目的:比较胰腺协议光子计数CT(PCCT)和常规能量积分探测器CT(EID-CT)对胰腺腺癌可切除性评估的读者之间的一致性。
方法:回顾性单机构数据库搜索确定了从2022年4月11日至2022年10月30日在门诊设施中使用PCCT和EID-CT进行的所有对比增强胰腺肿块方案腹部CT。无胰腺腺癌的患者被排除在外。四名受过研究金训练的腹部放射科医生,不知道CT类型,独立评估血管肿瘤受累(未受累,邻接≤180°,包裹>180°;腹腔,肠系膜上动脉(SMA),肝总动脉(CHA),肠系膜上静脉(SMV),门静脉主干),转移的存在/不存在,整体肿瘤可切除性(可切除,边界线可切除,本地先进,转移性),诊断信心。Fleiss\的kappa用于计算读者之间的协议。记录CTDIvol。辐射剂量指标采用双样本t检验进行比较。p<.05表示统计学意义。
结果:145名患者(71名男性,平均[SD]年龄:66[9]岁)。读者之间达成了实质性的协议,腹腔动脉,SMA,PCCT的SMV受累(kappa=0.61-0.69)与EID-CT的中度一致(kappa=0.56-0.59)。CHA在PCCT(kappa=0.67)和EIDCT(kappa=0.70)两个方面都具有实质性的读者共识。对于转移识别,放射科医师在PCCT时(kappa=0.78)与EID-CT时(kappa=0.56)有相当的读者间一致性.PCCT和EID-CT的CTDIvol分别为16.9[7.4]mGy和29.8[26.6]mGy,分别(p<.001)。
结论:对于4/5主要胰周血管(腹腔动脉,SMA,CHA,和SMV)在PCCT上与EID-CT的2/5相比。PCCT还为转移检测提供了实质性的读者之间的共识,而在EID-CT中具有中等的一致性,并具有统计学上的显着辐射剂量减少。
OBJECTIVE: To compare the inter-reader agreement of pancreatic adenocarcinoma
resectability assessment at pancreatic protocol photon-counting CT (PCCT) with conventional energy-integrating detector CT (EID-CT).
METHODS: A retrospective single institution database search identified all contrast-enhanced pancreatic mass protocol abdominal CT performed at an outpatient facility with both a PCCT and EID-CT from 4/11/2022 to 10/30/2022. Patients without pancreatic adenocarcinoma were excluded. Four fellowship-trained abdominal radiologists, blinded to CT type, independently assessed vascular tumor involvement (uninvolved, abuts ≤ 180°, encases > 180°; celiac, superior mesenteric artery (SMA), common hepatic artery (CHA), superior mesenteric vein (SMV), main portal vein), the presence/absence of metastases, overall tumor
resectability (resectable, borderline resectable, locally advanced, metastatic), and diagnostic confidence. Fleiss\'s kappa was used to calculate inter-reader agreement. CTDIvol was recorded. Radiation dose metrics were compared with a two-sample t-test. A p < .05 indicated statistical significance.
RESULTS: 145 patients (71 men, mean[SD] age: 66[9] years) were included. There was substantial inter-reader agreement, for celiac artery, SMA, and SMV involvement at PCCT (kappa = 0.61-0.69) versus moderate agreement at EID-CT (kappa = 0.56-0.59). CHA had substantial inter-reader agreement at both PCCT (kappa = 0.67) and EIDCT (kappa = 0.70). For metastasis identification, radiologists had substantial inter-reader agreement at PCCT (kappa = 0.78) versus moderate agreement at EID-CT (kappa = 0.56). CTDIvol for PCCT and EID-CT were 16.9[7.4]mGy and 29.8[26.6]mGy, respectively (p < .001).
CONCLUSIONS: There was substantial inter-reader agreement for involvement of 4/5 major peripancreatic vessels (celiac artery, SMA, CHA, and SMV) at PCCT compared with 2/5 for EID-CT. PCCT also afforded substantial inter-reader agreement for metastasis detection versus moderate agreement at EID-CT with statistically significant radiation dose reduction.