Improved pancreatic imaging with photon-counting CT: a retrospective comparison with conventional CT

Background Imaging is crucial for the detection of pancreatic diseases. Photon-counting computed tomography (PCCT) is a recent improvement in CT detector technology that may improve pancreatic imaging quality. Purpose To compare the image quality in pancreatic imaging with PCCT versus conventional CT (EIDCT) both subjectively and quantitatively. Material and Methods We retrospectively identified 35 patients scanned with both EIDCT and PCCT in multiple contrast phases. Image quality over 11 peripancreatic areas was rated on a 5-point Likert scale. One reader made quantitative measurements of density and noise. Data analysis was performed using R Studio. Continuous data were compared using a paired t -test and ordinal data with a Wilcoxon signed-rank test. Results Image quality was rated significantly higher on PCCT for the pancreatic parenchyma in the late arterial phase (3.87 vs. 2.77; P <0.01), the pancreatic parenchyma in the portal venous phase (3.31 vs. 2.53; P <0.01), pancreatic ducts (2.88 vs. 2.62; P <0.01), superior mesenteric artery (4.10 vs. 2.74; P <0.01), coeliac axis (4.04 vs. 2.70; P <0.01), and portal vein (3.29 vs. 2.52; P <0.01). Noise levels were significantly lower with PCCT with a mean reduction of 5.8 HU across all areas. Dose-length-product was significantly reduced in both the late arterial phase (31.8%; P <0.01) and the portal venous phase (21.5%; P <0.01). Conclusion Image quality was subjectively and quantitatively significantly improved for all evaluated pancreatic and peripancreatic structures with PCCT compared to EIDCT. In addition, radiation dose was significantly reduced.