Diffusion-weighted Echo Planar Imaging with Compressed SENSE (EPICS-DWI) for Pancreas Assessment: A Multicenter Study.

PURPOSE: This study aimed to evaluate the feasibility of single-shot echo planar diffusion-weighted imaging with compressed SENSE (EPICS-DWI) for pancreas assessment by comparing with single-shot echo planar DWI with parallel imaging (PI-DWI). METHODS: This multicenter prospective study included 27 consecutive participants with untreated pancreatic ductal adenocarcinoma (PDAC) (15 men; mean age, 67 ± 10 years) who underwent pancreatic protocol MRI including both PI-DWI and EPICS-DWI. Two radiologists independently and randomly reviewed the high b-value DWI images and qualitatively assigned confidence scores for overall image quality, image noise, pancreas conspicuity, and PDAC conspicuity using a 5-point scale. One radiologist measured the PDAC-to-pancreas contrast-to-noise-ratio (CNR) on high b-value DWI images and the apparent diffusion coefficient (ADC) value of PDAC. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon signed-rank test. RESULTS: The confidence scores for overall image quality (P < 0.001 in both radiologists) and image noise (P < 0.001 in both radiologists) were higher in EPICS-DWI than in PI-DWI. The pancreas conspicuity was better in EPICS-DWI than in PI-DWI in one of the radiologists (P = 0.02 and 0.06). The PDAC conspicuity was comparable between PI-DWI and EPICS-DWI (P > 0.99 in both radiologists). The PDAC-to-pancreas CNR was higher in EPICS-DWI than in PI-DWI (P = 0.02), while the ADC value of PDAC in PI-DWI was not significantly different compared to that in EPICS-DWI (P = 0.48). CONCLUSION: The image quality and PDAC-to-pancreas CNR was improved in EPICS-DWI compared to PI-DWI. However, the conspicuity and ADC value of PDAC were comparable between PI-DWI and EPICS-DWI.

Assessment of Arterial Involvement in Pancreatic Cancer: Utility of Reconstructed CT Images Perpendicular to Artery.

The purpose of this study was to investigate the utility of reconstructed CT images perpendicular to the artery for assessing arterial involvement from pancreatic cancer and compare the interobserver variability between it and the current diagnostic imaging method. This retrospective study included patients with pancreatic cancer in the pancreatic body or tail who underwent preoperative pancreatic protocol CT and distal pancreatectomy. Five radiologists used axial and coronal CT images (current method) and perpendicular reconstructed CT images (proposed method) to determine if the degree of solid soft-tissue contact with the splenic artery was ≤180° or >180°. The generalized estimating equations were used to compare the diagnostic performance of solid soft-tissue contact >180° between the current and proposed methods. Fleiss' ĸ statistics were used to assess interobserver variability. The sensitivity and negative predictive value for diagnosing solid soft-tissue contact >180° were higher (p < 0.001 for each) and the specificity (p = 0.003) and positive predictive value (p = 0.003) were lower in the proposed method than the current method. Interobserver variability was improved in the proposed method compared with the current method (ĸ = 0.87 vs. 0.67). Reconstructed CT images perpendicular to the artery showed higher sensitivity and negative predictive value for diagnosing solid soft-tissue contact >180° than the current method and demonstrated improved interobserver variability.

Appropriate pancreatic phase image acquisition by free-breathing dynamic contrast-enhanced pancreatic MRI using stack-of-stars radial sampling and Compressed SENSE.

PURPOSE: To evaluate the feasibility of a free-breathing sequence (4D FreeBreathing) combined with Compressed SENSE in dynamic contrast-enhanced pancreatic MRI and compare it with a breath-holding sequence (eTHRIVE). METHOD: Patients who underwent pancreatic MRI, either eTHRIVE or 4D FreeBreathing, from April 2022 to November 2023 were included in this retrospective study. Two radiologists, who were unaware of the scan sequence, independently and randomly reviewed the images at the precontrast, pancreatic, portal venous, and equilibrium phases and assigned confidence scores for motion and streaking artifacts, pancreatic sharpness, and overall image quality using a 5-point scale. Furthermore, the radiologists assessed the appropriateness of the scan timing of the pancreatic phase. Mann-Whitney U and Fisher's exact tests were conducted to compare the confidence scores and adequacy of the pancreatic phase scan timing between eTHRIVE and 4D FreeBreathing. RESULTS: Overall, 48 patients (median age, 71 years; interquartile range, 64-77 years; 24 women) were included. Among them, 20 patients (42%) were scanned using 4D FreeBreathing. The 4D FreeBreathing showed moderate streaking artifact but improved motion artifact (P <.001-.17) at all phases. Pancreatic sharpness and overall image quality were almost comparable between two sequences (P = .17-.96). All 20 examinations in 4D FreeBreathing showed appropriate pancreatic phase images, but only 16 (57%; P <.001 for reviewer 1) and 18 (64%; P = .003 for reviewer 2) examinations showed it in eTHRIVE. CONCLUSION: The use of 4D FreeBreathing combined with Compressed SENSE was feasible in pancreatic MRI and provided appropriate pancreatic phase images in all examinations.

Deep-learning image reconstruction for 80-kVp pancreatic CT protocol: Comparison of image quality and pancreatic ductal adenocarcinoma visibility with hybrid-iterative reconstruction.

PURPOSE: To evaluate the image quality and visibility of pancreatic ductal adenocarcinoma (PDAC) in 80-kVp pancreatic CT protocol and compare them between hybrid-iterative reconstruction (IR) and deep-learning image reconstruction (DLIR) algorithms. METHOD: A total of 56 patients who underwent 80-kVp pancreatic protocol CT for pancreatic disease evaluation from January 2022 to July 2022 were included in this retrospective study. Among them, 20 PDACs were observed. The CT raw data were reconstructed using 40% adaptive statistical IR-Veo (hybrid-IR group) and DLIR at medium- and high-strength levels (DLIR-M and DLIR-H groups, respectively). The CT attenuation of the abdominal aorta, pancreas, and PDAC (if present) at the pancreatic phase and those of the portal vein and liver at the portal venous phase; background noise; signal-to-noise ratio (SNR) of these anatomical structures; and tumor-to-pancreas contrast-to-noise ratio (CNR) were calculated. The confidence scores for the image noise, overall image quality, and visibility of PDAC were qualitatively assigned using a five-point scale. Quantitative and qualitative parameters were compared among the three groups using Friedman test. RESULTS: The CT attenuation of all anatomical structures were comparable among the three groups (P = .26-.86), except that of the pancreas (P = .001). Background noise was lower (P <.001) and SNRs (P <.001) and tumor-to-pancreas CNR (P <.001) were higher in the DLIR-H group than those in the other two groups. The image noise, overall image quality, and visibility of PDAC were better in the DLIR-H group than in the other two groups (P <.001-.003). CONCLUSION: In 80-kVp pancreatic CT protocol, DLIR at a high-strength level improved image quality and visibility of PDAC.

Comparison of image quality and pancreatic ductal adenocarcinoma conspicuity between the low-kVp and dual-energy CT reconstructed with deep-learning image reconstruction algorithm.

PURPOSE: To compare the image quality and conspicuity of pancreatic ductal adenocarcinoma (PDAC) between the low-kVp and dual-energy pancreatic protocol CT reconstructed with deep-learning image reconstruction (DLIR). METHOD: A cohort of 111 consecutive patients (median age, 72 years; 56 men) undergoing a pancreatic protocol CT were retrospectively analyzed. Among them, 58 patients underwent 80-kVp CT (80-kVp group), and 53 patients underwent dual-energy CT and reconstructed at 40-keV (40-keV group). The medium-strength level of DLIR were used in both groups. Quantitative measurements, qualitative image quality, PDAC conspicuity, and dose-length product (DLP) were compared between the two groups using Mann-Whitney U test. RESULTS: A total of 20 and 16 PDACs were found in the 80-kVp and 40-keV groups, respectively. CT numbers of the vasculatures and parenchymal organs (P <.001 for all) and the background noise at both pancreatic and portal venous phases (P <.001) were higher in the 40-keV group than in the 80-kVp group. The signal-to-noise ratio (SNR) of all anatomical structures (P <.001-0.005), except for the liver in reviewer 2 (P =.47), and the tumor-to-pancreas contrast-to-noise ratio (CNR; P <.001-0.01) were higher in the 40-keV group than in the 80-kVp group. No difference was found in the image quality at both phases (P =.30-0.90). PDAC conspicuity was better in the 40-keV group than in the 80-kVp group (P =.007-0.03). DLP at pancreatic (275 vs. 313 mGy*cm; P =.05) and portal venous phases (743 vs. 766 mGy*cm; P =.20) was comparable between the two groups. CONCLUSION: Under the same DLP, virtual monoenergetic images at 40-keV demonstrated higher SNR and tumor-to-pancreas CNR and better PDAC conspicuity compared to the 80-kVp setting.

Detection of pancreatic ductal adenocarcinoma and liver metastases: comparison of Gd-EOB-DTPA-enhanced MR imaging vs. extracellular contrast materials.

PURPOSE: To compare the detectability of pancreatic ductal adenocarcinoma (PDAC) and liver metastases between Gd-EOB-DTPA- and extracellular contrast materials (ECCMs) contrast-enhanced MR imaging contrast. METHODS: Two hundred seventy-two patients with suspected pancreatic disease underwent Gd-EOB-DTPA-enhanced MR imaging (EOB group, n = 79) or ECCMs-enhanced MR imaging (ECCM group, n = 193). The ECCM group were administered the following contrast agents: Gd-DTPA (n = 158), Gd-BT-DO3A (n = 28), Gd-DOTA (n = 5), and Gd-DTPA-BMA (n = 2). Signal intensities of pancreatic parenchyma, paraspinal muscle, PDAC (if present), and background noise were measured. The signal intensity ratio (SIR) of the pancreas and tumor-to-pancreas contrast-to-noise ratio (CNR) were also calculated. If present, the conspicuity of PDAC was evaluated with the arterial dominant phase images. Liver metastases, if present, were also evaluated for all sequences. Qualitative and quantitative imaging parameters were compared between EOB and ECCM groups. RESULTS: SIR of the pancreas (P < 0.001) and CNR (P = 0.0037) were significantly lower in EOB group when compared with the ECCM group. However, the sensitivity (97.1% vs. 93.5%, P = 0.42) and specificity (100.0% vs. 99.2%, P = 1.00) for detecting PDAC were not significant between EOB and ECCM groups. The EOB group showed a significantly greater sensitivity for detecting liver metastases compared with the ECCM group (95.0% vs 84.5%, P = 0.04) when evaluating on a lesion-by-lesion basis. CONCLUSION: Gd-EOB-DTPA-enhanced MR imaging performed similarly to ECCMs-enhanced MR imaging in detecting PDAC but had better sensitivity in detecting liver metastases.