Comparison of Volume-Mode 2-Rotation kV-mA Switching Dual Energy Computer Tomography (CT) and of CT Subtraction Imaging with Magnetic Resonance Imaging for the identification of enhancing septa and mural nodules in cystic pancreatic lesions: a change in paradigm?

Project Code

Project Title

Comparison of Volume-Mode 2-Rotation kV-mA Switching Dual Energy Computer Tomography (CT) and of CT Subtraction Imaging with Magnetic Resonance Imaging for the identification of enhancing septa and mural nodules in cystic pancreatic lesions: a change in paradigm?

Proposal Abstract

Cystic pancreatic lesions are increasingly detected incidentally in imaging studies, reportedly in up to 45% of the abdominal Magnetic Resonance (MR) examinations. The majority of these lesions have potential to become cancer, therefore requiring surgery or imaging follow-up to monitor the development of features indicative of malignant transformation. Abdominal MR is the current standard of care for the follow-up of pancreatic cysts (PCs). However, MR is expensive and access is limited, with long waiting times. We will compare MR to two new computed tomography (CT) techniques - dual energy CT (DECT) and Subtraction imaging - with regards to their ability to detect features associated with increased risk of malignancy (enhancing septa and mural nodules) in PCs. Using DECT or Subtraction instead of MR for the assessment and follow-up of PCs would save significant healthcare costs and MR slots, which could be released to other indications and to reduce waiting times. Furthermore, if DECT and/or Subtraction imaging end up demonstrating to be superior to MR for this purpose, patients with cystic pancreatic lesions could have a direct benefit.

Reporting Abstract

Pancreatic cystic lesions (PCs) are increasingly detected incidentally in imaging studies. Most of these lesions have potential to become cancer, therefore requiring surgery or imaging follow-up. Abdominal MR is the current standard of care for follow-up. However, MR is expensive and access is limited, with long waiting times. We compared MR to two new computed tomography (CT) techniques - dual energy CT (DECT) and Subtraction imaging - with regards to their ability to detect features associated with increased risk of malignancy in PCs. Using DECT or Subtraction instead of MR for the assessment and follow-up of PCs would save significant healthcare costs and MR slots, which could be released to other indications and to reduce waiting times. 163 patients were interviewed for consideration of participating in the study and 30 patients were scanned with Dual Energy CT/Subtraction. Preliminary findings suggest DECT and Subtraction CT are non-inferior to MRI for characterization of PCs with regards to the presence of features indicative of malignancy. The study will continue. If the preliminary results are confirmed, our initial hypothesis will be proven correct and the benefits for patients and healthcare are significant.

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MSU - Mount Sinai Hospital - University Health Network Academic Medical Organization

Project Summary

Comparison of Volume-Mode 2-Rotation kV-mA Switching Dual Energy Computer Tomography (CT) and of CT Subtraction Imaging with Magnetic Resonance Imaging for the identification of enhancing septa and mural nodules in cystic pancreatic lesions: a change in paradigm?

MSU - Mount Sinai Hospital - University Health Network Academic Medical Organization

Project Summary

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