Investigating the value of dual-layer spectral detector CT in distinguishing resectable pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis

doi:10.19401/j.cnki.1007-3639.2024.01.003

Abstract

Abstract:

Background and Purpose: Accurate differentiation of pancreatic ductal adenocarcinoma (PDAC) from mass-forming chronic pancreatitis (MFCP) is clinically significant. The application of dual-layer spectral detector CT (DLCT) in pancreas has been explored. This study aimed to investigate the value of DLCT in distinguishing resectable PDAC from MFCP. Methods: We retrospectively collected data of 33 patients with resectable PDAC and 19 patients with MFCP admitted to Fudan University Shanghai Cancer Center from September 1, 2021 to May 31, 2023. Prior to surgery, patients underwent enhanced DLCT scans, including arterial phase (AP), parenchymal phase (PP) and venous phase (VP). DLCT quantitative parameters, including attenuation enhancement fraction (AEF), lesion-to-parenchyma ratio (LPR) and iodine enhancement fraction (IEF) were calculated. Difference analysis was conducted using independent sample t-test or chi-square test. Univariate and multivariate analyses were performed using binary logistic regression. Receiver operating characteristic (ROC) curves were used for performance evaluation. P<0.05 was considered statistically significant. Results: Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP, LPR₄₀_VP, IEF_PP/VP, carbohydrate antigen 19-9 (CA19-9) and double-duct sign (all P<0.05). The spectral combined model composed of LPR₄₀_VP and IEF_PP/VP exhibited the best discriminatory efficacy, surpassing CA19-9, double-duct sign and AEF_AP/PP (all P<0.05). The combined model demonstrated an area under curve (AUC) of 0.841, sensitivity of 90%, specificity of 73%, and accuracy of 79%. Conclusion: DLCT has certain potential in differentiating resectable PDAC from MFCP. Spectral quantitative parameters can complement CA19-9 and outcome shortcomings of conventional CT in distinguishing resectable PDAC from MFCP.

Key words: Pancreatic ductal adenocarcinoma, Mass-forming chronic pancreatitis, Dual-layer spectral detector computed tomography, Conventional computed tomography

CLC Number:

R735.9

LIU Wei, XIE Tiansong, CHEN Lei, ZHANG Zehua, ZHOU Zhengrong. Investigating the value of dual-layer spectral detector CT in distinguishing resectable pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis[J]. China Oncology, 2024, 34(1): 67-73.

Figures/Tables 6

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Data	PDAC (n=33)	MFCP (n=19)	P value
Clinical variables
Age/year x±s	62.75±10.45	63.95±11.76	0.707^*
Gender male/female	16/17	11/8	0.513^#
CA19-9 ≤37 U/mL/>37 U/mL	6/27	10/9	0.010^#
CA12-5 ≤35 U/mL/>35 U/mL	32/1	19/0	1.000^#
CEA ≤5.2 ng/mL/>5.2 ng/mL	30/3	18/1	1.000^#
Size/cm x±s	2.50±0.83	2.67±0.66	0.429^*
Location head/body and tail	26/7	13/6	0.618^#
Imaging morphological variables
Duct-penetrating sign yes/no	0/33	1/18	0.365^#
Collateral duct dilatation yes/no	0/33	0/19
Duct-to-parenchyma ratio≤0.34 yes/no	23/10	15/4	0.469^#
Displaced calcification yes/no	0/33	0/19
Double duct sign yes/no	14/19	2/17	0.016^#
SMA-to-SMV ratio>1 yes/no	0/33	0/19
Vessel encasement or deformity yes/no	1/32	0/19	1.000^#

Variable	Univariate analysis		VIF	Multivariable analysis
Variable	OR (95% CI)	P value	VIF	OR (95% CI)	P value
LPR₄₀_PP/%	1.046 (1.010-1.084)	0.012	3.165		0.111
LPR₄₀_VP/%	1.054 (1.022-1.087)	0.001	2.253	1.050 (1.015-1.086)	0.004
IEF_PP/VP/%	1.057 (1.016-1.099)	0.006	1.716	1.051 (1.002-1.102)	0.039

Variable	AUC (95%CI)	Cutoff value	Sensitivity/%	Specificity/%	Accuracy/%	Youden index
CA19-9	0.672 (0.539-0.806)		53	82	71	0.35
Double duct sign	0.675 (0.563-0.786)		90	46	60	0.36
AEF_AP/PP	0.703 (0.562-0.845)	79%	95	49	65	0.44
LPR₄₀_VP	0.825 (0.712-0.937)	91%	90	67	75	0.57
IEF_PP/VP	0.777 (0.648-0.905)	91%	79	70	73	0.49
Combined model	0.841 (0.736-0.945)	0.34	90	73	79	0.63