plzeň

⁴ Chirurgická klinika LF UK a FN, Plzeň

Aim: The aim of this study is to evaluate the possibility of application of the CT acquisition with dual energy X-radiation (DECT) for assessment of the viability of the pancreatic tissue in patients with a severe form of acute pancreatitis.


Material and method. 16 patients were prospectively enrolled in the study (the average age was 53.2, age range of 34-75, 9 males, 7 females). The patients underwent CT due to clinical signs of severe, acute pancreatitis. All the CT examinations were performed in the dual-energy regimen (DE) using data acquisition with the voltage of 140 kV in the A system and 80 kV in the B system from the dome of the diaphragm to the symphysis. The examinations were performed after the intravenous application of 100 ml of iodinated contrast material with the concentration 400 milligrams of iodine per milliliter. The analysis of material decomposition allowed obtaining virtual non-contrast images (VNC) and maps of iodine distribution (IDM). The findings on post-contrast conventional images were compared with the presence of deficit of iodine distribution within pancreas and the presence of increased density on virtual non-contrast images. The prognostic values of necrosis more than two thirds of pancreas and presence of bleeding were tested according to the survival.

Results: Virtual-non-contrast images of valuable quality were obtained in all cases. The assessment of iodine distribution maps provided to change the stage of acute pancreatitis in three cases in comparison to the assessment of conventional post-contrast images. The most important factor involving the fatal prognosis was necrosis more than two thirds of pancreas found on iodine distribution map, it reached sensitivity, specificity, negative and positive predictive value of 100%.

Conclusion: Dual-energy CT with the analysis of iodine distribution allows assessing the viability of the pancreas with the high accuracy in patients with severe acute pancreatitis.

Keywords: acute pancreatitis, dual-energy CT, viability, virtual non-contrast imaging

Grants and funding:

Podpořeno výzkumným záměrem MSM 0021620819.

Accepted: January 15, 2009; Published: March 1, 2009  Show citation