ArticleAbdominal radiology (New York)2026
Conspicuity and characterization of pre-selected hypodense hepatic lesions in pancreatic cancer patients: limited clinical value of dual-energy portal phase CT.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess the impact of 50-keV virtual monoenergetic images (VMIs) and iodine metrics on conspicuity and characterization of hypodense hepatic lesions in pancreatic ductal adenocarcinoma (PDAC) patients undergoing dual-energy portal phase CT.
methodsConsecutive patients with hypodense hepatic lesions who underwent dual-energy portal phase CT between January and December 2025 were retrospectively identified. Lesions were pre-selected by a resident. Two radiologists independently evaluated blended and 50-keV VMIs for lesion conspicuity and confidence for metastasis using 5-point Likert scales. Contrast-to-noise ratio (CNR) and iodine metrics were calculated. Subjective scores and CNRs were compared using the Wilcoxon test. Diagnostic performance for characterization was assessed using histopathology and/or imaging as the reference standard. Iodine metrics were compared using non-parametric tests. Subgroup analyses included lesions ≤ 10 mm and those in steatotic livers.
results181 lesions in 86 patients were included (58% metastases). Interobserver agreement was good/very good, except for diagnostic confidence in steatotic livers (k = 0.58/0.48). No differences were found between image sets in subjective conspicuity, diagnostic confidence, or characterization performance. Metastases had higher CNR on 50-keV VMIs than on blended images in the overall cohort (9.9 ± 5.7 vs. 8.5 ± 5.3, p < 0.001) and for lesions ≤ 10 mm (9.5 ± 5.1 vs. 8 ± 4, p = 0.003), but not in steatotic livers. Iodine metrics were higher in metastases than in cysts, with substantial overlap with non-cystic benign lesions.
conclusion50-keV VMIs improve objective conspicuity but not subjective conspicuity, diagnostic confidence, or characterization performance. Iodine metrics provide complementary information but cannot distinguish metastases from non-cystic benign lesions.
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