Spectral CT
Truth in beauty and beauty in layers...

Cases

What kind of scan would you want?

58 year old male presents with abdominal pain which began suddenly about 4-5 days ago and is associated with fatigue, body aches, nausea, darker skin, white colored stools and itching. Bilirubin is 7.2 mg/dL. Alk phos, AST and ALT all elevated. Ultrasound shows dilated common bile duct measuring 11 mm. A routine CT scan was performed in the ED. 

On the conventional CT scan, there is obvious biliary dilatation. Is there a mass in the pancreas? You would be hard pressed to be sure. 

Turn on spectral, and you cannot miss the hypoenhancing mass in the pancreas. This was confirmed on endoscopic ultrasound, and a stent was placed on ERCP. Unfortunately EUS biopsy samples so far have shown only atypical cells. Further sampling is planned.

If this was you, and you (unfortunately) had jaundice, with a suspected pancreas mass, what kind of CT scan would you like your radiologist to have read, conventional or spectral?

Conventional CT, coronal plane: Biliary dilatation

Conventional CT, coronal plane: Biliary dilatation

Conventional CT, axial oblique. Is there a lesion in the pancreas?

Conventional CT, axial oblique. Is there a lesion in the pancreas?

40 keV, axial oblique: Now you're talking! Obvious lesion in head/uncinate process.

40 keV, axial oblique: Now you're talking! Obvious lesion in head/uncinate process.

Iodine map, axial oblique: Lesion is easy to see! Hypoenhancement is characteristic of pancreatic adenocarcinomas.

Iodine map, axial oblique: Lesion is easy to see! Hypoenhancement is characteristic of pancreatic adenocarcinomas.

Iodine overlay image, axial oblique: Just showing off.

Iodine overlay image, axial oblique: Just showing off.

EUS confirms mass.

EUS confirms mass.

ERCP shows obstruction of distal CBD. A biliary stent was placed.

ERCP shows obstruction of distal CBD. A biliary stent was placed.

Gopal Punjabi