Combining Low-Dose Perfusion with Dual-Energy CT Scanning for Pancreatic Neuroendocrine Tumors

Objectives This study explores the clinical value of one-time, low-dose pancreatic CT perfusion combined with dual-energy scanning for detecting pancreatic neuroendocrine tumors.

Methods : We retrospectively analyzed data from 23 patients with surgically or pathologically confirmed pancreatic neuroendocrine tumors who underwent pancreatic CT perfusion and delayed dual-energy CT scanning at our hospital between January 2020 to June 2024. The perfusion scan was performed at 80 kV and 40 mAs, with 28 scans acquired at 1.5-s intervals over a total duration of 42.42 s. The dual-energy CT scan used a tube voltage of 100/Sn at 150 kV and a reference tube current of 180/90 mAs. The radiation dose was recorded, the image quality of perfusion and dual-energy CT scans was subjectively assessed. The interobserver agreement was evaluated using the Kappa coefficient. Differences in blood flow (BF), blood volume (BV), mean transit time (MTT), flow-extraction product (FE), and time-density curve (TDC) characteristics between tumor lesions and normal pancreatic parenchyma were analyzed using the t-test. The diagnostic accuracy was assessed against surgical and pathological findings.

Results The image quality of both low-dose pancreatic perfusion and delayed dual-energy CT images met the diagnostic criteria, with high interobserver agreement (Kappa=0.79). The total effective radiation dose of the combined scan was 6.48±0.84 mSv. Compared to normal pancreatic parenchyma, the BF and BV in the abnormal perfusion areas of the lesions were significantly higher (both P < 0.01), whereas the MTT and peak TDC in lesion areas were slightly but significantly lower (both P < 0.05). The diagnostic accuracy of the single perfusion CT was 70.37% (19/27), whereas the combined one-time perfusion and delayed dual-energy CT achieved an accuracy of 85.18% (23/27), as confirmed in the 27 tumor lesions by the surgical and pathological results.

Conclusions One-time pancreatic perfusion CT combined with dual-energy CT scanning improves the diagnostic accuracy of pancreatic neuroendocrine tumors by enhancing morphological and perfusion parameter analysis while maintaining a low effective radiation dose. This approach has significant clinical value.