siemens-healthineers.ca

White Paper

Improving clinical confidence and reducing dose with dual energy CT Tertiary care institution maximizes the benefits for its patients

Exceptional dose reduction and image qualityCaseIncreased conspicuity of pancreatic carcinoma using dual-energy CT

HistoryA 63 year-old woman presented to her physician with a several week history of increasing pelvic fullness. Single-energy contrast-enhanced CT was performed at an outside institution, demonstrating a large mixed cystic and solid mass (Figure 1, arrow) felt at that time to be an ovarian carcinoma. The patient underwent surgical removal of the mass and pathology revealed mucinous adenocarcinoma with some features suggesting a gastrointestinal origin. The CT was reviewed at a multidisciplinary tumor conference following normal upper and lower endoscopy.

Review of the portal phase single energy images raised some concern of a subtle alteration in density within the body of the pancreas without a definite mass or ductal dilatation (Figure 2, arrow). A repeat CT at a tertiary care institution on a Siemens Healthineers Definition Flash scanner using a dual energy pancreatic protocol revealed a pancreatic mass which was profoundly more conspicuous (Figures 3A–C).

DiagnosisMucinous adenocarcinoma of the pancreas with adnexal metastasis

Procedure or Protocol•150ccintravenousiohexol(350mgI/mL)injectedat5cc/secondfollowedby50cc

salineflushat5cc/second

•Pancreaticphaseobtainedwith20secondtriggerdelayfollowingpeakabdominalaorticenhancementusingdualenergy(referencemA200)

•Portalphaseobtainedfollowingafurther30seconddelayusingsingleenergy(100kV)

WhitePaper| Improving clinical confidence and reducing dose with dual energy CT

2

Courtesy of: Dr. Iain Kirkpatrick, MD, radiologist, Manitoba, Canada

Figure 1: Single energy contrast-enhanced CT of the pelvis showing a large mixed cystic and solid mass (arrow).

Figure 3A: Optimum contrast reconstruction of a dual energy pancreatic phase CT obtained with a Definition Flash scanner proves the existence of a pancreatic mass (arrow).

Figure 2: Single energy contrast enhanced portal phase CT through the pancreas shows a subtle decrease in attenuation within the body (arrow).

Figure 3B: Colour iodine map shows a reduction in iodine uptake within the lesion (arrow).

Figure3C:Virtualmonoenergetic40keVreconstructiondemonstrates how conspicuous a pancreatic mass can become as the mean energy level of the photon beam begins to approach the k-edge of iodine, maximizing the contrast between the iodine in normal pancreas and focal lesions at the expense of an increase in image noise.

WhitePaper| Improving clinical confidence and reducing dose with dual energy CT

3

Subscribe now!Keep up to date on the latest trends in healthcare. Visit: healthcare.siemens.ca/news-and-events

Local Contact Information in CanadaSiemensHealthcareLimited1577NorthServiceRoadEastOakville,ONL6H0H6Canada Phone:+1905-465-8000 siemens-healthineers.cacustomeradvocate.ca@siemens.com

Siemens Healthcare HeadquartersSiemens Healthcare GmbHHenkestr.12791052ErlangenGermany Phone:+499131840siemens-healthineers.com

Theproducts/features(herementioned)arenotcommerciallyavailable in all countries. Due to regulatory reasons their future availabilitycannotbeguaranteed.PleasecontactyourlocalSiemens Healthineers organization for further details.

The statements by Siemens Healthineers customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.

Note:Anytechnicaldatacontainedinthisdocumentmayvarywithin defined tolerances. Original images always lose a certain amount of detail when reproduced.

PrintedinCanada.©SiemensHealthcareLimited,2018.