Background: Multidetector CT is a valuable technique for diagnosis/staging in several pancreatic pathologies. Diagnosis is usually based on tissue density measurements. Recently, newer functional CT techniques have been introduced. The aim of this study was to assess variability in perfusion and dual-energy CT data, and to compare these data with density measurements in the pancreas of a healthy population. Methods: Two groups were included: 20 patients underwent perfusion CT imaging, and 10 patients were scanned using a dual-energy protocol. In both groups, tissue density [Hounsfield units (HU)] was measured in the pancreatic head, body and tail. Functional data were calculated (blood flow/blood volume in the perfusion CT group, iodine concentration in the dual-energy group), and variability was assessed. Results: Density measurements were comparable for the perfusion and dual-energy CT groups, and ranged from 14 to 60 HU. Maximal enhancement differences between the head/body/tail of the pancreas ranged between 2 and 21 HU. Considerable variability was observed, both in density measurements (ranging from 3 to 34%) and in functional parameters (mean variability in perfusion CT parameters blood flow and blood volume was 21.3 and 10% respectively; mean variability in dual-energy iodine-mapping results was 24.4%). Conclusion: This study demonstrated the presence of important intraindividual variability in pancreatic tissue contrast enhancement, regardless of the CT technique used. Considering the variability observed in this study, the use of cut-off values to characterize pancreatic pathologies seems troublesome, and morphologic primary and secondary changes will remain important, even when using novel functional imaging techniques.

1.
Dupuy DE, Costello P, Ecker CP: Spiral CT of the pancreas. Radiology 1992;183:815–818.
2.
Fishman EK, Wyatt SH, Ney DR, Kuhlman JE, Siegelman SS: Spiral CT of the pancreas with multiplanar display. Am J Roentgenol 1992;159:1209–1215.
3.
Balthazar EJ: Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002;223:603–613.
4.
Balthazar EJ: Complications of acute pancreatitis – clinical and CT evaluation. Radiol Clin N Am 2002;40:1211–1227.
5.
De Waele J, Vogelaers D, Decruyenaere J, De Vos M, Colardyn F: Infectious complications of acute pancreatitis. Acta Clin Belg 2004;59:90–96.
6.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC: Acute-pancreatitis – value of CT in establishing prognosis. Radiology 1990;174:331–336.
7.
Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, Perez A, van Sonnenberg E, Ros PR, Banks PA, Silverman SG: A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am J Roentgenol 2004;183:1261–1265.
8.
Delrue LJ, De Waele JJ, Duyck PO: Acute pancreatitis: radiologic scores in predicting severity and outcome. Abdom Imaging 2010;35:349–361.
9.
Bradley EL: A clinically based classification system for acute pancreatitis – summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga., September 11–13, 1992. Arch Surg 1993;128:586–590.
10.
Graser A, Johnson TRC, Chandarana H, Macari M: Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur Radiol 2009;19:13–23.
11.
Miles KA, Hayball MP, Dixon AK: Measurement of human pancreatic perfusion using dynamic computed-tomography with perfusion imaging. Br J Radiol 1995;68:471–475.
12.
Miles KA, Griffiths MR: Perfusion CT: a worthwhile enhancement? Br J Radiol 2003;76:220–231.
13.
D’Assignies G, Couvelard A, Bahrami S, Vullierme MP, Hammel P, Hentic O, Sauvanet A, Bedossa P, Ruszniewski P, Vilgrain V: Pancreatic endocrine tumors: tumor blood flow assessed with perfusion CT reflects angiogenesis and correlates with prognostic factors. Radiology 2009;250:407–416.
14.
Wang JW, Wu N, Cham MD, Song Y: Tumor response in patients with advanced non-small cell lung cancer: perfusion CT evaluation of chemotherapy and radiation therapy. Am J Roentgenol 2009;193:1090–1096.
15.
Ohno Y, Koyama H, Matsumoto K, Onishi Y, Takenaka D, Fujisawa Y, Yoshikawa T, Konishi M, Maniwa Y, Nishimura Y, Ito T, Sugimura K: Differentiation of malignant and benign pulmonary nodules with quantitative first-pass 320-detector row perfusion CT versus FDG PET/CT. Radiology 2011;258:599–609.
16.
Petersilka M, Stierstorfer K, Bruder H, Flohr T: Strategies for scatter correction in dual source CT. Med Phys 2010;37:5971–5992.
17.
Sheiman RG, Sitek A: Feasibility of measurement of pancreatic perfusion parameters with single-compartment kinetic model applied to dynamic contrast-enhanced CT images. Radiology 2008;249:878–882.
18.
Yoshikawa T, Kawamitsu H, Mitchell DG, Ohno Y, Ku Y, Seo Y, Fujii M, Sugimura K: ADC measurement of abdominal organs and lesions using parallel imaging technique. Am J Roentgenol 2006;187:1521–1530.
19.
Xu J, Liang ZH, Hao SJ, Zhu L, Ashish M, Jin C, Fu DL, Ni QX: Pancreatic adenocarcinoma: dynamic 64-slice helical CT with perfusion imaging. Abdom Imaging 2009;34:759–766.
20.
Bali MA, Metens T, Denolin V, De Maertelaer V, Deviere J, Matos C: Pancreatic perfusion: noninvasive quantitative assessment with dynamic contrast-enhanced MR imaging without and with secretin stimulation in healthy volunteers – initial results. Radiology 2008;247:115–121.
21.
Fletcher JG, Wiersema MJ, Farrell MA, Fidler JL, Burgart LJ, Koyama T, Johnson CD, Stephens DH, Ward EM, Harmsen WS: Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 2003;229:81–90.
22.
McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A: Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement AF the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 2001;220:97–102.
23.
Delrue L, Blanckaert P, Mertens D, Cesmeli E, Ceelen WP, Duyck P: Assessment of tumor vascularization in pancreatic adenocarcinoma using 128-slice perfusion computed tomography imaging. J Comput Assist Tomogr 2011;35:434–438.
24.
Berrington de Gonzalez A, Mahesh M, Kim K-P, Bhargavan M, Lewis R, Mettler F, Land C: Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071–2077.
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