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Pancreas: Optimal Scan Delay for Contrast-enhanced Multi–Detector Row CT¹

¹ From the Departments of Radiology (S.G., M.K., H. Kondo, H. Kato, Y.T., H.H.), Radiology Services (M.K., R.Y., T.M.), and Medical Informatics (Y.S.), Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan; Department of Physiology and Neuroscience, Kanagawa Dental College, Yokosuka, Japan (M.O.); Research Center for Cancer Prevention and Screening, National Cancer Center Hospital, Tsukiji, Japan (N.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.T.B.). Received August 11, 2005; revision requested October 17; revision received November 3; accepted December 1; final version accepted January 10, 2006. Supported in part by the Health and Labour Sciences Research Grants for Third Term Comprehensive Control Research for Cancer. Address correspondence to S.G.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Diagram illustrates timing scheme in three-phase imaging protocols. Patients were prospectively assigned among four groups for three-phase scanning (arterial, pancreatic parenchymal, and venous phases). Scanning commenced at start of contrast medium injection. In group 1, scanning occurred at 25, 45, and 65 seconds; in group 2, at 30, 50, and 70 seconds; in group 3, at 35, 55, and 75 seconds; and in group 4, at 40, 60, and 80 seconds. Scanning duration was 4.3 seconds for first- and second-phase scanning and 9.1 seconds for third-phase scanning. First- and second-phase scanning was performed during single breath hold, and third-phase scanning was performed after 15-second breathing interval.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Graph shows scan delay versus contrast enhancement (Mean HU) curves for abdominal aorta and superior mesenteric artery. Scan delay is time from start of contrast material injection. Mean contrast enhancement of both abdominal aorta and superior mesenteric artery peaked at 35 seconds (P < .001) and then decreased with time. Error bars = standard error of the mean.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 3: Graph shows scan delay versus contrast enhancement (Mean HU) curves for spleen, pancreas (parenchyma), and liver (parenchyma). Mean contrast enhancement of spleen increased constantly from 25 to 40 seconds and peaked at 40–45 seconds. Mean contrast enhancement of spleen was significantly higher at 40 seconds than at 25–35 seconds (P < .001). Mean contrast enhancement of pancreatic parenchyma increased constantly from 25 to 40 seconds and peaked at 35–45 seconds. Mean contrast enhancement of pancreatic parenchyma was significantly higher at 35–40 seconds than at 25–30 seconds (P < .001). Mean contrast enhancement of hepatic parenchyma increased constantly, peaked (59.7–59.8 HU) at 55–60 seconds, and then plateaued. Mean contrast enhancement of hepatic parenchyma was significantly higher at 55–60 seconds than at 45–50 seconds (P < .001). Error bar = standard error of the mean.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Graph shows results of prospective qualitative image review. Mean degree of pancreatic parenchymal enhancement increased constantly from 25 to 40 seconds, peaked at 35–45 seconds, and decreased with time. Mean degree of pancreatic parenchymal enhancement was significantly higher at 35–40 seconds than at 25–30 seconds (P < .001) and at 45 seconds than at 50–60 seconds (P < .05). Mean degree of peripancreatic artery enhancement was constantly high at 25–40 seconds and then gradually reduced with time. Mean degree of peripancreatic vein enhancement gradually increased and peaked at 55–60 seconds. Mean degree of peripancreatic vein enhancement was significantly higher at 55–60 seconds than at 45–50 seconds (P < .001). Error bar = standard error of the mean.

View larger version (5K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Transverse CT image of a 46-year-old woman with malignant lymphoma. Amount of contrast material administered was 100 mL. Image was obtained 40 seconds after start of contrast material injection and shows intense enhancement of abdominal aorta (*), intense enhancement of superior mesenteric artery (small arrow), intense enhancement of pancreas (large arrow), and minimal enhancement of hepatic parenchyma.

View larger version (6K): [in this window] [in a new window] [Download PPT slide]   Figure 6: Transverse CT image of a 37-year-old man with hepatic hemangioma. Amount of contrast material administered was 150 mL. Image was obtained 30 seconds after start of contrast material injection and shows intense enhancement of abdominal aorta (*), intense enhancement of celiac, splenic, and peripancreatic artery (lower left, lower right, both upper small arrows, respectively), slight enhancement with moiré pattern of spleen (arrowhead), slight enhancement of pancreas (large arrow), and minimal enhancement of hepatic parenchyma.