NAEOTOM Alpha Class - Clinical Case Video: Pancreatic Tumor

Today I'd like to share an interesting case with you. We had a 63 year old female patient. Her BMI was 19.57 kilograms per square meter. She came to the hospital with a history of hypothyroidism, and she'd been suffering from fatigue, weakness, loss of appetite, and hypoglycemia, so she was referred to the radiology department for further evaluation. First, the calcium stimulation challenge test was done, and it showed diffuse insulin secretion throughout the pancreas. That immediately raised the suspicion of a pancreatic insulinoma. But here's the thing, A previous CT examination using an energy integrating Detector CT or EIDCT for short didn't pick up any pancreatic lesion at all. So we decided to go ahead with a contrast CT scan, this time using a photon counting detector CT neotom alpha. And guess what we found? When we looked at the virtual mono energetic images or Vmis displayed AT50KV, there was a hypervascular nodular lesion in the pancreatic body during the arterial phase. It was about 1 centimeter in size. This lesion also showed up clearly in the iodine maps and the VNC iodine fused images. Interestingly in the virtual non contrast or VNC images it seemed to be ISO dense and in the standard image reconstructions it was hardly visible. After that, we wanted to be extra sure, so we did a dote tape PET CT scan and an endoscopy, ultrasound or AUS examination and both of them confirmed the presence of the lesion. Eventually, the patient underwent A distal pancreatectomy with splenectomy. The pathology result came back and it confirmed the diagnosis. AG, one well differentiated neuroendocrine tumor with insulin hyperproduction. Now let's talk a bit about insulinoma. As we all know, it's a type of functional pancreatic neuroendocrine tumor or peanut. It comes from the endocrine cells of the pancreas. Most of the time it stays within the pancreatic gland and its main characteristic is that it hyper secrets insulin which leads to hypoglycemia. When it comes to treatment, surgery is the only option that can potentially cure the disease, especially when it's localized and generally small pancreatic insulinomas have a really good prognosis. But you see, the real challenge here is identifying the primary tumor. Why? Because it's usually so small. This is where the photon counting CT comes in. It provides energy resolved CT data. What does that mean? Well, it means we get increased spatial resolution and inherent spectral information. The way it works is quite fascinating. It optimizes tissue contrast by increasing the weight of the lower energy X-ray photons and getting rid of electronic noise. In this particular case we used an ultra high resolution mode called quantum HD. During the arterial phase we had a fine collimation of 120 by 0.2mm. The quantum HD mode uses these small subpixels. They're defined by a strong electric field, and we don't need any further mechanical separation. We read them out separately and that's how we increase the spatial resolution. Then we reconstruct the Vmis at 0.4mm and display them at 50KV and that combination, the increased spatial resolution and the enhanced tissue contrast, allowed us to clearly visualize the small insulinoma that was initially missed by the EIDCT. This is so important because it helps us plan the surgery properly. The.

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