Manuel Patino MD, Presenter: Nothing to Disclose

Jorge Mario Fuentes MD, Abstract Co-Author: Nothing to Disclose

Pritesh Patel MD, Abstract Co-Author: Nothing to Disclose

Avinash Ranesh Kambadakone MD, FRCR, Abstract Co-Author: Nothing to Disclose

Dushyant V. Sahani MD, Abstract Co-Author: Research Grant, General Electric Company

To evaluate performance of Single source Dual-energy CT (ssDECT) in detection of local recurrence on post Whipple patients compared to conventional single-energy CT scans.

Thirty-five patients (17 males; 18 females) with history of pancreatic adenocarcinoma and Whipple procedure (0.1 to 5 years after the procedure) underwent a follow up ssDECT (GE-CT750 HD, 140/80 kV). Two blinded radiologists independently reviewed the 140 kVp and DECT processed iodine and monochromatic images in a separate session for the presence of local recurrence, liver metastasis, and surgical complications and provided recommendations. Multiple follow up studies, tumor markers (CA-19.9) and histology served as standard reference. Quantitative analysis of the iodine concentration in the surgical bed was performed, and subsequently compared for post-operative changes and recurrence using t-test.

15 patients had local recurrence and 20 showed expected post-operative changes. The sensitivity and specificity for SECT for local recurrence was 75% and 65% for R1, and 70% and 65% for R2 and for DECT it was 86% and 75% for R1, and 83% and 70% for R2. Interobserver agreement for DECT was good with a kappa value of 0.7. Iodine concentration was different in patients with local recurrence vs. those with expected changes (p<0.05).

ssDECT shows higher sensitivity and specificity for diagnosing local recurrence detection after Whipple surgery compared to SECT. Tumor recurrence can be differentiated from normal post operatory changes based on iodine quantification.

Distinction between normal postoperative changes vs. tumor recurrence after Whipple procedure impacts patient management, and can be challenging on conventional CT. DECT have potential to overcome these limitations by mapping the iodine distribution within tumor and normal tissue.

Patino, M, Fuentes, J, Patel, P, Kambadakone, A, Sahani, D, Evaluation of Tumor Recurrence after Whipple Surgery Using ssDECT.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045773.html