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Reply

University "Federico II" Naples, Italy

We thank Dr. Erturk for his careful reading of our article [1]. He is correct in pointing out that in our article we do not report data to support our statement that the time to peak enhancement of the pancreas is reached at 60 sec. However, this has been shown in previous articles. In particular, Lu et al. [2] achieved satisfactory tumor conspicuity by scanning the pancreas from 40 to 70 sec; with a contrast medium dose of 150 mL and an injection rate of 3 mL/sec, peak pancreatic enhancement would have occurred at approximately 60 sec. Tublin et al. [3] showed that with an injection rate of 2.5 mL/sec, time to peak pancreatic enhancement is reached at 69 ± 8 sec. Finally, our results are also supported by our preliminary data in a group of 18 patients who underwent a dynamic helical CT study with different injection rates (3, 4, and 5 mL/sec) and a total injected dose of 150 mL. In that study [4], applying the formula suggested by Tublin et al. with an injection rate of 3 mL/sec, the time to peak pancreatic enhancement was reached at 60 sec.

The main goal of our study was not to correlate the rate of injection and the volume of contrast material administered with pancreatic parenchyma enhancement; this has been shown in a previous study [5]. Our goal was to show that with a large dose of contrast material (150 mL) and an injection rate of 3 mL/sec, it is possible to obtain a high degree of enhancement of the normal pancreatic parenchyma, a high tumor-to-gland attenuation difference, and maximal enhancement of both arterial and venous peripancreatic vessels, with the clinical end point of correctly diagnosing and assessing tumor resectability in patients with suspicious pancreatic tumors.

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1. Imbriaco M, Megibow AJ, Ragozzino A, et al. Value of the single-phase technique in MDCT assessment of pancreatic tumors. AJR 2005; 184:1111 -1117[Abstract/Free Full Text]
2. Lu DSK, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas and vascular structures. Radiology 1996;199 : 697-701[Abstract/Free Full Text]
3. Tublin ME, Tessler FN, Cheng SL, Peters TL, McGovern PC. Effect of injection rate of contrast medium on pancreatic and hepatic helical CT. Radiology 1999;210 : 97-101[Abstract/Free Full Text]
4. Camera L, Danlele S, Di Giacomo A, Soscia E, Salvatore M. Abstract book of the 40th Conference of the Italian Society of Radiology, 2002; 103[suppl 3]: 318
5. Kim T, Murakami T, Takahashi S, et al. Pancreatic CT imaging: effects of different injection rates and doses of contrast material. Radiology 1999;212 : 219-225[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Imbriaco, M. Search for Related Content PubMed Articles by Imbriaco, M. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?